Effective assistive treatment for gout - physiotherapy
In modern medicine, physiotherapy with gout is considered one of the most used ancillary ways to combat the disease. A greater effect can be achieved by combining this therapy with traditional methods of treatment, such as the use of medicines, diet compliance, as well as allowable physical activity.
What is the disease in general and what are the symptoms of gout? In what ways can the symptoms be relieved and what kind of complex treatment should be followed?
Concept and basic symptoms of the disease
Gout is one of the oldest diseases that are known in medicine. The causes of such an illness include the failure of the purine exchange process, which as a result provokes an increase in the amount of uric acid that is deposited on the tissues of the musculoskeletal system and on the surface of the internal organs.
Exceeding the permissible level of uric acid in the human body leads to insufficient cleavage and release of the purine bases by the kidneys. The residues begin to crystallize and concentrate in the kidneys, the joints of the legs and hands, soft tissues, thus provoking the development of arthritis, the appearance of tophi in the soft tissues, as well as the possible damage to the kidneys and the formation of stones in them.
Gout is characterized by the following main symptoms:
- slight reddening of the skin;
- inflammation of one or more joints;
- increase in the temperature of the diseased area;
- deformation and joint destruction.
The main manifestation of gout is the acute attack, which is accompanied by an inflammatory process in the joint. Most often suffer joints on the legs - thumbs, knees, ankle. As a rule, the attack begins at night, characterized by an increase in pain during 3 hours. Sometimes, swelling of the affected joint and visible reddening of the skin can occur. By the morning the pain ceases to bother, but by the evening again comes back.
In case of an attack, a small fever, a chill with increased sweating, may occur. Such symptoms persist for 2-3 days, although the duration of the attack is about 7 days. A second attack occurs about 3 months later, but can lead to inflammation of other joints, leading to their partial destruction.
Thus, ignoring the disease is undesirable, this is fraught with adverse health consequences. With gout recommended treatment and methods of alleviating the symptoms, as well as effective prevention, it is considered physiotherapy and proper nutrition.
In sanatoriums, the concept of physiotherapy includes a number of procedures aimed at improving the patient's condition. Using mineral water, performing moderate physical activity and using therapeutic massage, you can quickly feel an improvement in health. Spa treatment is not only pleasant, but also very useful procedures.
However, not every patient can afford to pay such ancillary treatment. Such people will be useful to get acquainted with what physical exercises can be done at home and how self-massage is performed to alleviate the symptoms.
With gout, you can at home simply massage the areas nearby to the aching joint, gradually proceeding to massage the joint itself. Such procedures for gout are highly not recommended during acute attacks. Only after the pain subsides, it is possible to knead the skin around the affected joint, slowly turning to gymnastics and rubbing.
Physical loads are allowed only during the inter-attack period. In the chronic form of the disease, moderate pain in the joints is not a contraindication to the conduct of gymnastics, because the state of rest provokes an attack of pain.
It is possible to carry out both passive and active movements of patients with joints at the highest possible speed, accompanied by dynamic breathing exercises. Gradually, it is necessary to include physical exercises with the use of various objects and using a gymnastic wall. Apart from gymnastics, it is welcomed in the treatment of gout and dosed walking.
If therapeutic physical exercises are combined with massage and thermal procedures, then it is better to exercise to the exercises after their completion.
Gout - rheumatic pathology caused by the deposition of crystals of uric acid salts - urates in the joints, then in the kidneys. The gout clinic is characterized by recurrent and progressive attacks of arthritis with intense pains and the formation of tofusi - gouty nodules, leading to deformity of the joints. In the future, the kidneys are affected, urolithiasis and kidney failure may develop. For the diagnosis of gout, synovial fluid is studied for the presence of urates, X-ray examination of the affected joints. Treatment of gout is aimed at stopping inflammation( NSAIDs, glucocorticoids), reducing the level of uric acid in the blood, normalizing nutrition.
At the heart of the pathogenesis of gout are metabolic disorders caused by a violation of the regulation of purine metabolism in the body and leading to the accumulation of uric acid and its derivatives - acid urate salts. Increased concentration of uric acid( hyperuricemia) in blood plasma and urate deposition is a consequence of their increased synthesis and decrease in urinary excretion. Urine microcrystals accumulate in the articular cavities with the development of gouty inflammation, as well as in the kidneys, causing nephropathy.
Gout usually affects patients after 40 years, while in men it is detected 20 times more often than in women.
Classification of gout
In the gout clinic, renal, metabolic and mixed forms are distinguished. Renal form of gout is characterized by a decrease in the excretion of uric acid, metabolic - the excess of its formation;a mixed form combines moderate disorders of synthesis and removal of uric acid from the body.
