As you have rightly suspected; this can be gout, despite that you never had an increased uric acid. The diagnostic test would be aspiration of the joint fluid as many times, attack of gouty arthritis can have normal serum uric acid. Your pain in the kidney area also can be due to uric acid crystals passing from the kidney causing pain. The other possibilites to consider would be;
1) Cellulitis of the toe; it is infection of the skin and subcutaneous tissue.
2) Crohn's related arthritis; joint pain is the most common extraintestinal manifestation of the Crohn's; despite it being in remission for last so many years. Please read about it;
I agree that going to urgent care is advisable for the x-ray and blood work.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
A couple questions, please. Because of all I read on different sites re gout last night,, the big toe was the only toe mentioned. So, it is possible that gout could be in the 2nd toe? Sounds like a dumb question, but don't know the answer for sure. Also, re uric acid crystals you mentioned, are you referring to kidney stones or something different? The pain I had for about 1 1/2 days was extremely minor compared to other pain I've had for Crohn's & other issues. I mention this because my best friend had kidney stones a few times and it was extremely painful, as I had already heard. Perhaps you're referring to a different condition. As far as the arthritis is concerned, I thought I was being so proactive having my family practice dr. check for the RA factor in blood work every year, going back 5-6 yrs, since my mother & all her siblings had it badly. Always negative. Then 2 yrs. ago was diagnosed with bone-on-bone osteoarthritis in my left shoulder, needing complete shoulder replacement, which I had done in Sept. 2009. Then finally having xrays on my right foot in Jan. and finding out about the severe osteoarthritis there! My dad had small issue in one knee with osteoarthritis is all, but obviously I took after him instead of my mom! But, since I've never had these symptoms before in any toe of the redness, swelling & pretty severe pain, I assumed that wasn't from the osteoarthritis. But can it be? I actually assumed it was from the osteoarthritis at first, but then decided to look up gout and got that info, a lot of which made sense, then concern about possibility of some kind of infection set into my head. Obviously that would not be good to let go, although I do not understand how I could have gotten this infection. Definitely no wound or anything like that. Also, I will look up Cellulitis to see if that makes sense to me for this.
I though perhaps another foot soak, next time with hydrogen peroxide, might make a difference, later this morning. It is so late now, I need to get to bed. If in the AM it does look better after the epson salts I used a few hrs. ago, and it looks even better & feels better after a hydrogen peroxide soak, do you feel perhaps it is safe enough to just play it by ear from there? I'd certainly rather not go to Urgent Care unless I have to, but I won't be silly about this either. I believe your answers to these questions will suffice, and I will go ahead & approve payment. Thank you very much.
The big toe is the most commonly involved, but other toes may present with gout. Yes, I meant the kidney passing the uric acid crystals or small stones, which may be responsible for the pain. The pain of the kidney stones can be of varied intensity and is dependent on the size of the calculus and crystals and obstruction caused by them. So the pain can vary from, mild to moderate to severe in different individuals. The toe pain is not likely due to osteoarthritis, which does not cause swelling and redness and rarely have acute onset of pain and other symptoms and isolated toe involvement is very rare.
If your symptoms are better and hydrogen peroxide helps you further, you may wait and watch. If the symptoms are static or worsen; going to urgent care is warranted.
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