Gout is a subset of arthritis, the occurrence of which is associated with a malfunction of the metabolic purine metabolism that occurs with the formation of uric acid crystals in the joints. An exacerbation of gout brings a painful pain to a person, accompanied by another pathological symptomatology. If the state of health worsens, the patient needs urgent medical help, which only specialists can provide him.
In this article:
Causes of gout exacerbation
Depending on the catalyst that caused the attack( and the growth of uric acid in the blood), the disease under consideration is divided into primary and secondary pathologies. But experience shows that the source of hyperuricemia, which provokes the development of primary gout, remains largely undefined in most cases. One of the assumptions of modern physicians is the version of the complex imposition of hormonal and genetic factors that have worked on the basis of certain features and addictions of a person in nutrition.
The causes of exacerbation of gout secondary type are determined by such sources:
- Drug therapy. Long-term use of certain drugs can provoke the development of this pathological process. For example, such effects can be given by thiazide diuretics, aspirin, nicotinic acid, pyrazinamide,
- Overweight. As statistics show, in people with excess kilos this problem occurs three times more often than people with lean physique.
- Genetic predisposition of the patient. If in his family a close relative had such a problem. Every fifth patient with this diagnosis has a relative of the patient with gout.
- Excessive consumption of alcoholic beverages. They provoke an increase in the level of uric acid in the body of the drinker, which ultimately leads to the pathology considered in this article.
- Organ transplantation.
- Leukemia is a group of malignant diseases that damage cells that participate in the process of hematopoiesis.
- Psoriasis - presumably an autoimmune non-infectious pathology, affecting mainly the skin of the patient.
- Lymphoma is a cancer pathology that affects the human lymphatic system.
The age and sex of the patient can be included in the risk factor. Predominantly gout suffer men who have reached the age of forty. But this does not exclude the appearance of this disease in women, it's just that such cases are diagnosed much less often.
To effectively treat the disease, physicians should understand its pathogenesis, only so you can count on a complete cure or transfer of the disease to the stage of remission. Otherwise, the therapy affects only the symptomatic indices of the disease, which can somewhat improve the patient's condition, but not solve the problem as a whole.
The basis of the problem is the growth of uric acid in the blood, which can be caused by various reasons. Similarly, hyperuricemia is not a single symptom of gout, it is present in the symptoms of a fairly wide range of diseases.
Therefore, the pathogenesis of the disease considered in this article is based on the triumvirate of factors:
- The deposition in the tissue structures of uric acid compounds.
- Modified transition of these compounds into crystalline structures.
- Inflammatory processes affecting the joint tissues of the human body, that is places of accumulation of substances forming in the gouty granules( tofusi).
Failures in purine metabolism lead to activation of the process of formation of uric acid. The source of this phenomenon can be endogenous purines, produced directly by the patient's body, and exogenous purines that a person receives with food.
In an organism of almost all mammals, there is an enzyme such as uricase. It works on splitting uric acid and removing it from the body. If genetically or in the process of development in the patient's body the process of producing uricase was broken, then, accordingly, there is a failure in the destruction of the acid, which provokes its accumulation in the human body.
Symptoms of gout exacerbation
As practice shows, the medical condition under consideration is divided at the stage having its own symptomatology:
- Asymptomatic hyperuricemia.
- Acute gouty arthritis.
- Monoarticular gout.
- Polyarticular gout.
- Intercritical gout.
- Chronic gout.
Symptoms of gout exacerbation, perhaps, have the most pronounced symptomatic color:
- High pain intensity, localized in the region of joints and adjacent tissues.
- The pain is aggravated by any movement in the problem area. Sometimes even an insignificant load is unbearable. For example, a blanket, which the patient is hiding during rest.
- Predominantly painful syndrome permeates in the night and morning.
- Puffiness of the joint, in a number of cases, and adjacent tissues.
- The growth of temperature indicators locally in the place of injury.
- Hyperemia of the skin. The dermis becomes smooth and glossy.
- It is possible to chill and a slight increase in the temperature of the whole body.
- Deterioration of the general condition of the body and appetite.
Predominantly symptomatic affects one joint.
First signs of
Speaking directly about the disease, its first signs are manifested by the appearance and growth of articular growth in the articular region. When the illness worsens, a person begins to feel growing pain in the place of the lesion. Sometimes on several painful attacks the aggravation can and will stop. And perhaps further development of pathology, in which gradually begins to manifest the entire spectrum of pathological symptoms.
The essence of the matter directly depends on those actions that were made or not made against the background of an exacerbation of gout. If timely measures have been taken to stop the attack, the consequences of exacerbation are represented by attenuation of the inflammatory process. Gradually, pain and all accompanying symptoms begin to disappear. Man eventually returns to the familiar life.
But not everything is as rosy as it seems at first glance. Over time, the destructive process progresses, involving new joints. The uric acid substances begin to accumulate, destroying them, but for the time being the disease does not manifest itself. Crystalline deposits( tofusi) grow and, under a certain confluence of circumstances, there is a new, but already more large-scale, exacerbation.
Places of primary accumulation are articular joints of phalanges of fingers and toes, knees, elbows, forearm area, curls of ears and a number of others.
With proper therapeutic treatment, one can expect a sufficiently high standard of living. Timely treatment, prevention of disease and regular medical supervision - these are the three whales on which the normal life of a person with a history of gout is maintained.
But with improper care, ignoring the doctor's recommendations or in case of neglected disease, complications can occur. They are able to express such deviations in the patient's state of health:
- Transition of the disease into a chronic form.
- There is destruction of cartilaginous and bone tissue.
- Deformation of the articular apparatus.
- Immobilization of the joint.
- Practically constant incessant pain.
- Difficulty walking.
- Appearance and increase in the size of tofus. In the absence of adequate therapy, they can achieve significant dimensional parameters( there are cases when the sizes approached the parameters of the golf ball).The growth of these bone formations leads to complete disability of the person.
- Up to 40% of patients with a diagnosis of gout have problems with the kidneys. This is a scroll and stones in the organ, nephrolithiasis, with a special neglect of the case - renal failure.
- With prolonged course of the disease, pathological changes begin to affect the cardiovascular system, causing ischemic heart disease and cardiac dysfunction, as well as hypertensive manifestations.
- This process affects the development of the patient's diabetes, cataracts, dry eye syndrome.
- Rarely, but there have been cases of complications affecting the respiratory system, that is, the appearance of deposits of uric acid crystals in the lung tissues.
Diagnosis of gout exacerbation
Only an experienced and qualified doctor is able to diagnose a disease correctly. At the same time, he must have the necessary results of tests and other medical examinations, and the patient's examination by the doctor himself. Direct diagnosis of gout exacerbation consists of a number of studies:
- Laboratory tests.
- Synovial fluid analysis.
- Blood test to determine the level of uric acid.
- Instrumental diagnostics.
- Computed tomography( CT).
- Magnetic resonance imaging( MRI).
- Differential diagnosis - exclusion of other diseases with similar symptoms:
- Pseudogout is a common inflammatory arthritis typical of people aged. Primary pain syndrome appears in the knee, then in other joints, but, usually, it does not affect small joints( for example, on the fingers).The aggravation, mainly, overtakes in the autumn period or early spring.
- Septic arthritis.
- Infectious arthritis.
- Rheumatoid arthritis. Severe inflammation, pain syndrome. The diagnosis is made only on the basis of detailed analyzes and studies.
- Osteoarthritis, osteoarthritis.
- Various infections.
