Long-lasting gradually intensifying toe joint pain

i'm gonna save you time, pain and money by this advice. No matter how you change your diet, you will always have issues. You cannot stop gout by dietary changes. You can slow down the symptoms a bit, but diet will never solve gout. You must get on daily medication(eg-alluporinol) to reduce your uric acid. Rheumetologists are one of the few doctors that can help you. 80% of GPs are misinformed regarding gout treatment.

Thank you to those who responded. Some interesting discussion between the use of natural supplements to reduce UA enough to prevent flares and the use of allopurinol to get UA down to less harmful levels.

Rusty Gecko brings up some interesting points about what exactly is a safe level of UA. Below 3 mg/dL seems very low as most of the stuff I've read talks about getting levels lower than 6 mg/dL. The basics of what I've read in the science papers is that loads of people have hyperuricemia (a blood UA level of above 6.8 mg/dL). Like 25% of the adult male population in North America. One of the potential symptoms of hyperuricemia is gout - this is much less common (at least in the numbers of people that seek treatment and get diagnosed with gout) at about 5%. Other complications from hyperuricemia are not nearly as well understood. Cardiovascular disease for instance seems to be a higher risk in people with chronic hyperuricemia. They don't really know why exactly but it seems related to inflammation from oxidative stress caused by high uric acid levels. Although people suffering from gout also tend to have a host of other problems that can be problematic for cardiovascular diseases so maybe some confounding there. Basically it is my understanding that higher uric acid levels can lead to more inflammation issues.

I visited my GP today and we basically ruled out other possibilities of my joint issues and were still left with gout as the probable cause. I feel the best path for me to avoid future pain and loss of activity and manage any other related complications is to start a low dose allopurinol regime (100 mg/day) to get my UA levels down below 6 mg/dL. I'll continue with my current healthy diet and try and stay moderate on the alcohol consumption and above all make sure I'm drinking plenty of fluids to keep the kidneys in good shape. I'm concerned with knocking the current inflammation out of my toe as I still can't really walk on it properly and it's been 3-weeks. If I can't do that with ibuprofen over the next week or two I'll probably have to try some prednisone (steroid based anti inflammatory) to get the inflammation down and hope it doesn't return.

Going to follow up with some blood tests after a month or so of being on the allopurinol to see how things are progressing. Thanks again everyone.

Ibuprofen is unlikely to tackle that mate and ideally you should be gout free to start allopurinol. I used Cholcicine to get rid of the persisitent rumbling gout and 2 days later started allopurinol. It worked well. Prednisolon also worked well. I kept taking the cholcicine when I started allopurinol as prophylaxis - its likely to trigger an attack as the crystals start dissolving,. In fact I have fresh packs of both meds to hand and can also take the NSAID diclofenac with them too if required - this just in case allopurinol kicks off an attack, as is common.

Just wanted to update this thread as after 6-months of continuing pain in my big toe and ball of foot I finally got a diagnosis that was being masked by suspicions of gout. This particular toe and ball of foot pain I described in my original post is actually sesamoiditis (really common for it to be diagnosed as gout). Probably resulted from a stress fracture of the bone or an acute injury from sports. My particular complications with this actually led to me exacerbating a damaged sesamoid bone in my foot - which because it never healed has actually undergone avascular necrosis because of lost blood supply. So for anyone reading this that has had more chronic pain and discomfort in that big toe ball of foot area - make sure you rule out the sesamoid problem.

Funnily (not really), as part of the treatment for the sesamoid problem - I've had to go non-weight bearing. Just prior to that I upped my dose of allopurinol from 100 mg/day to 200 mg/day as I still noticed my UA was not falling below 6 mg/dL. Being off my foot and with the increased allopurinol - I woke up last weekend with excruciating pain in my left ankle joint. That's got to be actually gout this time right? It's been awful. I went on ibuprofen for a few days and it seems to be subsiding now.

All the doctors I've seen are pretty useless with understanding all this stuff. You've really got to figure a lot of this out for yourself to manage various injuries and conditions.

I am in the same boat. Here is the short story.

In 2017 I was doing box jumps and noticed my toe feeling a bit sore. I put it down to the box jumps.

I talked to my doctor who diagnosed me with gout. He recommended allopurinol. I said I wanted to manage it through diet. I have never had a 'Gout Attack'. I just have a constantly sore big toe.

This was a big mistake.

Approximately one year on I went back to him because my toe was not getting better and was constantly sore. He sent me for an xray and found that I had a 'lucency' (basically a small hole) in my big toe joint that the radiologist said was consistent with gout.

I guess the lesson I learned is not to ignore my doctors advice, especially when I don't have much knowledge on the subject.

Fast forward to today, I have been on 300mg of allopurinol and have had a sore toe for most of that time.

The doctor recently recommended a long term prescription of Diclofenac (75mg) for 6 months which seems to actually be having an effect on that residual pain.

Regards

Andrew