Treatment of joints

Gout in men: causes, symptoms and treatment methods

To date, gout is commonly considered a fairly common problem. This disease is the result of a violation of normal metabolism and leads to the deposition of salts of uric acid in the joints. Statistics also confirms that gout is more often diagnosed in men, while women suffer from this ailment about 20 times less often. So what are the causes and symptoms of the disease?

Gout in men and its causes

As mentioned above, the disease is associated with a violation of uric acid metabolism, resulting in its compounds, in particular sodium urates, accumulate in the articular bag, leading to joint inflammation and acute pain attacks.

In some cases, the cause of the disease is increased uric acid formation. But sometimes the level of this metabolic product in the human blood corresponds to the norms - this means that the disease is the result of certain kidney diseases, as a result of which the excretory system can not cope with its basic functions.

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Signs of gout in men

Immediately it is worth noting that this disease most often affects the big toes, and sometimes the hands. Nevertheless, inflammation of the elbow and knee joints can occur. Less often, urate crystals accumulate in the ankle joints.

Gout is a chronic disease in which periods of relative calm suddenly turn into violent exacerbations. It is worth noting that the deterioration of the patient often occurs against a background of malnutrition or strong physical strain.

Inflammation of the joint is accompanied by severe pain, which prevents movement. Along with this, redness and swelling of the skin are observed - these are also symptoms of gout in men. At the initial stages of the development of the disease, the attack lasts several days, after which it passes by itself. A few months later, there is a repeated exacerbation.

Gradually, periods of relative calm almost disappear - patients are constantly suffering from joint pain. The accumulation of a diseased amount of uric acid salts leads to a gradual destruction of the articular cartilage. In addition, urate crystals can be deposited under the skin, forming noticeable nodules of white or yellowish color.

In more severe cases, salts begin to be deposited in the tissues of the kidneys, which leads to the development of pyelonephritis, or urolithiasis.

Gout in men: treatment methods

Therapy depends on the severity of the disease. During periods of aggravation, the doctor's task is to relieve the main symptoms. For this purpose, anti-inflammatory ointments and pain medications are used. Many patients are prescribed drugs that accelerate metabolism and excretion of uric acid.

But the disappearance of the main symptoms does not mean that the disease has receded. And the only way to avoid another exacerbation is to carefully monitor the level of uric acid. It is the gout in men that is treated mainly with the help of the right diet. In particular, it is recommended to exclude meat, fatty fish, caviar, liver, lungs and kidneys from the menu. You should also limit the amount of some vegetables, including sorrel, asparagus, spinach, cauliflower, radish, eggplant, mushrooms and legumes. People with a similar diagnosis are also contraindicated in alcoholic beverages. Most often, proper nutrition and a healthy lifestyle help to get rid of the main signs of gout for a long time.

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The main signs of gout and its treatment

Signs of gout occur usually after 40 years. Gout can affect any joint: knee, elbow, fingers and toes, feet. Gout attacks provoke excessive overeating or abuse of alcohol, especially beer. Mostly the disease occurs among men. This is due to the peculiarities of the structure of the male body. In some cases gout occurs after menopause in women.

General information on gout

The imbalance between the received, assimilated and excreted substances from the body leads to the fact that the types of gout become quite common. It can be found among the most diverse age categories, people of different income levels and lifestyle. Synchronous damage to the kidneys and articular apparatus, the distinctive symptoms in the female and male half, a variety of symptoms leads to the fact that the study of this condition is being done by the Aesculapius for a long time.

For the first time gout was described by the founder of classical medicine Hippocrates and gave her that name. The disease was characterized by acute pain in the feet. Subsequently, when analyzing gout, she was given the title of pathology.

Disturbance of metabolic functions of the body is a hereditary trait. Nevertheless, because of the current tense rhythm of life, the wrong mode of work and nutrition, constant stress and nervous exhaustion, this pathology began to appear more often.

With the alarming symptoms of gout, you should consult a doctor and follow his appointments exactly. The diagnosis of arthritis or arthrosis is far from being a verdict, if properly observed and followed up with useful recommendations. The first signs of the disease can occur even in toddlers, which parents should think about, because it is in childhood that the foundation of health is laid.

Features of gout

The first signs of this disease are sometimes very difficult to identify and identify, since the impairment of metabolic functions passes almost imperceptibly and until a certain time does not bother the patient. Pain in the feet is manifested already in a fairly neglected phase of the disease. In violation of metabolic processes, the kidneys do not cope with the task assigned to them, which is the basis for the appearance of gout. The body does not excrete all the toxic material that is the result of vital activity. Every minute microscopic elements in the form of crystals are deposited in a variety of organs and systems. It is uric acid, which gradually, year after year, settles in the bone tissue. Probably, it is difficult to find a person who has never seen the pathologically changed, practically mutilated hands of older people, especially men.

