Is there always swelling with gout?

Not always: Although swelling and redness often are present in an acute attack, every case is different, clinical history, physical exam as well as blood work and joint aspiration will provide more information.

See details: Acute gout is always an inflammatory condition. Chronic tophaceous gout may not always be.

Swelling Gout: Nothing in medicine is 100% but most often there is swelling seen with gout. There are certainly people who has less symptoms and it may be cause by arthritic change (wear and tear arthritis). The more osteoarthritic pain at the big toe has much less swelling. Sometime this can mimic gouty symptoms or be a long term sequelae of previous gout.