Sudden pain in the big toe is often a first sign of gout

Sudden and intense pain in the big toe in the middle of the night is often the first sign of gout, a complex type of arthritis that occurs when there is excessive uric acid in the blood. The skin covering the big toe may appear red and inflamed and the joint may feel swollen, tender and hot, as if it’s ‘on fire’.

A gout attack of this kind typically occurs suddenly without warning. The pain is likely to be most severe in the first 12 hours of an attack, but joint discomfort can persist for weeks. Gout attacks come and go, and are likely to be frequent at an advanced stage.

“Gout is common in Singapore. If you suspect you have gout, do consult your doctor,” says Dr Jon Yoong, Senior Consultant, Department of Rheumatology & Immunology, Singapore General Hospital.

Gout occurs more frequently in men aged 30 to 50, particularly among those who are overweight. Women are more likely to develop gout after menopause. While gout often affects the big toe, other joints of the feet as well as the knees, ankles, elbows, wrists, and hands can be affected.

What are the causes and risk factors of gout?

Your body produces uric acid when it breaks down substances known as purines found in red meats, organ meats, seafood, as well as vegetables such as mushrooms and asparagus, and alcoholic beverages, particularly beer. Excess uric acid in the blood can cause urate crystals to accumulate in the joints, which can trigger a gout attack.

“Having a high uric acid level does not necessarily mean that the patient has or will get gout. Conversely, a low uric acid level does not mean the patient will not have gout for sure,” says Dr Yoong.

You have a higher risk of developing gout if you:

  • consume foods and beverages high in purine
  • have a family history of gout
  • are obese
  • have abnormal kidney function
  • suffer from persistent dehydration

How is gout treated?

Gout cannot be cured and is typically treated with medication to manage joint pain/inflammation (e.g. NSAIDs, corticosteroids). Patients at an advanced stage will also require medication (e.g. allopurinol) to lower their blood uric acid level.

“In order to reduce the risk of gout, adjustments to lifestyle such as avoiding consumption of high purine foods like sardines, alcohol, red meat and even mushrooms would help. Exercising and staying hydrated all the time would help to prevent a gout attack,” says Dr Yoong.

Untreated gout can lead to joint deformity and kidney failure.

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