Intense Big Toe Pain From Gout: a Classic Symptom of an Attack
While the big toe is the most common place for a gout attack to happen, gout can also affect surrounding joints in the foot, ankle, and knee. People with gout typically experience flare-ups, or attacks, of symptoms followed by periods with no symptoms. The attacks typically last 3 to 10 days. Some people go months or even years without a gout attack after having one. In other people, attacks may become more frequent over time. Gout can be difficult to diagnose. Once it’s diagnosed, it can be treated with medication and lifestyle changes.
Sudden crushing or throbbing pain in one or a few joints (often in the big toe, knee, or ankle) that may last for a few daysSometimes an acute gouty arthritis attack has a sudden onset at nighttime. The big toe joint pain may be so severe that even the weight of bedsheets causes discomfort.Joints that appear swollen and inflamed, with reddish-purple skin that may feel warm
Chronic Gout Signs and Symptoms
Compared with the dramatic nature of acute gout pain, chronic gout pain is more of a soreness or persistent ache.Pain that tends to be a more continuous feeling of dull aching or soreness in the jointsHard white deposits or lumps of uric acid crystals under the skin, called tophi, found on the elbows, ears, or fingers.
Learn More About Gout Signs and Symptoms Having too much uric acid in the blood is a condition called hyperuricemia. (3) Certain foods, medicines, and lifestyle factors can cause high uric acid levels in the blood, triggering a gout attack. Your risk of gout goes up when your diet is high in naturally occurring compounds called purines. When purines break down in the body, they cause uric acid to form. Purines are found in certain high-protein foods and some drinks. It used to be thought that gout was caused only by lifestyle and diet, but new research has found that’s not true; instead, gout is thought to have a genetic link. Diet, however, does play a role in the disease. Other risk factors for gout include:
Male genderBeing overweightConsuming excessive amounts of alcohol regularlyA family history of goutHigh blood pressureHypothyroidism (an underactive thyroid)Chronic kidney diseaseObstructive sleep apneaType 2 diabetesHealth conditions that cause rapid turnover of cells (including some cancers, psoriasis, and hemolytic anemia)Kelley–Seegmiller syndrome or Lesch–Nyhan syndrome (rare disorders affecting males that cause overproduction of uric acid)
As the disease progresses, gout becomes more aggressive in patients who develop symptoms before the age of 30, and whose baseline serum uric acid level is greater than 9.0 milligrams per deciliter (mg/dL). If caught and treated early, people with gout can live a relatively normal life. Some patients do not respond to treatment because they fail to follow physician recommendations, consume excessive amounts of certain forms of alcohol, or are undertreated by physicians. (4)
Medication Options
A number of different drugs can be used to treat gout flare-ups:
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) These medications block the production of prostaglandins, which promote pain and inflammation. Common over-the-counter ones include ibuprofen (Advil), aspirin, and naproxen (Aleve); common prescription ones are celecoxib (Celecoxib), meloxicam (Mobic) and naproxen in prescription form. You must talk to your doctor before you take these.Colchicine If you are unable to tolerate NSAIDs, your doctor may prescribe colchicine (Colcrys), but it must be taken daily. There can be side effects such as diarrhea, nausea, vomiting, and abdominal cramps.Corticosteroids Taken orally or injected directly into affected joint, the most common corticosteroids used for gout are prednisone (Deltasone), prednisolone (Orapred), and methylprednisolone (Medrol).Uric Acid–Lowering Medicine These medications, such as febuxostat (Uloric) or allopurinol, must be taken daily and used long-term. The new gout guidelines recommend taking these with a three- to six-month course of NSAIDS.
Alternative and Complementary Therapies
Many complementary and alternative medicine (CAM) approaches for managing gout focus on diet, weight loss, and exercise. Your risk of gout goes up when your diet is high in naturally occurring compounds called purines. When purines break down in the body, they cause uric acid to form. In most cases, people who have gout will still need medication even when they follow a diet for gout. That said, tweaking your diet can be a powerful way to help manage gout and gout symptoms. Some research suggests that food changes alone can lower your uric acid levels by up to 15 percent. (11) The main principles of a gout diet are basically the same as those of any healthy diet: Reduce calorie consumption if you are overweight; opt for unrefined carbohydrates like fruits, vegetables, and whole grains; and limit your intake of sugar, organ meats (such as kidney, liver, or sweetbreads), and saturated fats.
