Gout is an inflammatory joint disease commonly affecting men in their 40s and 50s but sometimes younger. It causes severe pain and swelling. What are options for immediate gout pain relief and is a cortisone injection an option?

What does gout look like? 

Too much uric acid in the blood causes gout. Uric acid is a byproduct of the breakdown of purines. Generally, purines are produced by the body, but we also get purines from diet. As purines are broken down, uric acid crystals are produced. These small uric acid crystals build up in joints. The big toe is affected but other joints such as the ankle, knee, and patella are also be affected.

Can you get gout in your shoulder? 

While most gout occurs in the big toe or foot, severe gout can affect the upper limb such as the shoulder, wrist, and finger. However, uric acid levels need to be high and other inflammatory arthritis should be ruled out.

gout attack

Main causes of gout 

Generally, the higher the uric acid in the blood, the greater the risk of acute gout. Important genetic and lifestyle factors that increase uric acid levels include:

  • family history – high uric acid levels are often genetic
  • gender – males are at higher risk
  • diet – certain foods high in a compound called purine increase uric acid. Examples include red meat, prawns, broad beans and cakes, and pastries.
  • alcohol
  • certain medications
  • weight gain

A gout attack is often triggered by an event such as a high intake of purine-rich foods or alcohol intake. Also, an acute injury such as rolling your ankle can cause an attack.

What does gout look like? 

Normally, we recommend you see a doctor if you think you have acute gout. Gout can be difficult to diagnose as some of the signs are similar to other conditions.

In most cases, people present with acute pain and swelling of a joint, more commonly the big toe joint or foot gout. Also, the ankle, knee, or patella can be affected. It is important to rule out other reasons for joint pain such as infection, trauma, or other joint arthritis. Imaging such as X-rays or ultrasound may be needed to confirm the diagnosis. Also, we may need to take some fluid from your joint and test it for crystals. Finally, blood tests may also be done to check uric acid levels, inflammatory markers, and other causes of inflammatory arthritis.

Gout vs pseudogout: how can we tell?

Pseudogout is inflammatory arthritis caused by the. the build-up of calcium crystals in joints. As the name suggests, pseudogout looks like gout.

Generally, it can be challenging to differentiate between the two. However, there are clues as to whether symptoms are pseudogout or gout.

First, unlike gout, pseudogout tends to affect older people in their 60s and 70s. Second, pseudogout affects the knees, ankles, and wrists rather than the toes. Finally, attacks of pseudogout can last for many weeks and sometimes months rather than days in gout.

Immediate gout pain relief: what are your options?

Generally, you can take simple steps to get the pain and swelling under control. Examples include ice, compression of the joint, and rest from sport. Also, you need to keep well hydrated and avoid alcohol.

Medications from your doctor can help. Anti-inflammatory tablets such as ibuprofen can stop an acute attack if taken early. Similarly, a drug called colchicine can stop gout in its tracks if taken in the first 24 hours. Often, the dose of colchicine is one tablet three times a day decreasing to twice a day after a week as the pain settles.

Can you take colchicine with ibuprofen together? 

Yes, both medications treat acute gout and have different actions. Overall, however, we favour colchicine for acute attacks as this drug is well tolerated and works quickly.

Is a cortisone shot for gout an option for immediate gout pain relief? 

Cortisone is a powerful anti-inflammatory steroid drug that works almost immediately to stop acute gout. Cortisone can be taken by mouth, but side effects are common. In some cases, a cortisone injection into an inflamed joint is very effective. For example, injection for big toe or foot gout can be effective if severe. It is important to use ultrasound to guide a needle into the joint to improve accuracy and effect.

Generally, a cortisone shot for gout such as foot gout often takes a few days to start working. If given early in an acute attack, it can stop it in its tracks.

What about PRP injections for gout?

PRP injections for gout are only reserved for special cases. Just like cortisone injections, PRP injections are anti-inflammatory and will have a beneficial effect. This effect is probably better if the injected joint has underlying degenerative changes such as osteoarthritis. Nevertheless, the effect of PRP is less than cortisone. Overall, we would only consider PRP injection for gout if the risks of a cortisone injection are too great.

How do we prevent gout flare-up? 

gout foods

Generally, we need to get your uric acid levels lower to prevent gout flare-ups.

Firstly, you need to treat lifestyle factors. Examples include losing weight, reducing alcohol intake, and eating a healthy diet. Secondly, your doctor may prescribe medications to lower uric acid. The most common drug is allopurinol. It is important to wait until an acute attack has settled before starting this drug. Speak to your doctor about whether you should consider this drug. In general, preventative medication such as Alluprinol is useful if you’re uric acid levels are high (usually above level of 500).

When you start taking Allopurinol, you should take another tablet such as colchicine (1 tablet twice a day) for about 4 weeks to prevent another attack.

Typically, a change in lifestyle can reduce uric acid levels. Examples of foods that increase purine and should be avoided include organ meats, sardines, anchovies, prawns, board beans, and foods containing a high concentration of high fructose corn sugar. In addition, yeast and yeast-based foods such as frozen foods and canned food can cause problems. Also, sugar-sweetened beverages and alcoholic drinks increase acid levels. Generally, wine is better than hard liquor or beer.

On the contrary, foods that reduce uric acid include cherries, fruit and vegetables high in vitamin C, low-fat dairy products, and a vegetarian diet. Also, keeping well hydrated can prevent and treat an attack.

Dos and don’t for gout

  • Treat symptoms aggressively as soon as you feel an attack coming. Early treatment of big toe or foot gout will mean a less painful episode.
  • Avoid alcohol and keep well hydrated during an acute attack
  • Avoid binging on foods that are high in purines but a little in your diet is ok
  • Repeated attacks of gout should be treated with a preventative medication such as allopurinol especially if your uric acid levels are above 500

Final word from Sportdoctorlondon about immediate gout pain relief

Acute gout can mimic other common MSK disorders. Also, we need to be aware that acute gout just doesn’t affect your big toe. It can also affect your ankles, knees, and sometimes your upper limb. The key is early diagnosis and treatment including a cortisone shot for acute gout.

Other related foot and ankle conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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