- Charcot's foot, neuropathic arthropathy. In the early term, the symptomatology of this disease is akin to gout: edema of the lower limb, hyperemia, cracks in bone tissue, displacement of blood vessels.
- Bunion of the big toe.
- A number of other pathologies.
When establishing the diagnosis, the specialist must have a complete clinical picture of the disease. To do this, the patient is assigned laboratory tests. In this case, if there is a suspicion of gout, the patient is assigned:
- Investigation of synovial fluid. This analysis is quite an informative and accurate method of diagnosing the disease in this article. The synovial fluid is essentially an articular lubricant that "envelops" the entire joint, forming a protective pouch. With the help of this analysis it is possible to diagnose the disease even during the period of remission. The method network is the taking of fluid from the articular sac by means of a puncture. The procedure is not so painful that even local anesthesia is applied. It is not applied disinhibiting and for other reason - it is capable to lower reliability of the received result. The taken liquid enters a specialized laboratory, where it is possible to recognize the presence( or absence) of monosodium urate crystals( MSU).Their presence and confirms the disease described in this article.
- Urinalysis. If a patient exhibits signs of hyperuricemia, even if it is a young man, then this analysis will establish the amount of uric acid in the urine. If this parameter is higher than the accepted standards, then the attending physician directs his patient to additional studies. After all, this indicator can speak of both gout and the formation of sand and stones in the kidney or bladder. The intake of the test fluid is carried out during the period of pain abatement, after the patient starts purine diet. During this period, the patient should not take even low-alcohol drinks and any pharmacological agents. These substances can change the veracity of the result.
- Blood test. This study is conducted to determine the level of uric acid in this liquid. If the parameter in question has a low level of characteristics, then this diagnosis is immediately discarded as not well-founded. If the result is significantly higher than normal, it begins to go about hyperuricemia and, accordingly, the suspicion of gout. In this case, an analysis of concomitant symptoms is performed. But it is worth remembering that the presence of hyperuricemia is not necessarily a sign of the disease under consideration, but in the case of an exacerbation of gout, the level of uric acid is not always higher than normal. It can be within acceptable limits or even be somewhat lower. But still, as medical statistics show, in more than 80% of cases of a high urinary acid content in the urine, a diagnosis was confirmed-gout.
Do not dispense with modern medicine and without additional research, produced with the help of specialized medical equipment. Instrumental diagnosis of the disease in question can be expressed in a number of techniques, but the most popular are:
- Radiography, which gives a complete picture of the state of bone tissue and the presence, as well as the extent, destruction and deformation of the joint. This technique allows you to identify and other related diseases. The X-ray image reflects the real state of the musculoskeletal system, the presence of tofus even before they are visible with an armed gaze.
- Computed tomography. This technique visualizes the processes occurring in the area of interest.
- Magnetic resonance imaging( MRI).The method is similar to the previous one. Allows you to view the joint in 3D measurement. At the same time, the produced photographic package makes it possible to use the obtained survey results more than once.
- Ultrasonic dopplerography is a survey conducted to investigate the state of blood flow in vessels invaded in the area of interest.
Even having on hand all the results of studies and analyzes, having received a complete picture of the disease, only a qualified experienced doctor can put the correct diagnosis. He carries out differential diagnosis, the essence of which is to exclude diagnoses that have such a symptomatology and confirmation of one.
Most often, people who are far from medicine confuse the diagnosis in this article with a pseudogout. The symptomatology of these diseases is very similar. Therefore, in order to differentiate the disease, physicochemical analysis of urate crystals is foreseen.
Assign an analysis that identifies infectious damage to the body, resulting in diseases such as infectious arthritis, Lyme disease, fungal, bacterial, tubercular, septic, viral arthritis, osteomyelitis.
The doctor should also exclude such pathologies as rheumatoid arthritis, big toe bursitis, systemic vasculitis, Reiter syndrome, Still's disease, Charcot's foot, neuropathic arthropathy and many other pathologies of similar symptoms.
Treatment of gout exacerbation
Once the diagnosis is established, the doctor can proceed with the appointment of a protocol for the therapy of the disease. Treatment of gout exacerbation is conditionally divided into two main stages. Primarily it is necessary to reduce the intensity of pathological symptoms. The second stage of the physician is being transfigured for the treatment of pathology or preventive measures, which makes it possible to withdraw the disease in question to the stage of remission, thus avoiding recurrence.
In a modern protocol for the treatment of gout medics are injected soft drugs to at least partially protect the stomach from their effects. The most commonly used drugs are celecoxib, meloxicam or nimesulide, related to the pharmacological group of selective blockers.
Even before the recent sharpness of the attack, physicians were removed with drugs that have anti-inflammatory characteristics: diclofenac or indomethacin. But as further observations show, these drugs negatively affect the work of the kidneys and liver, which is unacceptable, especially in the case of gout diagnoses, in which these organs are already undergoing negative changes.
Sometimes colchicine is prescribed, but it does not enjoy such popularity as the drugs voiced above. This is due to its wide enough side effects and negative impact on the kidneys, digestive tract and liver.
But a number of patients do not need a medical correction, it is enough to restrict themselves in the diet during an exacerbation, excluding from it food products that bring uric acid into the body. It will not be superfluous to watch your weight, not allowing the development of obesity.
In case of exacerbation, patients may be prescribed drugs with analgesic characteristics. It can be: no-spa, analgin, diclofenac, paracetamol, instant 400, aspirin, ketanov, nurofen, took, tramal and others.
Drugs As already mentioned above, the patient is prescribed
antidotal drugs such as purinol, allopurinol alopron, egis, allupol, sanipipurol and others.
The essence of drug therapy is a decrease in the level of uric acid in the patient's blood. And here allopurinol, an active antidotal drug, is highly effective.
It is administered in amounts directly dependent on the level of the uric acid medium. The minimum dosage of the drug is 100 mg, the maximum dosage is 800 mg. Usually, on average, this level is 200 to 400 mg daily, divided by one or two doses.
Monthly monitoring of serum uric acid levels is required.
Contraindications for this medicine include hypersensitivity to the components of the drug, kidney failure, pregnancy and the period of the newborn's breast-feeding.
Non-steroidal anti-inflammatory drugs( NSAIDs) are entered in the protocol for the treatment of patients who do not have special health problems, since they have a significant effect on liver function and release organs. These include: ibuprofen( in low dosages), mothrin, naproxen, indomethacin, diclofenac, sulindac, ketoprofen, voltaren, dexibuprofen and a number of others.
Indomethacin - the strongest inhibitor of prostaglandin biosynthesis is usually taken after a meal in the amount of 25 mg two to three times a day. If necessary, this dosage can be increased to 100 - 150 mg daily, divided into three to four doses.
Contraindications for this pharmacological agent include hypersensitivity to the components of the medicine, peptic ulcer disease of the digestive system, renal failure, bronchial asthma, pregnancy and the period of the newborn's breast-feeding.
Drugs of this pharmacological orientation are applied in a limited way, due to their negative impact on the functioning of excretory system and liver.
Anti-inflammatory and antirheumatic drug nimesulide is prescribed to adult patients at a dosage of 100 mg twice daily. For maximum effectiveness, it is recommended to drink after eating. Children who are not yet twelve years old, the drug is not prescribed, and the dosage of older teens is calculated by the formula of 5 mg per kilogram of the patient's weight, separated by two daily doses.
Contraindications of nimesulide include the hypersensitivity of the patient's body to its components, significant disruptions in the work of the kidneys and liver, the presence of internal gastric bleeding, ulcerous or erosive lesions of the stomach or duodenal mucosa( especially during the exacerbation period), as well as the period of pregnancy and lactation in a woman.
