Gout: Your Big Toe Might Provide Important Health Clues

When you picture someone with gout, you may think of an older, overweight man who likes his burgers and Budweiser— and that wouldn’t be inaccurate. Being male and eating a diet that’s high in red meat, seafood, and alcohol— particularly beer—are common risk factors for gout.

But gout also can be a painful, chronic health issue for women, especially after menopause.

Gout is the most common type of inflammatory arthritis, and an estimated 8.3 million Americans have this condition, of whom more than 2 million are women.

“Gout can be a serious problem in women, and women should be more aware of it,” says Theodore Fields, MD, a rheumatologist at the Weill Cornell-affiliated Hospital for Special Surgery. “After menopause, women are much more likely to develop gout due to the decrease in estrogen that occurs. It is believed that estrogen helps keep uric acid low by increasing the amounts of uric acid eliminated in the urine.” Women, as well as men, should be alert for the warning signs of gout and seek medical attention if they experience signs of joint inflammation.

But gout awareness is about more than noticing painful joints: Gout is associated with higher risks of heart attack, stroke, and heart disease.

Symptoms and Causes

Dr. Fields notes that gout’s most obvious symptom is usually isolated in the large joint of the big toe, or the “bunion joint,” in particular. But some people feel the stinging pain of gout elsewhere, in their feet or ankles, as well their hands and knees. The pain usually subsides after a couple of days, though some minor pain and stiffness may linger. Gout is caused by a buildup of uric acid that forms urate crystals. “In 90 percent of patients, the crystals build up because their kidneys don’t excrete uric acid normally; in 10 percent of patients, their bodies make too much uric acid,” says Dr. Fields. “Either way, uric acid builds up in the blood and then gets deposited, especially in the joints.” Urate crystals cause the release of inflammatory chemicals called cytokines that can cause pain, swelling, and joint damage.

Links to Other Diseases

When large numbers of urate crystals are found in the urine, they may cause kidney stones. Excess uric acid in your body also may make you more resistant to insulin, increasing the odds that you’ll develop diabetes.

But it is the cardiovascular risk associated with gout that may be the most alarming. “In studies, heart attack appears to be more common in patients with gout,” says Dr. Fields. “It is believed that, as in many inflammatory conditions such as rheumatoid arthritis and psoriatic arthritis, the inflammation in blood vessels caused by urate crystals may predispose you to develop hardening of the arteries. Gout patients also more commonly suffer from hypertension, high cholesterol, and obesity than the general population, which all increase cardiac risks.”

Treatment Options

Gout can’t be cured, but it can be managed fairly easily for some patients. “If a patient has had only one gout attack, we can try dietary changes and weight loss,” says Dr. Fields. “Dietary strategies include limiting alcohol of all types, especially beer, limiting red meat and shellfish, and limiting highfructose corn syrup, which is typically found in soft drinks.” Your body produces uric acid when it breaks down purines, substances in these foods— the more purines, the more uric acid.

Other patients may require medications that may include over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs), as well as colchicine, a pain reliever specifically designed to treat gout. Other medications include long-term uric acid-lowering medications, such as allopurinol (Zyloprim) or febuxostat (Uloric).

However, to keep symptoms under control, it’s important for gout patients to become educated about why they need long-term treatment and to commit to the treatment. “The success of long-term treatment of gout is spectacular, but only if people stick to the recommended diet and stay on medication if it’s been prescribed,” says Dr. Fields.

Your primary care physician may be able to handle your gout treatment, but Dr. Fields advises that patients with serious cases consult a rheumatologist. Dr. Fields urges women who have gout symptoms to see a doctor as soon as possible. When gout is diagnosed and treated early, symptoms often can be reduced, and a proactive treatment plan can be developed to prevent future flare-ups.

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