Causes, Symptoms and Treatment of Gout On Legs
What is gout?
Gout is a metabolic disease in which salts of uric acid( known as urate) are deposited in the joints. Gout is otherwise called "disease of kings", an ancient disease that was known even in the time of Hippocrates. Now gout is considered a rare disease, it affects 3 people out of 1000. And most often it affects men over the age of 40, in women it is most often manifested after menopause. Gout itself is one of the types of joint diseases caused by the deposition of salts.
All gums suffer from gout, ranging from the joints of the fingers to the joints of the toes.
It was known even in the time of Hippocrates and is called "disease of kings" because the main source of its occurrence is the excess in food and alcoholic beverages. Gout is often chronic.
Causes of gout
The cause of gout is an elevated and persistent level of uric acid in the blood. During the course of the disease, urate crystals( a derivative of uric acid) are deposited in the joints, organs and other body systems. Sodium urate crystallizes and small particles are deposited in the joints, which ultimately leads to partial or complete destruction of the joint. For the same reason, such situations are called microcrystalline.
A large amount of uric acid in the body can be for two reasons: the first reason is when healthy kidneys can not cope with the withdrawal of an unusually large amount of uric acid, the second reason is when uric acid is released in normal amounts, but the kidneys are unable to remove it.
Every year, more gout is getting sick. Doctors explain this phenomenon by the fact that in recent years people are more likely to consume food rich in purines( for example, meat, fatty fish) and a huge amount of alcoholic products. This is confirmed by the fact that during wars the percentage of people suffering from gout fell sharply due to the fact that meat products, and, especially, alcohol, it was very difficult to get.
Symptoms of gout
The symptom of gout is a common attack of gouty arthritis - it is usually an inflammation of one joint, most often it turns out to be the joint of the big toe, knee or ankle. Usually, a gout attack occurs in the early morning or at night, it manifests itself in the form of unexpected severe pressing pain in one or another joint, the affected joint swells up, the temperature in the joint area rises, the skin turns red and starts to shine. Usually during the day the pain becomes a little less, but by the night it again intensifies, the duration of a gout attack lasts from two to three days to a week, sometimes more. With a repeated attack in this inflammation, other joints may be involved, this can lead to partial destruction of the joint.
Signs of gout is the appearance on the hands or feet of unusual growths, while the level of uric acid is significantly increased. When growths, in other words, tofusi burst, a person can see whitish crystals of uric acid. The patient can feel quite intense pain in the affected areas. Such salt deposits in the joints interfere with a full life.
Possible complications of
The main and most severe complication of gout is the appearance of gouty arthritis, it is also possible the occurrence of urolithiasis, in which the resulting stones consist of urate or crystallized uric acid.
Gouty nodes , also called "tophi" - it's nothing more than conglomerates of sodium urate crystals that have the ability to be deposited in all parts of the body. And in cases where such deposits get stuck in the joints or periarticular tissues, the immune response occurs, as these deposits are perceived by the body as a foreign body, which causes the accumulation of leukocytes and begins a strong inflammation called gouty arthritis.
It is worth paying special attention to the fact that gout-stones in the kidneys can become the main cause of kidney failure and can eventually lead to death.
Pain with gout
To understand the beginning of a gout you can by sudden pain in the joint. They are accompanied by severe redness, swelling and heat."Burn" can not only hit the place, but also the area of the body in the immediate vicinity. At the same time, the body temperature can rise to 39-40 degrees. Symptoms in most cases develop within an hour. Most often, this affects the big toe. Ordinary pain medications, such as aspirin, will not help.
Pain, as a rule, begins at night and becomes, in practice, unbearable. In the daytime there is often some improvement, the pain recedes, but do not think that everything has passed. Such acute symptoms can torment the patient for about a week.
Gout in men on legs
Gout is a chronic disease. Cure it completely impossible. This ailment often manifests itself on the feet. After the onset of the disease, the symptoms may recur after six months or a year. The disease can go into a dormant state, but, without any doubt, will make itself felt. With each attack, the time between them will be reduced. Gout will return to the person more and more often.
Damaged places on the legs are often destroyed more and more, the disease can affect the neighboring joints. With a long illness over time in the affected areas, under the skin may appear peculiar hillocks, which are called "gouty nodes" or "tofusi."
This is due to the fact that the body begins to perceive large salt deposits in the joints on the legs as a foreign body, the immunity begins to inevitably react - to accumulate leukocytes, after which a strong inflammation begins. Sometimes tofusov burst and out of them stand out whitish dust - crystals of uric acid.
Often gout develops in old age. In men, it occurs much more often and at an earlier age. The male population is susceptible to this disease by the age of 40.It should be noted that women begin to suffer from gout closer to 55, mainly after menopause, when the amount of estrogen, female hormones, is sharply reduced in the body. Children and young guys are practically not prone to gout. There are rare exceptions, in cases of hereditary impairment of uric acid metabolism.
The role of uric acid in the development of gout
This disease severely impairs metabolism. Purines enter the human body with food, but they are also produced by him. Next, purines are split into uric acid, which is excreted by the kidneys. In people with gout, the content of this uric acid is much higher than normal. Excess uric acid is deposited in those tissues where there is no blood supply. There, crystals are easier to gain a foothold.
The joints, cartilage and tendons are the most affected. As a result of this disease, not only these places, but also the kidneys suffer. Most often with gout develops urolithiasis, with a lower probability of the patient may suffer from renal colic.
This can occur for two reasons: if the uric acid is produced too much and the kidneys do not cope with the output volume, so it must be deposited in the human body. And the second reason is that the amount of uric acid is normal, but the kidneys can not remove it.
However, an elevated uric acid content in the body is not the only cause of gout. Here, several other factors play a decisive role: excessive nutrition, fatty food, overweight, sedentary lifestyle and hereditary predisposition.
What should I do if I have an acute attack of gout?
Even with adherence to recommendations, an acute attack will not be instantaneous. But this will significantly reduce the time during which the disease will torment the person. Mainly you need to observe strict bed rest. Painful limbs are best kept in an elevated position, for example, to lay a pillow under them.
In case of intolerable pain, ice can be applied. Then it is desirable to make a compress on a sore spot with Vishnevsky ointment or dimexide. In the intake of food, it is better to restrict yourself, you can use liquid porridge and vegetable broth. But drink is worth as much as possible alkaline drinks, for example, a decoction of oats, jelly, milk, mineral water or plain water, but with the addition of lemon juice( lemon juice dissolves uric acid deposits with rheumatism and gout).You need to drink at least 3 liters a day.
Any painkillers will not help. You can take modern anti-inflammatory drugs without steroids. If you took any preventive measures prescribed by your doctor, then the procedure should be continued.
Preventing exacerbations of gout
Most often gout appears in places where the joint was injured. Therefore, treat such places with caution. Do not wear narrow and uncomfortable shoes, as it can severely damage the big toe, which so "loves" gout. Mainly to prevent the onset of gout attacks, diet and balanced nutrition are used.
The way of life will have to be completely revised, making it healthy. You should reconsider your taste preferences. Recommended diet number 6, which helps reduce the body's uric acid and urate. Strictly limited, or even excluded, products containing urine bases - the main source of urate. But poor purines, and therefore allowed milk, cheese, eggs, vegetables, fruits and cereals will not leave you hungry. The patient's diet should contain whole grains, eggs, vegetables, fruits, dairy products with low fat content.
In food should restrict the intake of meat, fish, caviar, mushrooms, legumes. In addition, you need to limit consumption: smoked meat, marinade, anchovies, cauliflower, asparagus, sorrel, chocolate. Such a diet will lead to normalization of body weight and significantly reduce the burden on the joints during an exacerbation of gout.
More information on what you can eat and what not, as well as other features you can find here
Alcohol and smoking inhibit the excretion of uric acid from the body. Consequently, its crystals are more deposited in the joints. For prevention, alcohol should be completely excluded, especially beer, and also quit smoking. It is not recommended to drink tea, coffee, cocoa. In addition to dieting, it is worth doing at least once a week a fasting day with the use of a mono-product.
First of all, small joints are affected. Therefore, it is worth paying special attention to the development of their mobility. Attention should be concentrated on those sites where there are attacks of pain. Daily it is necessary to do gymnastics for joints. At first, it will be unusual, because the joints are harder to be mobile because of the deposits. It is recommended to be more often on air and to make walks.
Mineral water for gout
Mineral waters perfectly contribute to removing unnecessary purines from the body. Prefer alkaline and organic substances. They can be attributed primarily to Narzan, Essentuki and Borjomi. Remember that any liquid should be consumed at least 2.5 liters per day.