The uricolytic drugs that are designed to protect the kidneys of the patient from the reabsorption of uric acid substances can be introduced into the protocol of treatment, which contributes to their better removal from the body.
These drugs include, for example, sulfinpyrazone( anturane) and probenecid( benemid, probalan).
The starting dose of probenecid is 0.25 g two to three times a day for a month. Dosage is increased gradually. Thus the skilled expert knows, that to achieve greater efficiency it is possible entering in the protocol of treatment together with probenecid and colchicine.
People suffering from gout often have problems with blood pressure. Therefore, such a patient may be prescribed antihypertensive drugs.
Ointment with exacerbation of gout
When the symptoms of the attack increase, its blockade is primarily carried out. Then, therapy is carried out aimed at the recovery processes in bone and connective tissues. It can be prescribed with an exacerbation of gout ointment, which has anti-inflammatory, anti-snuff and analgesic characteristics. In this regard, ointment fullflex proved to be quite good.
Ointment should be rubbed into the affected joint tissue twice a day. It is recommended to do this immediately after a morning awakening and before going to bed. Apply the drug until the moment the inflammation is stopped and the pain symptomatology disappears.
To optimize the treatment it is recommended to use full cream ointment, together with oral administration of fullflex capsules, against the background of proper nutrition.
Due to the fact that the medicinal product under consideration is manufactured on the basis of natural plant components, its contraindications are not so significant. These include only increased sensitivity or intolerance to at least one of the components of the drug, the tendency to allergic reactions, the period of pregnancy and lactation, the age of the patient to 14 years.
Often other ointments are used to relieve pain and inflammation. For example, fastum gel, niflugel and others.
Traditional treatment of exacerbations of gout
The experience of our ancestors allows us to use folk medication to stop many diseases. This fact applies to our problem.
One of the methods of treatment our ancestors considered purification of the body, including joints. For example, this procedure can be carried out with infusion from laurel sheets.
The medicine is being prepared the day before.5 g of raw material is poured with half liters of boiling water, boiled for another five minutes and, after pouring into a thermos bottle, it is given over a night. In the morning, the medicine should be drained and drunk in small sips throughout the day. Take this infusion should be two to three days, after which you need to make a week break. Then purification continues.
An excellent remedy for this pathology are bee products. They are applied as ointments, on the basis of bee venom, so directly the bee stings themselves, which are made into the area of the affected joint. But this technique is suitable only for a patient who is not allergic to a bee product.
The recipe will also find its use: three heads of onions are rinsed and placed in a liter of boiling water. Put on medium heat and cook until the bulbs begin to lose shape, falling apart. The composition should be allowed to cool slightly, after which it should be drained and taken 150 ml before each day's meal. The duration of onion therapy is at least two weeks. Broth not bad copes painful symptoms. If you have another attack, you can repeat this "medicine".
A significant place in the treatment of gout is given to various herbal tinctures and their broths - this is the basis of non-traditional methods of treatment.
Treatment with herbs
Due to the fact that nature has presented us with a great variety of medicinal plants with diverse characteristics, herbal treatment for gout takes not a small part of the prescription heritage. Here we recall only a few of them.
- Romashkov - salt baths. To prepare them, you must first prepare a decoction of 100 g of vegetable raw materials and a couple of liters of water. Then, dilute the liquid with another 8 liters of water, placing it in a basin. Add 200 grams of salt here( not bad, if it will be marine).Procedures are carried out by lowering the diseased joint into the prepared solution.
- You can do the same procedure, but taking for broth 50 g of chamomile and 50 g of elderberry black flowers. With such a decoction, you can make baths or apply compresses on its basis to the joint.
- Well-proven sequence that should be brewed in a water bath for a quarter of an hour, diluting a tablespoon of the plant with a glass of boiling water. Drink instead of tea.
- Effective and oat broth, cooked which will take some time. Glass of grain pour a liter of water and put in a container on the fire, bring to a boil and keep on fire until the volume of liquid is reduced by half. In this case, the fire should be small. Then set aside on the edge and allow to cool slightly. To strain. The resulting liquid is mixed with two glasses of whole milk. Bring to a boil again. Drink one glass of "medicine" three times a day.
- A tincture of lilac flowers is also suitable. The medicine is prepared as follows: take a container of dark glass, fill it completely with vegetable raw materials. After that, pour in alcohol or vodka. At 0.5 liter bottle of lilac flowers will take approximately 200 ml of alcohol. The vessel should be sealed and placed in a darkened place for seven days. The product must be shaken periodically. Tincture is taken before a meal of 20 - 30 droplets.
- Teas, brewed on cranberries or strawberry leaflets, are well established. Such a drink should be drunk for two to three months in a cup twice a day. In the season of berries, they can be eaten raw, not less than a glass a day.
- The ginger root, taken in the form of tea, is an excellent anti-inflammatory agent. One or two teaspoons of grated food for a cup of boiling water, taken three times a day, to feel the surge of energy and prevent the development of the disease.
There are also many other recipes, but before being treated with folk remedies, it's not superfluous to ask a specialist for advice.
Homeopathy with exacerbation of gout
To date, homeopathy is gaining increasing popularity among people who adhere to the treatment of various diseases using alternative medicine.
With regard to the relief of the disease under consideration, homeopathic doctors are ready to offer a number of drugs that, if not allow to lead a person to a full recovery, will help to eliminate pathological symptoms, improving the patient's condition.
Уртика уренс - this homeopathic product cleans well the joints and many body systems. Its basis is stinging nettle. The drug takes 5 drops, diluted with a small amount of water every two to three hours. Taking surplus uric acid, the medicine does not lessen the severity of the attack.
Benzoicum acidum is another preparation of homeopathy of a similar action. Its basis is benzoic acid, obtained from natural raw materials.
Colhicum - removes puffiness and stops the inflammatory process. The basis of the drug is a medicinal plant.
Sarsaparilla is an analgesic that helps with pain symptoms during gout.
Ledum Palustre - removes inflammation of small joints of the foot and hands, tendons and heels. Helps to remove excess uric acid. The basis of the drug is the medicinal plant rosemary bog.
Urea Pura - relief of acute manifestations of gout and gouty specimens. The basis of the drug is urea.
Urikum acidum - allows softening of gouty conglomerates of uric acid deposits. The drug is especially effective for gout, gouty eczema, rheumatism.
But, as it is not regrettable it sounds, you can not always do just by adjusting the diet, medication or a recipe of folk medicine. If the clinical picture of the disease is presented by tofus or tofusomi of large dimensions, the pathology area is infected, causing the patient a lot of discomfort( pain and difficulty in movement), this patient is shown surgical treatment.
If joint immobilization is aggravated by infection, the situation is associated with a high risk of complications, which can only be prevented by performing an operation to remove uric acid from the joints adjacent to the soft tissue joint. In some cases, this operation can affect the joint itself. The deformed organ can be a substitute for a prosthesis.
Diet in case of exacerbation of gout
If a person has a diagnosis of gout in the medical history, it is very important to eat properly, because a number of food products bring additional uric acid to the human body, which is already in excess, which only exacerbates the pathological picture. Therefore, a diet with an exacerbation of gout is an integral element of treatment.
This patient needs to control the intake of excess purines in his body.
From the diet of such a patient must be excluded( or minimized):
- Smoking( nicotine).
- Strong tea.
- By-products: liver, tongue, brains, kidneys.
