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The first symptom you are likely to notice is very bad pain in one of your joints. This is most likely to happen in your big toe. It comes on suddenly, over a few hours.

People often get attacks of gout at night. The pain may wake you from your sleep. The joints most likely to get gout are the big toe, and joints in the foot, ankle, knee, wrist, finger and elbow.¹

Your affected joint will probably swell up. The skin around it may look red, shiny and inflamed. You may also notice that:²

• Your joint feels stiff
• You have a fever
• Your joint feels warm or hot to the touch.

The pain is worse if you bump the joint. You may find that even the weight of your bedding over your foot makes it too sore to bear.

Doctors can usually diagnose gout by examining the swollen joint. Your doctor will probably also do a blood test, to check how much urate you have in your blood. If you have a high level of urate, it's more likely that gout is causing the problem.

If your doctor is not sure whether you have gout, another test may be done. The doctor will take some of the fluid out of the swollen joint, using a needle and syringe and send it to the laboratory. The laboratory will then look at the fluid under a microscope. If you have gout, they may be able to see urate crystals in the fluid.³

Sometimes, urate crystals form under the skin, on your hands, knees, wrists, elbows and ears. They look like white bumps. Doctors call these bumps tophi.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.