Which symptom is associated with acute flare-ups of gout?

The symptom most associated with acute flare-ups of gout is localized swelling and pain in joints. Gout is a type of inflammatory arthritis characterized by sudden and severe episodes of pain, redness, and swelling, typically occurring in the big toe or other joints. This acute pain is due to the deposition of uric acid crystals in the joint spaces, triggering inflammation. The swelling is a direct response from the body as it attempts to fight off the perceived threat from these crystals, leading to tenderness and discomfort in the affected area.

The other options listed are not specific to gout. Fatigue and malaise can occur with various conditions and are too general to be indicative of a gout flare-up. Unusual bleeding tendencies are not typically associated with gout, as the condition does not affect the blood's clotting factors. Persistent fever and chills may suggest an infectious process or systemic illness, rather than being a direct consequence of a gout attack. Hence, localized swelling and pain in joints is the hallmark symptom of a gout flare-up.