- Reduce the consumption of meat, even low-fat varieties up to 200 - 300 g per week.
- Daily intake of salt - no more than 5 g.
- Fatty varieties of fish.
- Spices and Pickles.
- Strong coffee.
- Canned food and smoked products.
- Any saturated broth.
- Leguminous crops.
- Fresh fruits and vegetables. Accepting only thermally processed products.
- Fresh baking.
- Dried fruits.
It is allowed to leave in the ration:
- Porridges and soups based on any croup.
- Sour-milk products.
- Only thermally processed vegetables and fruits are allowed.
- Milk in small quantities.
- Natural fresh juices, compotes, fruit drinks.
- Whole grains.
- Stale yesterday's bread.
Doctors recommend such patients during the week to do one - two days of shipment, during which it is necessary to take only one kefir or cottage cheese with kefir. Allowed and apple unloading( or another mono-product).
Do not overeat( go to five to six meals a day) and fast. The volume of one serving is not more than 200 ml.
If you eat according to the diet and follow the other doctor's recommendations, then the exacerbation of the disease can be quickly stopped, and then generally put the disease into a state of remission.
Preventing exacerbations of gout
Any disease or attack is better to prevent than to deal with the problem later. To prevent relapse, it is necessary to prevent the disease. Doctors recommend:
- Keep track of your food, do not get carried away by eating foods with high purine content.
- Doing sports. It does not have to be a heavy load. It is enough to get by morning jogging, walking or light exercises, which would form a muscular corset. It will reduce the burden on the joints, having spent some of the effort on yourself.
- Do not heavily load joints.
- Drink a sufficient amount of liquid, which will allow the timely and complete removal of excess uric acid.
- Strong twists are forbidden.
- If the patient has sedentary work, it should be compensated by regular training.
- Keep track of the weight. Extra kilograms - this is an excessive burden on the musculoskeletal system.
- Avoid injury to the joints.
- Do not wear narrow and uncomfortable shoes. She traumatises the joints of the foot.
- The same applies to clothes.
- If the patient has gone through chemotherapy, then to prevent the prevention of urine acid deposits in the body, he is prescribed antihyperuricemia therapy. Mostly it is the reception of the drug allopurinol.
As the statistics show, the forecast of gout is favorable enough. Practically all patients with this diagnosis suffer more from the symptoms of accompanying pathologies than from the directly considered disease, the exception is the period of exacerbation. But the sooner adequate measures are taken, the easier it will be for the patient to suffer an attack.
It is also known that such patients, in most cases, suffer from nephrolithiasis( stones and sand in the kidneys) or urolithiasis( metabolic disorders leading to the formation of urinary stones), as well as from kidney failure and it may be the causelethal outcome, and not considered in this article disease.
If you have read this article, then, we hope, have drawn the right conclusions that an exacerbation of gout can be completely avoided. When all the recommendations of the doctor are implemented, patients usually live happily to a very old age, while leading a quality, familiar life. For this purpose it is necessary to put a little bit of zeal: proper nutrition, active way of life, positive emotions and attention to one's organism guarantee this. But if the aggravation is still there, do not brush aside the problem, resorting to self-management. It will be right to seek the help of a qualified specialist who, after evaluating the clinical picture of the attack, will help to find the most effective and quickest solution to the problem. And we wish you good health and a full and rich life!
Treatment of gout with exacerbation of
Gout is a disease that affects the joints on the human body. Most often, the lower limbs, in particular the big toes, give way to negative influences. Treatment of gout with exacerbation is aimed at reducing negative symptoms and alleviating the condition of a person. The frequency of these periods is completely dependent on the course of the disease, as well as the habits of the person. Ignoring the main recommendations and not tracking the level of uric acid leads to frequent and severe attacks.
Treatment for gout during an exacerbation of
The disease can be eliminated in two stages. First of all, it is necessary to stop an acute attack, then to start to prevent the relapse. During the exacerbation it is necessary to use special drugs, they are the basis of treatment for gout. You can suppress an acute attack with the help of anti-inflammatory drugs. These include Diclofenac and Indomethacin. Take medication can be no more than 3 times a day for 1 tablet. Use them is not recommended for hypersensitivity and during pregnancy. Medications can adversely affect the body, leading to the development of disorders from the gastrointestinal tract.
Anti-inflammatory drugs can be replaced with drugs that have a milder effect on the stomach. They include Meloksikam and Nimesulid. You can use them for 2 days, after the onset of an attack. One tablet per day is sufficient to suppress the exacerbation. Take medication is not possible with a marked violation of the functionality of the liver and kidneys, as well as in the presence of ulcers. Can lead to the development of nausea, abdominal pain, and impaired renal function.
Therapy is successful if medications were taken for the first time after the onset of an attack. Treatment in the period of exacerbation is aimed at eliminating negative symptoms and preventing the progression of the disease. A person should get used to a healthy lifestyle. Correction of body weight, proper nutrition and high fluid intake will greatly facilitate its condition and will reduce the duration of seizures.
It is necessary to exclude foods rich in purine content from the diet.
These include: meat broths, fatty foods, seafood and milk proteins. The daily fluid intake is 2 liters. It is necessary to refuse from the use of alcoholic beverages, they provoke the development of exacerbation. And the attack can develop immediately after drinking alcohol. Compliance with all the rules, proper nutrition, abundant drink and the necessary medication will help ease the attack.
Gout treatment for exacerbation at home
Removing gout at home is aimed at suppressing an acute attack. Once the exacerbation has begun, it is necessary to provide the affected joint with complete rest. The limb should be in an elevated position. Treatment of gout at home is aimed at arresting an exacerbation.
If you can touch the patient's joint, you need to make an application using dimexide or ointment. Vishnevsky ointment is also widely used. It is necessary to apply the remedy to gauze and attach to the affected area, fixing everything with polyethylene. A person should drink a lot, preference is given to lemon juice, mineral water and oats broth. Medicines do not allow the lightning speed of pain, they need to be taken in conjunction with all methods to improve the effect. Diclofenac, Indomethacin and Movalis should give preference. These drugs can reduce pain.
When treating the attack, special attention is paid to folk remedies. The main recipes will be presented below.
Treatment of gout with exacerbation of folk remedies
Treatment should be carried out in a comprehensive manner, together with the use of alternative medicine. This will ease the pain and contribute to a quick recovery. Before you start treatment for gout with exacerbation of folk remedies, you need to consult a doctor.
To eliminate seizures, folk healers recommend using infusions and decoctions based on medicinal herbs. They can include several medicinal plants. Particularly effective are the following: chamomile, oak bark, needles, nettles and string. It is advisable to use infusions and decoctions on their basis inside.
- Recipe # 1.For cooking, you need to take a tablespoon of turn and chamomile. The ingredients are poured into 500 ml of hot water and insisted for an hour. Then the drug is filtered and used 2 times a day for 200 ml.
- Proven means for eliminating gout is needles. It is used as compresses.
- Recipe # 2.For cooking, take 500 grams of fresh needles and pour it with boiling water. The resulting product must be insisted for an hour, and then boil 60 minutes over low heat. When the broth cools, it is necessary to moisten the gauze and apply it to the affected area. It is advisable to leave a compress for the whole night.
- Recipe # 3.In equal parts it is necessary to take the bark of oak and the flowers of horse chestnut. Ingredients are taken in the amount of one tablespoon. All this is poured into 500 ml of alcohol and insisted for a week. After the set time, the remedy can be consumed on a tablespoon 3 times a day. The duration of therapy is 1 month.
