Last night, you fell into bed, exhausted from the day... you drifted into a peaceful sleep... and then it happened. You awoke to an excruciating pain in your big toe. When you turned on the light and took a look, you found that your big toe was red, swollen, and hot to the touch. No matter what you tried, the pain didn't subside.
When you finally made it in to your doctor's office, she took some blood tests and made her diagnosis. You have gout, she said. But when you reached into your memory bank to pull out what you knew about the disease, all you could think of was reading about it in history books. Well, here's a short refresher course.
"Gout was formally introduced in the Thirteenth century, but was described by
Hippocrates long before that, says Don Stewart, M.D., chairman of the family practice department at Overlake Hospital and Medical Center in Bellevue, Washington.
The classic symptom is pain in the joint at the base of the big toe, he continues. But gout can affect any other joint of the feet and hands, as well as the knees, shoulders, and elbows. Sometimes you'll even get a fever and chills because the joint gets so swollen and inflamed, he adds. Gout comes on very suddenly, produces severe pain, and usually lasts three to five days if untreated. But Stewart warns that it can recur and last a lot longer than that. Many patients describe gnawing pain accompanied by a feeling of pressure and tightening in the area. The pain is like that of a dislocation, yet the parts feel as if cold water were being poured over them, says Denise Kraft, M.D., F.A.A.F.P., a family practitioner in private practice in Bellevue, Washington.
There are several conditions that can result in gout, but the primary cause is an abnormally high level of uric acid in the blood, either from the body's producing too much or from the body's not excreting it properly. Uric acid is a waste product of cell activity. When the level of uric acid in the blood increases, sodium urate crystals may form. The crystal deposition in itself is not sympto-matic, says Peter A. Simkin, M.D., a rheumatologist and professor of medicine in the Department of Medicine at the University of Washington in Seattle. It's when those crystals deposit in a joint and cause arthritis that you start to see the classic symptoms of gout.
High blood pressure and obesity are also contributing factors, says Kraft. Stewart adds that diseases involving the breakdown of tissue including cancer, lymphoma, psoriasis, and anemia can cause high levels of uric acid in the blood and result in an attack of gout.
Gout is overwhelmingly a problem in men rather than women because women are more efficient in the way they excrete uric acid in the kidneys, says Simkin. Stewart clarifies this further. Gout is classically a disease of middle-aged men who are fat and who drink too much, he says. But frequently it affects perfectly healthy individuals as well. Severe dehydration can also bring on an attack of gout, says Kraft.
Gout itself isn't necessarily dangerous, but the underlying causes for it are, warns Stewart. Gout, therefore, requires diagnosis and treatment by a doctor. Once you've seen your physician, however, there are a few things you should do on your own.

Don't put any weight on the joint.
This usually means staying off of your feet as much as possible until the episode subsides, according to Stewart. Any pressure you put on the joint will increase the pain and possibly damage the area further. This is a serious condition because it can go on to cause a lot of major joint damage and destruction, warns Stewart.

Keep the joint elevated.
This again will reduce some of the pain and keep the blood from rushing to the area, which can cause additional inflammation, says Stewart.

Immobilize the joint.
This could be achieved by lying still or by actually building a splint for the joint, says Kraft. The less you move the joint, the better it will feel.

Take ibuprofen.
This will help to reduce some of the swelling and decrease some of the pain associated with that swelling, says Kraft. Both ibuprofen and aspirin are anti-inflammatories, but Stewart warns against taking aspirin to relieve the symptoms. Aspirin in low levels can actually exacerbate the problem, he says.

Avoid icing or heating the area.
Heat may feel good on the area, but it also increases circulation to the area and brings in more white blood cells, which can make it more irritated, says Kraft. Simkin adds that icing the joint can cause more crystals to form.

Wear comfortable shoes.
Many people like to wear stylish shoes with narrow, pointed toes. But any shoe that forces the big toe inward can make the problem of gout worse, says Simkin.

Symptoms and Statistics

Although the big toe is a common place for it to start, the painful aching of gout can be felt in joints in almost any part of the body, but never in the spine.
Gout is often extremely painful and it is by no means rare. It affects 16 men in every 1000, but is less common in women (3 in every 1000), who rarely suffer from it before the menopause.