Is your big toe on fire?

Gout is treatable and there are ways to reduce the possibility of recurrence, writes Dr Kizito LubanoEver woken up in the middle of the night feeling like your big toe is on fire? Is your joint hot and swollen while the tender weight of your bedsheet feel as if tonnes of brick are on top of it? Well, this could signal an acute attack of gout, which is a complex form of arthritis characterised by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe. Gout can affect anyone although men are more susceptible with the risk amongst women rising after menopause. Fortunately, gout is treatable and there are ways to reduce the risk that it will recur. Gout occurs when urate crystals — ions and salts accumulate around your joint, causing the inflammation and intense pain during an attack.Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body — as well as in certain foods, such as meats, anchovies, herring, asparagus and mushrooms. Having too much uric acid is not harmful and many people with high levels in their blood never suffer from gout.Your chances of getting gout are higher if you are overweight, have a family member who has gout, drink too much alcohol or eat too much meat, fish and diets that are high in the chemicals called purines. Some medicines such as water pills (diuretics), can also bring on gout. The most common sign of gout is a night time attack of swelling, tenderness, redness, and sharp pain in your big toe. The joint of the big toe is commonly affected although the others in the feet, ankles, knees, wrists, fingers and elbows may also be involved.Inflammation of the fluid sacs that cushion tissues may occur, particularly in the elbow and knee.A gout attack can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years. Sometimes there are no symptoms of gout and it may first appear as nodules on the hands, elbows, or ears.Therefore, even if the pain disappears, the build up of uric acid that led to the attack can still harm your joints and hence the need to see a doctor.For diagnosis, the doctor will perform a physical exam and may also take a sample of fluid from your joint to look for uric acid crystals, which is the best way to test for gout. Blood tests to measure the amount of uric acid in your blood may also be done.GoutTo stop a gout attack you will receive a shot of corticosteroids or a large daily dose of one or more medicines. The doses will reduce as your symptoms disappear. Relief from a gout attack often begins within 24 hours of beginning treatment.To relieve pain during an attack, rest the hurting joint. Taking ibuprofen or another anti-inflammatory medicine also helps. Avoid taking aspirin as it could worsen the gout by raising the uric acid level in the blood.There are medicines that can reduce uric acid build up in your blood and avert future attacks. It is important to adhere to the doctor’s instructions as some people continue to take the medicines forever.Also watch what you eat by consuming moderate amounts of a healthy mix of foods to control your weight and replenish your body with the nutrients it requires. Avoid regular daily intake of meat, seafood and alcohol (especially beer) and drink plenty of water and other fluids.

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