Symptoms usually begin by affecting a single area. Larger joints are most commonly affected first. Other areas of the body that are readily affected are the instep, ankle, knee, wrist, and elbow. In rare instances the hip, spine, and shoulder are involved.
The pain associated with high levels of uric acid becomes progressively more severe, usually over a few hours, and is often excruciating. Swelling, warmth, redness, and exquisite tenderness may suggest infection. The overlying skin may become tense, warm, shiny, and red or purplish. Fever, tachycardia, chills, and malaise sometimes occur.