[Noah930]

I have gout. Traditionally, it's been thought of as a lifestyle disease: too much good living. Like others have commented, it comes from a build-up of uric acid crystals in joints. Most commonly the pain occurs in the big toe--called podogra; however, it can happen in any joint, really. The uric acid crystals come as metabolites of purine amino acids--most commonly found in things like alcohol, red meat and fatty foods/cheeses. Personally, my diet has nothing to do with my attacks, IMO. Add in some dehydration, and the uric acid tends to precipitate out of solution and form crystals which accumulate in the joints, causing irritation/inflammation and pain. If your urine is yellow/dark, you're not hydrated well enough. In med school, you're taught that it's so painful that even a sheet on the toe at nighttime is intolerable. It might not be the MOST painful thing I've ever experienced, but I can attest to the bedsheet part being true.

In reality, it's more of an inborn error of metabolism. It tends to run in families, for instance (for me: father/grandmother/some cousins on that side of the family). For some reason, the purines don't get effectively eliminated from the bloodstream, and tend to form crystals.

In the past, I'd just stay really well hydrated whenever I felt an attack coming on. That usually limited the pain to just a day or two. Motrin was my friend. Not the measly 200mg over-the-counter dose, but either 600 or 800 mg (every 6 or 8 hours, respectively) for its anti-inflammatory effects. That worked best for me. NSAIDS, in general, are an important part of symptomatic treatment.

Gouty attacks are only supposed to last a couple days. At least that's what the literature says. A couple years ago, I dropped my motorcycle on my foot and broke a metatarsal. The pain from the fracture was tolerable within 24 hours. However, it set off an attack of gout that lasted 7 weeks for me. I took 800 mg of Motrin every 8 hours for 7 weeks straight. Definitely not recommended, but that's what got me through that miserable experience. Heck, I was ready to amputate the friggin' toe by then.

Other options for medication are colchicine for acute attacks, and allopurinol for maintenance in between. Problem with colchicine is that the main side effect is diarrhea. Essentially, you keep taking it every two hours until either the pain goes away, or diarrhea hits. For me, it was the latter. Allopurinol is something to take in between the attacks, to try to prevent them. However, in an acute attack, allopurinol may actually prolong the pain.

There are a couple more nuances to diagnosing and treating gout, as well as managing the meds with their potentially serious side effects, so definitely go see your PCP (or a rheumatologist, if you can swing an appointment with them).