Treatment of gout
The diagnosis of "gout" means that a person will have to significantly change his lifestyle and constantly take medication, because it is unfortunately impossible to achieve a complete cure for this disease. However, timely treatment starts allows you to take gout under control, reduce painful attacks to a minimum and hedge against serious complications.
The main principle of treating gout is to control the level of uric acid in the body. For medical treatment should contact a doctor-rheumatologist. Its prescriptions will be aimed at reducing the volume of uric acid and its rapid removal from the body. Only a qualified specialist can prescribe medications that, with possible concomitant diseases, do not cause the greatest harm to health.
Most often, doctors prescribe for non-steroidal anti-inflammatory drugs for 1-2 weeks, such as methindole, diclofenac, butadione, indomethacin, naproxen. To quickly reduce the concentration of uric acid in the body, allopurinol, orotic acid, thiopurinol, hepatocatalcil, milurite can be discharged. To stop acute signs of gout, doctors recommend taking colchicine.
Drug therapy for gout is aimed at solving two main problems:
Reducing the level of uric acid in the patient's body;
Coping with acute inflammation and pain relief.
The earlier the patient undergoes the examination, reconsiders his habits and proceeds to treatment, the more likely it is to achieve a stable remission. Without adequate therapy, gout rapidly progresses, especially in patients of mature and advanced age, therefore, it is by no means impossible to reason on the principle of "caught-let-go".
Drug therapy for reducing uric acid level
Since the cause of gout is precisely the excess of uric acid, the solution of this problem in 90% of cases leads to the cessation of attacks of excruciating pain and allows you to count on a comfortable life in the future.
To reduce the level of uric acid in the body, the following drugs are used:
Allopurinol is a synthetic analogue of hypoxanthine. This substance inhibits the activity of the enzyme xanthine oxidase, responsible for the transformation of human hypoxanthine into xanthine, and then xanthine to uric acid. Thus, Allopurinol reduces the concentration of uric acid and its salts in all body environments, including blood, plasma, lymph and urine, and also promotes the gradual dissolution of already accumulated urate deposits in the kidneys, soft tissues and joints. However, this drug has a number of serious side effects and greatly increases the excretion of xanthine and hypoxanthine with urine, therefore Allopurinol is contraindicated in patients with severe renal failure. Nevertheless, for the majority of patients with gout, it remains to this day a preparation of the first order. Cost: 80-100 rubles per packing 30-50 tablets;
Phoebusostat( Ulorik, Adenurik) is a selective xanthine oxidase inhibitor that, unlike Allopurinol, does not affect other purine and pyramidal enzymes of the human body, besides it is excreted not by the kidneys, but by the liver. Phoebusostat is a relatively new drug for the treatment of gout, it is not produced in Russia, and in Western Europe and the United States it has undergone numerous clinical trials and has shown excellent results. Febuksostat for three months completely dissolves accumulations of crystals of salts of uric acid in the region of fingers and elbows and effectively prevents their repeated formation. Can be used by patients with concomitant renal pathologies. It costs a drug not cheap - an average of 4500 to 7000 thousand rubles, depending on the country of origin;
Peloticase( Pegloticase, Krystexxa) is an infusion solution of enzymes that rapidly dissolve urate crystals( deposits of uric acid salts).It is used intravenously twice a month to stabilize the condition of patients with severe gout, which are not helped by traditional drugs. Anaphylactic shock is possible during the procedure. This is a very expensive drug that is produced exclusively abroad and is sold on order;
Probenecid( Santuril, BeneMid) is a drug that prevents re-absorption of uric acid in the renal tubules and enhances its excretion in the urine. Probenecid was originally used in complex antibacterial therapy to reduce the damage to the kidneys with antibiotics. But then it began to be prescribed for chronic gout and hyperuricemia( increased uric acid in the blood).It is important to understand that Probenecid enhances the excretion of uric acid, rather than suppresses its synthesis. Therefore, the treatment of gout with this drug is advisable only at the stage of remission. If you prescribe Probenecid to a patient with an acute inflammatory process, this will lead to active dissolution of already accumulated urates, an increase in the level of uric acid in the plasma, and, as a result, to attacks of excruciating pain. To avoid this risk, the first months of treatment with Probeecid gout are accompanied by additional hormonal and anti-inflammatory therapy. It costs a drug from 3500 to 7500 rubles.
Treatment of gout with decongestants and pain medications
Symptomatic treatment of gout is to stop seizures, relieve edema and pain, and is performed with the following drugs:
Colchicine( Colchicum, Colchimine) is an alkaloid, is released from the poisonous plants of the Melantie family. The most common source of colchicine is autumn autumnal. Colchicine inhibits the formation of leukotriene, stops the cell division of granulocytes, prevents the movement of leukocytes to the focus of inflammation and prevents urates( salts of uric acid) from crystallizing in the tissues. This drug acts as an emergency aid, and is recommended for admission in the first twelve hours after the onset of an acute attack of gout. It is necessary to drink immediately two tablets of Colchicine, an hour later - another, and then one tablet three times a day for a week. The drug very often causes unwanted reactions from the gastrointestinal tract - nausea, vomiting, loose stools. The average price of Colchicine in pharmacies is from 1,000 to 2,000 rubles;
Glucocorticoids( Cortisone, Hydrocortisone, Prednisone, Prednisolone) are synthetic analogues of human corticosteroids, that is, hormones produced by the adrenal cortex. Preparations of this group break the chain of natural reactions of the body to the interference of allergens, chemicals, bacteria, viruses and other foreign elements. Glucocorticoids quickly stop inflammation, but suppress immunity, so hormonal treatment of gout is advisable only if the expected benefit exceeds the potential risk. The cost of synthetic steroid hormones varies from 30 rubles( the oldest drug is Prednisolone), up to 1500 rubles( Cortisone);
NSAIDs( Aspirin, Analgin, Diclofenac, Ibuprofen) - Non-steroidal anti-inflammatory drugs are called so in order to emphasize their difference from hormones. However, the action of drugs in this group is somewhat similar to that of glucocorticoids. NSAIDs are non-selective inhibitors of cyclooxygenase, the enzyme responsible for the synthesis of thromboxane and prostaglandins. Thus, these drugs also suppress inflammation, but, unlike synthetic corticosteroids, do it more slowly, and are not immunosuppressants. For symptomatic treatment of gout, Diclofenac and Ibuprofen are most often used, the average cost is 10-30 rubles, the price of a popular generic( drug with the same active substance) Nurofen can reach 150 rubles.
How to prevent gout attacks?
To minimize the risk of new gout attacks, follow a few simple rules:
If possible, do not subject the joint to any load, periodically fix it in a raised position and apply ice for 15-30 minutes 2-3 times a day until the painsubsides;
Do not overuse aspirin, which can cause a jump in uric acid levels in the blood and aggravate the symptoms of gout;
Regularly measure the level of uric acid - it should not exceed 60 mg / l;
Every day, devote more than half an hour to physical education: walk, ride a bike, jog, dance, swim. In the morning, do exercises. Regardless of age and weight, patients with gout should give themselves daily physical exercise - sport works with gout more effectively than any medication;
Drink at least two liters of clean water a day. So that the kidneys can excrete uric acid from the body, they need water first of all - not the liquid that the kidneys still need to filter( coffee, tea, juice), namely pure water. Without enough water, even healthy kidneys can not cope with the cleansing of the body;
Hand over the blood test to determine the level of the most important minerals and vitamins, and, if necessary, supplement the diet with a good vitamin and mineral complex. It is especially important for patients with gout to provide themselves with vitamin C;
Do not drink carbonated drinks with sodium benzoate and powdered juices with fructose, completely discard alcohol;
Revise your diet in favor of vegetables, fruits and cereals, eat no more than 120 grams of animal protein a day, avoid offal and fatty sausages.
On the topic: From the pains of gout can also see popular folk remedies
The newest data on the treatment of gout
According to the latest data, obesity is most likely to predispose to gout caused by excessive consumption of fatty foods of animal origin. At risk, lovers of sausages, wursts, bacon and hamburgers. It is the excess of proteins that leads to the excess of uric acid, and the extra weight creates an increased strain on the joints and, thereby, accelerates the development of the inflammatory process.
American scientists have also established a direct link between deficiency of calcium and ascorbic acid and the development of gout. With age, these important substances for the body begin to be missed even by those people who lead a healthy lifestyle and do not complain about excess weight. Therefore after forty years it is necessary to annually be examined and take multivitamins prescribed by the doctor.
Recently, a new drug, suppressing the synthesis of uric acid - Benzobromarone, has been developed. Now there are active clinical trials of this drug, and in some Western countries it has already been allowed and put on stream. But before the novelty rests on the domestic pharmaceutical market, it is likely that a lot of time will pass.
