Gout Flare in Your Big Toe? How to Ease the Pain and Prevent the Next One

What a Gout Flare Feels Like

Gout flares often start suddenly at night, and the pain can be bad enough to wake you up. A big toe, ankle or knee that felt fine at bedtime becomes so swollen, red, warm and tender that even the weight of a bedsheet can hurt.

With early diagnosis, treatment and lifestyle changes, gout is one of the most controllable forms of arthritis. Many people avoid flares and ease their symptoms, and some even become gout free.

What Is Happening Inside the Joint

Gout is a painful type of arthritis that usually strikes one joint at a time, most often the big toe. It starts with uric acid, a normal waste product the body makes as it breaks down its own cells and many foods. Normally the kidneys filter uric acid out of the blood, and it leaves the body in urine.

Trouble begins when the body makes too much uric acid or does not get rid of enough. Not everyone with high uric acid gets gout, but over a long time the extra can form sharp, needle-shaped crystals in and around a joint. The body reacts to those crystals with swelling and pain, and that reaction is called a flare. A flare is often followed by stretches with no symptoms at all.

What Raises the Risk

Gout is more common in men, in women after menopause and in older people. Being overweight raises the risk, and so does a family history of gout. It is also more common in people with heart failure, high blood pressure, diabetes or kidney problems.

Some medicines can raise the risk too, including water pills (called diuretics), low-dose aspirin, large amounts of the vitamin niacin and some drugs that weaken the immune system. If you take any of these, do not stop without talking with your doctor first.

Step One: Get It Diagnosed Early

Left untreated, flares may come more often and last longer. Over the years, hard lumps of crystals can form under the skin and around joints, where they can become painful, damage bone and soft tissue and leave joints misshapen. The right treatment can prevent those lumps and help clear up ones that have already formed.

Gout can look like other problems, so a doctor should make the diagnosis. If you have not been diagnosed with gout, see a doctor about sudden, intense joint pain, especially with swelling and discolored skin. Your doctor will ask about your symptoms, health history and medicines, examine the joint and may order a blood test for uric acid. Some doctors also use a needle to draw a little fluid from the joint and check it for crystals. Gout is usually diagnosed during a flare, when those crystals are easiest to find.

Step Two: Calm the Flare

If you already know you have gout, start the medicine your doctor recommends as soon as a flare begins. At home, rest the joint, raise it if you can and put ice on it to ease swelling and pain. The medicines used to ease a flare include:

• Anti-inflammatory pain relievers, which can reduce pain and swelling. Ibuprofen and naproxen are sold over the counter, and stronger anti-inflammatory medicines come by prescription.
• Colchicine, a prescription drug that works best when taken at the first sign of a flare.
• Steroid medicines such as prednisone, taken as a pill or given as a shot into the joint.

With treatment, the pain often starts to ease within 12 hours, and in many cases it is gone within two days. Too much ibuprofen or naproxen can cause stomach pain, bleeding and ulcers. If you have kidney disease, stomach ulcers or other health conditions, you may not be able to take them, so talk with your doctor before using them. Colchicine can upset the stomach, and steroids can raise blood sugar and blood pressure.

Step Three: Lower Uric Acid Over Time

Calming a flare does not fix the cause. If you have frequent or severe flares, joint damage, lumps of crystals under the skin, kidney stones or kidney disease, your doctor may prescribe a daily medicine to bring uric acid down. These include allopurinol, febuxostat and probenecid. Febuxostat may raise the risk of death from heart problems. If you take it or are offered it, talk over the choices with your doctor before making any change.

You may need one of these medicines for life. Taking it regularly is a big part of preventing flares. For a while after you start the medicine, flares can come more often. That is normal, and your doctor may add colchicine or an anti-inflammatory pain reliever to help prevent them. Whichever medicine you take, do not stop it without a doctor's advice.

Step Four: Watch What You Eat and Drink, and Stay Active

Alcohol, sugary drinks, red meat and certain seafood can all raise uric acid. Cut back on alcohol, especially beer, and limit nonalcoholic beer too. Avoid soda and other sugar-sweetened drinks, limit fruit juice and drink plenty of water.

Go easy on red meat, on organ meats such as liver and kidney, and on seafood such as shrimp, lobster, sardines, anchovies and tuna. The National Institutes of Health suggests an eating plan called DASH, especially for people with gout who also have high blood pressure. It can help bring down high blood pressure and may also help lower uric acid. The plan calls for plenty of vegetables, fruits and whole grains, with low-fat dairy, poultry and oils, and fewer saturated fats and sweets.

If you carry extra pounds, losing weight through fewer calories and more exercise helps lower uric acid and can reduce flares. Low-impact activities such as walking, bicycling and swimming are easier on the joints. The CDC recommends at least 150 minutes of moderate activity a week, and its page on staying physically active with arthritis has ideas.

Talk With a Doctor Before Changing Anything

Always talk with your doctor before changing your diet or medicines. If you have gout and take a water pill for high blood pressure, ask whether you should keep taking it or switch to another medicine. Many other blood pressure medicines do not raise the risk of gout.

Before your visit, write down your symptoms and when they started, any family history of gout and every medicine, vitamin and supplement you take. Bringing a family member or friend along can help you remember what your doctor says.