A Sharp Sudden Pain in Your Big Toe

The pain of an acute gout attack, which often occurs in the early hours of the morning, can be so severe that even the weight of a blanket can be excruciatingly painful. It is among the most common and painful joint problems. Gout, a type of arthritis, is caused by an excess of uric acid. While any joint in the body can be affected, an acute attack typically affects only one joint, and it’s usually the big toe. The affected joint can swell up within just a few hours of gout onset, becoming red and extremely tender. It can take up to two weeks for the pain and inflammation to subside. During that time, even putting on a shoe can be impossible.

Gout occurs more often in men, though women’s risk for it rises after menopause. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, and cold packs (if you can stand the pressure). Some people may need prescription medication. Though months or years can pass before another gout attack occurs, avoiding certain food and drinks may prevent another painful encounter.

Reducing Gout Recurrence

Uric acid is a waste product of substances called purines, which are normally excreted through urine. But some people’s kidneys don’t remove enough. Gout symptoms occur when uric acid builds up, accumulates around a joint, and forms needle-shaped crystals causing pain. Once you’ve had one attack, you are at greater risk for another.

“Consuming high amounts of purine-rich foods can contribute to more uric acid,” explains registered dietitian Lia Berjis, MS, Clinical Dietitian, Ronald Reagan UCLA Medical Center. “To help keep the uric acid production in check, it is often helpful to reduce the consumption of foods high in purine.”

When It Feels Like Gout, But Isn’t.

Pseudogout refers to a condition that mimics gout but is actually caused by deposits of calcium phosphate crystals, not uric acid crystals. The symptoms are similar, but this condition mostly affects the knee and rarely the big toe. There are no medications to dissolve these crystal formations. One underlying cause is hypothyroidism, and treating that disorder may reduce the accumulation of calcium phosphate crystals.

In addition to high-purine foods, beer and high-proof alcohol can increase gout risk, studies have shown. Wine, in moderation, appeared to have no influence.

According to Berjis, diet alone, without medication, may not be enough to control uric acid levels, but avoiding high-purine foods can help reduce the number of flare-ups and their severity. Maintaining a healthy body weight, staying well-hydrated, and following a heart-healthy diet also helps avoid recurrence. Left untreated, gout can permanently damage joints.

The journal Arthritis & Rheumatology recently reported that the drug febuxostat reduced gout attacks in a double-blind, placebo-controlled study of 314 adults with early gout. Febuxostat treatment also reduced synovitis, or inflammation of the joint lining. According to the study author, current clinical practice guidelines do not recommend routine use of urate-lowering therapy for people after the first gout flare. “This study indicates that even for people who have had only one or two prior gout flares, urate-lowering therapy to reduce serum urate may have benefit in reducing future flares,” says lead author rheumatologist Nicola Dalbeth, MD, University of Auckland, New Zealand.

Some medications can increase gout risk, including:

  • Diuretics, which are taken to rid the body of excess fluid in conditions like hypertension, edema, and heart disease. Diuretics reduce the amount of uric acid passed in the urine.
  • Drugs with salicylate, such as aspirin.
  • Niacin, a vitamin also known as nicotinic acid.
  • Cyclosporine, a medication that blocks the body’s immune system to treat some autoimmune diseases and to prevent the body from rejecting transplanted organs.
  • Levodopa, a medicine used to treat Parkinson’s disease.

Always check with your physician before you stop or add any medication.

Gout Food Awareness

These are some foods to avoid and those which can be helpful.

  • Avoid high-purine foods such as: agave, anchovies, bacon, beef, beer, herring, lamb, high-fructose corn syrup, mackerel, mussels, salmon, pork, sardines, scallops, shrimp, tuna, and organ meats.
  • Limit foods that have moderate purine content, including apricots, artichokes, broccoli, dried beans, lentils, green peas, green peppers, fish (other than the ones mentioned under “high”), oatmeal, poultry, wheat bran, and yeast.
  • Enjoy foods low in purine, such as cauliflower, peas, beans, sweet potatoes and low-fat dairy. Studies suggest that eating 10-12 cherries every day may lower the risk of an attack.


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