History and Physical Exam
Pain can be excruciating. Sometimes it is so painful that patients cannot bear weight and even the touch of a bed sheet is painful . Gout can predispose to septic arthritis so be wary of systemic symptoms such as fevers and pain that doesn't respond to traditional therapy. The classic exam finding is a swollen erythematous bursa over the 1st MTP joint. Chronic gout can leave urate deposits called tophi of the olecranon bursa, Achilles, tendon, ulnar forearm, hands, fingers, knees, feet, toes and helix of the ear.