Inflammatory arthritis that starts with pain and swelling of the big toe is most likely due to gout. This condition is chronic and progressive, but highly treatable.
Gout is a form of inflammatory arthritis that results from an excess of uric acid in the blood.
Uric acid is a chemical that is created in the body when it digests and breaks down certain substances in food called purines. Gout is genetically inherited and affects men more than women by a ratio of about 3 to 1.
The key symptom is painful attacks in the joints – often, appearing first in the big toe. Other joints that may be affected include the ankle, foot, knees and, in severe cases, the wrists, elbows and fingers. People with gout may also experience kidney stones and damage to their kidneys.
Gout is caused by disordered metabolism of purines. In people with gout, an excess of purines causes uric acid to crystallize in the joints, causing inflammation and pain.
You get purines mostly from food, and they are essential for the body to work properly. Excess purines are normally eliminated in the urine. But sometimes, an excess can lead high levels of urate (a breakdown product of purines) in the blood. This is called hyperuricemia, and it can leave needle-like urate crystals inside your joints.
A similar condition, known as pseudogout has similar symptoms. In both conditions, white blood cells surround chemical crystals, which leads to inflammation. In pseudogout, the associated crystals are formed from calcium pyrophosphate dihydrate, rather than from uric acid, as in gout. Pseudogout requires different treatment.
Men get gout more than women by about three to one. Having one or more of the following conditions puts someone at a higher risk for gout.
Diagnosis of gout usually involves:
A definitive diagnosis of gout requires that six of the following 12 markers must be present:
Changes in diet to avoid foods high in purines reduce the inflammation and pain in mild cases. Your doctor may also prescribe NSAIDs (to alleviate pain and swelling).
For more severe gout, other medications are needed to lower the uric acid. These may include one or more of the following:
Most people who suffer from gout attacks must take medication throughout their lifetime.
If your doctor has prescribed colchicine to prevent gout attacks, the attacks will return if you stop the drug. If you are given allopurinol to reduce the uric acid in the blood (to reduce gout attacks) or to reduce the uric acid in the urine (to reduce the risk of uric-acid-related kidney stones), the risk returns if you stop the drug.
Whether or not you take medication for your gout, it is important to limit your intake of foods high in purines. For the first six months after starting allopurinol for gout, your diet is especially important in helping to prevent attacks.
Find more detailed information about gout in the articles and other content below, or find a doctor at HSS who treats gout.