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25, not overweight, female: Gout

Okay, I'm new here but just got home from the doctor's office with prescriptions for medication to treat gout. Over the last 6 days or so, I have been dealing with inflammation and severe pain in my right great toe. Somebody suggested gout to me and I laughed it off. I'm not overweight (sure, I'd like to be thinner, but I'm within the weight range for my height). I eat healthy foods, mostly chicken or vegetarian. Red meat and seafood infrequently. I drink, but pretty infrequently. It's rare for me to have more than 2 drinks, even on weekends. I have one biological child, 5 years old.

Last night the pain was so great, I was just in tears on the couch. When I went in to the doctor's, they were actually pretty quick in diagnosing me, especially since I don't remember hurting my toe.

So, I'm kind of at a loss. The doctor couldn't tell me why this has happened or what I can expect, except that it will most likely flare up again. Could anyone in a similar position tell me of their experiences and what I can do or expect from this? Thank you!
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replied June 11th, 2014
Thank you for asking!
Gout is a metabolic issue and has nothing to do with weight though overweight people are more prone to it even thinner people can have it.Gout and pseudogout are the 2 most common crystal-induced arthropathies. Gout is caused by monosodium urate monohydrate crystals; pseudogout is caused by calcium pyrophosphate crystals and is more accurately termed calcium pyrophosphate disease. It may not always involve big toe Podagra .
Here is how gout presents
Symptoms of gout or pseudogout include the following:

Podagra (initial joint manifestation in 50% of gout cases and eventually involved in 90%; also observed in patients with pseudogout and other conditions)
Arthritis in other sites - In gout, the instep, ankle, wrist, finger joints, and knee; in pseudogout, large joints (eg, the knee, wrist, elbow, or ankle)
Monoarticular involvement most commonly, though polyarticular acute flares are not rare, and many different joints may be involved simultaneously or in rapid succession
In gout, attacks that begin abruptly and typically reach maximum intensity within 8-12 hours; in pseudogout, attacks resembling those of acute gout or a more insidious onset that occurs over several days
Without treatment, symptom patterns that change over time; attacks can become more polyarticular, involve more proximal and upper-extremity joints, occur more often, and last longer
In some cases, eventual development of chronic polyarticular arthritis that can resemble rheumatoid arthritis
Physical findings may include the following:

Involvement of a single (most common) or multiple joints
Signs of inflammation - Swelling, warmth, erythema (sometimes resembling cellulitis), and tenderness
Fever (also consider infectious arthritis)
Migratory polyarthritis (rare)
Posterior interosseous nerve syndrome (rare)
Tophi in soft tissues (helix of the ear, fingers, toes, prepatellar bursa, olecranon)
Eye involvement - Tophi, crystal-containing conjunctival nodules, band keratopathy, blurred vision, anterior uveitis (rare), scleritis
Complications of gout include the following:

Severe degenerative arthritis
Secondary infections
Urate or uric acid nephropathy
Increased susceptibility to infection
Urate nephropathy
Renal stones
Nerve or spinal cord impingement
Fractures in joints with tophaceous gou
Gout is managed in the following 3 stages:

Treating the acute attack
Providing prophylaxis to prevent acute flares
Lowering excess stores of urate to prevent flares of gouty arthritis and to prevent tissue deposition of urate crystals
Acute treatment of proven crystal-induced arthritis is directed at relief of the pain and inflammation. Agents used in this setting include the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin
Colchicine (now less commonly used for acute gout than it once was)
Adrenocorticotropic hormone (ACTH)
Combinations of drugs (colchicine plus NSAIDs, oral corticosteroids plus colchicine, intra-articular steroids plus colchicine or NSAIDs)
Therapy to control the underlying hyperuricemia generally is contraindicated until the acute attack is controlled (unless kidneys are at risk because of an unusually heavy uric acid load).

Long-term management of gout is focused on lowering uric acid levels. Agents used include the following:

Because these agents change serum and tissue uric acid levels, they may precipitate acute attacks of gout. This undesired effect may be reduced by prophylaxis with the following:

Colchicine or low-dose NSAIDs
Low-dose prednisone (if patients cannot take colchicine or NSAIDs)
Other therapeutic agents that may be considered include the following:

Uricase and pegloticase
Vitamin C
Nonpharmacologic measures that may be warranted are as follows:

Avoidance or restricted consumption of high-purine foods
Avoidance of excess ingestion of alcoholic drinks, particularly beer
Avoidance of sodas and other beverages or foods sweetened with high-fructose corn syrup
Limited use of naturally sweet fruit juices, table sugar, and sweetened beverages and desserts, as well as table salt
Maintenance of a high level of hydration with water (8 glasses of liquids daily)
A low-cholesterol, low-fat diet, if such a diet is otherwise appropriate for the patient
Weight reduction in patients who are obese

Seek our health centre for further guidance Meanwhile and don;t forget to stay in touch with your rheumatologist for further management.
Take care
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