Honey, iodine and activated carbon. Painful joints can be lubricated with honey in its pure form. Its composition contains many useful components that have a curative effect. From honey, you can prepare ointments, mixing it with animal fat, herbs and essential oil.
Iodine was used in the old days. It has an incredible effect on gout. Apply it as an antiseptic.
- Recipe # 4.In 10 ml of iodine, 5 tablets of aspirin should be dissolved. As a result, a colorless liquid will appear, which should be rubbed into the diseased joints.
- Recipe # 5.Baths from iodine. For their preparation, it is necessary to take 3 drops of the main ingredient for 5 liters of liquid. Such baths are used once every two days.
Activated carbon. These pills will help to eliminate gout completely, but only in the early stages. To prepare an effective remedy, take 20 tablets and crush them to powder. This adds a tablespoon of flax seeds and mixes to the state of gruel. The drug is infused for 12 hours. Apply the obtained ointment to the formed cones on the joints.
Treatment of gout on the legs - ways to treat gout and getting rid of gout at home - Healthy age
Criteria for diagnosing gout
Symptoms of the disease
In 2000, WHO adopted diagnostic criteria allowing a high probability of verifying a diagnosis"Gout".Each clinician of the therapeutic profile must follow the scheme adopted in this document in his diagnosis.
The first diagnostic feature is the detection of urates in the puncture of intra-articular fluid. This sign is revealed by performing a puncture of the joint cavity, which in itself is a very painful procedure.
The second sign, pathognomonic and mandatory for the diagnosis of "gout" is the presence of tofus - accumulations of urates in soft tissues. This symptom, as a rule, is detected with a simple clinical examination by an experienced doctor and does not require additional instrumental diagnostic methods.
The third prerequisite for a verified diagnosis of "gout" is the presence of at least half of the following symptoms:
more than 1 case of an exacerbation of gout in anamnesis;
- the most pronounced inflammation of the joint in the first day of the disease;
- defeat only one joint, without involvement in the process of neighboring;
- redness of the skin above the affected joint;
- swelling or acute pain most often localized in the I metatarsal joint on the foot;
- increase in urate concentration in urine;
- one-sided lesion of the joints of the foot;
- unilateral lesion of the first metatarsophalangeal joint;
- asymmetric swelling above the affected joint;
- detection of subcortical cysts on radiographs;
- does not reveal flora in the joint fluid.
Despite a large number of the symptoms listed above, the greatest diagnostic value is still possessed: the detection of urates in the synovial fluid, gouty attacks in the anamnesis and the detection of tofus. As a rule, these three manifestations are sufficient for the conclusion that this patient is ill with gout.
As can be seen from the above described clinical picture, the most characteristic for gout is the defeat of the joints on the legs, namely, the I-flat-phalanx joint.
Treatment of gout
Given the poly-physiology and variety of manifestations of gout, the approach to its treatment should also be comprehensive, taking into account all the pathological processes that develop with this disease.
In connection with this, the following mandatory directions are distinguished in the treatment of gout:
Treatment of gout
Coping with a painful attack( with exacerbation of gout, or, so-called "gouty attack");
- Achieving a stable remission and preventing new exacerbations of the disease;
- Recurrence of complications of the disease associated with the deposition of urate in various organs and tissues;
- Treatment of comorbidities aggravating the course of gout( treatment of obesity, hypertriglyceridemia, hypertension)
- Prevention of development of nephrolithiasis due to impaired urate metabolism.
Treatment of manifestations of acute gout with lesions of the Iplusne-phalangeal joint of the foot
Treatment of acute gouty attack, or "gouty attack" has a number of features and it is aimed mainly at arresting the pain syndrome, removal of the inflammatory process in the joint( most often Iom metatarsus phalanxon the foot) and improvement of the general condition of the patient.
For gouty arthritis, colchicine is most often used as an anti-inflammatory drug. This is a proven tool for years that has proven effective in stopping a gout attack.
Colchicine is administered at a dose of 0.5 mg every hour or 1 mg every 2 hours until the symptoms of gout exacerbation subsided. The maximum daily dose of the drug is 6 mg.
In the absence of the effect of the introduction of an hourly total dose of 6 mg, colchicine is canceled and proceeds to the introduction of a drug more powerful in its effect drugs. However, most often this scheme of treatment is effective and brings relief, according to different data, from 75 to 80% of patients.
An unpleasant side effect from the use of this drug are unpleasant manifestations of the gastrointestinal tract( nausea, vomiting, diarrhea).Often the severity of these adverse reactions reaches such a strength that it goes one level with the actual manifestations of gout itself and require separate treatment.
Colchicine can be administered intravenously and orally. With intravenous administration of colchicine, nurses should be extremely cautious, because of non-compliance with the technique of performing colchicine injection, it can enter neighboring vessels and cause severe pain at the site of injection, and subsequently - necrosis. Another unpleasant side effect of colchicine is the development of allopecia, in other words, hair loss, baldness. In high doses colchicine can cause depression of the respiratory center and even death, so doctors should be extremely cautious in prescribing this drug.
Other anti-inflammatory drugs that have shown a good result in stopping gouty attacks are: phenoprofen, indomethacin.
Indomethacin is prescribed at the starting dose of 75 mg, after which the patient is administered an additional 50 mg of the drug every 6 hours before the symptomatology subsides. After the attack managed to stop, the intervals in the administration of the drug are increased to 8 hours. Thus, the patient is administered indomethacin in a maintenance dose of 50 mg every 8 hours. Indomethacin can also quite often, as an adverse event, cause disturbances in the work of the gastrointestinal tract to reduce mood( up to the development of depression).
However, the toxicity of this drug is still significantly lower than colchicine, thereforeindomethacin is the drug of choice for arresting an attack of gouty arthritis.
When colchicine and NSAIDs are ineffective, patients are shown intra-articular injections of glucocorticoids. In this case, drugs containing cranocorticosteroids may be prescribed for oral administration. In this case, you should also be extremely careful with dosages and do not overdo it.
How to treat gout at home
Many patients are supporters of having to treat manifestations of gout on their legs at home. There are a number of folk methods of treating gout. To one of the most effective ways to combat the manifestations of gout at home, one can attribute adherence to diet and the fight against obesity.
Diet for gout
The principle of nutrition for gout is that you should sharply limit the intake of foods that increase the formation of urates in the body during their metabolism. These are products containing purines.
For the most part it is meat and fish. For this reason, a vegetarian diet is recommended for gout. With a sharp restriction of the amount of proteins consumed.
In addition, patients suffering from gout should severely limit the amount of alcohol consumed, as this dramatically increases the likelihood of exacerbation of the disease.
In addition, it should be noted that in recent years, a number of clinical studies have shown that weight loss has a beneficial effect on the development of remission and contributes to reducing episodes of exacerbations in gout.
Based on all of the above, it can be concluded that it is extremely important for patients with gout to reconsider their lifestyle. It is not for nothing that gout has long been considered a disease of people prone to lush festivities, overeating and consuming a large amount of alcohol. And despite the fact that at the moment the role of hereditary factors in the formation of this pathology is proved, the values and such factors as healthy nutrition, moderate consumption of alcoholic beverages and spices, physical activity and a mobile way of life should not be diminished.
Folk remedies for the treatment of gout
Widely used to treat gout is also traditional medicine. This is a different kind of ointments, tinctures, decoctions, etc.
