What should I do if my big toe is swollen and painful due to gout?

Our human body is like a machine. The operation of the machine requires consumption. Similarly, when we humans work and study every day, our bodies are consumed. The difference is that we are much more complex than machines. We can also restore our previous state by resting every day. But the consumption among us is different. Knowledge workers mainly engage in mental work. Manual workers mainly engage in physical labor. Physical labor can cause great damage to human joints. Just like sometimes exerting too much force can cause muscle strain. Constant pressure on the feet can cause pain in the foot joints. Some injuries are caused by illness. What should I do if my big toe is swollen and painful due to gout?

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Primary gout lacks etiological treatment and cannot be cured[4].

The purpose of gout treatment is: 1. Rapidly control acute attacks; 2. Prevent recurrences; 3. Correct hyperuricemia and prevent joint damage and kidney damage caused by urate deposition; 4. Surgically remove tophi and perform orthopedic surgery on damaged joints to improve quality of life.

1. General treatment

Eat a low-purine, low-energy diet, maintain a reasonable weight, quit drinking, drink plenty of water, and drink more than 2000ml of water per day. Avoid overeating, excessive drinking, cold and dampness, excessive fatigue and mental stress, wear comfortable shoes, prevent joint injuries, and use drugs that affect uric acid excretion such as certain diuretics and low-dose aspirin with caution. Prevent and treat concomitant diseases such as hypertension, diabetes and coronary heart disease.

2. Acute gouty arthritis

Rest in bed, elevate the affected limb, apply cold compress, and resume activities only after the pain is relieved for 72 hours. Seek treatment as early as possible to prevent prolonged illness. The following drugs should be used early and in sufficient amounts, and dosage should be gradually reduced after effectiveness is achieved. Do not start uric acid-lowering treatment during an acute attack. Those who are already taking uric acid-lowering drugs do not need to stop taking them during an attack, so as to avoid fluctuations in blood uric acid, prolonging the attack time or causing metastatic attacks.

(1) Nonsteroidal anti-inflammatory drugs (NSAIDs) Nonsteroidal anti-inflammatory drugs can effectively relieve acute gout symptoms and are the first-line medication. Common adverse reactions of non-selective non-steroidal anti-inflammatory drugs such as indomethacin are gastrointestinal symptoms. Gastric protectants can be added when necessary. They are contraindicated in patients with active peptic ulcers and should be used with caution in patients with renal insufficiency. Selective cyclooxygenase (COX)-2 inhibitors such as celecoxib have fewer gastrointestinal reactions, but attention should be paid to their adverse reactions to the cardiovascular system.

(2) Colchicine is a traditional medicine for treating acute attacks. Colchicine has many adverse reactions, mainly gastrointestinal reactions, but can also cause bone marrow suppression, liver damage, allergies and neurotoxicity. Adverse reactions are dose-related, and patients with renal insufficiency should use a reduced dose.

(3) Glucocorticoids are effective in treating acute gout and are usually used for patients who cannot tolerate nonsteroidal anti-inflammatory drugs and colchicine or who have renal insufficiency. For acute attacks involving only one or fewer joints, joint fluid aspiration and injection of long-acting glucocorticoids can be performed to reduce systemic drug reactions, but concurrent infection should be excluded. For polyarticular or severe acute attacks, small to medium doses of glucocorticoids can be used orally, intramuscularly, or intravenously. To avoid "rebound" of symptoms after stopping the medication, a small dose of colchicine or non-steroidal anti-inflammatory drugs can be added when stopping the medication.

3. Intermittent and chronic phases

The purpose is to effectively control blood uric acid levels in the long term, prevent gout attacks or dissolve tophi. Indications for the use of uric acid-lowering drugs include recurrence of acute gout, involvement of multiple joints, tophi, chronic tophi-induced arthritis or imaging changes in affected joints, and concurrent uric acid nephrolithiasis. The treatment goal is to reduce serum uric acid to < 6 mg/dL in order to reduce or eliminate the deposited monosodium urate crystals in the body. The uric acid-lowering drugs currently used in clinical practice mainly include drugs that inhibit uric acid production and drugs that promote uric acid excretion. Both should be started with a small dose and gradually increased at least 2 weeks after the acute attack ends. The dose should be adjusted to the minimum effective dose within a few months based on the target level of uric acid lowering and maintained for a long time or even for life. Only on a single drug.