Editing Gout (section)

==Signs and symptoms==
[[Image:Gout2010.JPG|thumb|alt=side view of a foot showing a red patch of skin over the joint at the base of the big toe|Gout presenting as slight redness in the [[metatarsophalangeal joint]] of the [[big toe]]]]
Gout can present in several ways, although the most common is a recurrent attack of acute [[inflammatory arthritis]] (a red, tender, hot, swollen joint).<ref name="Neogi2016"/> The [[metatarsophalangeal joint]] at the base of the [[Hallux|big toe]] is affected most often, accounting for half of cases.<ref name=PM2010/> It can also involve midfoot structures, including the cuneiform bones.<ref>{{Cite journal |last1=Cohen-Rosenblum |first1=Anna R. |last2=Somogyi |first2=Jason R. |last3=Hynes |first3=Kelly K. |last4=Guevara |first4=Myriam E. |date=2022-11-01 |title=Orthopaedic Management of Gout |journal=Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews |volume=6 |issue=11 |pages=e22.00216 |doi=10.5435/JAAOSGlobal-D-22-00216 |issn=2474-7661 |pmc=9645791 |pmid=36346841}}</ref> Other joints, such as the heels, knees, wrists, and fingers, may also be affected.<ref name="Neogi2016"/> Joint pain usually begins during the night and peaks within 24 hours of onset.<ref name="Neogi2016"/> This is mainly due to lower body temperature.<ref name="Dalbeth2016"/> Other symptoms may rarely occur along with the joint pain, including [[fatigue (medical)|fatigue]] and high fever.<ref name=PM2010/><ref name=Egg2007>{{cite journal |author=Eggebeen AT |title=Gout: an update |journal=Am Fam Physician |volume=76 |issue=6 |pages=801–808 |year=2007 |pmid=17910294}}</ref>

Long-standing elevated [[uric acid]] levels ([[hyperuricemia]]) may result in other symptoms, including hard, painless deposits of uric acid crystals called [[Tophus|''tophi'']]. Extensive tophi may lead to chronic [[arthritis]] due to bone erosion.<ref name=Nature2009/> Elevated levels of uric acid may also lead to crystals precipitating in the [[kidney]]s, resulting in [[kidney stone]] formation and subsequent [[acute uric acid nephropathy]].<ref name=German09/>