Depending on the reasons leading to the development of the disease, gout may be primary or secondary. Primary gout is often due to genetic defects and hypofunction of enzymes involved in the exchange of purines and excretion of urinary salts. Gout development factors include excessive and monotonous eating patterns, increased consumption of meat and alcohol, and a low-activity lifestyle. Secondary gout is a consequence of other diseases - renal pathology with violation of their functions, blood diseases( leukemia, lymphoma, polycythemia), psoriasis, drug therapy with cytostatics, saluretic drugs and other drugs.
The clinical classification distinguishes seven forms of gout: a typical( classic) attack of acute gouty arthritis, polyarthritis of the infectious-allergic type, subacute, rheumatoid-like, pseudo-reflagious, periarthritic and malosymptomatic variants.
Symptoms of gout
In the gout clinic, there are 3 phases: premorbid, intermittent and chronic.
The premorbid phase is characterized by asymptomatic uricemia and is not yet a gout. At the laboratory level, hyperuricemia is detected in 8-14% of adults. The intermittent phase of gout is characterized by episodes of attacks of acute arthritis, alternating with asymptomatic periods. To manifestations of chronic gout form the formation of gouty nodules( tofusov), chronic course of gouty arthritis, extraarticular manifestations in the form of kidney damage( in 50-70% of clinical cases).
A classic attack of acute gouty arthritis develops in 50-80% of patients. Typically a sudden start, more often at night. The primary attack of gout is often provoked by alcohol, fatty foods, trauma, hypothermia. The attack of gout is characterized by severe pain in the area of the metatarsophalangeal joint of the first toe, febrile syndrome, swelling of the joint, gloss and hyperemia of the skin above it, a violation of the function of the joint. After 3-10 days, the attack of gout subsides with the disappearance of all signs and the normalization of functions. Repeated gouty attack can develop after several months and even years, but each time the intervals between attacks are shortened. In men, the primary attack of gout occurs more often as a monoarthritis with lesion of the foot joints, in women - oligo- and polyarthritis involving the joints of the hand.
Polyarthritis for infectious-allergic type in gout develops in 5% of patients. This form of gout is characterized by migraine pain in multiple joints, rapid regression of signs of inflammation, as in the case of the clinic of infectious-allergic polyarthritis.
The subacute variant of the gout current is characterized by the typical localization of pain in the first metatarsophalangeal joint and moderately expressed signs of lesion. In subacute gout in young patients, the development of mono- or oligoarthritis of medium and large joints is possible.
The rheumatoid-like form of gout is distinguished by primary interest in the joints of the hands in the form of mono- or oligoarthritis.
In pseudo-reflux-type gout, monoarthritis of various locations with inflammation of the joint and paranasal tissues, fever are observed. At the clinic, this option resembles the course of phlegmon or acute arthritis.
Malosymptomnoe variant of the gout current is characterized by poorly expressed, worn out symptoms - a small pain, weak flushing of the skin in the affected area.
For the periarthritic form of gout, the lesion of the bursa and tendons( often calcaneal) is prone to damage to the joints. In the future, the phenomena of chronic gouty polyarthritis with lesions of the joints of the legs, their defoguration and stiffness;deformation of articular tissues, bony proliferation;contractures, a crunch in the knee and ankle joints, incomplete dislocation of the fingers. Against this background, gout attacks continue with the possible development of gouty status - non-subsiding exacerbation of arthritis with chronic inflammation of the parasynthetic tissues due to their infiltration with salts. As a result of severe gout attacks, patients lose their ability to work and physical activity.
With prolonged anamnesis of gout( longer than 5-6 years) and hyperuricemia of high degree, there are specific signs - tofusi or gouty nodules, which are a cluster of urate crystals in soft tissues. Favorite sites of tofus locate are the ears, subcutaneous tissue of forearms, elbows, fingers, feet, legs, thighs. During attacks of gout, tofu can be opened with an outflow of whitish discharge.
Complications of gout
Hyperuricemia and accumulation of urate salts with gout leads to their deposition in the kidneys with the development of nephropathy;Gouty nephritis, characterized by proteinuria, microhematuria, cylindruria;arterial hypertension with the subsequent transition to chronic renal failure.
In 40% of patients there is a development of urolithiasis with renal colic at the height of a gout attack, complications in the form of pyelonephritis.
Diagnosis of gout
Patients with suspected gout are recommended to consult a rheumatologist and urologist.