Gouty deposits on joints and articulations covered with hyaline cartilage, lead to irreversible processes in both women and men. Subsequently, these deposits become more and more large-scale and powerful, becoming stronger, turning into formations similar to certain types of stone. This is due to improper treatment of gout in men leading to partial, and sometimes complete disability. Therefore, if redness occurs in the joints of the legs, their swelling, tenderness, increased body temperature, possible nausea, vomiting, changes in pressure indicators, minor back pain and heartburn, it is necessary to visit the doctor. In this situation, the therapist, vertebrologist, neurologist and other specialists will help. In men, the detection of such a serious illness occurs with routine examinations, dispensary activities, in women - in consultations about completely different diseases, employment, preventive examinations.

Symptoms of gout

The result of accumulation of uric acid salts becomes very painful and uncomfortable. Develop symptoms of gout, gouty arthritis, specific granulomas, which are called tofusov. Statistics show that gout is predominantly a pathology inherent in men. But only up to a certain age. When the period of postmenopause or menopause occurs, female hormones become weaker and do not have the ability to fully carry out the function of evacuation of urates, in such situations, women can develop gout. In this case, the symptomatology of the representatives of both sexes is almost the same. The main symptoms that can be diagnosed are:

  1. Painful fits in the joints.
  2. General nervousness against the background of inconvenience in the joint.
  3. Strong weakness.
  4. Febrile state.
  5. Stable nerve and sleep disorders.
  6. Elements of indigestion.
  7. Chills.
  8. The temperature rise is quite rapid, it can reach 40 ° C.
  9. The onset of pain during eating and during digestion.
  10. Physiological indigestion of the stomach. It appears as a pain within the epigastrium, the subcostal area, severity along the digestive tract, a sense of oversaturation when eating.
  11. Acute pain in the metatarsophalangeal articular system, swelling and enlargement, the skin becomes bright red, peeling off.
  12. A general blood test shows pronounced leukocytosis with a synchronous increase in the ESR index.
  13. A traditional attack of inflammation can take place spontaneously if the patient is at rest.

During the whole period of exacerbation, the patient has a significant decrease in vital functions, a general depletion of the body and other symptoms of significant poisoning with salts of uric acid. In this case, one should not resort to self-medication of gout, traditional home methods and techniques. Warming and other procedures without consulting a specialist can only aggravate the situation and significantly worsen prospects for the development of the disease, and further prognosis will become disappointing.

Diagnosis of gout

With gouty changes, the doctor prescribes a full examination. Many people suffer not only from joint pain, but also from other manifestations associated with a general change in metabolic functions and water-salt balance.

The most vivid and comprehensive picture of gout is obtained by the following diagnostic methods:

  1. Classic history, interview and examination of the patient, identification of weighed heredity.
  2. General tests of urine and blood, biochemistry allow to reveal an increase in the level of uric acid, the degree of failure of the kidneys.
  3. Puncture joint allows you to study the composition of the synovial fluid, identify pathological microflora and determine the possibility of aggravation of the inflammatory process.
  4. Ultrasonic scanning of the kidneys to establish the presence of stones.
  5. Computed tomography of internal organs to determine the degree of damage to salt deposits.

Treatment of gout

Treatment measures are developed after obtaining all the exhaustive information regarding the pathology and general vitality of the patient's body. The doctor informs the patient that it is impossible to completely get rid of gout. Of great importance is the restriction of the consumption of various fish( both marine and freshwater) and all sorts of meat. It is worth giving up such products as spicy seasonings, acidic and containing oxalic acid. For men, limit the intake of alcohol. It is recommended to reduce the consumption of water and replace it with juices, cranberry and cowberry mors, compote, herbal teas and infusions, mineral neutral or alkaline water, which will reduce the uric acid content in the blood.

Therapy of gout consists in the relief of pain syndrome with the use of analgesics and anti-inflammatory non-steroid drugs.

During an attack, the foot should occupy a comfortable position, cooling compresses can be applied to the joint. A stable decrease in the parameters of the presence of uric acid salts is achieved by prescribing antipoprotein drugs: Uralit, Allopurinol. All doses and the decision on the preferences of this or that drug are chosen by the doctor. Be sure to observe the specialists of a narrow profile.

Preventive measures to prevent just such a violation does not exist. Given the fact that the male incidence rate is much higher and at any age they are prone to the appearance of metabolic disorders and the development of a dangerous pathology, one must be very careful about the signals of your body. For women, doctors recommend a regular examination, especially during the menopause. In addition, a healthy balanced diet, normal regimen and the absence of bad habits will allow everyone to avoid the disease.

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Symptoms and Diagnosis of Gout

Gout is a chronic, slowly progressing disease that is caused by disruption of purine metabolism in the body, resulting in an increased amount of uric acid, which is deposited as salts( urates) in the structures of the joints on the hands and feet, which leads to the development of attacks of acute arthritis, the formation of gouty nodules( tofusov), as well as damage to other organs, for example, the development of cholelithiasis or urolithiasis.

