Gout of the big toe

Among all the diseases associated with purine metabolism disorder, gout of the big toe is the most common. The pathology is characterized by the deposition of sodium urate in the joint tissues of the big toe - urate precipitates into crystals, which provoke the appearance of microcrystalline arthritis, with all the corresponding symptoms.

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Causes gout of the big toe

The cause of the disease is an increased and persistent content of sodium urate (uric acid) in the bloodstream. In the initial stage of the disease, crystallization occurs in the joint of the big toe, which contributes to the gradual destruction of joint tissue.

Excess urate can occur for a variety of reasons:

• with insufficient function of the renal filtration system;
• with excess production of uric acid in the body.

It is possible to identify a general range of possible causes for the development of the disease:

• renal failure;
• injuries and hypothermia of joints;
• alcoholism;
• constant and severe stress;
• treatment with diuretics and other drugs that affect kidney function or purine metabolism;
• wearing unsuitable and uncomfortable shoes, which can contribute to deformation of the big toe joint.

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Pathogenesis

The trigger for the development of gout is considered to be a persistent increase in the level of sodium urate. Excess uric acid leads to its deposition in the form of crystals in joint tissues. Crystals have sharp edges and damage tissues, resulting in an inflammatory reaction with joint deformation and severe pain.

Also characteristic is the formation of so-called gouty nodules - tophi. Without proper treatment, tophi gradually increase in size and deform the joint.

The disease often occurs against the background of other pathologies that are related to metabolic processes. This may be obesity, diabetes mellitus, calculous cholecystitis and pyelonephritis. Renal dysfunction is often the cause of hypertension, and metabolic failure leads, in turn, to vascular damage, including coronary ones.

The course of gout alternates with periods of attacks and remission. The acute period can last 7-14 days, and the period of remission of the disease is determined by the severity of the disease and may vary.

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Symptoms gout of the big toe

The defeat of the big toe by gout is determined by the presence of characteristic symptoms that the patient himself can detect. The first signs of the disease are manifested by a sharp acute pain in the joint. An attack can be accompanied by a feeling of general fatigue, headache, swelling in the affected area of the foot, hyperemia of the skin at the site of inflammation, as well as an increase in local and general temperature.

Patients usually seek medical attention complaining of sharp pain in the first metatarsophalangeal joint – that is, where the big toe connects to the first metatarsal bone. The pain may intensify when putting weight on the forefoot, both at rest and while walking. The condition often worsens at night, especially after a heavy meal or drinking alcohol. The joint of the big toe becomes hot to the touch and increases in size. The skin becomes purple-red.

As a rule, the first occurrence of the disease is easily cured. Subsequent attacks become longer and more difficult to treat.

Forms

• M 00-M 99 – diseases affecting the musculoskeletal system and connective tissue.
• M 00-M 25 – arthropathy.
• M 05-M 14 – polyarthropathies of inflammatory nature.
• M 10 – gout.
  • M 10.07 – idiopathic gout with ankle and foot lesions.
  • M 10.17 – lead gout with damage to the ankle and foot.
  • M 10.27 – drug-induced gout with ankle and foot lesions.
  • M 10.37 – gout due to renal dysfunction, with lesions of the ankle and foot.
  • M 10.47 – other secondary gout with ankle and foot involvement.
  • M 10.97 – unspecified gout with ankle and foot involvement.

Complications and consequences

Gout is a complex chronic pathology, so complications of this disease are not uncommon. The most common and formidable complication of gout of the big toe is the development of gouty arthritis, which is accompanied by signs of general intoxication and acute inflammatory process.

In addition, urolithiasis with the formation of urate stones (uric acid crystals) may occur.

Tophi – the second name for gouty nodes – are accumulations of sodium urate. They can accumulate in any part of the body. When tophi are deposited inside the joints, the immune defense is triggered, due to the fact that these accumulations are a kind of foreign body. Leukocytes are activated, an inflammatory reaction occurs, which is the beginning of the development of arthritis.

The formation of kidney stones can lead to insufficient kidney function, which can also have corresponding complications and adverse effects on the body.

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Diagnostics gout of the big toe

The majority of diagnoses are established based on the patients' complaints and external examination. If the case is complicated, other diagnostic methods may be needed.

• Laboratory tests:
  • increased leukocyte count in a general blood test, accelerated ESR;
  • high levels of sodium urate in the blood;
  • the content of leukocytes in the synovial fluid is from 10 to 60;
  • When examining tophi, urate crystals are found.

• Instrumental diagnostics:
  • When performing radiography, erosive changes are detected in the subchondral bone region, and the first metatarsophalangeal joint is primarily affected;
  • X-ray, CT and MRI do not detect the presence of periarticular osteoporosis.

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Differential diagnosis

Differential diagnostics are carried out with the following pathologies:

• infectious inflammation of the joint;
• amyloidosis of joint tissues;
• chondrocalcinosis (the so-called "pseudogout");
• rheumatoid arthritis.

