What If the Big Toe Isn't the Culprit?

Gout flaring up somewhere besides the big toe may be more likely to return

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) The most common place for gout to first show up is in the big toe. This form of arthritis causes painful swelling where the toe meets the foot. But that's not the only place gout starts.

A recent study found that people may be more likely to experience a second flare-up of gout if it starts somewhere besides the big toe.

A little more than half the people in the study who had gout saw a later flare-up of it.

The research was presented at a conference in Europe and has not yet been published in a journal.

"See a podiatrist for severe swelling in your foot joints."

The study, led by Tim Bongartz, MD, of the rheumatology department at the Mayo Clinic, aimed to determine how common later gout attacks were after a patient experienced an initial attack.

The researchers followed 46 patients who had all experienced their first flare-up of gout at an average age of 66.

The first flare-up occurred in the big toe for 72 percent of the patients. The big toe is the most common place that gout first shows up.

During the approximately 13 years (on average) the patients were followed, 28 of them (61 percent) developed at least one more flare-up of gout. Overall, 101 flare-ups occurred among the patients during the study period.

Those who experienced the additional flare-ups were less likely to have had their first flare-up in the big toe. In fact, those who experienced their first flare-up in a joint other than the big toe were about four times more likely to have flare-ups again later on.

Gout is caused by a build-up of uric acid in the blood, and uric acid levels in these patients also provided clues about who would develop later flare-ups — but not as much as the first joint affected did.

The patients who had high levels of uric acid in their blood at the start of the study were a little less than twice as likely to have a later flare-up.

The researchers did not find the patients' risk of a later flare-up to be affected by their age, gender, weight or lipid levels.

The amount of alcohol patients drank or when they started taking medication to lower their blood levels of uric acid also did not appear to affect their risk of later flare-ups.

The researchers therefore concluded that patients whose first gout flare-up was somewhere besides the big toe and those with higher uric acid levels were more likely to develop flare-ups again.

This information should be considered in determining whether those patients at higher risk should receive medication to lower the uric acid in their blood, the researchers wrote.

This study was presented June 11 at the European League Against Rheumatism annual meeting in Madrid. The research has not yet been published in a peer-reviewed journal and therefore requires review by other scientists.

The research was internally funded, and the authors declared no potential conflicts of interest.

Reviewed by: 
Review Date: 
June 9, 2013
Last Updated:
December 31, 2013