Gout is one of the few diseases that has been known to mankind since ancient times. It was also called the disease of kings or aristocrats. The fact is that the development of the disease is greatly influenced by the characteristics of nutrition, in particular, the consumption of a large amount of food enriched with purine bases, for example, meat, alcohol. Therefore, the symptoms of gout arose precisely from noble people who could afford such food. Today, the situation has radically changed and everyone can get sick, although the genetic predisposition to violating purine metabolism, and not just the way of life, also plays a big role.


The inflammation of the joint is based on the deposition of crystals of uric acid salts in its tissues.

Gouty arthritis is found mainly in men, this infestation affects women much more rarely( 9 to 1 ratio).This is due to the fact that the representatives of the stronger sex initially had a slightly higher level of uric acid in the blood plasma. It is known that female sex hormones protect their mistress from such a disaster. But the situation changes with the onset of menopause: during this period, the incidence between the two sexes is almost equal.

Development, course and stages of gout

As is known, uric acid is the end product of the metabolism of purine bases, which is excreted from the body by the kidneys. The main sources of purines are the food we eat, mostly protein, and also the processes of nucleotide exchange in the body. Increase the level of uric acid can result from excessive intake of purines with food, increased their formation already in the body or slowing the excretion of uric acid by the kidneys.

It's important to remember! The increased concentration of uric acid in the blood plasma does not yet confirm the diagnosis of gout. There are many people with hyperuricemia, but no signs of illness. It should also be remembered that the higher the level of uric acid, the greater the chance of getting sick.

So, during the gout from the moment of increasing the level of uric acid( hyperuricemia), several clinical stages are distinguished:

  1. Asymptomatic hyperuricosuria is an increased release of urate with urine, which is also called urine acid diathesis. This stage can last several years, while the level of uric acid to the blood will be normal. But, if by external signs a person is inclined to develop gout( male 35-50 years old with excess body weight, elevated blood pressure and with a predilection for alcohol and fatty foods), then the level of uric acid in the blood should be regularly monitored in order to catch the onset of the disease even beforean attack of arthritis.
  2. Acute gouty arthritis is a classic attack of gouty inflammation of one or more joints. Most often affects the first metatarsophalangeal toe.
  3. Interstitial gout. At the beginning of the disease, the periods of remission are long, can reach even 2 to 3 years, but as gout progresses, interictal periods decrease, and the attacks themselves become prolonged and frequent.
  4. Chronic tofusnaya gout occurs with a sufficiently long duration of the disease. During this period, specific gouty nodules( tofusi) appear under the skin, remissions almost completely disappear, and arthritis acquires a chronic course.

It should be noted that the first signs of gout, as such, are absent. The disease debuts with a sharp attack of inflammation of the joints. Until such a first episode, the patient may not know that he is sick.

Symptoms for gout on the legs

Of particular importance is the recognition of gout at an early stage, which will help to know the symptoms of classic arthritis when gout foot. Although they are generally known, but the correct diagnosis in the first year of the disease is exhibited only in 10% of cases, and in the next 5-7 years, the diagnosis is not more than half the patients.

Symptoms of an attack of gouty arthritis:

  • The onset of arthritis is sudden, amid total health. Most often the joint becomes inflamed at night, which leads to a person waking up from terrible pain. As a rule, patients can specify not only the day that the joint is inflamed, but also the exact time.
  • With detailed questioning, you can identify factors that triggered an attack, for example, hypothermia, joint injury, eating fatty foods or alcohol.
  • In 50-80% of cases, the metatarsophalangeal joint of the first toe suffers.
  • The area of ​​the joint swells, the skin turns red and becomes hot to the touch. Skin covers have a bluish or dark-cherry hue, shine.
  • The pain is so severe that it can not be touched to the inflamed area. Also, because of the pain syndrome, the function of the leg suffers, the patients can not step on the aching leg.
  • Simultaneously, the general condition of a person suffers, there is a fever, general weakness and malaise.

External signs of gouty arthritis

After 7-10 days, all signs pass independently, with treatment this period is reduced to 3-4 days. The next attack can develop several months or even years later, but as the disease develops, they become more frequent. You should also know that the classic picture of gouty arthritis with the involvement of the foot joints is found mainly in men. Women are more likely to identify symptoms of gout on their hands, and not just one joint( monoarthritis) is affected, but several joints of the hand( oligo- and polyarthritis) are affected. This often leads to a false diagnosis of rheumatoid arthritis in women.

Diagnosis of gout

Establishing a diagnosis of gout is not an easy task. It is necessary to correctly assess the history of the patient( detection of risk factors), clinical picture, the results of additional laboratory and instrumental techniques.

Clinical criteria of the disease:

  1. A history of at least 2 episodes of acute arthritis in the patient, regardless of the location and number of inflamed joints, which ended after 1-2 weeks without treatment or with it.
  2. Acute arthritis of the first metatarsophalangeal toe in the anamnesis or at the moment.
  3. Presence of tophi of different size and localization.
  4. Symptoms or diagnosed urolithiasis.