Avoid Foods That May Trigger Gout
Purines are found in certain high-protein foods, such as certain types of seafood (including mackerel, herring, scallops, anchovies, and sardines), and red meat and organ meat (especially beef kidneys, liver, game meats, and sweetbreads). Avoid drinks that may trigger gout:
Alcoholic beverages (beer, whiskey, gin, vodka, and rum)Sugary drinks (sodas, juices, energy drinks)Coffee and other caffeinated beverages. While some studies show that caffeine can actually protect against gout pain, others find that sudden spikes in caffeine intake can trigger an attack.
RELATED: Gout Diet and Eating to Help Prevent Gout
Can You Drop 8 Pounds? Weight Loss Helps Prevent Gout
If you’re overweight, you are likely to have higher-than-normal uric acid levels, a primary risk factor for developing gout. That’s why weight loss is an important part of a gout diet. Losing weight may help lower uric acid levels and reduce the risk that you will experience future gout attacks. In fact, a weight loss of about eight pounds or more led to long-term reductions in uric acid levels and gout attacks in overweight or obese people. (12) While some people with gout benefit from cutting back on foods that are high in purines, a chemical that contributes to uric acid formation, it is not clear how much purine intake makes a difference. You don’t have to avoid all high-purine foods. Moderate changes to your eating style may help you feel better and reduce gout risks, and research suggests that purine-rich vegetables don’t trigger gout. High-purine foods such as lentils and beans can be a smart source of lean protein.
Get Appropriate Exercise
Many people with gout avoid exercise because they fear it will make the inflamed joint worse. There are special programs that help people with all kinds of arthritis adapt their exercise needs. The Centers for Disease Control and Prevention has a list of recommended programs that you can find in your local hospital, community center, or YMCA. (13) Learn More About Gout Treatment
Diuretics (used to treat high blood pressure or heart disease)Salicylate-containing drugs (such as aspirin)Niacin (vitamin B3 and nicotinic acid)Cyclosporine (Neoral) (an immune-suppressing drug)Levodopa (used to treat Parkinson’s disease)
Recurrent Gout (Chronic Gouty Arthritis) People with recurrent gout experience flare-ups, or attacks, several times a year. If these attacks aren’t treated, they can cause permanent joint damage.Tophi These are chalky lumps or deposits that form under the skin. They’re often found on the elbows, ears, or fingers. Tophi may swell during a gout attack. If they break through the skin, they can become infected, leading to pain and a loss of function. (6)Kidney Stones People with gout are more likely to develop kidney stones as a result of too much uric acid in the kidneys. Medications that increase the amount of uric acid excreted from the kidneys can also lead to kidney stones.Chronic Kidney Disease High levels of uric acid in the blood can increase the risk of chronic kidney disease. (7)
Learn More About Gout Complications Gout is the most common type of inflammatory arthritis among men. It’s more common in men than women. About 6 percent of men in the United States have gout, while only about 2 percent of women have it. Women rarely develop gout before reaching menopause. (1) Gout is rare in children and young adults.
Reactive arthritis (joint pain that is triggered by a bacterial infection somewhere else in the body)Infectious arthritis (joint pain caused by a bacterial infection in the joint)Psoriatic arthritis (a type of arthritis that occurs in 4 to 6 percent of people with the skin condition psoriasis)Rheumatoid arthritis (RA), which occurs when the body releases too many inflammatory chemicals (cytokines). Gout is caused by too much uric acid.Osteoarthritis (OA), known as wear-and-tear arthritis.
What Is Pseudogout? And How Does Pseudogout Relate to Gout?
Pseudogout has similar symptoms to gout and is often confused with gout. Pseudogout is also a type of arthritis. (9) Like gout, it is caused when painful crystals form in the joints. Unlike gout (which is caused by a buildup of uric acid), pseudogout happens when there is too much calcium in the body. Pseudogout most commonly affects the knees and wrists.
Gout Myths and Misconceptions and the Facts
Gout was once called the “disease of kings,” because of its propensity to affect overweight, rich men throughout history. Famous gout sufferers have included Alexander the Great, Charlemagne, Henry VIII of England, and Benjamin Franklin. While gout is no longer thought to be a disease of the wealthy, it is more common in men and people with weight-related health problems including high blood pressure and type 2 diabetes.
