Gout: why your big toe hurts and how it is controlled

Pain that starts suddenly, often at night, in the big toe. The joint becomes swollen, red and warm, and the pain can wake you up. That’s how gout usually shows up — a type of arthritis that, according to the CDC, usually affects one joint at a time.^[1][2]

How many people does it affect?

According to an analysis of the 2015–2016 NHANES national survey:^[3]

Adults with gout in the U.S., 2015–2016

Men (5.9 million)

5.2%

Women (3.3 million)

2.7%

Total (9.2 million)

3.9%

The same study found that only a third (33%) of people with gout were taking treatment to lower uric acid.^[3]

Why it happens

Gout happens when uric acid (urate) builds up in the body. Urate forms when purines break down; purines are found in body tissues and many foods. Normally it leaves the body in urine, but if the body makes too much or removes too little, it builds up and forms needle-shaped crystals in the joints, causing inflammation.^[2]

That said, many people with high uric acid levels never develop gout.^[2]

Risk factors and triggers

Sources: CDC (2024)^[1]; NIAMS (2023).^[2] Don't stop any medication without talking to your doctor first.

Flares and complications

Gout flares usually last a week or two, and symptoms disappear in between.^[2] Without treatment, flares can become more frequent and last longer.^[1] Other complications include:^[2]

• Tophi: buildups of crystals that form hard lumps under the skin and can damage bones and joints.
• Kidney stones, from high uric acid levels.

How it is treated

NIAMS sums it up: with early diagnosis, treatment and lifestyle changes, gout is one of the most controllable forms of arthritis.^[2] The American College of Rheumatology’s 2020 guideline strongly recommends:^[4]

• During a flare: colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.
• Urate-lowering therapy for people with tophi, joint damage visible on X-rays, or frequent flares, with allopurinol as the first choice.
• A “treat-to-target” strategy: adjusting the dose with regular blood tests until urate stays below 6 mg/dL.
• When starting that therapy, adding anti-inflammatory preventive medication for at least 3 to 6 months.

No medication should be taken without medical advice: each one has contraindications and side effects.

Habits that help

The CDC recommends:^[1]

1. Getting regular physical activity, at least 150 minutes a week at moderate intensity.
2. Limiting purine-rich foods and drinks, especially beer and hard liquor.

If you have sudden attacks of pain in a joint, an assessment can confirm whether it’s gout and help you keep it under control so it doesn’t come back.