This is how tofuy look at gout

Laboratory diagnostics of gout:

  1. Increase of uric acid level in blood plasma in biochemical analysis: in men more than 0.42 mmol / l, in women more than 0.36 mmol / l.
  2. During the seizure in the general blood test, ESR increases, the number of leukocytes increases, a neutrophilic shift of the formula is observed. Outside the attack, there are no inflammatory changes in the blood.
  3. Microscopy of urine sediment reveals an increased amount of urate crystals( urate diathesis).
  4. In a laboratory study of the joint fluid( joint puncture), a cluster of microcrystals of the sodium salt of uric acid is found.
  5. When microscopic puncture material from tofusov detect uric acid crystals.
See article: Treatment of gout with medicines

Instrumental diagnostic methods:

  1. Radiography allows you to identify typical gout changes, but only in later stages of the disease. Characteristic is the presence of osteoporosis of the subchondral areas of the bones, as well as specific enlightenments( cysts or urate deposits) inside the bones that form the joint. This sign is called the symptom of a piercer( the bone is as if riddled with bullets or shell fragments).
  2. ultrasound will help to detect concrements in the kidneys, bladder and bile ducts.

Differential diagnosis of gout must necessarily be present in every case, since the course of the disease, especially its atypical variants( pseudophlegmonous, rheumatoid, subacute, polyarthritis as infectious-allergic, periarthritic and extraarticular) are very similar to other joint diseases that requirecardinally different treatment.

Most often, differential diagnosis is performed with such pathologies:

  • traumatic arthritis,
  • pyrophosphate arthropathy( pseudogout),
  • rheumatoid arthritis,
  • deforming osteoarthritis,
  • psoriatic arthropathy,
  • reactive arthritis,
  • infectious arthritis.

When making a conclusion, it is worth noting that, despite the typical picture of gout, there are often mistakes in its diagnosis that contribute to the rapid progression of the disease without adequate treatment. Therefore, in every case of acute arthritis, this disease should be suspected, especially for "gouty personalities", that is, people who are prone to this pathology and have known risk factors for violating purine metabolism.

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Often during an attack heart palpitations increase, sweating increases, the temperature rises and chills appear. So the period of an acute attack proceeds.

In the chronic form of the disease, urate crystals are combined into granules and the disease passes into gouty polyarthritis. Often there is a parallel development of kidney disease.

Symptoms of chronic gout:

  • A joint crunch( one or more).
  • Restriction of movements in the joint.
  • Inflammation in the joint( redness of the skin around it).
  • Increased body temperature near inflammation or the entire body.

Pain in gout

The appearance of mild pain in the joint is the main feature that characterizes the onset of gout. Tumor, heat on the skin of the affected joint are the main factors that accompany pain. The heat can be localized in the surrounding tissues. All the symptoms accompanying pain, occurs within an hour. The usual painkiller, like aspirin, will not help relieve the pain in such attacks.

With gout at night, there is an attack of pain in the injured joint, by the morning the pain comes weakening, but not the end of the disease.

Gout in men on their feet

Gout is characterized by a chronic form that can not be cured until complete relief from disease. In men, the observation of the disease begins after 40 years, first there are attacks of pain of a very rare periodicity, but over time, seizures occur more and more often. The first period can be characterized by a year of calm or more, but then the frequency of seizures may be less than a month.

Joints during the course of the disease can be destroyed, and the destroyed places will begin to fill with salts, it is because of this that the build-ups appear.

Severe inflammation begins as a response of leukocytes to the appearance of a large number of salts that are perceived by the body, like aggression and an aggressive body.

Gout in women

In women, gout begins to develop in adulthood and advanced age, after 55 years, which is caused by the end of menopause, when the body reduces the production of estrogens, female hormones. The manifestation of the disease is similar to that of men.

Actions in case of acute attack

Compliance with the recommendations does not guarantee a rapid cessation of the attack or its painlessness. But in many respects the recommendations will help to reduce the pain.

  • Bed rest should be observed. Sick foot is best placed on the pillow.
  • If the pain is intolerable, then an ice compress can be applied. After 15 minutes of compress from the ice, it is better to replace it with a compress with warm ointments, such as Vishnevsky.
  • In food, it is better to give preference to vegetable broths and cereals in milk. You need to drink plenty of water or oatmeal.
  • Painkillers will not help, it is better to use non-steroidal anti-inflammatory ointments. If there were any funds prescribed by a doctor, then their reception is better to continue. As a rule, the treatment of gout with medicines provides for medication.

Preventing exacerbations of gout

Gout, as a rule, occurs in places of injury. Therefore, such joints should be treated very carefully. It is necessary to stop wearing uncomfortable and narrow shoes. As one of the main activities can be identified - timely detection of elevated urate levels in the blood, but mainly for the prevention of food is used.

The diet should include the following products:

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Gout

Gout is one of the most common types of arthritis( inflammation of the joints) and occurs more often in men( mostly middle-aged).Gout occurs more often in men( mostly middle-aged) than in women.
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Causes of

The onset of the disease is closely related to the amount of uric acid that occurs as a result of processing certain foods rich in purines in the body.

