When Your Big Toe Feels like It's on Fire: Gout

When it first occurred, I thought that I had been bitten by a spider. My big toe looked swollen and red, and it hurt so much that even a fan blowing a breeze across it seemed to exacerbate the pain.

Unlike a spider bite, though, the swelling, redness, and pain seemed to radiate out from the base of my big toe.

"Maybe you broke your toe somehow?" my best friend asked me when I had to cancel our planned hike. I couldn't recall any accidents that might have caused this misery, though.

Taking My Toe to the Doctor

When the pain continued to limit my activities (and my ability to sleep), I decided it was time to seek a professional's advice. When my doctor saw the location and heard my list of whines - er, make that symptoms, he immediately said, "Ever heard of gout?"

"Yes, but I thought that rich old men who ate too much and drank too much, like King Henry the VIII, got gout," I admittedly truthfully.

That won a grin from my doctor - and a lecture on the causes of what turns out to be a form of arthritis. He recommended various dietary modifications as well before resorting to medication.

Dietary Changes May Help

Nationally known arthritis expert Dr. Nathan Wei is Director of the Arthritis Treatment Center located in Frederick, Maryland. "Gout attacks are characterized by swelling, heat, redness, and severe pain," noted Dr. Wei. "They are caused by the accumulation of monosodium urate (uric acid) crystals that cause an acute inflammatory response. Monosodium urate is a byproduct of the metabolism of purines, which are a building block of certain foods."

One option for alleviating the pain of gout, therefore, is to avoid foods that are high in purine. Examples of such foods include "red meats, shellfish, beer, wine, gravies, organ meats, and legumes," according to Dr. Wei. In addition, he notes that "diuretics can aggravate gout. The key is to make sure the serum uric acid is kept at 6.0 or lower."

Don't Assume It's a Condition to Be Ignored

Dr. Wei cautions against thinking that gout is "not serious. Untreated gout can cause crippling, deformity, and kidney failure. Also, many patients with gout have other conditions such as high blood pressure, coronary artery disease, elevated lipids, obesity, and diabetes which need to be treated as well."

In general, the arthritis expert feels that while dietary modifications can help, "medication is usually required."

The treatment depends on the severity of the attack. "Acute attacks are treated with anti-inflammatory medicines, colchicine, or steroids, all of which break the inflammation," explains Dr. Wei. "Chronic gout is treated a bit differently. While the old standby treatments such as probenicid (which makes a person pee out their uric acid) and allopurinol (which suppresses uric acid production) are still used extensively, newer treatments are available."

Among these newer treatments is Febuxostat (Ulroic), which "works by suppressing uric acid production, much like allopurinol, but appears to be safer," according to Dr. Wei. "It is an oral tablet. PEG uricase is a drug that is given intravenously in patients with very difficult to treat gout. It converts uric acid to an inert ingredient. It's not yet FDA approved and there are concerns regarding safety."

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Source: First-person interview with Associated Content columnist Joanne Eglash.