Although gout typically affects the joint of the big toe, it is actually a systemic inflammatory condition that may require maintenance treatments. Gout is the most common inflammatory arthritis affecting men over 40 years of age. It is characterized by "gout flares" that cause an extreme amount of pain, swelling and redness in the big toe. The flare itself typically only lasts a few days, but over time they may become more painful, last longer and occur more frequently. Gout itself is caused by high uric acid levels in the blood, causing crystals that may precipitate in joints, most commonly the big toe(~75%). As your uric acid levels increases, the likelihood of gout flares also increases.
Gout flares most commonly occur at certain times of the year, onset during the night and without warning. These are all important aspects that are used in its diagnosis. The symptom that I hear the most from patients is that "it hurts to even have my sheet touch it while laying in bed." Since the gout flare is an inflammatory attack, treatment at this point is aimed at relieving the extreme pain with some sort of anti-inflammatories.
Triggers for Gout Attacks
- Alcohol (or Dehydration)
- Medications (often "water pills")
- Certain diets high in purines
- Rapid lowering of uric acid levels with uric acid lowering medicines
As a podiatrist, it can be anti-inflammatories and steroids can be a great treatment to relieve a painful attack, but how do you keep them from coming back. Changing your diet is the first step. Avoiding foods high in purines and staying hydrated will help reduce formation of gout crystals. Other lifestyle changes should be made as well, such as adding an exercise routine. In some cases, a maintenance medication must be started in order to lower blood uric acid levels.
If you have suffered from gout attacks in the past or fear that you maybe having a flare please contact your podiatrist for evaluation. You can also visit gout.com to download materials that could help you manage your gout.