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Normally uric acid is excreted by the kidneys in the urine. However, in patients with gout uric acid or too much is formed, or it is poorly excreted by the kidneys, as a result, the body accumulates its surplus. When uric acid is too much in the body, it begins to be deposited in the joints in the form of tiny crystals, which leads to inflammation and pain. It should be borne in mind that there is no clear connection between the level of uric acid in the blood and the development of gout - in some cases, attacks gout develop in people who have uric acid levels within normal limits.

An increase in the level of uric acid in the body can be associated with impaired renal function, as well as with the use of certain medications.

Symptoms of gout

There is acute pain, swelling and redness of the joint( usually one or two).This acute condition( it is often referred to as by gout ) can last for several days or weeks( if not treated). The attack of gout often occurs at night, the joint becomes hot to the touch and very sensitive even to light touches.

Very often the joints of the thumb on the foot are affected, but other joints( ankle, knee, fingers and hands) may be involved. In some cases, joint tendons become inflamed at the same time.

Complications of

If attacks of gout occur frequently and for a long time, it can lead to serious damage to the joints and to a restriction of their mobility. In some cases, white nodules( tophi) are noted under the skin of the joints or around the auricle, which are a cluster of uric acid crystals.

What you can do

You should consult a doctor to make a precise diagnosis. The sooner you go to the doctor, the sooner the treatment will begin. With properly selected therapy, exacerbation of gout occurs after 1-2 days. If you really have gout, then, in addition to meeting all the prescriptions of the doctor, you should follow the diet very strictly.

You should not eat( especially during an exacerbation) all products rich in purines: meat by-products( heart, kidneys, liver, brains, etc.), fatty fish( especially during the exacerbation period), salted and fried fish, canned foodmeat and fish), sharp and salty cheeses, red meat and products from it, lard, soups on meat, chicken, fish, mushroom broth;smoked meat products, beans( lentils, peas, beans, beans, soybeans).

You should not drink alcohol that increases the uric acid content and worsen its excretion by the kidneys( beer, cognac drinks, fizzy and dessert wines).

It is recommended to drink plenty of water, green tea.

When attacks gout , it is necessary to provide sufficient rest for the affected joints and try to injure the joint as little as possible with clothing or shoes.

Keep track of your weight. However, any program for weight loss should be carried out under the supervision of a doctor, tk. A sharp weight loss can lead to an exacerbation of gout.

Be sure to tell your doctor about all medications that you are taking.

What the doctor can do

The physician should make a diagnosis by conducting various additional studies( including a blood test and determining the level of uric acid).With prolonged gout, an X-ray examination of the joints may be required.

The doctor will prescribe drug therapy during the period of exacerbation, give recommendations on the diet and the regime of physical activity and motor activity.

Based on the results of the additional studies, the doctor will select a treatment aimed at reducing the level of uric acid in the blood. Keep in mind that drugs prescribed during the period of exacerbation are not intended for long-term use and, as a rule, do not affect the level of uric acid.

Prevention of gout

If there are cases of gout in your family, then you are at risk. In this case, it is recommended to monitor the level of uric acid in the blood regularly, and also try to adhere to a healthy lifestyle. Gout often occurs in individuals with high body weight and high blood pressure. Proper nutrition with the restriction of meat and other purine-rich foods plays a crucial role in the prevention of gout.

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Gout in men and women - signs, symptoms, methods of treatment

As the disease progresses, the intervals between attacks are significantly reduced.

Period of chronic course

If you do not treat acute arthritis, whether it is a metatarsophalangeal toe, knee or ankle, do not stop the attack in time and do not normalize the level of uric acid, then gout can go to a chronic course. Characteristic focal deposition of urates( tofus) in the synovial membrane, cartilage, periarticular tissues.

Most often tofusi, which are painless papules or nodules, are located on the hands, feet, elbows or Achilles tendon.

Tofuses can even be seen in men and women who have never had acute arthritic arthritis.

Chronic arthritic arthritis will be manifested by pain, deformity and a significant restriction of function in the joints. The knee and ankle joints suffer most, as well as the joints of the hand. The peculiarity of gout, unlike other diseases, is that simultaneously there can be an exacerbation in one joint, when in another - the attenuation of the pathological process will be noted.

After transition to the chronic form, approximately half of the patients have renal damage in the form of interstitial nephritis, urolithiasis, hydronephrosis and progressive renal failure. At the same time, kidney pathology can develop at any stage of the disease.

Diagnosis

In most cases, after a survey and an objective examination, you can suspect gout. Nevertheless, without carrying out additional diagnostic methods, it is certainly impossible to state. From which should be based on the diagnosis:

  • Clinical picture of the development of the disease.
  • Diagnostic puncture of the affected joint and tofus.
  • Radiography of affected joints.
  • Magnetic resonance imaging( MRI).

Laboratory investigations of

Among the laboratory methods of gout diagnostics, biochemical analysis of blood, due to which the level of uric acid is controlled, is of particular importance. It is an important diagnostic criterion, but non-specific.