It is also known about the experimental development of new non-hormonal anti-inflammatory drugs that directly affect the protein interleukin, which provokes gouty inflammation of the joints and tissues. But the exact timing of the appearance of these drugs in a free sale is difficult to call.
Allopurinol: Pros and Cons
The most popular drug for treating gout, Allopurinol, is increasingly being sharply criticized by modern doctors, since the large number of side effects and complications associated with its regular use raises questions about the advisability of such therapy. According to statistics, an average of one in two hundred and sixty patients with gout Allopurinol provokes sudden death as a result of renal coma or cardiac arrest.
Nevertheless, the largest international study of Allopurinol, the results of which have recently been published in the scientific journal Annals of the eumatic Diseases, proves the high effectiveness of the drug, moreover - the ability to prevent the onset of death. This study certainly does not disprove the presence of side effects and high risk for the kidneys, and does not eliminate the need for new development. But we must admit that Allopurinol is still a first-line drug in the treatment of gout, at least because of good knowledge, reliability and affordable price.
Scientists have tracked the fate of 5,927 patients who received Allopurinol on a regular basis and the same number of patients treated with gout with other drugs that reduce uric acid levels. It turned out that the mortality in the first control group was 19% lower than in the second, and such results persist throughout the life of patients. That is, Allopurinol is still the most effective and safe drug, both for the treatment of acute, first-diagnosed gout, and for maintaining normal health in elderly patients with chronic disease.
Author of the article: Candidate of Medical Sciences Volkov Dmitry Sergeevich, surgeon
Gout( gouty arthritis): what is it, symptoms and treatment
Gout( gouty arthritis) is a disease in which there is an accumulation in the body of excess saltsuric acid( urates).
This disease manifests itself in that from time to time the patient has acute attacks of gouty arthritis.
In addition, near the joints are formed special nodules - tofusi.
Who most often develops the disease?
Gout is predominantly a male disease: in the stronger sex it is more common than in women.
gout attack: salt crystals injure tissues
On average, one woman who suffers from gout is from 3 to 7 men, who are affected by this disease.
Mostly mature and older people are ill: most often gout manifests in men after the age of 40-45 years, and in women - after 55-60 years.
This is due to the fact that female sex hormones( estrogens) have a positive effect on the exchange of uric acid in the body. When the climacterium content of estrogen decreases dramatically, then the likelihood of becoming ill with gout is significantly higher.
In addition, it is considered that there is a hereditary predisposition to arthritic arthritis: if someone from your relatives had a gout, chances are that it will arise from you( especially if you are a man) is much higher, and you arein the risk group for the development of this disease.
In addition, factors such as overweight, as well as alcohol abuse, also increase the risk of developing this disease.
In general, in the world, according to statistics, 2-3% of the population suffers from gouty arthritis( data for the USA), but for men after 40-50 years this indicator grows to 5-6%.In Russia, the incidence of gout is about 0.1-0.2%.
Why this disease arises
how the gout arises( schema)
Because gouty arthritis is a metabolic disease, it arises in those people who have either increased the intake of substances containing purines, or their excretion due to whichit's a disease.
Which products contain many purines? This is primarily meat and by-products( not for nothing, gout is also called "meat-eating disease"), as well as legumes, tea, cocoa, some fish, and especially alcohol, including beer and red wine.
People who have a lot of such foods in their diet have a high risk of getting gouty arthritis.
And when the removal of purines from the body can be difficult? Most often - because of concomitant kidney diseases, as a result of which renal filtration is reduced, and therefore - the body retains more uric acid salts than necessary, and it begins to be deposited in various tissues - both in the joint region and in the renal themselvestubules.
In addition, an additional risk factor for gout is arterial hypertension, as well as taking certain serious medicines for serious illnesses.
Symptoms of gout
The main and main sign of gout is an acute attack of gouty arthritis, which is also called a gout attack.
Inflammation of the big toe - the main sign of gout
Often such an attack is observed after a plentiful meal with alcohol. Suddenly, more often in the evening or at night, acute pains appear in one of the joints.
Most often, with an attack of gouty arthritis, for some reason the big toe is affected, but it can be another joint - for example, the knee or elbow.
The joint begins to ache strongly - so that it can even be painful to touch the affected area( for good reason "gout" is literally translated from ancient Greek as a "trap for the leg").The joint swells, the skin around it due to swelling acquires a purple-red hue, and the skin temperature in this area rises.
This condition( attack), if left untreated, can last up to several days and longer. But usually the patient and his relatives quickly turn to doctors who, with the help of medicines for gout, more or less successfully relieve the attack.
The heavier the course of gout, the more likely to occur such attacks. Conversely, if all the conditions are met to ensure that uric acid and its products do not accumulate in the body, then attacks of the disease can be avoided altogether.
Tofusi with gout
tofuy( photo) with gout
If a gout attack with joint inflammation and pains in it can be considered acute manifestations of this disease, tofusi is a sign of a chronic disease.
Because gout accumulates an excessive amount of uric acid in the body, it is clear that these salts should be deposited somewhere. They also are postponed - in the field of various joints( at some point causing a gouty attack), in the skin in the region of the elbows, heels, and also in the area of the cartilage of the auricles.
Collecting in these places, salt crystals gradually turn into small nodules of white color, which can be palpated in the area of small joints on the hands and feet. These nodules are called tofusi in case of arthritis arthritis.
No special damage to the body by tofus is directly applied - it only signals to the person himself, as well as to his doctor, that there is an excess of uric acid salts in the body - and this means that you need to pay attention and take the necessary measures. But we will talk about this in the treatment and prevention of gout.
We offer you to watch an interesting video about what is gout and gouty arthritis, and how dangerous this disease is:
disease Treatment of gout can be conditionally divided into two tasks:
- cupping( interruption) of an acute attack;
- normalization of metabolism in the body, that is, treatment and prevention of the disease outside seizures.
Treatment of an acute attack of gout( acute gouty arthritis)
The first attack of gouty arthritis is best treated in the hospital
. As often the first manifestation of gout, unfortunately, usually becomes a developed gouty attack, its treatment is usually carried out in a hospital - in the rheumatology department of the hospital.
This is necessary not so much to cure this attack, how many to conduct a full-fledged examination and to put the correct diagnosis. After acute arthritis of the joint can be with a variety of diseases - infectious or reactive arthritis, as well as with other ailments.
After the diagnosis of "gouty arthritis" is set, there is usually no need for repeated hospitalizations.
So, what medicines do doctors use to take a gout?
1. Non-steroidal anti-inflammatory drugs
NSAIDs, including all known diclofenac, ibuprofen, naproxen and other drugs. These drugs are good at both pain relief and effective reduction of inflammation in the affected joint. They are prescribed in certain dosages according to the scheme, and anti-inflammatory drugs are an important component of the complex treatment of a gouty attack.
Please note: Non-steroidal anti-inflammatory drugs do not treat gout really: they are needed in order to reduce the severity of its symptoms - pain and inflammation in the joints. Do not try to treat gouty arthritis yourself with NSAIDs, consult a doctor!
treatment of this disease should be prescribed only by the doctor
Colchicine is a medicine that can reduce inflammation in acute gouty attacks and restore the function of a sick joint.
This drug is prescribed according to a special scheme and is taken every few hours for 1-1.5 days - until the severity of the attack goes to zero or when it becomes clear that you need to use another medicine.
In those cases when colchicine did not have a therapeutic effect( as sometimes happens), the doctor prescribes hormonal drugs that suppress inflammation - glucocorticoids. This group of drugs includes such drugs as methylprednisolone and betamethasone. They are usually administered topically as injections into the joint area.
Using these or other means, doctors manage to defeat a gouty attack already within one and a half to two days from the beginning. But, as you know, treating an acute attack of gout is only part of the therapy.
Another interesting and useful video about this disease is the fragment of the program "Live Healthily" with Elena Malysheva:
Treatment of the disease outside of attacks
As this form of arthritis is a metabolic disease and arises from the increase in the amount of urate in the body,will be aimed at reducing the content of these substances in the body.
For this, during the interictal period, the doctor prescribes medications to the patient that reduce the formation of uric acid salts( eg, allopurinol) in the body, as well as drugs that increase the excretion of these substances from the body.
Diet for gout
In fact, it is difficult to name any other disease, in the treatment of which the right nutrition is so important.
therapeutic diet is an important element of
recovery Even if after a first attack of arthritis you received this disappointing diagnosis, then, following the right diet and taking medications, after a while you will be able to give up medicines only due to the fact that you will observe the rules of therapeutic nutrition. And it, unfortunately, is not so simple, considering what foods can not be eaten with this disease.
