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What Is Gout?

If you’ve had excruciating pain in your big toe, it could be due to gout, a form of arthritis that causes severe, sudden attacks of inflammation, often in the middle of the night. Gout typically affects a single joint at a time, but if left untreated, many joints can be affected. The big toe is the most common spot, but gout can also affect the ankle, knee, elbow, wrist, or fingers.

During a gout attack, the affected joint will feel hot, swollen, and very painful. Many people can’t bear to put on their shoe during a gout flare.

Gout happens when there is too much of a chemical called urate in your blood (known as hyperuricemia). This causes uric acid crystals to build up in your joints, causing the telltale gout pain. Your body produces uric acid when it breaks down purines, substances that are naturally found in your body as well as in certain foods. However, gout occurs mostly because of a genetic predisposition, not diet.

Common Gout Symptoms

  • Intense joint pain that comes on suddenly, often in the middle of the night
  • Most commonly affects the big toe; can occur in other toe joints, ankle, knee, and more
  • Typically strikes one joint at a time; more can be affected as the disease progresses
  • Pain occurs in flares that last up a week or two with long periods of remission
  • Affected joint is swollen, painful, warm to the touch, and red

What To Do Next

Gout attacks usually subside on their own after a week or two, but if you don’t treat gout, the flares can become more frequent, spread to other joints, and cause tophi, hard lumps that form in the joint. Gout that goes untreated and persists for years could lead to chronic gouty arthritis and cause permanent joint damage, deformity, and persistent pain.

Gout treatment includes certain medications to treat pain during flares and others to prevent flares from occurring. Lifestyle changes such as losing weight, avoiding alcohol and high-purine foods, and changing medications associated with hyperuricemia (such as diuretics) can help too.

If you think your foot pain or other symptoms could be gout, see a health care provider. It’s very important to go during a flare, so your doctor can look for uric acid crystals in the joint to confirm the diagnosis. Your primary care doctor, such as an internist or family medicine doctor, is a good place to start. If your gout is getting worse or not responding to initial treatment, your doctor may refer you to an arthritis specialist called a rheumatologist for ongoing management.

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