Primary Care in Rochester and Kasson

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Oh, my aching toe!

3/9/2020 by Jaclyn (Jackie) Houghton, PA-C

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Cartoon images abound of the often-chubby older gent with his foot resting on a footstool and his puffed-up big toe wrapped in a white bandage. His ailment? Gout. But for anyone who's experienced the symptoms of a warm, painful, swollen big toe, it's no joke. It's also not uncommon. Gout affects about 9.2 million people in the U.S. each year. 

What is gout?

Gout is a form of inflammatory arthritis that typically causes a warm, painful, swollen joint. It can affect any joint, but the most common joint is the one at the base of the great or big toe. Those with chronic gout can even have multiple joints flare up at one time. 

Gout occurs when monosodium urate crystals deposit and accumulate in the joints. It can be diagnosed based on symptoms, but your provider will likely order some lab work, such as a uric acid level. Uric acid levels in the blood are typically high in those with gout. Testing the joint fluid for urate crystals under under a microscope can confirm the diagnosis. This confirmation is important because there are many illnesses that cause joint pain and inflammation. 

Who is at risk?

A variety of factors can predispose an individual to developing gout, including: being male, medications, diet, obesity, family history and medical conditions, such as cardiovascular and renal disease. Circumstances that promote a gout flare include a recent trauma to a joint, changes in diet, dehydration and starting certain medications. Diets high in red and fatty meats, alcohol, seafood and sugary foods can potentially trigger a gout flare because the body breaks down these foods into uric acid. 

What is the treatment for a flare?

Nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen, naproxen and indomethacin work well to treat an acute gout flare and are usually given when it starts. Taking medications in this class may not be an option for those with kidney disease, older than 65, on blood thinner medications or with a history of stomach ulcers. Colchicine is another anti-inflammatory medication used in gout flares. Corticosteroids also reduce inflammation and can be given either orally or injected. 

How can it be prevented?

Gout flares can be prevented by a combination of dietary changes and medications. It's important to focus on eating a healthy diet, including plenty of fruits, vegetables, whole grains and low-fat dairy products. Losing weight and increasing water intake can help reduce the chances of repeat flares, along with following a low-fat, low-sugar diet. For those with frequent gout flares, daily medication, such as allopurinol, may be necessary to lower uric acid in the blood. 

If you're looking to avoid getting gout or preventing flares, some foods to minimize and/or avoid include: 

  • Alcohol, specifically beer and liquor
  • Certain types of seafood, including shellfish, anchovies, sardines and tuna
  • Organ meats, red meat and processed meats
  • Sodas or beverages with high fructose corn syrup
  • Sugary foods

Mayo Clinic offers more information and options for modifying your diet to control gout. 

If you have concerns about gout, please discuss any questions with your provider. 

Jaclyn (Jackie) Houghton, PA-C, is a physician assistant in Primary Care in Rochester/Kasson's Division of Community Internal Medicine (CIM). She has special interest in chronic disease management, preventive and acute care.