So, on the anti-gouty diet, you need to exclude red meat and its products, meat by-products( kidneys, liver, heart), fatty fish, legumes, sharp and salty cheeses, as well as alcoholic beverages( this concerns cognac,beer, champagne and sweet dessert wines).Learn more about what you can, and what you can not eat with this disease, you can read in the article Therapeutic diet for gout.
Despite the fact that gout is accompanied by a painful attack of arthritis, remember that this disease with timely access to a doctor is successfully treated, and not only medicamental, but also folk remedies.
Therefore, if you find symptoms of gout listed in this article, do not suffer pain, consult a doctor, and very soon mobility and health will return to your joints again!
Women's gout is the final verdict?
Foci of inflammation
Gout in all its glory
Scientists are perplexed: worldwide, especially in developed countries, there is such a trend - the disease is gaining strength, the number of cases increases every year. This is alarming and makes you think. Specialists-epidemiologists assume that the fault is the wrong way of life and, in particular, the nutrition of most people. It's no secret that very few people can and want to limit themselves to eating. This is where the dog is buried. However, sometimes the disease has a chronic form and is due to heredity.
With gout, one can be confused, often a disease in women, which has nothing to do with gout. This orthopedic disease, called in the common people "bone", and scientifically - hallucks valgus, associated with inflammation and deformity of the joint in the region of the big toe. In this case, the deposition of salts does not occur, since the nature of deformation is a large load on the feet.
If the kidneys do not have severe complications, then in some patients gout can easily go on for many years. Disability occurs only in severe cases:
- with gouty kidney and joint destruction,
- with developed atherosclerosis of cerebral and coronary vessels.
In general, jokes with gout are fraught with not only serious complications and painful attacks, but premature mortality. It depends on how well the cardiovascular and renal pathology is developed.
Gout on the fingers
Where lie the causes of the disease?
What doctors suspect now, has long been known to ancient healers, who said that gout is caused by incontinence, debauchery and heredity. With a high standard of living, there are many temptations that it is difficult for women of the fair sex to overcome. It turns out that food cravings can be very harmful. Meat, fish, eggs, confectionery, sour, pickled products, mushrooms are the cause of blood saturation with uric acid. This includes alcohol, which is a poison for the body.
Metabolic disorders occur due to self-poisoning. Since most often it takes years, while the toxins are being accumulated, the disease does not appear suddenly, but it is quite natural. The products of decay of uric acid cells are called purines. They are rich in all meat products.
One of the causes of gout is a violation of renal function( due to hypothermia or omission).Since the state of the kidneys is closely related to the condition of the joints of the lower extremities, in the case of imbalance, they are the first to suffer most often. The development of gout is called both an independent disease( primary) and appeared against the background of intoxications and blood diseases( secondary).Gout affects the finger, wrist, elbow and knee joints, but mostly its favorite place of residence - the thumb of the foot( metatarsophalangeal joint).
Gout on the leg
Most often, gout attacks in women are unpredictable and harsh, intensifying at night and delivering unbearable pain for several hours. It is very short-sighted to give up such serious signs and not be treated, because in this case the disease starts to progress and spread to other joints, kidneys and ureter. And besides, the attacks themselves become more frequent, acute and prolonged. Sometimes gout provokes stressful situations, viral infections and articular microcracks.
Urates are deposited in the kidneys and urinary tract, and if so, then urolithiasis can develop which will require special treatment. In addition, the scientists found that every second lady, who is sick with gout, is overweight. Also those who have superfluous diseases are susceptible to the disease: hypertension, obesity and diabetes mellitus. Is this a reason to think about the right way of life and your health in a timely manner?
Symptoms of the disease
This disease in women is not completely cured, is metabolic and is divided into 4 stages of development.
- At the initial stage, the woman does not feel any changes in the body, although the level of uric acid is already rising. The first swallow can fly in the form of preliminary symptoms, when the patient begins to complain of joint pain, discomfort, frequent urination, abdominal pain and insomnia.
- The second stage is already characterized by a sharp gouty attack, when joints, one or more, begin to swell quickly for several hours and cause severe pain. Chills, nausea, general weakness can accompany this inflammatory process. After a while, the pain subsides, the general condition is normalized and the patient feels completely healthy. Further attacks become rare, but the disease continues to do its job from within, gradually hitting other joints.
- At the third stage, everything is calm, there are no more seizures, it seems that everything is fine, but it's just a calm before the storm. Here, the level of uric acid is already high enough and it continues to accumulate in the tissues and joints of the body.
- At the last stage the process changes into a chronic form, in which gouty nodes( tophi) appear due to nodular formations of uric acid crystals in the tendons and joints. In this case, tenderness of the calcaneal tendon and mucous sacs in the elbow region is often observed. In this case, the woman's health is seriously threatened, because as a result of metabolic disturbances, the kidney is wrinkled.
A healthy lifestyle
is required. With prolonged observation of the development of gout, it is possible to note how the symptoms develop: first the joints become inflamed, then the tofus are formed, and then the internal organs are affected. It is noted that the articular syndrome manifests itself most vividly. The strength and duration of seizures take from 3 days to 1.5 months. The thumbs of the feet are most often affected. In extremely severe cases, the disease can affect even the spine.
Traditional medicine advises
Prevention has always been the most important remedy against any disease. Gout is no exception. It is necessary to observe the correct drinking regime, drinking 2-3 liters of clean water a day and give up products that can easily provoke gout. These are alcoholic beverages, coffee and tea, as well as meat, fish, salted and sour, sharp and smoked foods, eggs and chocolate. When the disease is on these products must be imposed a complete taboo.
Pain and gout are recommended for physiotherapy and balneotherapy. These include:
- mud and paraffin applications,
- hydrogen sulfide and radon baths.
In the arsenal of modern medicine there are many remedies that stop strong attacks of gout and normalize the amount of uric acid in the blood in patients.
The strongest drug for gouty arthritis are colchicine, indole, pyrazolone, as well as bone-steroids and smoking-depressant drugs. The main principle on which treatment is based is that throughout the whole life, one almost continuously maintains oneself with anti-gouty drugs, since after their withdrawal gout attacks return.
Surgical intervention is required only in the most extreme, severe and neglected cases, when urate deposits are large enough to be removed. The fact is that tofuses and fistulas do not resolve when using gouty therapy. In this case, they can become infected and immobilize the diseased joint. It happens that the destruction of cartilage leads to disability, and then the only way out is restorative surgery like arthroplasty.
Traditional methods of treating gout
To achieve the best possible result, an acute or chronic illness can be treated in combination with different procedures. Here it is "grandmother's recipes" and are just right!
Traditional methods of treating gout
- Coal not only stove stoves! Activated carbon will perfectly cope with such a simple task as the removal of pain from an inflamed joint. To do this, take 0.5 cups of ground coal, add a little water and 1 tablespoon.ground linseed. Then, with this paste, apply a painful joint overnight, wrapping it with polyethylene and tying it with a bandage. By morning the pain is gone.
- A simple method for severe pain in the feet. Before putting on a shoe, you need to attach a small piece of foil to the sore spot.
- Butter relieves pain. You need to take in equal amounts of butter and alcohol. Heat the oil until foam appears, then turn off the heat and add alcohol to the oil. Then burn it and as soon as it burns - the magic ointment is ready. Transfer it to a clean jar and put it in the refrigerator. Rub in a warm place, for example, near the fireplace, until the pain disappears.
- Universal healer. It turns out that iodine is treated not only by wounds. Nice foot baths with iodine before bed. In 3 liters of water, dissolve 9 drops of iodine and 3 tsp.soda. Sprains on the joints stop worrying, and then gradually disappear.
- In the event that there is no acute inflammation of the joints, you can apply a regular self-massage, gently stroking the area next to the inflamed joints, and then the joints themselves. Finish the procedure can be a gentle kneading of tissues and rubbing medicines.
Gout in Women - Causes and Methods of TreatmentCategory: Beauty and Health |19/09/2014 |0 CommentsThe disease of an inflammatory nature called gout, has come to us since ancient times. The strongest pain and puffiness of the big toe, which for several days deprives the person of mobility, was described by Hippocrates. However, in those days gout was considered a purely masculine disease. But modern doctors often diagnose this disease and in the fair sex. What causes the ailment and how is gout treated in women? It is necessary to understand everything.
Causes of the disease in women
Gout is a chronic disease in which the metabolism is disturbed in the body, in particular, because of the deposition of uric acid salts, the wrist, elbows or knee joints are affected in a person, but the joint of the big toe often becomes inflamed.
