Do you have burning pain in your big toe at night? It can be a sign of gout. Read the article to know ways to get rid of this pain
Gout is a complex form of arthritis, which results from the buildup of uric acid in the body. It causes sudden pain, swelling, and redness in the joints, most commonly the big toe. You might feel like your big toe is on fire, suddenly in the middle of the night. Gout causes bouts of severe pain and tenderness in your joints. It commonly affects men, and it affects woman usually after menopause.
Gout is a type of arthritis.
Pain and inflammation of the joint results due to uric acid crystal formation in them.
Burning pain in the big toe is characteristic of gout.
Medications can treat most cases of gout.
Hyperuricemia (excess uric acid in the blood) causes gout. Uric acid is produced when purines, which are naturally found in the body and food like seafood and organ meats, breakdown. Usually, the uric acid that is produced, gets excreted through the urine.
But if the body produces too much uric acid or the kidneys are not able to efficiently excrete it, then excess uric acid builds up in the body. The excess uric acid form urate crystals, which get accumulated in the joints. These urate crystals result in inflammation and intense joint pain.
Eating too much of foods like shellfish, red meat, sweet juices, and salt can also result in gout. Kidney problems, thyroid diseases, and medications (diuretics and Cyclosporine) can affect the body’s ability to eliminate uric acid.
Patients usually experience sudden and intense pain, mostly in the night. The symptoms are:
Severe joint pain, most commonly the big toe. The other joints that can get affected are knee, ankles, elbows, and fingers.
The pain is severe for the first 4 to 12 hours. After which, the pain subsides and can last for days to weeks.
The joints appear red and become inflamed.
The joints range of motion decreases.
Asymptomatic hyperuricemia - This stage is when the uric acid in the blood is high, but no other symptoms are seen.
Acute gout - In this stage, the high uric acid results in the formation of uric acid crystals in one joint. This causes pain, swelling, and tenderness in the affected joint. The pain will develop suddenly and last for 3 to 10 days. A person may have multiple such attacks over months or years.
Interval gout - Otherwise called intercritical gout, is the time between two attacks of acute gout.
Chronic tophaceous gout - If gout is left untreated for many years, hard nodules (tophi) form in the joints and surrounding tissue. This permanently damages your joints.
Some of the factors that increase the risk of gout are:
Men between 40 and 50 years of age.
Family history of gout.
Consuming more of purine-rich food like red meat, shellfish, etc.
Consuming more alcohol.
Taking medicines like Cyclosporine or diuretics.
Depending on the clinical presentation, medical history, and physical examination, your doctor will come to a diagnosis. If necessary, you might need to do the following tests:
Blood test - To check the level of uric acid and creatinine. Diagnosis cannot be made only based on the levels of uric acid, as some people with high uric acid do not develop any symptoms.
Joint fluid test - A needle is used to draw fluid from the joint, and urate crystal can be seen under a microscope.
X-ray - To rule out other causes of joint pain.
Ultrasound and CT scan - To detect urate crystals in the joint.
Drugs used to treat acute attacks of gout are as follows:
Nonsteroidal anti-inflammatory drugs (NSAIDs) - Ibuprofen, Naproxen, Indomethacin.
Corticosteroids - Prednisone.
Drugs to help reduce uric acid levels:
Block the production of uric acid - Xanthine oxidase inhibitors (Allopurinol, Febuxostat).
Aid in uric acid removal - Uricosurics (Probenecid, Iesinurad).
Avoid alcoholic and sweetened beverages.
Limit consumption of red meat, organ meat, and shellfish.
Foods like coffee, vitamin C, and cherries can be used to lower uric acid levels.
Steps to prevent gout are:
Do not drink.
Eat a diet low in purine-rich food.
Consume a low-fat diet.
Drink a lot of water.
Some of the complications are:
Recurrent gout may lead to permanent joint destruction.
Tophi can form in different parts of the body.
Chronic gout leads to impaired renal function, and may cause secondary hypertension.
If your pain is getting worse and gout attacks are becoming frequent, consult a rheumatologist online now.
Some of the main triggers are joint injury, surgery, chronic illness, infection, taking Cyclosporine and diuretic medications, and chemotherapy. The other causes are fasting, crash diet, alcoholism, dehydration, and sweet beverages.
The first signs of gout are sudden and severe joint pain, joint tenderness, and joint stiffness. It usually affects the joint of the big toe.
Foods like fruits, vegetables, soy items, whole grains, and low-fat dairy products might help in lowering uric acid levels and prevent gout.
Drinking coffee and cherry juice regularly has shown to reduce the risk of gout.
Painkillers like Ibuprofen, Naproxen, Colchicine, and Prednisone are effective in relieving gout pain.
The acute attacks of gout can last anywhere between 3 to 10 days.
Making lifestyle changes and avoiding foods that trigger gout will prevent acute attacks. During acute attacks, painkillers like Ibuprofen, Naproxen, Colchicine, and Prednisone are used.
Food items that need to be avoided are alcohol, red meat, organ meat (kidney, liver), seafood (shrimp, lobster), and sweetened beverages.
Some natural treatment includes cherries, magnesium supplements, ginger, apple cider vinegar, and hibiscus.
Last reviewed at:
06 Aug 2019 - 4 min read
Query: Hi doctor, I have been suffering lately from pain in my big toe joint. It is very severe that I could not sleep two nights when I ran out of painkillers. I thought it might be a gout attack. Because I do have gout. Though my uric acid levels are mostly high, I do not really watch what I eat. My tr... Read Full »
Query: Hi doctor, My uric acid in blood shoots up to 7.9. I do not have the problem or gout or kidney stones. How to reduce it? I have already started to drink lemon water the whole day. I have attached the photographs. I have only knee pain, which is at the backside of the knee while climbing up and down... Read Full »
Query: Hi doctor, I have been having joint pain in my left foot on the first joint of big toe for two weeks. It came on upon waking. The pain was inconvenient, but bearable for the first 36 hours. Then, it was extremely painful on the second day ( a worse pain I have ever had). Then, it has got slightly be... Read Full »
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