General clinical analysis of blood outside the gouty attack is not changed;in the period of attack there is a neutrophilic shift to the left, an increase in ESR.A biochemical blood test with exacerbation of gout reveals an increase in uric acid, fibrin, seromucoid, sialic acids, haptoglobin, γ- and α2-globulins.
On radiography of joints, characteristic changes are revealed in chronic gouty polyarthritis. Radiological picture reveals the presence of osteoporosis, against which background the centers of enlightenment in the region of epiphyses and joints up to 2-3 cm in size are determined;with a deep neglect of the process - the destruction of the bony epiphyses with their replacement by the accumulation of urate masses. Specific signs of gout on radiographs are determined after 5 years from the manifestation of the disease.
To collect the joint fluid, puncture the joint. Microscopic analysis of synovial fluid in gout shows the presence of microcrystals of sodium urate in it. In the study of punctate tofusov crystals of uric acid are found. During ultrasound of the kidneys, urate calculi are determined.
Diagnostic gout markers are:
- microcrystalline urates in the synovial fluid;
- laboratory-confirmed tofusi with the deposition of crystalline urates;
- presence of at least six of the following signs: a history of more than one acute attack of arthritis;maximum signs of inflammation of the joint in the acute phase;redness of the skin over the inflamed joint;monoarticular type of lesion;pain and swelling of the I metatarsophalangeal joint on one side;one-sided nature of the defeat of the arch of the foot;tofus-like nodules;asymmetrical swelling of the joint;hyperuricemia;X-ray-detectable subcortical cysts without erosion;lack of growth of microflora in joints of articular fluid.
Treatment of gout
The main principle of gout therapy is the control of the content of uric acid by suppressing its production and accelerating excretion from the body.
A diet is prescribed that excludes consumption of fish and meat broths, meat of animals, kidneys, liver, lungs, alcohol. The diet includes a restriction on legumes and vegetables( beans, peas, beans, spinach, sorrel, radish, eggplant, asparagus, cauliflower), mushrooms, caviar, some fish species( sardines, Baltic herring, etc.).With gout, the calorie requirement is met by carbohydrate food, so patients should control their weight. In moderation, eggs, cereals, lean fish, lamb, beef can be eaten. With gout it is required to limit the salt load and intake of a sufficient volume of liquid( up to 3 liters per day).
The medical approach to gout therapy is aimed at arresting acute gouty attacks, their prevention in the future, prevention of urate deposition in the joints and kidneys.
For the reduction of gout attacks, NSAIDs( indomethacin), vegetable alkaloids( colchicine), local ointments and gels are used. As antiresidivnoy therapy for gout is appointed colchicine in small doses or antihyperuricemic drugs. The goal of treating gout is to reduce the concentration of uric acid in the blood 2 times lower than the norm required for dissolving urate crystals. To activate the excretion of uric acid, uricosuric drugs are prescribed: pro-benefic, sulphinpyrazone, azapropion, benzbeteron. The means inhibiting the production of uric acid include milurite, allopurinol.
At an atypical form of gout, which proceeds with the accumulation of intra-articular effusion, its puncture evacuation is performed.
Conducting sessions of extracorporeal hemocorrection is aimed at reducing the concentration of uric acid and urate salts, suppressing inflammation and reducing the dosage of the drugs taken.
Physiotherapy and spa treatment for gout is performed in the remission phase. Conducting the UFO area of the joint in the acute phase in a number of cases helps to stop the onset of gout.
Prognosis for gout
Timely recognition and the initiation of rational treatment give predictably favorable results. The factors aggravating the prognosis of the gout are young( up to 30 years) age, a combination of urolithiasis and urinary tract infections, weighed somatic anamnesis( diabetes mellitus, arterial hypertension), progression of nephropathy.
Prevention of gout
The need for gout prevention should be considered in chemotherapy, as well as in patients with the threat of decay and necrosis of the tumor. From the first day of the chemotherapy course, the appointment of hypo-ricerchemic drugs( allopurinol) is necessary.
Prevention of new exacerbations of gout depends on compliance with water-salt regime, diet, body weight control. In the presence of relatives suffering from gout, other family members are advised to monitor the level of uric acid. Gout is a kind of arthritis. It can cause episodes of acute pain, stiffness, and swelling in the joint, usually the big toe. These episodes can be repeated many times if gout is not treated. For a long time gout can damage joints of the tendon and other tissues. Gout is more common in men.
Causes of gout
Gout is caused by an excess of uric acid in the blood( hyperuricemia).Hyperuricemia usually does not cause much harm, and quite a few people with high levels of uric acid in the blood never get sick with gout. The exact cause of hyperuricemia can sometimes not be detected( a certain genetic predisposition is not excluded).When the level of uric acid in the blood becomes too high, the probability of crystallization of uric acid in the joints increases. And although gout, can manifest itself without obvious reasons, there are, nevertheless, risk factors that contribute to its development:
- Food, with predominance of meat products or seafood( with a high content of purines).