The prevalence of the disease in recent years is associated with malnutrition, namely the use of foods containing a large number of uric acid salts( meat products, tomatoes, offal, chocolate, mushrooms, smoked and spicy dishes).The likelihood of developing an ailment increases dramatically with alcohol abuse, especially with excessive consumption of beer. Perhaps this is the reason for the appearance of the disease in women.
Most often gout occurs in women during menopause. This is due to the use of drugs that reduce the severity of symptoms of menopause, which do not have the best effect on metabolism. The risk group includes also women with a hereditary predisposition to this disease, suffering from overweight, suffering from diabetes and hypertension.
Features of the disease
The insidiousness of gout is that the symptoms of the disease appear suddenly, more often in the night or morning hours. Symptoms of gout, and this swelling, redness of the joint, nausea, weakness and unbearable pain, accrue in for several hours, and it is simply impossible to touch the inflamed joint. However, starting suddenly, after about 2-3 days, the symptoms of the disease also disappear on their own. The person in this case simply forgets about this unpleasant episode and does not take any measures to prevent relapses that will necessarily appear again, and will appear more and more often, and the attacks themselves will become more prolonged.
If you do not fight gout, the seizures will eventually last from 1.5 to 3 months, and the inflamed joint will begin to deform and collapse. Moreover, gout can cause kidney failure and heart pathologies, and therefore lead to premature death.
How to treat gout
First of all, a patient with a gout attack is prescribed NSAIDs to stop the pain syndrome. These are such medicines as Diclofenac, Indomethacin, and now Meloxicam and Celecoxib. Less commonly, glucocorticoids are prescribed, such as colchicine to suppress the release of inflammatory mediators. In order to reduce the concentration of uric acid in the body, patients are advised to take the drugs Sulfinpyrazone or Probenecid.
It is known that the best remedy for any disease is its prevention. With gout in women, the most effective prevention is dietary nutrition. It is worth taking as a rule to drink 2.5 liters of clean water a day and at the same time give up foods that are rich in salts of uric acid. It is necessary to exclude from the diet fat meat( pork and beef, lamb and liver), seafood( shellfish, shrimp and fish), protein foods( all beans, soy and asparagus), and mushrooms. On the contrary, food should be diversified with dairy products, as well as various herbs. Remember, proper nutrition and rejection of bad habits, will be the key to the fact that gout will never bother you again. Be always healthy!
Gout for a disease in women |Women's advice
This is a disease that affects middle-aged and elderly people. It is characterized by the fact that in various tissues of the human body occurs the deposition of salts, which are called urates. These deposits occur in the form of uric acid. Signs of gout is an attack of acute arthritis, which develops for a person quite suddenly against a background of general health. However, few people notice that a couple of days before the exacerbation a person has unpleasant sensations in the affected joint, malaise, nervousness, irritability, insomnia and a slight increase in temperature. Most often the disease appears on the legs, but not just. There are certain predisposing factors for this:
- Increased food intake, which contains a large number of purines - beer, coffee, tea, meat by-products, chocolate, lentils.
- Increased disintegration of purine bases, which is especially often observed in the treatment of cancer tumors and in people suffering from autoimmune diseases.
- Renal failure, in which there is a violation of excretion of uric acid from the body together with urine.
- High body productivity of uric acid and simultaneous disruption of its excretion. This condition is especially characteristic of people suffering from alcoholism.
- Hereditary predisposition to accumulation of uric acid in organs and tissues.
The course of the disease in women
Among the female half of the population, this ailment is relatively rare. And if it happens, it is much easier. Representatives of the fair sex very rarely experience acute attacks of the disease, which are called acute gouty arthritis. The main manifestation of the disease here is chronic pain in the knee joint, however these pains are tolerant and never sharp and strong. In addition to the knee, the ankle joint may suffer. That's why I guess that the patient has gout, not arthrosis.it is rather difficult - for this purpose it is necessary to conduct a whole series of analyzes and to get on reception to the skilled expert.
Symptoms of gout in women include swelling of the joint and its inflammation, which is never the case with arthrosis. In addition, it is worth paying attention to age. Gout on the legs is not manifested in women who have not had a climacteric period. After all, women's hormones, which are fully developed before menopause, protect her body very well from this disease. And with the onset of menopause, the release of hormones decreases, and here the disease begins to manifest itself.
The course of the disease in men
Symptoms of the disease in men are much more pronounced, and confusing them with another disease is quite difficult. As a rule, seizures at the very beginning of the disease are not long and quickly pass. This attack begins suddenly and more often at night. In most cases, the inflammation begins with the big toe, with one or both joints being inflamed at the same time. The remaining joints rarely inflame.
A gout attack is a very strong pain sensation, in which a person literally "climbs on the walls".Joint, gout that a disease in women , which was stricken, first swells, then blushes, and the skin above the site of inflammation has a crimson hue. In addition, the joint becomes hot to the touch.this state lasts 3 to 4 days. In this case, any touch to the affected area brings very severe pain. And then the attack goes by itself and the person again feels perfectly healthy. After a while the attack of pains in a joint again repeats. At the beginning of the disease, the intervals between them are about a month, but in time they can be reduced to a week, and even up to several days. And the attack itself becomes more and more prolonged.
An experienced physician on specific signs of a man can immediately put a correct diagnosis. In doing so, he does not even need to see the results of human analyzes & # 8212;The diagnosis is based on examination and on the complaints of the person himself. At the very end of the disease, such attacks become permanent, and there is no interval between them. That is, a person constantly feels pain in the knee.which makes his life unbearable. As a result, the cartilage of the joint is destroyed, and in the bones that are near the joint, cavities appear that are filled with crystals of uric acid. Such cavities are called "piercers".
Very often such a disease can be detected in people who are obese. That's why every person, especially a male representative, is simply obliged to watch what he eats, how much, and whether he does not have excess weight. Proper nutrition is the guarantee that a man's gout will never manifest.
Symptoms on the legs are not only severe pain or the identification of "piercers" in bones that are not far from the affected joint. This is also a decline in the quality of human life. During the attacks of the disease, the patient simply can not move, and in the affected joints, secondary osteoarthritis is often detected during the study. Moving to a person with such problems becomes more difficult and more difficult every year. And if he does not stop eating harmful foods - those that contain purines, then soon he will not be able to move at all and go out into the street.
From the first signs of the disease on his feet until the moment when the disease enters its last stage, it usually takes 5-6 years. After this time, the person complains about constant pain in his legs, it's harder and harder for him to move around. Affected joints remain constantly swollen, begin to deform, and inside them very often accumulates intra-articular effusion, which further exacerbates the situation. Symptoms of the disease on the legs in women do not give such symptoms. It is fashionable to say that the fair sex was very fortunate in that this disease bypassed the disease, and the manifestation of the disease itself is not expressed so much.
Treatment during attacks
The first thing a person thinks about at the time of an acute attack of the disease is & # 8212;how to relieve pain. The first thing that needs to be done in this case is to provide complete rest to the affected leg. At the same time to hide a leg or put a sock on it is not worth it - it also causes a severe attack of pain. If the touch brings a tolerable pain, then on the affected place it is necessary to put a bag of ice. This brings relief to many.
When a fit of the disease should be sure to drink as much liquid as possible - up to 3 liters a day. It can be water, mineral water, infusions of herbs( yarrow, dog rose, mint).Pain relief with gout anesthetics does not have any effect. Neither aspirin, nor baralgin, nor tempalgin here will help. Many people who suffer from the disease begin to engage in self-medication, for example, they lower their legs into herbal decoctions( which causes pain even more), or they take a particular folk remedy that they heard from a neighbor or were subtracted from a magazine. Such treatment is unacceptable. But it is only necessary to establish the right diet and with bouts of ailment it will be possible to say goodbye for a long time.
Some sauna lovers like to visit her during an exacerbation of a disease. But in this case there can be no question of going to the bath. And this is worth remembering. However, after the attack is over, the bathhouse will be visited, but it is not recommended to stay in it for too long.
Many folk healers say how to get rid of gout. But in fact, this disease can not be cured, it is chronic, which means it is characterized by seizures and periods when a person feels just fine. The disease itself, or rather its signs, will disappear only when a person realizes that he needs to get rid of excess weight and establish proper nutrition, while almost completely need to give up meat and fat, gout that the disease in women , andin your diet include as much vegetables and fermented milk products.
Symptoms of gout: what is this disease, how to recognize and cure it
Gout & # 8212;it is a disease in which there is an accumulation in the body of excess salts of uric acid( urate).This disease manifests itself in that from time to time the patient has acute attacks of gouty arthritis. Who has the disease most often?
gout attack: salt crystals injure tissues
Gout & # 8212;predominantly male disease: in the stronger sex it is more common than in women. On average, for one ill gout woman accounts for between 3 and 7 men, who are affected by this ailment.
