The first attack of gouty arthritis usually involves only one joint, most commonly the big toe. However, it sometimes affects other joints, such as a knee, ankle, wrist, foot or finger. In gouty arthritis, the joint can become red, swollen and extremely tender to the touch. Typically, even a bed sheet brushing against the joint will trigger intense pain. After the first attack of gout, later episodes are more likely to involve several joints. Sometimes, if gout lasts for many years, uric acid crystals can collect in the joints or tendons, under the skin, or on the outside the ears, forming a whitish deposit called a tophus.