- Too low-calorie diets.
- Drugs that can increase the concentration of uric acid, such as: frequent use of aspirin, nicotinic acid.
- Drugs that reduce the amount of salt and water in the body( diuretics).
- Drugs that cause cell necrosis( chemotherapy for oncological diseases).
- Drugs that suppress the immune system,( cytostatics, which are often used in organ transplants).
- Chronic kidney disease.
- Diseases associated with excessive regeneration( myeloma, cancer, hemolytic anemia, psoriasis).
- Lead poisoning.
- Congenital genetic defects in enzyme systems that regulate the level of uric acid( Kelly-Sigmiller syndrome or Lesh-Nihan syndrome)
Gout usually develops after years of accumulation of uric acid crystals in joints and surrounding tissues. Symptoms include:
- Increased local temperature, pain, swelling, and severe soreness in the joint, usually in the joint of the big toe. This is a classic manifestation of gout. Sometimes a similar pattern can develop in another joint, such as the ankle or knee.
- It is possible to change the color around the damaged joint( bright red or purplish)
- The pain usually begins during the night and is so intense that even a light touch is very painful.
- Rapid build-up of discomfort, for several hours and then gradual regression over the next few days.
- Limited movement in the damaged joint.
- After the gout attack subsides, the skin around the damaged joint comes back to normal and the itch may persist.
- Some people may have a gout-free current without a bout of so-called chronic gout. Chronic gout in the older age group may not be very painful and is often confused with other types of arthritis.
- Gout may initially manifest as knots( tophi) on the hands, elbows, or ears. In such cases, there may not be classic symptoms of a gout attack.
Three stages of gout
First stage: High level of uric acid in the blood
- The level of uric acid in the blood can be increased, but there are no clinical manifestations.
- A high level of uric acid in the blood( hyperuricemia) may not progress, and gout symptoms may not appear at all.
- Some people may have a primary manifestation of the appearance of kidney stones, rather than an attack of gout.
Second stage: Episodes of acute gouty arthritis alternate with periods without symptoms.
- This stage is also called interstitial.
- Uric acid crystals begin to form in the synovial fluid, usually in one joint( big toe) - and the body responds to it with an inflammatory reaction and an episode of attack occurs.
- And although the most common lesion of the thumb is possible, it is possible that other joints may be involved. Although the big toe is the most common place for a gout attack, gout can develop in other joints.
- After the attack of gout ends the damaged joint quickly returns to normal within 2-3 days before the next attack( usually the attack is necessarily repeated for 1-2 years).
- Over time, the intervals between attacks become shorter and the intensity of the symptoms is more pronounced. In addition, other joints are involved in the process.
Third stage: Chronic tofus gout
- If the symptoms of gout occur sporadically and the treatment is not performed for several years, then a chronic process arises and other joints are involved. Intervals disappear between attacks. This stage of gout often resembles other types of arthritis( more often osteoarthritis).
- By this time, there is a sufficient accumulation of uric acid crystals to form nodules( tofus) in various parts of the body. Tofusi, dense to the touch, mobile and located under the skin. The skin can be red and thinned( the color of tofus can be yellow or cream).
- As a rule, tofus are localized near the elbow or near the toes, hands, auricles. With progression, the development of tofus about the joints or in the cartilaginous tissue of the auricle is possible. Tofusi, located in the cartilaginous tissue, can lead to destruction of the cartilage.
The most reliable confirmation of gout is the analysis of synovial fluid obtained by arthrotcentesis. But if there is inflammation in the joint( redness, soreness), it is not advisable to make a puncture. In such cases, the diagnosis is made on the basis of a blood test for uric acid
The diagnosis of gout is based on the history of the disease, the analysis of blood and urine for uric acid.
Radiography is informative only in the late stages of gout and is necessary for differential diagnosis with other types of arthritis.
Treatment of gout
The task of treating gout is to reduce pain and prevent recurrent attacks and complications( joint and urolithiasis damage).The following treatment methods are applied:
Diet. If you have excess weight, you need to reduce the calorie intake. In addition, significantly reduce the presence in the diet of meat products and seafood. Reduce the use of alcohol and especially beer.
Medication. There are drugs that increase the secretion of uric acid( uricosuric agents - for example, benemide), which reduce the production of uric acid( uricodepressant drugs - for example, allopurinol), drugs that relieve acute attack - colchicine, NSAIDs, corticosteroids.
