Without treatment, an acute attack of<unk>  usually resolves in five to seven days; however, 60% of people have a second attack within one year. Those with<unk>  are at increased risk of hypertension, diabetes mellitus, metabolic syndrome, and kidney and cardiovascular disease and thus are at increased risk of death. It is unclear whether medications that lower urate affect cardiovascular disease risks. This may be partly due to its association with insulin resistance and obesity, but some of the increased risk appears to be independent. Without treatment, episodes of acute<unk>  may develop into chronic<unk>  with destruction of joint surfaces, joint deformity, and painless tophi. These tophi occur in 30% of those who are untreated for five years, often in the helix of the ear, over the olecranon processes, or on the Achilles tendons. With aggressive treatment, they may dissolve. Kidney stones also frequently complicate<unk> , affecting between 10 and 40% of people, and occur due to low urine pH promoting the precipitation of uric acid. Other forms of chronic kidney dysfunction may occur. File:Case 30-top.Gouty tophi presenting as nodules on the finger and helix of the ear Image:ChronicGout.Tophus of the knee Image:Case 30-bottom.Tophii on the toe and ankle Image:Tophigout.Gout complicated by ruptured tophi, the exudate of which tested positive for uric acid crystals File:Gout Comparison.Gout in the big toe of left foot, compared to the healthy right foot Image:GoutCropped2016.Gout in the joint of the big toe File:Gross pathology of tophus.Gross pathology of a large tophus
Gout
Septic arthritis
Greyout
Rheumatoid arthritis
Blackout 
Calcium pyrophosphate dihydrate crystal deposition disease
Barefoot
Alkaptonuria