Mostly mature and older people are ill: most often gout manifests in men after the age of 40-45 years, and in women & # 8212;after 55-60 years. This is due to the fact that female sex hormones( estrogens) have a positive effect on the exchange of uric acid in the body. When the climacterium content of estrogen decreases dramatically, then the likelihood of becoming ill with gout is significantly higher.
In addition, it is considered that there is a hereditary predisposition to arthritic arthritis: if someone from your relatives had a gout, chances are that it will arise from you( especially if you are a man) is much higher, and you are at risk for developing this disease.
In addition, factors such as overweight, as well as alcohol abuse, also increase the risk of developing this disease.
In general, in the world, according to statistics, 2-3% of the population suffers from gouty arthritis( data for the USA), but for men after 40-50 years this indicator grows to 5-6%.In Russia, the incidence of gout is about 0.1-0.2%.
Why does it occur
how does the gout originate( schema)
Because gouty arthritis & # 8212;it is a metabolic disease, gout that a disease in women , then it occurs in those people who have either increased the intake of substances, gout that the disease in women containing purines, or their excretion is difficult because ofsome diseases.
Which products contain many purines? It is, first of all, meat and by-products( not for nothing, gout is also called a disease of meat-eaters & # 187;), as well as legumes, tea, cocoa, some fish, and especially & # 8212;Alcohol, including beer and red wine.
People who have a lot of such products in their diet, gout that the disease in women , the risk of getting gouty arthritis is high enough.
And when the removal of purines from the body can be difficult? Most often & # 8212;because of concomitant kidney diseases, as a result of which renal filtration is reduced, which means & # 8212;the body retains more uric acid salts than necessary, and it begins to be deposited in various tissues & # 8212;as in the joint region, gout that the disease in women , and in the renal tubules themselves.
In addition, an additional risk factor for the disease is arterial hypertension, as well as taking certain serious medicines for serious illnesses.
Thigh inflammation & # 8212;the main sign of gout
The main and main sign of gout & # 8212;this is an acute attack of gouty arthritis, which is also called a gout attack. Often such an attack is observed after a plentiful meal with alcohol. Suddenly, more often in the evening or at night, acute pains appear in one of the joints.
Most often, with a gouty attack, for some reason, it affects the big toe, but it can be another joint & # 8212;for example knee or elbow. The joint begins to ache strongly & # 8212;so that it can even be painful to touch the affected area( not without reason & # 171; gout & # 187; literally translated from Ancient Greek as & # 17; foot trap & # 187;).The joint swells, the skin around it due to swelling acquires a purple-red hue, and the skin temperature in this area rises.
This condition( attack), if left untreated, can last up to several days and longer. But usually the patient and his relatives quickly turn to doctors who, with the help of medicines for gout.more or less successfully relieve an attack.
The heavier the course of gout, the more likely these seizures may occur. Conversely, if all the conditions are met to ensure that uric acid and its products do not accumulate in the body, then attacks of the disease can be avoided altogether.
Tofusi with gout
tofuys( photo) with gout
If a gout attack with joint inflammation and pains in it can be considered acute manifestations of this disease, tofusi & # 8212;this is a sign of a chronic disease. Since gout accumulates an excess amount of uric acid in the body, it is clear that these salts should be deposited somewhere. They are postponed & # 8212;in the field of various joints( at some point causing a gouty attack), in the skin in the region of elbows, heels, and also in the area of the cartilage of the auricles.
Collecting in these places, salt crystals gradually turn into small nodules of white color, which can be felt in the area of small joints on the hands and feet. These nodules are called tofus.
No special damage to the body by tofus directly applied & # 8212;only signal to the person himself, as well as to his doctor about the fact that in the body an excess of salts of uric acid & # 8212;so, it is necessary to pay attention to this and take the necessary measures. But we will talk about this in the treatment and prevention of gout.
Treatment of this disease can be conditionally divided into two tasks:
- cupping( interruption) of an acute attack;
- normalization of metabolism in the body, that is, treatment and prevention of the disease outside seizures.
Treatment of an acute attack of gout( acute gouty arthritis)
the first attack of gouty arthritis is best treated in a hospital
Since most often the first manifestation of gout is usually a developed gouty attack, its treatment is usually performed in a hospital # 8212;in the rheumatological department of the hospital.
This is necessary not so much to cure this attack, how many in order to conduct a full-fledged examination and make the correct diagnosis. After acute arthritis of the joint can be with a variety of diseases & # 8212;infectious or reactive arthritis.as well as with other ailments.
After the diagnosis is made, there is usually no need for repeated hospitalizations.
So, what medicines are used by doctors in order to relieve a gouty attack?
NSAIDs, including all known diclofenac, ibuprofen, naproxen and other drugs. These drugs are good at both pain relief and effective reduction of inflammation in the affected joint. They are prescribed in certain dosages according to the scheme, and anti-inflammatory agents & # 8212;an important component of the complex treatment of gout.
Please note: Non-steroidal anti-inflammatory drugs do not treat this disease properly: they are needed to reduce the symptoms of its symptoms & # 8212;pain and inflammation in the joints. Do not attempt to treat the disease yourself with NSAIDs, consult a doctor!
treatment of this disease should be prescribed only by the physician
Colchicine & # 8212;this medicine, which can reduce inflammation in acute gouty attacks and restore the function of the patient's joint. This drug is administered on a special schedule and is taken every few hours for 1-1.5 days & # 8212;until the severity of the attack does not diminish or when it becomes clear that you need to use another medicine.
In cases where colchicine did not have a therapeutic effect( as sometimes happens), the doctor prescribes hormonal medications that suppress inflammation & # 8212;glucocorticoids. This group of drugs includes such drugs as methylprednisolone and betamethasone. They are usually administered topically as injections into the joint area.
Using these or other medications, doctors manage to defeat a gouty arthritis already within one and a half & # 8212;two days from its beginning. But, as you understand, the treatment of acute attack & # 8212;this is only part of the therapy.
Treatment of the disease outside seizures
Because this form of arthritis is a metabolic disease and arises from the increase in the amount of urate in the body, gout that the disease in women , then its treatment will be aimed at reducing the content of these substances in the body. To do this, during the interictal period, the doctor prescribes medications to the patient, which reduce the formation of uric acid salts( for example, allopurinol) in the body, as well as drugs that increase the excretion of these substances from the body.
Diet for gout
therapeutic diet & # 8212;an important element of recovery
In fact, it is difficult to name any other disease, in the treatment of which is so important the proper nutrition. Even if you after the first attack of arthritis received this disappointing diagnosis, then, following a proper diet and taking medications, after a while you will be able to give up your medicines only due to the fact that you will observe the rules of therapeutic nutrition. And it, unfortunately, is not so simple, considering what foods can not be eaten with this disease.
Despite the fact that gout is accompanied by a painful attack of arthritis, remember that this disease with timely access to a doctor is successfully treated, and not only medicamental, but also folk remedies. Therefore, if you find symptoms listed in this article, do not suffer pain, consult a doctor, and very soon mobility and health will return to your joints again!
Symptoms of gout and its variants
Gout is an insidious disease, the development of which deprives the body of mobility. The main manifestation is acute pain in the joints or the appearance of a bulging bone especially on the big toe. Knowing the symptoms of gout .you can overcome it in time by returning to normal life.
Gout development factors
Acute gouty form of arthritis begins with a deterioration in the functionality of one joint. In most cases, gout that the disease in women , first "under the impact" are toes. symptoms of gout on the legs of appear not only externally, but also internally. The emergence of this phenomenon is preceded by certain factors:
Gout: photos, symptoms and treatment of gout in men and women
Gout is a systemic disease that affects the entire body, a disease in which crystals are deposited in various tissues of the uric acid salt - monoaurate sodium. In this case( in the presence of provoking factors) in patients with elevated levels of uric acid in the blood serum inflammation of the joints develops.
Who is the most affected with gout?
It is believed that the classic portrait of a patient with gout is a large middle-aged man, wealthy enough to regularly eat good red wine and young meat. I remember English kings and dukes, our compatriots - the emperors Peter I and Anna Ioannovna. But research convincingly proves: the incidence of gout is determined not only by the diet and well-being of patients. It is estimated that at least 3% of the adult population of the world suffer from this ailment. What is true, then the truth: men suffer from gout at times more often: one woman receiving treatment for gout, there are 7 men with this disease. The disease begins in men much earlier: at the 40-year limit, while the peak incidence of gout among women falls to the age of over 60 years. It is believed that this is due to the natural level of hormones that promote the excretion of uric acid from the body, and protect the female body from a variety of different troubles.