Approximately 1/3 of the cases show a normal concentration of uric acid in the blood, even during the height of an attack of the disease. In addition, the urine is analyzed for urate( salt of uric acid).

Evaluation of these two analyzes in dynamics allows to determine whether excretion or increased production of uric acid is impaired, and to monitor the effectiveness of the therapy.

Puncture of affected joint and tofus

If a suspected gout is suspected, a diagnostic puncture of the affected joint should be performed to collect the synovial fluid and further its biochemical analysis. The main sign of gout will be the determination of urate crystals in the synovial fluid. After the tofus puncture, a biochemical analysis of the sample taken for the presence of uric acid salts is carried out.

X-ray examination of

After detection of urates in the synovial fluid, it is necessary to confirm the diagnosis radiographically. Nevertheless, X-ray reveals lesions of the subchondral bone zone( bone tofusi).

Magnetic resonance imaging

In some cases, the most modern diagnostic method - computer or magnetic resonance imaging( MRI) - is used to obtain a more accurate picture of lesions in gout or other pathology. However, again, if diagnostic criteria are sufficient to diagnose gout, then an MRI is not required.

How to treat gout

Regardless of the location of the affected joint( metatarsophalangeal toe, knee, ankle), the stage of the disease and the intensity of expression of clinical symptoms, the approach to treating gout for both men and women should be comprehensive. The general tactic of treatment is reduced to:

  1. Rapid disposal of acute gouty arthritis.
  2. Normalization of the exchange of purine bases.
  3. Prevent the development of new seizures.
  4. Prevention of accumulation of uric acid salts in the joints, skin, etc.

It is very important to inform the patient about the disease itself and its consequences. The attending physician should explain clearly how important it is to constantly monitor the level of uric acid, adhere to a diet, take regular medications and completely eliminate the use of alcohol.

This is especially true of men who, as a rule, are quite skeptical of this kind of recommendations.

Dietotherapy

Before the advent of medicines, the diet was the only method for treating gout. It is strictly forbidden to eat beef and pork kidneys, liver, concentrated meat broth, seafood, dishes from fried beans. Also, the diet should not include products such as canned vegetables, dried fruits, seasonings, various sauces, alcohol.

The use of young beef, poultry meat, fish, beans, peas should be significantly reduced.

Practical experience shows that purines in the daily diet should not exceed 200 mg.

Special attention should be given to drinking regimen. To accelerate the removal of products of purine metabolism, it is recommended to drink up to 2.5-3 liters per day( of course, in the absence of contraindications).If there is still urolithiasis, then in the water you need to add baking soda( 4 g per 1 liter) or drink special mineral water.

Drug therapy

Drug administration helps to cope with an attack of acute arthritis, and to conduct effective maintenance therapy in the period between exacerbations. To date, treating gout without medicines is not possible only with a diet. What medicines are used:

  1. To stop the first and subsequent bouts of gout, non-steroidal anti-inflammatory drugs( Diclofenac, Naproxen, Indomethacin), colchicine and glucocorticoids are prescribed. The drug of choice are NSAIDs. If they are ineffective or if there are contraindications, colchicine is used. To glucocorticoids resorted only after NSAIDs and colchicine were powerless.
  2. To normalize the level of uric acid in the body use Allopurinol, which reduces its synthesis, and Losartan or Urisan, increasing its excretion. The basic drug is Allopurinol, which is effective both in terms of inhibition of synthesis, and in terms of enhancing the excretion of uric acid.

Local treatment with anti-inflammatory gels or ointments with gout practically does not bring any benefit. Expressed massive tofuys better to treat by surgical means, smaller ones usually dissolve.

Physiotherapy

During the period between attacks and with a chronic course of gout, the appointment of physiotherapy procedures is indicated. As a rule, paraffin and mud applications, magnetotherapy, ultrasound, radon or hydrogen sulphide baths are prescribed.

Therapeutic exercise

A special set of exercises on how to develop the affected joints( knee, ankle, etc.) after exacerbation of the gout, paints the treating doctor. Classes of curative physical culture can begin and end with an easy massage.

Forecast

For early diagnosis and compliance with all the recommendations of the doctor, the prognosis is quite favorable. Modern approaches to the treatment of gout allow even with fatal forms to eliminate focal deposits of urates( tofusi), significantly improve the function of the affected joints and prevent the progression of renal pathology.

However, when you ignore the prescribed course of therapy, the continued use of alcohol and inadequate treatment, improvement is usually not observed.

In such cases, the patient's condition deteriorates sharply and may end up lethal.

Prevention

The primary prevention of gout is reduced to a transition to a healthy lifestyle, diet, the complete refusal of alcohol. It is recommended to engage in sports, swimming, running, walking, which helps increase the excretion of purine-based exchange products.

In addition, patients who have undergone gout should be observed regularly with the attending physician and, if necessary, undergo a supportive course of therapy.