Ointments and their use
A. Ointment for the treatment of gout according to the old prescription
This ointment has long been widely used by the Slavs in order to treat gout at home. To prepare the ointment, take the butter and alcohol. Mix the ingredients in a 1: 1 ratio. Then evaporate the alcohol from the mixture - and the ointment is ready!
B. Treatment of gout with iodine
Another well-known folk method that allows treating gout at home is iodine-based compresses. In order to prepare a composition for compresses, mix 10 ml of iodine and 5 tablets of aspirin.
Remember! Before you start to treat gout at home, be sure to consult a doctor! Otherwise, such treatment is not only inefficient, but also dangerous! At the first manifestations of gout symptoms - go for treatment to an experienced doctor.
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Treatment of gout in the period between exacerbations
Between two recurrent exacerbations during a calm period, it is necessary to try to keep the uric acid and purine metabolism products in blood serum normal. Such actions will not allow the development of a second attack and stop the release of uric acid into other organs. In addition, between the exacerbations of gout, the following steps are taken:
- A special diet is prescribed. Protein food is consumed in small quantities, emphasis is placed on dairy products.
- It is recommended that you drink plenty of fluids. The patient should drink up to 2 liters of water per day, this reduces the formation of uric acid and the possibility of the formation of stones in the urinary tract.
- In some cases, medication is prescribed with drugs that reduce the concentration of uric acid in the body, contributing to its rapid elimination. They also reduce its formation in the body. But this method of treatment during a quiet period of the disease is rare, only if there are indications in the form of extensive injuries, surgeries, burns. Also when taking medications that release uric acid, during chemotherapy or when using certain medications.
Attack of Gouty Arthritis: Treatment of
If an exacerbation of gout occurs, all therapies prescribed by the doctor are used. Dietary nutrition, which was prescribed during a moderate course of the disease, is significantly toughened. Those products, in the content of which there is a purine, are excluded from the diet completely. The volume of consumed liquid increases. It is necessary only to follow at this moment for the work of the kidneys. The doctor necessarily prescribes uricosuric drugs that have the effect of accelerated excretion of uric acid. In addition, the patient should take drugs that inhibit the formation of uric acid, anti-inflammatory drugs and painkillers.
If there is an exacerbation of gout, it is best to conduct treatment in a hospital. This is done so that doctors can quickly stop the attack. In addition, all diagnostic methods will be carried out, allowing the appointment of the desired treatment.
All this is very important because gout can be the result of other diseases: from infection of blood to unclear infections.
In case of impossibility or unwillingness of hospital treatment, the following measures should be observed at home:
- Required bed rest.
- The painful limb should be placed above the body level - place a roller under it, etc.
- The area of damage should be treated with Vishnevsky ointment in the form of a compress.
- Abundant fluid intake.
Urologist and rheumatologist are engaged in gout problems. The patient initially gives a general blood test. At the stage of exacerbation, the analysis will show an increased level of uric acid. If the period of remission has come, then the analyzes will show the norm. If gout has become polyarthritis, then x-rays of the joints will be needed. It is possible that after the examination, osteoporosis will be revealed. The next type of examination is puncture of the joint and further examination of the liquid in it. Based on the results of the tests, treatment and prevention measures are prescribed.
Exacerbation of gout: is it so damn devil as he is painted?
"Nothing special. Mrs. Greencourt left for six weeks in Menton, but a few days ago she returned. The major had a gout attack. " S. Maugham. Pies and beer
This disease inspired the writings of writers of the XIX - early XX century: its descriptions are often found in the literature of that period. Apparently, the disease was so common that it was perceived as an integral part of a well-fed life.
From the scientific point of view, gout is a chronic disease, the emergence of which is associated with a violation of metabolic processes, in particular, with a violation of the exchange of purine bases, leading to the accumulation of uric acid in the body. The disease is manifested by attacks of acute synovitis and arthritis, the deposition of salts of uric acid in various organs and tissues.
Why does gout occur?
The etiology of this disease is colorfully described in novels and novels of the XIX century. Lush feasts, abundance of poultry, meat, fatty, fried dishes, pouring wine and beer. Today it is proved that it is the constant use of fatty meat, chicken meat and dry grape wines that leads to a sharp accumulation in the body of urates and exacerbation of gout.
If you dig deeper, the immediate cause of gout is the lack or inadequate activity of the enzymes involved in the metabolism of purines. Along with this, kidney diseases can lead to the development of gout, accompanied by a violation of their function, a delay in the salts of uric acid in the body, the deposition of urate crystals in tissues and the development of gouty inflammation.
Symptoms of gout exacerbation
In eight cases out of ten, gout occurs in the form of acute attacks of arthritis arising from the abuse of fatty foods and alcohol, after hypothermia or joint trauma.
Sometimes the exacerbation of gout is preceded by a short period of prodroma, weaknesses, fatigue, moodiness, nervousness, headaches, fever up to 37.2-37.4 degrees Celsius are precursors of the disease. Already at this stage, there may be vague feelings in the joints in the form of aches, heaviness and blunt pain.
The attack of gout itself begins usually at night, against a background of complete health. In the area of the foot bone of the foot there is a sharp pain, the joint swells quickly, the skin over it stretches, becomes smooth, shiny, hot, red, and then purple-blue. The body temperature rises to 38-39 degrees, the patient is literally paralyzed by pain, but can not stand on foot - the joint is completely immobilized.
In the subacute form of gout affects mainly the joint of the big toe, pain is not strong and changes in the tissues of the joint are not too pronounced.
Rheumatoid gout reminiscent of rheumatoid arthritis, occurs with lesions of small joints of the hand or wrist, but does not involve more than one bone joint.
The phlegmonous form of the disease is difficult. Exacerbation of gout in this case is accompanied by fever, chills, sharply pronounced inflammation of the joint, outwardly reminiscent of purulent tissue melting in infectious arthritis.
There is a periarthritic form of gout, in which the tendons of the muscles adjacent to the joint are affected, for example the heel tendon at the place of attachment to the ankle joint.
Other manifestations of gout
In addition to arthritis, exacerbation of gout may have other symptoms. Accumulation of uric acid salts in the skin 5-6 years after the onset of the disease leads to the formation of tofus - surrounded by connective tissue gouty subcutaneous nodules that are yellowish in color and contain urate crystals. Tofusi are most often located on the back of the forearms, elbows, joints of the fingers and toes, on the hips and legs. They can be found on the auricles, on the forehead, in the area of the cartilaginous septum of the nose.
Exacerbation of gout can lead to liquefaction of the contents of tofus and its release through the fistulas formed on the skin. Unlike usual abscesses, the contents of gouty nodules are not pus, does not contain any microorganisms, since urates possess bactericidal properties.
Almost half of patients with gout suffer from fits of the disease with renal colic, manifested by acute pain in the lumbar region and along the ureter, a violation of urine output and often complicated by pyelonephritis.
What happens next?
The exacerbation of gout, that is, its attack, usually lasts for a short time, sometimes passes during the day, sometimes stretches for 5-10 days. The pain gradually disappears, the swelling of the joint decreases, the skin over it acquires a normal color, the functions of the joint are restored. Over the years, gout is exacerbated more often, light intervals become shorter. In severe cases, gouty status develops - a condition where gout exacerbations continuously replace one another and turn the patient into an invalid.
Repeated inflammation leads to deformation of the joint, limiting its mobility. The disease extends to other articular joints, arthritic polyarthritis arises, resulting in limiting the patient's ability to work.