The main cause of gout
It has long been determined that the main cause of gout is hyperuricemia - an increase in the level of uric acid in the serum. This happens if:The
- patient has an increased body weight. As is known, the causes of obesity( leading to an increase in the level of uric acid) - is a change in the composition of food and nutrition culture, with the ubiquitous "dominance" of simple carbohydrates, sweet drinks, the predominance of sedentary lifestyles;
- concomitant diagnosis - hypertension;
- , the patient suffers from a disease accompanied by hyperuricemia( eg, psoriasis);
- the patient often takes alcohol;
- has a genetic predisposition to increased production of uric acid or a reduced rate of its excretion( such conditions are rare and usually occur at a young age - up to 30 years);
- , the patient "abuses" products containing a large number of compounds and precursors of salts of uric acid. Traditionally, they include, besides "red" meat( beef, veal, lamb, rabbit), also by-products( liver, kidneys, heart, tongue) and broths from them. From fish products, tuna, anchovies, trout, squid, mussels and herring fall into the "risk zone", turkey and goose from poultry. Dangerous in terms of development of gout, all kinds of smoked meat, sausages, sausage, ham, eggs, especially fried. Not at all harmless are all legumes, whole grains, mushrooms, cauliflower, spinach, asparagus, coffee, chocolate, and even, according to some authors, ice cream and pastries. Old doctors called gout - "disease of kings", "disease of abundance";
- in connection with concomitant diseases prescribed medications that have the side effect of increasing the concentration of uric acid. Determine whether the drug increases the level of uric acid, it is quite simple: just look at the instructions for the use of the drug. More often than others, hyperuricemia is caused by anticancer drugs, diuretics( diuretics) and beta-blockers( a group of drugs used to treat hypertension).If the patient receives treatment from an oncologist, then drugs aimed at reducing uric acid are usually prescribed "automatically", and the development of gout in this group of patients can be avoided. With the rest of the drugs, things are much more complicated. One of the most "popular" among domestic therapists diuretics is furosemide. This drug acts quickly and powerfully, producing a diuretic effect, in connection with which its appointment for a long period is not recommended. Nevertheless, it is not uncommon for patients to take furosemide for several months or even years, as prescribed by the therapist or, more often, at their own will. Against the backdrop of this "treatment" gout develops with characteristic signs and possible rather serious complications.
A little more about uric acid
If the concentration of this substance in the blood exceeds the permissible limits( more than 320 μmol / l), a complex chemical reaction is triggered, and crystals start to form from the acid, in the people they are also called "sand".It is these crystals, deposited in the joints, skin cells and other organs, and cause gout - "disease of kings".
What happens in the joint?
Pain in the joints arises not so much from the "mechanical trauma" of the crystals of the surrounding tissues as from the penetration into the joint and the production of a large number of "inflammatory substances" directly in it. That is, the cause of pain in gouty attacks is not mechanical( acute crystals), but chemical( irritants).Attracted by "inflammatory substances"( they are called mediators of inflammation), immune cells penetrate into the joint, which, on the one hand, produce even more mediators; on the other, they begin to destroy their own joint structures, accepting them for "attacking foreign agents."This is a brief description of the development of an autoimmune reaction in gouty arthritis.
Classification of gout
Currently, it is common to distinguish between acute gouty arthritis, the interictal period and chronic gout.
1. Acute gouty arthritis
This is the main clinical, that is visible to the eye, the manifestation of gout. It is believed that acute gouty arthritis, or gouty - one of the most painful conditions in rheumatology. Symptoms of a gouty attack are so vivid that they were at one time the inspirers of artists to create masterpieces that survived the centuries. Pain in gouty attacks occurs at night or in the early hours, and is so strong that the patient is not able not only to move his foot, but even a slight touch of the sheet causes unbearable anguish. Without treatment, acute gouty arthritis lasts no more than 10 days, but in almost 100% of cases, patients still seek medical help. Most often, patients get to see surgeons complaining of pain similar to drilling, raspryaniyu, burning in the first( large) toe, and the classic "folk" painkillers like analgin to the patient does not help. Trying to take a warm foot bath only intensifies the suffering.
In search of an effective painkiller, both patients and surgeons are often able to make a lot of mistakes, beginning with the appointment of inconceivable combinations of analgesics in huge doses, ending with the use of antibiotics and local( cutaneous) agents( gels, ointments) - ineffective, but costly. True gout in everyday practice is not so common, but many doctors have the idea that allopurinol is treated with this ailment( we will talk about this a little later).But the fact that it is absolutely impossible to prescribe allopurinol in the acute period of the disease is usually forgotten. Moreover, allopurinol is able to aggravate the course of a gouty attack, and if the patient has already taken this drug at the time of exacerbation, it should be abolished as soon as possible for the entire "painful" period.
Another common mistake in treating an acute gouty attack is the patient's refusal to eat. As is known, most often the "gouty attack" is provoked precisely by the error in the diet. In search of relief, the patient is ready to switch to "bread and water", or even starve, just to get rid of the pain. This is fundamentally wrong, and can adversely affect both the general condition of the patient, and the work of the kidneys, the heart.
Wishing to save the patient from suffering as soon as possible, physicians often prescribe physiotherapy( UHF, magnetotherapy, thermal procedures), not taking into account the almost total uselessness, and sometimes the harm of such tactics during an attack.
2. Interictal period of the disease
Gout leads to an attack on the body gradually. It is a mistake to believe that this problem is limited to joints. Urat crystals - the smallest needles - are deposited in many organs, primarily in the kidneys, forming stones, disrupting the work of these vital organs. The patient may be disturbed by renal colic, manifested by pain in the lower back, abdominal pain, vomiting, pain and rezi when urinating. Sometimes the severity of the pain is such that it requires hospitalization, or surgery to remove the stones. With insufficient treatment and accumulation of uric acid and its salts, the disease goes so far that the heart is affected, with the development of heart failure.
3. Chronic tofus gout
Tofuses are soft formations, tubercles, "bumps" filled with urate crystals. Most often, the tofus are located on the back( external) surface of the fingers, the auricle, elbows, knees. But tophi can be hidden, that is, located inside the body: in the region of the joints, for example. Such "depots" of crystals can not be seen without additional methods of examination - radiography and ultrasound.
Diagnosis of gout
The diagnosis of gout is based on three pillars: examining the patient and talking to him, laboratory and instrumental methods of research.
A classic picture of a gouty attack - painful at feeling, red sometimes to blue, hot, swollen large( first) toe. The patient may notice an increase in body temperature, chills. Almost half the time, the first gouty attack becomes the last, but in the remaining 50% of cases the course of the disease becomes chronic. With such a long process and repeated attacks, there are problems from other joints: the thumb of the second leg, the ankle, knee joints, the joints of the brushes. The polyarthritis( inflammation of many joints) develops.
It is interesting that in recent years there has been an increasing departure from this classic picture, so juicy described in the literature. Increasingly, gout occurs with an initially large number of affected joints. In addition, over the past 20 years, many patients have gout from the first days of a protracted nature, exacerbation of the disease again and again, and the pain is still intense, regardless of the number of seizures.
The blood test is general clinical ( mainly an increase in the erythrocyte sedimentation rate( ESR) - a sign of inflammation and an increase in the level of leukocytes) and biochemical( an increase in uric acid is detected, and signs of concomitant diseases - diabetes, liver diseases,renal failure and others).It should be remembered that the concentration of uric acid in the blood serum, which is determined by biochemical analysis, at the time of an attack can be normal!
Study of the joint( synovial) fluid .This procedure can be quite unpleasant, but it is as a result of articular puncture( puncture) that the doctor will be able to obtain with sufficient accuracy the answer to the question: "What exactly happened?" The joint puncture considerably alleviates the patient's condition, because, firstly, from the jointremoves excess fluid, causing a sense of pressure from within and containing a large number of "inflammatory substances."Secondly, in the articular cavity, in the absence of contraindications, a medicinal preparation that rapidly removes signs of inflammation is introduced. The resulting liquid is collected in a test tube and sent to a laboratory for analysis and microscopy. If crystals of monoaurate of sodium of characteristic sizes and shapes are found, the diagnosis can be considered "in the pocket".
Analysis of the contents of the tofus .If there are soft formations accessible for inspection and taking material( like bubbles or warts), usually a rheumatologist tries to get their contents for analysis. When viewed with the naked eye, what stands out from tofus, resembles cottage cheese remotely, and with microscopy the same crystals are found as in the synovial fluid.
Radiography .The radiologist can answer the following questions: are we dealing with a gout? If so, how far did the disease go? Is there another pathology of the joints, against which gout was played?