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Gout: symptoms and treatment, photos, signs of gout

Ancient Greeks called gout "a trap for the feet."From the end of the XVII century gout is considered a separate disease. Gout was mostly male, but now it has overtaken the female half of humanity, and arises in the joints of the hands and feet. It was a consequence of the fact that people often overeat and abuse alcohol, in the treatment of diseases, many medications, diuretics( diuretics) are used. Since the withdrawal of uric acid from the body is delayed, it crystallizes and is deposited in the joints, turning into a sodium salt - sodium monourate. Modern physicians consider gout to be a systemic disease that affects the body completely. Signs and treatment of this disease, the first symptoms of gout you will learn from our article.

Causes of gout

The disease is divided into two groups, depending on the cause of the onset.
  1. 1) Primary gout in the vast majority of cases occurs as a consequence of the violation of hormonal and genetic factors, to which improper nutrition and the use of alcoholic beverages are added.
  2. 2) The secondary form is a consequence of metabolic disorders, as well as excessive intake of medications. To such medicines carry: Pyrazinamide, Aspirin, Nicotinic acid and various diuretics.
The main risk factors can be called:
  • genetic predisposition of
  • men have a higher chance of getting sick, unlike women.
  • as a rule, the disease is diagnosed up to 40 years.
  • taking medications, especially diuretics
  • , alcohol abuse increases the risk of gout, especially for beer.
  • excess weight also contributes to hyperuricemia.
From gouty pains, the lower extremities are the first to suffer. The attack occurs after injury to the legs, playing soccer, due to surgery, long walking or long driving. After surgical operations and injuries, debrided tissue is dehydrated, so more salt and uric acid are localized in this place, they are deposited in the problem joint. With a decrease in body temperature, even by half a degree, the urate begins to turn into crystals in the joints. Gout is often a consequence of overheating in the sauna or steam room, because sweating begins in the bath and the body is drastically dehydrated. Gout is exacerbated during trips to hot countries. Podgora often suffer from hypertension due to the frequent use of diuretics. Uric acid accumulates in the blood, creating ideal conditions for the development of gout. Also to the reasons include:
  • metabolic disorders, obesity;
  • consumes high-calorie meat, fish food in fried form, abuse of vegetable and animal fats and alcohol;
  • hypothermia or overheating of joints and a large physical load on them;
  • factor of heredity.
RNA and DNA contain purine bases - adenine and guanine compounds. When metabolism is disturbed, purines are converted into uric acid in the human body.

Signs and symptoms of gout

The first phase of gout proceeds without symptoms, the level of urates gradually increases in the body, which in the future can lead to gout. This stage lasts a very long time, up to 25 years or more. The second phase is acute gouty arthritis. The first symptoms of gout at this stage are manifested by pain and swelling near the affected joint, as well as a rise in body temperature. The clinical picture of gout has pronounced signs:
  • usually exacerbation begins early in the morning, or late at night;
  • there is a sharp pain in the joint affected by acid-uric crystals, usually a thumb on the leg;
  • there is redness and shine of the skin, together with swelling in the joint and periarticular tissues;
  • the temperature rises, touching the joint is very painful;
  • general weakness and malaise of the body is also present.
In the chronic stage - tofusi and nodules under the skin are formed, which is inherent in softening in attacks. Some attacks of gout initially differ sharp pain, then become frequent and can last several hours and even weeks. When the chronic stage of gout occurs, many small and large joints are affected with simultaneous development of chronic arthritis. People with gout early onset diabetes mellitus, atherosclerotic plaques are formed in the vessels, since low density lipoproteins are concentrated in the blood. Cholesterol in the blood in patients above the norm( see how to reduce cholesterol).

Diagnosis of gout

When diagnosed take into account the frequency of recurrent seizures. The diagnosis is made on the basis of:
  1. 1) The urate monosodium crystals found in the synovial fluid and the absence of microorganisms in it;
  2. 2) Confirmed tofus with chemical or polarization microscopy;
  3. 3) 6-12 signs of gout: X-ray, laboratory, clinical;
  4. 4) Hyperuricemia, asymmetric inflammation of the joints;
  5. 5) On the roentgenogram - subcortical cysts without erosion.

Treatment of gout

Treatment of gout reduces to the relief of acute attacks, drug treatment, diet and prevention of repeated exacerbations. Coping with an acute attack:
  • prescribe a copious alkaline drink 2-2.5 l / day.) And complete rest;
  • apply compresses, applying Dimexide in solution - 50% for analgesia and against inflammation;
  • stops the attack with non-steroidal anti-inflammatory drugs: Indomethacin, sodium diclofenac, Naproxen, Pyroxicam;
  • relieve pain and inflammation of Nimesil and Colchicine;
On the first day of treatment, the dosages of the drugs are increased, then reduced to a medial therapeutic dose. Adherence to the regimen should be in accordance with the recommendations of the doctor and take into account contraindications. For example, contraindications to the use of colchicine are severe damage to the kidneys and liver, peptic ulcer diseases of the stomach and 12 duodenal ulcer. Coping with an acute attack is possible with pyrazolone and indole preparations: Reopyrin, Butadion, Phenylbutazone, Ketazone. With increased resistance to drugs, Prednisolone is added to treatment. Take at first 20-30 mg / day, then the dose decreases. At the same time, Butadion and Indocid are taken in small doses. Uric acid is excreted from the body by Allopurinol and a specially selected diet.