Gout is a serious illness, and despite the fact that the heroes of the nineteenth century novels were light-minded about short bouts of the illness, the reality turned out to be much grimmer. A third of patients with gout develop gouty nephropathy, resulting in persistent impairment of kidney function and kidney failure and in 40% of cases resulting in death.
Somerset Maugham in The Razor Point described the case of nephropathy with gout: "Elliot has a uricemia attack, and the doctor thinks his condition is heavy. This time the attack has passed, and he is better, but the kidneys are seriously affected and complete recovery is impossible & lt;. .. & gt;his face is flooded with a terrible blue pallor, it gives off a sickening smell, characteristic of his illness. .. He falls into a coma. "
"Foot trap", "disease of kings" is the name of the usual gout in ancient times. This disease is considered the most common type of arthritis, which occurs in middle-aged people. As a rule, men from the age of 40 are suffering from the disease, but a woman may have problems on average after 60 years. It should be noted that the name "trap for the feet," which Hippocrates gave in ancient times, perfectly describes the problem.
Causes of gout
A similar disease is very common, but still some people have no idea what this ailment is and why it arises. And it begins to develop due to the fact that in the human blood there is a large accumulation of hyperuricemia, that is, uric acid. When a large amount of such a substance accumulates, the urinary system simply does not cope with its function and as a result it collects in the kidneys, but more often in the joints of the toes, hands, forming in these places the process of inflammation, which is accompanied by a strong, unbearable pain.
Doctors explain the reasons for the following factors:
- Inadequate nutrition most often gout occurs in people suffering from overweight, diabetes, psoriasis or hypertension;
- hereditary predisposition;
- impaired renal function responsible for removing uric acid from the body;
- pathology of the circulatory system;
- large, even excessive consumption of alcohol;
- reception of individual medical medicines. Such drugs include diuretics, antibiotics;
- quite often gout aggravated for no reason.
Symptoms of the disease
The development of gout goes in several stages. Each of them is accompanied by a certain symptomatology.What kind of pharmaceuticals are among the best antioxidants against aging?
The disease proceeds in this order:
- Asymptomatic hyperuricemia. This stage of the disease flows without any signs of gout. The period can last up to 30 years. In the process, the amount of uric acid increases in the human body. It is necessary to know that only in 20% this leads to an aggravation.
- Acute gouty arthritis.
- Monoarticular gout. An illness is formed in the joint of the big toe.
- Polyarticular gout. At this stage, the pains are felt not in one joint, but in several. Most often in the area of the feet, elbows, wrists, knees and ankle.
Lifestyle changes with gout
When a person is diagnosed with such a condition to ease pain, get rid of all the symptoms, have to completely change the way of life.then it concerns absolutely everything.
Changes occur in the following:
- people get on a diet as a rule, it does not help with the treatment of the disease, but by giving up some products containing purine, the likelihood of a gout attack decreases;
- weight loss special programs help reduce the amount of uric acid. But you need to competently lose weight, in no case you can not starve, as this can provoke an exacerbation;
- refusal of alcohol, fructose people should refuse from these drinks. The best option is to drink a lot of mineral, still water;
- rejection of individual types of shoes in people who have joint pain, you need to limit yourself from their damage. In this case, a close enemy is considered a dangerous enemy;
- reduction in the number of travel or rejection of them. Otherwise, there is a big risk and the probability of an exacerbation of the disease;
- rejection of certain types of medications, for example, from a daily dose of aspirin, diuretics. But only in the event that these drugs do not act against a serious disease.
Recommendations for exacerbation of
Especially painful with this disease is a gouty attack. In order to get acquainted with this process in detail, it is recommended to read the article, it will help you to find out what kind of process it is and what will help us at home.
If nevertheless it was not possible to avoid a gouty attack and severe pain began, follow these recommendations:
- It is necessary to go to bed, limb with sick joints to fix, to ensure her peace. In this case, the diseased leg should be kept in a raised position.
- Take an anti-inflammatory ointment. In this case, you can use inexpensive, but effective Vishnevsky ointment. It is necessary not to place it separately on the diseased area, but together with the compress.
- During the exacerbation it is necessary to increase the amount of water consumed. In this case, you can drink alkaline mineral water, sour freshly squeezed juices or infusions, broths with oats.
- Observe a very strict diet: eat vegetable broths, rare cereals, boiled on the water.
- During an attack, you can independently drink non-steroid medications, such as diclofenac, indomethacin. Such drugs have anti-inflammatory and analgesic effect. But it should be remembered that medications that are designed to stop an attack can not be used without the advice of a doctor.
If you listen to the above recommendations, then the exacerbation will be removed in 2-3 days and specialist assistance will not be required. In the opposite case, if nothing is done, the attack can be prolonged for a longer period.
Gout - Causes, Symptoms and Treatment. MF
Gout is one of the oldest diseases described in medicine. In the 5th century BC, Hippocrates called "gout"( from the Greek words "under" - foot, "agra" - the trap) acute pains in the foot. It was called "the disease of kings and the king of diseases", a disease of aristocrats, even considered a sign of genius. She suffered such famous people as Leonardo da Vinci, Alexander of Macedon, many members of the Medici family from Florence, Isaac Newton, Charles Darwin. And this list is far from complete.
Gout is a disease associated with impaired purine metabolism, which leads to an elevation in the blood of uric acid( hyperuricum) and its deposition in the tissues of the musculoskeletal system and internal organs.
In the human body, purine bases are broken down to uric acid and excreted by the kidneys. When the limit of uric acid concentration in tissues is exceeded, the deposition of its crystals in the form of sodium monoaurate in the joints, kidneys, soft tissues begins. There are clinical manifestations of arthritis( inflammation of the joint), there are formations in soft tissues( tofus), urate nephropathy( kidney damage) and nephrolithiasis( formation of kidney stones).
Changes in dietary habits and lifestyle led to the fact that in industrialized countries, 1-2% of the population suffers from gout.
Causes of gout
1. Drug administration: diuretics( thiazide diuretics), low doses of aspirin( 1 g per day), cyclosporins. Diseases and conditions that lead to the appearance of gout: diabetes, obesity, ischemic heart disease, arterial hypertension, metabolic syndrome, chronic renal failure, lead poisoning, organ transplantation, psoriasis, blood diseases. The intensification of gout is facilitated by intravenous contrast( with radiological examinations), trauma, surgical interventions. The risk of gout is extremely high among people who are in the habit of consuming products containing a large number of purine bases( fatty meats, seafood, alcoholic drinks, carbonated drinks).Gout more often develops in men( age 30-60 years), in women gout develops much less frequently and mainly in the menopausal period.
Symptoms of gout
Acute gouty arthritis begins with the lesion of one joint, most often the thumb of the foot. The emergence of acute arthritis can be preceded by heavy eating, alcohol intake, trauma, and surgical intervention. The disease develops suddenly, early in the morning there is a sharp pain, swelling and redness, the symptoms quickly increase and reach a peak within 24 - 48 hours. The pain becomes severe, patients often can not wear socks or touch a sick joint. Acute gout can be accompanied by an increase in body temperature to 38 degrees. Sharp weakness, general malaise. Even in the absence of treatment, exacerbation of gouty arthritis disappears gradually within 5 to 7 days.
Acute gouty arthritis
As the disease progresses and in the absence of adequate treatment, attacks of arthritis become more frequent and prolonged, new leg joints are involved. There is deformation of the joints due to nodular deposits and bone growths, tofusov.
Tofusi are uric acid crystals that are deposited in the periarticular tissues, are painless, dense nodules of yellowish color. Most often located in the area of the auricles, elbows, ankles, joints of hands and feet.