Ultrasound examination of joints .In the case of gout, this is a much less informative way than radiography. Currently, new methods are being developed that could help determine the presence of deposits of uric acid crystals in the joints. In the meantime, the ultrasound doctor can only determine whether arthritis really does take place, how much fluid is in the joint, and whether we can take it for analysis, whether there are traumatic injuries of soft joint tissues that could "disguise" under a gouty attack.
What diseases can I take for gout?
What other diseases occur according to the scenario similar to gout? Especially this information will be useful to those who are accustomed to making a diagnosis, using directories or information from the Internet.
- septic( purulent) arthritis .This condition can be preceded by any cutaneous or "general" infection, trauma or microtrauma of soft tissues around the joint. Almost always septic arthritis is accompanied by an increase in body temperature. The diagnosis is refined with the help of the same articular puncture, and already by the appearance of the received fluid the doctor will make a preliminary conclusion about the diagnosis.
- pyrophosphate arthropathy ( it will be described below);
- reactive arthritis .This disease is a response to the presence of any pathogens in the body, and is treated, respectively, together - by a rheumatologist and infectious disease specialist.
- rheumatoid arthritis is a chronic autoimmune disease of an unknown nature, affecting mainly women, unlike gout;
- osteoarthrosis ( often combined with gout);
- psoriatic arthritis ( inflammation of the joints in combination with skin disease - psoriasis).
Treatment of gout
It is accepted to share non-drug( non-drug) and drug treatment.
Non-pharmacological treatment includes dietotherapy, the use of orthopedic drugs and joint relief, as well as lifestyle adjustments. Not every patient, accustomed to not limiting himself in nutrition, passive leisure, or traveling by private transport, is ready to change habits for his own health. And, nevertheless, it is extremely important to adjust the patient to the implementation of recommendations, which, in fact, are half the success.
Treatment of gout has two main areas: reducing pain during the gout attack and reducing the risk or completely preventing new attacks by reducing the deposition of urate salts. To achieve this goal, anti-inflammatory and anti-hyperuricemic( that is, directed against increasing the concentration of uric acid in the blood) are used.
- Nonsteroidal anti-inflammatory drugs
The undoubted advantages of this group of drugs are that they start acting quickly, and exactly where it is needed - in the inflamed joint. It is very important to remember that increasing the dose does not necessarily lead to a greater effect. The anti-inflammatory effect will remain the same, but the harm from such "tactics" will be much greater, because with the increase in the dose the probability of development and the severity of side effects increase. The most effective and safe in this group, according to international studies, is etorikoksib, he is also arkoksia.
Another plus of non-steroidal anti-inflammatory drugs is the ability to penetrate the central nervous system. What is it for? The fact is that if a person experiences pain in remote areas of the body, then the signal about this immediately enters the brain and can enhance the subjective sensation of pain, and, therefore, multiply the sufferings of the patient. Further, the "cascade" reacts to pain: heart palpitations, vasoconstriction, release of stress hormones, elevation of blood pressure. .. The use of non-steroid medications helps to reduce or prevent these effects.
This drug is currently rarely used, although its effectiveness in gout is unquestionable. In most patients, it causes stool disorder and nausea, a sense of metallic taste in the mouth. Nevertheless, his appointment is resorted to, if for any reason the reception of non-steroidal anti-inflammatory drugs becomes impossible. It is important that severe damage to the kidneys, heart, liver and mucous membrane of the gastrointestinal tract - strict contraindications to the appointment of colchicine.
The purpose of this group of drugs is a difficult and responsible decision. Preparations of steroid hormones, or steroids( prednisolone, metipred) are prescribed in cases when non-steroidal anti-inflammatory drugs do not help, and colchicine is either ineffective or unavailable. In the treatment of steroids, such careful monitoring of the patient's condition is required, that the doctor often thinks ten times what will assign these effective, but not very indifferent to the body means. Among the side effects( they are also called undesirable), the effects of such therapy are called increased blood pressure, increased blood glucose, a tendency to bleed, a risk of damage to the small vessels of the eye, ulcers of the gastrointestinal tract. .. and this is not a complete list. Recall that gout more often affects patients who are obese, who initially enter the risk group for many of the conditions listed above, multiply this by the side effects of steroids and get a pretty sad, in terms of prognosis, picture.
- Decreased uric acid level
For this purpose, well-known allopurinol is used. Sometimes patients who "put" themselves a diagnosis with the help of neighbors or the Internet, independently start taking this drug. It should be noted that the dosage is selected individually, small doses are often ineffective, whereas the patient does not prescribe a large dose. .. This is why allopurinol treatment should be performed under medical supervision. So, allopurinol is prescribed:
- with frequent attacks( at least 1 time in 3 months);
- with an increase in the level of uric acid and concomitant damage to the joints;
- for serious abnormalities in kidney function;
- for kidney stones;
- for the deposition of uric acid crystals in soft tissues;
- in the treatment of antitumor drugs.
Diet for gout
Products that promote gout are already mentioned. What can you eat and drink to a patient with a gout or high uric acid in the interictal period?
From the first dishes you can recommend vegetarian soups, such as borsch or vegetable or potato. Meat, as already mentioned, is strictly limited - it's a chicken or a duck. Permissible "lean" varieties of fish( cod, pollock), not more than 3 times a week, in a moderate amount( maximum 200 g per reception).Whole milk is not recommended, you should give preference to lactic acid foods( kefir, cottage cheese, fermented baked milk, young cheeses).As a side dish, boldly choose any cereal or pasta, bread is not limited( within reason, remember the danger of excess weight!).
Vegetables and fruits, except raspberries, spinach and cauliflower, are allowed all, preferably in boiled or raw form, fried - not welcome. It is allowed to take in food any nuts and dried fruits, from sweets you can treat yourself to honey, molasses, pastille, nuts. It is useful to add enough olive oil to food.
From beverages are allowed light green tea, juices, fruit drinks, fruit compotes. Ideally, such a diet should be followed not only during an attack of gout, but also throughout the illness, while there is an increase in the level of uric acid in the blood.
Lifestyle of the patient with gout
After the pain is eliminated, the doctor must ensure that the level of uric acid remains safe for the patient, and the dosage of allopurinol is matched correctly. For this purpose, the level of uric acid is regularly determined using a biochemical blood test. At the beginning of treatment it is necessary to do this every 2-4 weeks, then every 6 months. If the optimal dose of medication is chosen, the patient follows a diet, returns to physical exercises, does not face gout attacks, does not need to take painkillers and anti-inflammatories, the dose of allopurinol can be slowly reduced under the supervision of a doctor. Practice shows that it is possible to completely abolish it quite rarely. Unfortunately, in the overwhelming majority of cases, patients who have abolished allopurinol are forced to return to it after a second gouty attack.
Almost all patients with gout survive to advanced years, suffering more from concomitant diseases than from joint pain. But it is also known that almost half develop nephrolithiasis( kidney stones), and kidney failure.
As already mentioned, gout refers to a group of diseases caused by impaired calcium metabolism in the body. The same group includes the disease associated with deposits of calcium pyrophosphate salts, or pyrophosphate arthropathy. These two diseases are so similar that they are treated as one large section - crystalline arthropathies.
This disease is equally common in women and men of advanced age, and among patients older than 85 years, according to research, half have this pathology. The disease occurs under the guise of osteoarthritis, gout or rheumatoid arthritis.
Usually the development of pyrophosphate arthropathy is accompanied or preceded by a chronic disease( eg, diabetes, thyroid disease) or the patient has ever suffered a joint injury.
When an elderly patient appeals with pain complaints more often in large joints( most often knee joints), the doctor will first prescribe radiography. If a "double line" of the joint space is found on the X-ray, the so-called phenomenon of chondrocalcinosis. In addition, the proof of the diagnosis of pyrophosphate arthropathy is the detection of special crystals when examining the joint fluid under a microscope. If the joint is inflamed, then this fluid, as in the case of gout, is obtained by puncturing the joint with a syringe. Further, it is only the laboratory. If the articular fluid for analysis can not be obtained, this can significantly complicate the diagnosis.
Treat or not treat?
Pyrophosphate arthropathy detected by accident( for example, during radiography) is not treated if there are no symptoms of inflammation of the joints. If there is arthritis( ie, swelling, redness, changes in skin temperature over the joint), and all other reasons for the appearance of these signs are excluded, excess fluid from the joint is removed with a syringe, then steroids are injected into the joint and cold applications( bandages) are applied. Further, course treatment with non-steroidal anti-inflammatory drugs is prescribed. Short courses of steroid hormones or colchicine are rarely prescribed. And of course, the main role is played by the treatment of concomitant diseases, which caused the deposition of crystals in the joints. Important also non-medicinal methods, such as physiotherapy exercises, physiotherapy, more often with the use of cold( in the absence of contraindications), wearing orthosis and others.