Treatment of gout between attacks at home

For the treatment of gout in the period between attacks at home eliminate hyperuricemia, recurrences of gout attacks, prevent damage to internal organs, restore the broken joint function with the help of complex therapy, including drugs, diet, physical effects and sanatorium treatment. It is important not to use long-term medicationgout at home with light attacks, and with a dubious diagnosis. The first two days should be used Colchicine( 1 mg / day) or Indomethacin( 75 mg / day). Before receiving antidotal drugs, the type of impaired purine metabolism is established. It can be metabolic, renal and mixed. Uricostatics inhibit the formation of uric acid, for example, Allopurinol: the daily dose is 100-900 mg, which depends on the degree of hyperuricemia. At a mild degree - 200-300 mg, at an average - 300-400 mg, at a heavy - 600-900 mg / day. For two days you can reduce the level of uric acid by 2-3 times. The drug is used constantly, because it does not have the durability and duration of action. The break is made in the summer for 1-2 months due to the appearance of a variety of plant products in the menu. Uricosuric means inhibits tubular reabsorption of uric acid compounds and increases production, so they are prescribed for renal hyperuricemia. Treat: Etamide, Benzbromarone, Probenecid( BENEMID) and salicylates - 4 g / day. Most often treated with Allamaron, it is convenient in the reception - 1 time per day for 1 table.and has a small number of adverse symptoms. Dissolve uric acid stones and prevent the formation of new ones - with the drug Uralit( Magurlit, Blamaren).

Menu for gout: what can you eat?

Usually prescribed for gout diet number 6, which has a full calorie, it limits animal fats and salt, reduced the amount of protein. The diet has many alkaline valences and it provides for increased fluid intake. The energy value of the diet is 3000 kcal. Diet No. 5 is also suitable. It is forbidden to eat:
  • by-products: liver, kidneys, tongue, brains.
  • with meat of young animals and poultry: veal and chicken.
  • with fat varieties of meat and fish, soups and broths from them.
  • beans, rich purines: peas, beans, beans, lentils, sorrel and spinach.
Restrict consumption of animal fats with saturated fats - they increase the level of uric acid in the plasma and decrease its excretion in the urine. Salt is limited to 5-7 g, including its content in products. Overeating and hungry days are prohibited, as uricemia increases and a gout attack can repeat. It is permissible to eat:
  • with meat and fish in boiled form - 2-3 times a week.
  • milk and dairy products.
  • with flour and cereals, white bread( in small quantities).
  • vegetables: potatoes, cabbage, zucchini, pumpkin, melons, watermelons.
  • fruits: apples, apricots, plums, pears, peaches, oranges.
  • berries: grapes, cherries, cherries, strawberries and blueberries.
  • before going to bed you need to drink a cup of soft tea, coffee, tea with milk or lemon, juice.
  • include curd, kefir, dairy and fruit-free days.
  • on meat days - boiled beef - 150 g or boiled fish - 150 g. You can combine meat and fish and enter that day with vitamin C and B¹.
  • during the exacerbation - only liquid food: milk, lactic acid products, kissels, compotes. And also: vegetable and fruit juices, weak tea with milk or lemon, broth of wild rose, vegetable soups, liquid porridges.
Alkaline mineral waters are used as liquids without gas. When the disorder occurs during a period of exacerbation of medications, a sparing diet is observed. With arterial hypertension and poor blood circulation, it is necessary to drink a lot of alkaline water, fruit juices and berry compotes.

Complications of gout

Gout is manifested by the following complications:
  1. 1) Gouty glomerulosclerosis and urate stones in the kidneys. Nephropathy, gouty nephritis, pyelonephritis develops.
  2. 2) Violation of kidney function in violation of purine metabolism( gouty kidney).In the presence of arterial hypertension and diabetes mellitus, acute kidney failure develops.
  3. 3) Gouty arthritis and destructive polyarthritis with joint deformities.
  4. 4) Osteoporosis( thinning of bone tissue).
  5. 5) The formation of tofus on the joints or soft tissues: on the wings of the nose, in the auricle, fingers, feet, in the internal organs - the heart, kidneys, etc.
Gout may accompany coronary heart disease and arterial hypertension.

Prophylaxis and prognosis of

Prolonged seizures can result in complete recovery. The prognosis is favorable and depends on the level of hyperuricemia and adequate treatment. People can maintain their ability to work for many years and their quality of life does not suffer. Prevention is reduced to diet, exclusion of fasting, use of diuretics, long-term use of drugs that dissolve urate salts( Uralit), the use of sanatorium treatment. You can apply compresses to the joints of a mixture of valerian( 3 bottles) and cologne( or vodka) - 200 ml. Compress warmed with a woolen scarf. After an exacerbation the status will improve.
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