Pain in Your Big Toe May Be Gout
When you think about gout, an image of an older man who eats a lot of steaks and burgers and drinks beer might come to mind—but gout is also a woman’s disease.
“Although women are less likely than men to suffer from gout, a woman’s chance of developing gout increases significantly in her postmenopausal years,” says Linda Russell, MD, a rheumatologist and the director of perioperative medicine at Weill Cornell. It appears that estrogen helps regulate uric acid content, and when estrogen levels drop, a woman’s body retains more uric acid.
Since gout is often thought of as a man’s disease, many women lack awareness of gout symptoms, which means that many women have gout but aren’t aware they have it.
“The most common symptom of gout is pain, sometimes accompanied by redness, swelling, and/or heat, at the base of the big toe,” says Dr. Russell.
WHAT YOU SHOULD KNOW
Risk factors for gout include:
- Being overweight or obese
- Being postmenopausal
- Consuming alcohol
- Eating foods high in purines (the substance that is broken down into uric acid), including red meat, organ meats, and some types of seafood (anchovies, sardines, scallops, mussels, trout, tuna)
- Consuming foods and beverages high in fructose
- Having heart failure, high blood pressure, diabetes, or impaired kidney function
Gout Symptoms and Causes
Gout is a form of inflammatory arthritis caused by a buildup of uric acid that coagulates and hardens into crystals. Uric acid crystals cause the release of inflammatory chemicals called cytokines that can produce pain, redness, and swelling and can damage joints.
“In the majority of patients, uric acid crystals build up because their kidneys don’t excrete enough uric acid. For some patients, the issue is an overproduction of uric acid,” says Dr. Russell.
For many patients, symptoms of gout appear only in the foot, in the large joint of the big toe. But some people experience gout symptoms in other areas as well, such as their ankle, knee, and hand joints. Gout pain may last for a few days or a few weeks, after which symptoms usually subside for weeks, months, or even years. When gout symp-toms recur, it’s called a “flare.”
If pain and swelling from gout occur only in the big toe joint, many women mistakenly believe they have a bun-ion—a bone deformity that develops at the joint of the big toe and causes similar symptoms—and don’t always report their symptoms to their doctors. And, you may have both gout and a bunion; the only way to find out if it’s gout is to have it evaluated by a healthcare professional.
Potential Consequences
Research indicates that gout is associated with a higher risk of cardiovascular disease. It is believed that too much uric acid can cause inflammation in blood vessels, which puts you at higher risk of developing atherosclerosis (hardening and narrowing of the arteries); this is also the case with other types of inflammatory arthritis, including rheumatoid arthritis and psoriatic arthritis. Gout patients are also more likely to have conditions that increase cardiovascular risks, such as hypertension, abnormal cholesterol levels, and obesity.
Excess uric acid in your body also may make you more resistant to insulin, increasing the odds that you’ll develop diabetes. And, if gout is not treated, it can cause so much damage to the joint that a joint implant may be required.
Treatment Options
For some patients, gout may be managed fairly easily. If a patient has had only one gout attack, dietary changes and weight loss may prevent further flares. Dietary strategies include abstaining from alcohol and limiting consumption of red meat, shellfish, and high fructose corn syrup.
Some patients may need medications, such as over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs), as well as colchicine, a pain reliever specifically designed to treat gout. Other medications, such as allopurinol (Zylo-prim) or febuxostat (Uloric), reduce the amount of uric acid produced.
To prevent gout flares, it’s important for patients to understand the importance of committing to a long-term treatment program.
“Long-term treatment of gout can be very successful, but only if patients stick to the recommended diet and stay on medication if it’s been prescribed,” says Dr. Russell.
Your primary care physician may be able to treat your gout effectively. However, if you have repeated gout flares and/or the flares are severe, you may want to consult a rheumatologist.
If you do experience the symptoms associated with gout, see a doctor as soon as possible. When gout is diag-nosed and treated early, symptom relief may be achieved quickly, and a proactive treatment plan can be developed to prevent future episodes.
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