Does gout always present itself with swollen joints or can you just have achy joints without the swollen joints?

Almost always. Joints are almost always swollen, or red or warm. Also, pain comes quick, reaching max pain within 1 to 2 days.
Yes. Most of the cases of gout I have seen in my practice have red, hot swollen joints that are very painful to move or even to touch. I guess you could have a minor case of gout where the joint is only mildly swollen and painful, but i think that might be an overuse issue or other form of joint pain not gout.