Gout Joint Pain And Your Orthopaedist
If you have sudden, intense pain in your toeor pain in any other jointmake an appointment with your orthopaedist. Your orthopaedic provider can diagnose the problem and work with you to provide both immediate pain relief and long-term solutions. If youre diagnosed with gout, your provider may recommend cortisone injections and/or medications along with lifestyle changes. At Countryside Orthopaedics, we work to keep every patient active and feeling good, so you can stick with the activities you love. If gout or another joint condition is slowing you down, lets get it diagnosed and take the first steps to get it under control.
What Is Hallux Limitus And How Is It Different From Gout
Hallux limitus is the initial stage of a gradual onset of arthritis in the big toe, which causes the range of motion in the big toe to be limited.
Hallux rigidus is used to describe the later stages, where the big toe becomes rigid and difficult to move or flex. Both hallux limitus and rigidus are caused by the decomposition of cartilage around the joint of the big toe, which causes pain and limited range of motion.
Although the pain can feel similar to gout, gout is a type of inflammatory arthritis that occurs when uric acid found in the blood stream gets deposited and becomes crystalized in the joint at the base of the big toe.
Symptoms Of Gout In Toe
Gout attacks are characterized by sudden throbbing or scorching joint pain, inflammation, stiffness, warmth, and redness. Hands, knees, toes, elbows, and feet are all affected. According to one study, some peoples discomfort is so intense that they cant even bear the weight of a pillow. Symptoms are typically at their most severe within 612 hours. In 12 weeks, the afflicted joint, or big toe, will heal. Due to the severe pain and inflammation associated with gout attacks, it is hard for some people to walk or stand.
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What Are Symptoms Of Gout
Chances are you wont even know you have gout until youve experienced your first painful attack, often at night. Symptoms may not develop for years, but these often include:
- Arthritis that develops quickly, resulting in a swollen, red, and warm joint with limited movement
- An arthritis attack in only one joint often the big toe, as well as a foot, ankle, or knee
- Bright red or purplish skin around the affected joint
- More than one attack of acute arthritis
What Are The Treatments For Gout
Most physicians recommend managing gout with lifestyle and diet changes. There are also medical interventions available for controlling and preventing gout pain. Treatment and prevention approaches include:
- Topical creams, like Voltaren, often provide immediate pain relief during a gout attack.
- Prescription medications, including the anti-inflammatory drug colchicine for pain. Providers may also recommend different drugs that regulate uric acid production for patients with recurring cases of gout.
- Injections including cortisone to relieve pain and inflammation.
- Dietary restrictions to reduce high-purine foods. Replace those foods with a diet high in whole grains, fruits, vegetables, nuts, and legumes. Your doctor may recommend switching from red meats to poultry and low-fat dairy foods for protein.
- Hydration: drink plenty of fluids to help eliminate uric acid. Water, milk, and tart cherry juice are the best choices.
- Immobilize and elevate the foot to reduce swelling and inflammation.
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How Can A Gout Attack Be Prevented
Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.
How Is Gout Diagnosed
Your health care provider will get your complete medical history and do a physical exam. She may run these exams and tests to diagnose gout:
- Ajoint fluid analysis to see if uric acid crystals are present. This is the only certain way to diagnose gout.
- Tests to measure uric acid levels in blood and urine
There are many conditions with symptoms similar to gout. Be sure to see your doctor for a diagnosis.
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The Role Of Medication In Prevention Of Gout
Table 3: Medications to pevent attacks of gout
Standard medications in preventing gout attacks
i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8
ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.
Table 4: Reasons to use medication to lower uric acid
How To Prevent Gout
You can manage gout symptoms and help to prevent them occurring by taking gout medication and making dietary and lifestyle choices. Medication can help to stop your level of uric acid getting too high, whilst avoiding certain foods which cause your body to create more uric acid can also be effective in preventing gout. Lifestyle choices, such as exercise, can also help to prevent gout.
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The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
Get An Accurate Diagnosis And Treatment
While gout attack symptoms do resolve on their own, people are advised to seek medical treatment. If left untreated, gout can become chronic and cause lasting joint damage.
Diagnosis begins with a clinical exam and interview. Patients are encouraged to be honest with their health care providers about their eating, drinking, and other lifestyle habits. This honesty can be helpful both for diagnosing gout and creating a treatment plan. Diagnosis may also involve blood tests, urine tests, and medical imaging, such as x-rays and ultrasound.
See Gout Diagnosis
Treatment typically involves advice to avoid alcohol and certain foods known to trigger gout, such as foods and drink high in sugar, seafood, red meat, and organ meats.19 Medications to lower urate levels in the bloodâwhich can lead to gout attacksâare often recommended. Losing excess weight is another effective way to reduce the risk of a gout attack and chronic gout.20
See Gout Treatment
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How Can An Attack Of Gout Be Treated
The management of an acute attack of gout is very different from the prevention of subsequent attacks.
Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.
There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.
If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.
Table 2: Medications to treat acute attacks of gout
Arthritis / Acute Gout Attack
Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection.
The joint most commonly involved in gout is the first metatarsophalangeal joint , and is called podagra. Any joint may be involved in a gout attack with the most frequent sites being in the feet, ankles, knees, and elbows.
An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack takes approximately 7-14 days.
An accurate and colorful discription of a gout attack was elegantly written in 1683 by Dr. Thomas Sydenham who was himself a sufferer of gout:
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Gout Big Toe Facts List
How long does gout last? First be clear what gout means. Next learn typical duration. Then get free personal help to make your gout end as soon as possible.
Tophi guide to uric acid lumps. Photos of destroyed joints, burst skin, damaged heart, kidney, and all organs. Get help with gout tophi all over your body.
The signs and symptoms of gout are often a red, swollen, extremely painful big toe. But what about other joints? See how gout can be different.
Are you running with gout? Exercise is good for gout. But you must avoid damage to gout-weakened tendons. See DECT images for gout in runners feet.
Do you need treatment for gout in toe? If uric acid is not made safe surgery might be required. See the gruesome photographs of treatment for gout in toe.
Gout and bunions both cause red swollen big toe pain. But they are very different. Learn how to control big toe joint swelling and walk normally again.
How Long does Gout last in Big Toe? Gout starts in toes and feet. Goes to ankles and knees. Then fingers, hands, elbows and every joint. See how to stop it.
The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
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Effective Medical Treatment For Gout
The American College of Rheumatology released gout management guidelines in 2012 and updated them in 2020. They recommend drugs classified as urate-lowering therapy for those who have experienced two or more gout attacks in a year as well as for those with joint damage from gout.
Specifically, the organization recommends allopurinol as a first-line treatment for all gout patients, even those with chronic kidney disease. Next in line is febuxostat both are a class of drugs called xanthine oxidase inhibitors.
In addition, the guidelines recommend use of anti-inflammatory medications including NSAIDs, prednisone, or colchicine along with the other medication.
Risk Factors And Potential Causes Of Gout
Gout strikes men more often than women until women undergo menopause, and then women experience increased risk. Being overweight or obese, having recent surgery, and experiencing a trauma also increase your risk, as well as your family history.
Your body produces uric acid when it breaks down purines a substance found naturally in your body, and also in high-protein red meat, organ meat, and certain types of seafood. In addition, alcoholic drinks, beer, and beverages sweetened with fructose can raise your natural uric acid levels. When your body either creates too much uric acid or excretes too little, it can lead to gout. Hundreds of years ago, gout was called the disease of kings because the average peasant couldnt afford such rich food and drink.
Medical conditions like untreated high blood pressure, diabetes, heart disease, and kidney disease can also increase your chances of developing gout, as does taking certain medications, such as thiazide diuretics and low-dose aspirin.
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How Do I Know If Its Gout Or Something Else
There are many other conditions that affect the big toe joint, as well as other joints in the feet, that cause redness, swelling and pain so this is a great question. Other common causes of pain in this joint include:
- Other arthritis like rheumatoid arthritis, osteoarthritis or septic arthritis
- Trauma to the big toe joint
A key characteristic of gout is that it presents in painful flares although other inflammatory arthritides do too. The only definitive way to know is to come in for an assessment and diagnosis. At My FootDr, well conduct a comprehensive assessment, review your history, and rule out the other possible causes of joint pain. If we suspect you have gout, well refer you appropriately, while setting to work in helping to relieve your painful symptoms by reducing pressure away from the affected joints.
Book your appointment with us online here or call us on .
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How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
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How Can I Manage My Gout And Improve My Quality Of Life
Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.
For gout in particular:
- Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines , and limit alcohol intake .
CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.
When To See A Healthcare Provider
Not everyone with gout will experience worsening symptoms or need urate-lowering therapy. With that being said, if you ignore symptoms or fail to take action to avoid attacks, you may end up causing yourself long-term harm.
People with gout will sometimes think that the prolonged absence of symptoms means that the disease has spontaneously disappeared. This is usually a fallacy. Unless the underlying cause of high uric acid levels is controlled, the disease can advance silently and reap irreversible harm.
For some guidance on talking with a medical professional about your gout, use our Healthcare Provider Discussion Guide below. It can help you start a conversation with your healthcare provider about symptoms, treatment options, and more.
Gout Healthcare Provider Discussion Guide
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
The following are reasons why you should definitely see a healthcare provider about your gout:
- This is your first attack. Even if treatment is not prescribed, you might benefit from lifestyle modifications to reduce the risk of future attacks.
- Your symptoms don’t improve after 48 hours or last for more than a week. If you are on therapy, this may be an indication that changes need to be made, including dietary and lifestyle interventions.
- You have a high fever. While a mild fever can accompany a gout attack, a high fever may be a sign of an infection.
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