Physiotherapy is used in the acute period( UFO, impulse currents) and during the interictal period( ultrasound, phonophoresis with hydrocortisone, mud therapy).
It is used in cases where large tofuys, there is infiltration of underlying tissues and the removal of uric acid crystals with medication is not possible.
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Treatment of gout of the toes
Chronic inflammatory process in the joints of the toes resulting from the deposition of uric acid salts is called gout or gouty arthritis. The disease is most often localized in the thumb. With gout, timely treatment is necessary, in the absence of which, complete destruction of the joint and the spread of the disease to internal organs can occur.
Causes of the disease
Development of gout of the fingers is provoked by a metabolic imbalance, which increases the production of uric acid and ultimately reduces its excretion through the kidneys. The very violation of the exchange can be caused by several reasons.
- Genetic failure. Its mechanism has not been studied, but it is proved that gout is transmitted through the hereditary line, through DNA.If there were cases of a disease in the family, the possibility of defeat increases dramatically.
- Incorrect food, bad habits. Food rich in saturated fats and purines enhances the deposition of uric acid salts( urates), like alcoholic beverages and smoking. With an unbalanced diet with a predominance of fatty meat, smoked foods and preservatives, carbonated beverages, sweets and confectionery, coffee and some other products, gout begins to actively progress.
- Diseases. Diabetes mellitus, renal failure, psoriasis, hypertension, ischemic heart disease, all these conditions and concomitant medication treatment, can become a catalyst for gout.
- External impact. Postponed trauma, overstrain caused by professional activity or excessive sport, wearing too tight shoes, hypothermia. These factors can trigger the onset of the disease, because the joint is already weakened or damaged, and the salts actively begin to accumulate in it.
It is not necessary that gout develops in all lovers of fatty foods, smokers or cores, but if several factors coincide, and even with bad genetics, the probability of a joint disease of the big toes increases many times.
Symptomatic of gout
Gout developing on the toes, which can only be the beginning of a vast lesion, is characterized by a sharp first attack, starting at night or at dawn, and accompanied by intense, throbbing pain in the area of the big toe joint. Other symptoms of the disease include the following manifestations.
- Puffiness - appears directly on the sore thumb and spreads to the entire foot. If the gout affected the joint of only one leg, the second remains perfectly normal.
- Changing the color of the covers - the skin above the joint first slightly reddens, but as the attack increases, it becomes almost crimson.
- Increase in temperature - the total body temperature rises to about 38 °, but in the zone of inflammation localization it can reach 39 °.
- Hypersensitivity - even an easy touch to the affected area causes an increase in the pain syndrome.
- Abrupt relief - after several days of pain( 3-5, rarely 10), all manifestations disappear even if treatment has not been performed.
Diagnosis of the disease
The attack was postponed, you can step on your leg, and you can safely touch the thumb before you do what? If health is expensive, do not wait for the next exacerbation. Although remission may occur up to several months( 2-8), gout does not go anywhere, and gradually destroys the joint. Therefore, as soon as it eased, and the ability to move normally returned, it is necessary to go to a polyclinic, to a specialized specialist: a rheumatologist( arthrologist).The formulation of an accurate diagnosis and determination of the degree of joint damage will be based on several studies.
- X-ray. Take a picture of the foot in several projections to reveal changes in the tissues of the joint of the thumb. In the early stages, manifestations are still not sufficient for visual detection, but so rarely are they addressed to a doctor so early. In the pictures, as gout progresses, bone tissue defects, narrowing of the interstitial luminal lumen, and destruction of the cartilage are visible.
- A blood test reveals the presence of an inflammatory process and an increase in the level of uric acid.
- Arthrocentesis - the study of synovial articular fluid taken in the toes during the remission period, determines the presence of crystalline formations - urate, the basis of the disease.
In addition to diagnostic procedures aimed at confirming gout of the toes( or legs), the physician prescribes a more detailed examination, including:
- ultrasound( ultrasound) of the kidneys, and the outflow tracts;
- urine analysis to determine the amount of acid excreted per day.
This is necessary in order to determine the root cause of gout, if it is the case in diseased kidneys that do not cope with the cleansing of the body from the products of decay, then their treatment simultaneously with gout will give a much greater effect than relief of pain attacks and anti-inflammatory therapy.
Treatment of gout of the toes
Assign an adequate condition, effective treatment is only possible by a qualified specialist. The greatest benefit and real improvement will come from an integrated approach that will include several ways of influencing the disease, depending on the stage and individual patient data. The basic component, used in all cases when the gout of the toes is diagnosed, consists of the following stages.