Gout attacks happen SUDDENLY with an onset of severe pain that usually starts in a big toe. The affected joint will appear red, hot, swollen and very tender. After the first symptoms the pain can get worse for one to two days. A gout attack can last up 2 two weeks if left untreated. Some people have just one gout attack, others have a long period without symptoms followed by another attack, and still others develop chronic gout. Those with chronic gout may get what are called TOPHI, which are lumps of urate crystal under the skin and sometimes need to be surgically removed.