Gout is a type of inflammatory arthritis that can cause sudden and severe pain in a joint. It is often associated with the big toe, although other joints can be affected too.
Because several rheumatological conditions can cause joint pain and stiffness, it is useful to understand the differences between gout, rheumatoid arthritis (RA), ankylosing spondylitis (AS), and osteoarthritis (OA). Your symptoms may give us some clues, but a diagnosis of gout should come from your GP or another appropriate healthcare professional.
What Causes Gout?
Gout develops when uric acid levels in the blood become too high, leading to crystal build-up in joints. Uric acid is produced naturally when the body breaks down purines, which are found in some foods and drinks. The immune system reacts to the crystals, causing a rapid and intense inflammatory response. Over the course of a few hours, a joint can go from normal to extremely painful, red, hot, and swollen.
The big toe is commonly affected. But gout can also affect the ankle, knee, wrist, fingers, and other joints.
Gout or Osteoarthritis?
Gout and osteoarthritis can both affect the toes, but their symptoms are different. OA tends to develop gradually. Pain is often related to how much (or little) the joint is being used, and stiffness usually improves relatively quickly once you start moving.
In contrast, gout tends to produce distinct flares. The pain can be severe enough that even the weight of bedsheets is uncomfortable. The joint may look visibly swollen and red, and the inflammatory symptoms can develop very quickly.
The two conditions can also occur together, with overlapping symptom patterns.
Comparing with Bunions
Gout is sometimes confused with a bunion, particularly when the big toe is involved. A bunion is a structural change to the foot where the big toe gradually moves towards the other toes and the joint becomes more prominent. Gout, in contrast, is an inflammatory response to uric acid crystals.
Bunions can become painful because of pressure from footwear or changes in the way you walk. It can also be associated with arthritis within the joint.
Diagnosis
If your symptoms look like gout, but you haven’t already had tests to confirm it, we would recommend that you do. Blood tests, joint aspirations, and scans are all options that your doctor may like to carry out. With this information, they may prescribe you medication. Anti inflammatory painkillers are the first port of call, but more persistent cases may require medication to reduce uric acid levels.
How Can Osteopathy Help?
During an acute gout flare, the joint will not benefit from manipulation. Ensuring appropriate medical management of the inflammation is more important.
Once the flare has settled, you may notice that you’re moving differently in response to the episode. If these compensations linger, your osteopath may be able to help. Changes in the way you move can demand more of other joints and muscles. We can assess the whole body and work on areas that have become stiff, overloaded, or uncomfortable. Exercise and movement advice can also help you gradually return to normal activity.
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