Big Toe Pain

I am curious to know if I have gout…

During the day (2PM) I stamped on a wooded pallet to break into smaller lengths of wood. A lot of the force associated with the impact passed directly thought the toe joint.

Around 8PM had a slight limp as a result of mild pain in the toe joint.

Around 10 – 12PM pains was much worse and limping quite badly. Able to walk but with difficulty as a result of the pain in the toe joint.

No particular discomfort during the night and able to sleep without any problem. Discomfort is just when walking.

Next day was able to walk to work but with a limp. I arranged to go and see a doctor however by the time I left (11-12PM) I had a mild limp, but nothing too serious.

Symptoms with which I presented as follows…

• Sudden onset (several hours for pain to become most severe after which pain subsided). Pain not extreme, just uncomfortable when walking and limp as a result.
• Pain localised to toe joint.
• Redness around joint
• First attack of pain to toe joint.
• Excess alcohol consumption
• Uncle currently suffering from gout so family history
• Age 44

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Note I take regular exercise, not overweight, excellent diet with low intake of risk foods at the time I presented. No alcohol consumed since attack.

Doctor diagnosed gout and the following medication was prescribed

1. Colchimax (0.5mg) to be taken twice daily.
2. Ibuprofen (600mg) to be taken at six-hour intervals.
3. some third medication to prevent an upset stomach.

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Stopped taking painkiller after second pill as not experiencing sufficient pain to justify painkillers. Also stopped taking medication for upset stomach as not experienced no stomach problems. During return visit to GP some days later confirmed normal Uric acid levels. Blood sample taken 36 hours after first onset of attack. Still limping when blood sample taken. No longer taking the painkillers and medication for upset stomach with consent of GP.

Been on Colchimax for approximately one month. Reduced does from twice daily to once daily approximately 10 days ago with out consulting GP. Lingering mild discomfort with toe joint. Also now acutely aware of any mild pain, sensation or discomfort in any of my joints which I would have probably disregarded previously.

Based on, ‘Janssens clinical prediction rule’ (see below) I score 6. Gout is highly unlikely with a total score of ≤4 and is >80% likely with a total score of ≥8:

• Male sex—2.0 points (I score 2)
• Previous arthritis attack reported by the patient—2.0 points (I score 0)
• Onset in <1 day—0.5 point (I score 0.5)
• Joint redness—1.0 point (I score 1)
• Involvement of first metatarsophalangeal joint—2.5 points (I score 2.5)
• Hypertension or one or more cardiovascular diseases—1.5 points (I score 0)
• Serum uric acid concentration >350 μmol/l—3.5 points (I score 0)

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So I would like to know the following…

1. Based on the clinical diagnosis of the symptoms I presented with, have I gout?
2. Is it worthwhile get a synovial fluid analysis to check for the presence of CPPD crystals, to confirm the diagnosis?
3. GP suggested that he would put me onto other medication when I had a return visit which incidentally is now overdue as I reduced the dose of Colchimax, which I am still taking. I guess the new medication might be NSAIDs but I have no idea.
4. Is it advisable to try to manage the condition without taking medication in the long term?

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