Treatment gout of the big toe

Gout cannot be cured completely: treatment is only symptomatic, to alleviate the condition during attacks. As a rule, analgesics and anti-inflammatory drugs are prescribed, as well as drugs that reduce the level of sodium urate in the bloodstream.

• Medicines used to control uric acid levels:
  • Allopurinol is a drug that disrupts the production of sodium urate. The average daily dosage of the drug is 200 mg. The treatment regimen is determined by the doctor individually;
  • Febuxostat is a xanthine oxidase inhibitor drug that suppresses and reduces the amount of uric acid. The average dosage of Febuxostat is 80 mg/day;
  • Pegloticase (recombinant uricase) is a new drug, an enzyme that causes the breakdown of uric acid to a neutral substance. A single dose of the drug is 8 mg;
  • Santuril is a medication that blocks the formation of uric acid stones and promotes their removal from the body.
• Medicines for the symptomatic treatment of gout:
  • Colchicine is a remedy for eliminating gout attacks. The effect occurs within 12 hours after taking the drug. It is used according to the treatment regimen agreed upon with the doctor, from 1 to 3 tablets up to 3 times a day;
  • Prednisolone is an anti-inflammatory, anti-edematous, antitoxic drug, an analogue of the hormones of the adrenal cortex. Use up to 4-6 tablets per day, depending on the situation;
  • Non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen) – drugs that reduce signs of inflammation and intoxication. Dosage – from 400 to 800 mg three times a day.

During periods of exacerbation of the disease, it is necessary to follow these rules:

• it is necessary to ensure rest for the affected limb and joint;
• You should drink plenty of fluids to reduce the concentration of urate in the blood (except carbonated water and alcohol);
• It is recommended to review your nutritional principles, refuse animal fats and limit the amount of animal proteins. Preference should be given to vegetables, fruits and cereals. Diet table No. 6 is especially recommended.

Traditional medicine can be used alongside traditional doctor's prescriptions. In many cases, it helps improve the patient's condition and speed up the onset of remission.

Herbal treatment usually includes the use of compresses, infusions, decoctions, and other remedies that can relieve pain and soothe inflammation.

1. Steamed turnips are ground to a mushy consistency and applied to the affected joint as a compress.
2. For internal use, prepare a mixture of 100 g of crushed garlic, 150 g of grated onion and 250 g of crushed cranberries. Place the mixture in a dark place for 24 hours, then add 500 g of honey and stir. Dosage: 1 teaspoon three times a day 30 minutes before meals.
3. Drinking a glass of celery juice every day on an empty stomach can speed up the removal of uric acid from the bloodstream.
4. To take foot baths, brew 150 g of chamomile flowers in 1.5 l of water and leave for 2 hours. The water temperature for the procedure is about 37°C. Duration is 20-30 minutes.
5. It is also useful to make baths with the addition of calamus root.

For adherents of alternative treatments, homeopathy is offered - this is the use of special homeopathic preparations of plant origin that restore one's own immunity and eliminate the adverse symptoms of gout. Such preparations do not cause harm and are not toxic to patients. The dose of the drug is calculated by a homeopathic doctor, based on the reaction of the patient's body.

Among the most popular homeopathic remedies for gout are:

• Berberis vulgaris - used for the formation of deposits in the kidneys, as well as for joint pain when walking.
• Calcarea fluorica - used for enlargement of the big toe joint, which is accompanied by acute pain.
• Colchicum - helps with painful swollen joints, as well as with night pain.
• Rhododendron – helps eliminate swelling and morning pain in the joints.

Surgical treatment is prescribed only in severe cases of gout of the big toe, with the formation of tophi against the background of infectious inflammation and deformation of the joint. Surgery may be the only method of treatment when medications no longer have the expected effect.

Prevention

• Try to wear only comfortable shoes, the size of which corresponds to the length of the foot. If shoes cause discomfort when worn, it is better to refuse them. If possible, for example, at home, it is preferable to walk barefoot.
• Massage of the toes is an excellent measure for preventing diseases of the joints of the lower extremities.
• Don't forget about proper nutrition and a healthy lifestyle. It may sound trivial, but it is precisely the rejection of bad habits and a well-thought-out diet that can prevent and alleviate gout.

Prevention methods are especially relevant for those people whose relatives already have this disease, since genetic predisposition is one of the possible causes of gout development.

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Forecast

The prognosis of the pathology is unambiguous - gout is considered an incurable disease. However, each patient can control the frequency and strength of attacks. To do this, it is necessary to carefully follow all recommendations for taking medications, nutrition and lifestyle, as well as regularly take tests for the level of uric acid in the body. This will help prevent a relapse of the disease in time.

Gout of the big toe causes a lot of inconvenience to the person who is sick. But it is very important to prevent further spread of the disease.

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