Gradually appears joint stiffness, which makes it difficult for patients to move. The risk of fractures is high. Each new exacerbation of gouty arthritis significantly worsens the course of the disease, contributes to the rapid development of complications.
In general, uric acid is excreted by the kidneys, the deposition of uric acid salts in the renal pelvis leads to the development of urolithiasis. Departure of stones( stones) is manifested by intense pain in the lumbar region - renal colic.
Diagnosis of gout
1. Biochemical blood test. Detection of hyperuremia: increased uric acid levels in men over 0.42 mmol / l, in women over 0.36 mmol / l. Definitions of the level of the creatinine of the blood - for the detection of renal failure. Investigation of the synovial fluid of the affected joint. When a chemical or microscopic study determine the crystals of uric acid, in the sowing there is no bacterial flora. Radiography of the joints determines changes in chronic gouty arthritis. Kidney ultrasound. Detection of X-ray negative stones( stones).
Radiography of joints - gouty arthritis
Consultation: rheumatologist, nephrologist, surgeon.
Treatment of gout
Dietary recommendations are important for preventing gout exacerbation. This restriction of consumption: meat and fish products, beans, sorrel, spinach, cauliflower, raspberries, figs, chocolate, strong tea, coffee. It is forbidden to drink alcohol, especially wine and beer.
It is recommended to increase the volume of liquid to 2 liters per day, if there are no contraindications. This is cranberry juice, juices, alkaline mineral water. Gradual normalization of body weight is mandatory for the patient, as it helps to reduce the level of uric acid in the blood.
The purpose of drug treatment is to reduce pain during an attack and to treat disorders of purine metabolism.
During an acute attack of gout, the patient is recommended complete rest, especially a sick limb. It should be given an elevated position of the foot, attach a blister to the joint with ice, and after the abatement of pain - a warming compress. For treatment of an attack non-steroidal anti-inflammatory drugs( NSAIDs) are used. The drug, its dose, the frequency of reception, duration is recommended by the attending physician.
To achieve a persistent reduction in uric acid, which prevents the progression of gout, antipodal drugs( alopurinol, sulpharperazone, uralite etc.) are used. These drugs are used for a long time( years).The necessary drug is chosen by the attending physician individually for each patient, depending on the age, concomitant diseases, the level of uric acid in the blood.
In the formation of large tophi, with ulceration of tissues, the presence of fistulas, surgical treatment is recommended - the removal of tofus, since they can no longer dissolve when taking antipodal drugs, and can significantly limit the function of the joints.
Physiotherapy for gout
In an acute period, applications of a dimexide solution on the affected joint are used. It has an analgesic and anti-inflammatory effect. Before the beginning of the procedure, samples for sensitivity to dimexide( the presence of an allergic reaction) are conducted, after 24 hours after the procedure begins procedures. For applications, a 30-50% solution of dimexide is used( dilute pure dimime with boiled water).A napkin soaked in a solution is put on a sick joint. Initially, the duration of the procedure is 10 minutes, later it is increased to 2 hours. In the period of remission apply applications with mud, paraffin, ozocerite, which improves the function of joints, reduces the urate content in them.
In the period of remission, patients are shown sanatorium-and-spa treatment. On the health status of patients, the course of the disease has a beneficial effect of health activities: diet food, intake of alkaline mineral water, balneotherapy, mud therapy.
Phytotherapy for gout
In complex treatment with diet and antidotal drugs, phytotherapy is used. Infusion of leaves of cranberries( 1/2 glasses 3 times a day).Infusion of leaves of black currant( ½ cup 4-5 times a day).Infusion is prepared: 1 tablespoon of dry leaves for 500ml of boiling water, 2 hours, drain. Apply the fruits of blueberries.
Diet for gout
From the diet it is necessary to exclude or minimize foods and dishes containing large quantities of purines, since purines form uric acid.
Foods that need to be excluded: liver, kidneys, brains, lungs, meat of young animals, chickens, meat and fish broths. A patient with gout should refuse to take alcohol, as it inhibits the excretion of uric acid by the kidneys and thus helps to increase its concentration in the blood.
Foods that need to be restricted: beans( beans, peas, beans), sorrel, spinach, eggplant, radish, cauliflower, asparagus, mushrooms, crustaceans, caviar, fish( Baltic herring, sardines, etc.).Large fish are allowed.
The need for calories for gout should be met mainly by carbohydrates. In small quantities, the diet can contain eggs, flour and cereal dishes, low-fat fish, beef, lamb. Fish and meat dishes should be eaten in boiled form, not more often 2-3 times a week. One portion should not be more than 250 g. During an attack of arthritis, fish and meat must be completely ruled out. Food should contain the necessary amount of vitamins, so the broths of dogrose, lemons, apples, black currants are useful. Without restrictions, you can consume milk and dairy products, cereals( bread, cereals, bran), most vegetables( potatoes, carrots, cabbage, cucumbers, tomatoes, pumpkin, onions, carrots, beets, radish, celery), nuts, watermelons, melons,berries and fruits, spices. It is known that cherries, strawberries, currants and other dark red and blue berries reduce the concentration of uric acid in the blood, so are useful for gout in any form. In the absence of diseases of the kidneys and the heart, an abundant alkaline drink( 2-2.5 liters per day) is necessary, fruit and berry compotes, alkaline mineral water, are suitable for this purpose.
Prevention of gout
Patients suffering from gout are observed by a rheumatologist and a therapist( family doctor).Twice a year, they undergo a comprehensive examination( determination of the level of uric acid, creatinine).Kidney ultrasound and joint radiography are performed once a year.
Complications of gout
Early abnormalities of purine metabolism are reversible, provided timely diagnosis and treatment, but at the stage of chronic gout with organ damage( heart, brain, kidneys) the disease forecast is unfavorable. Kidney damage develops in 30-50% of patients with gout. With persistent increase in the level of uric acid in each 4 patients with gout develops chronic renal failure.
Consultation of a doctor on gout
Question: Why does an antidepressant drug get worse? Answer: At the beginning of treatment with antipodal drugs( more often allopurinol), acute gouty arthritis can occur due to the excretion of uric acid from the tissue depots of the body. Therefore, in order to prevent, it is necessary to prescribe simultaneously NSAIDs.
Question: How long should I take antipodal drugs if the level of uric acid is normal? Answer: Antipodal drugs are taken within a year, after which you can take a break for 2 months( with normal uric acid in your blood), provided that you follow a diet.
Doctors therapist Vostrenkova I.N.# 4Anna13.02.2016 17: 31 can the use of paracetamol lead to an exacerbation of gout?. . edema on the legs do not pass for the third month, that is, the swelling of the legs decreases, and then again appear. Accept allopurinol and NSAIDs # 3andrey07.11.2015 03: 28All medications prescribed by doctors cause changes in the human body: Peasants become impotent and look like women, women, they have breasts, they stop shaving, hangs lower abdomen and pubis. What kind of life is this? !Nothing good. But you can help! There are mechanisms triggering the disease in the opposite direction. Write. I'll try to tell. I myself am ill with this disease.# 2 for Victorians 01.14.2015 11:26 I have severe pains of 15 years suddenly can not stand upright 6 years of them missing the coccyx of the spine at this moment, too, and I'm saved by prayer, it calms the body and I apply gel for horses long ago and recentlybegan to take Chinese little green pills from ortrrose super all obezbalivaet # 1Raisa 09.05.2014 15: 53also 6 months as a bone appeared near the thumb on my left foot now something strongly began to hurt please tell me how you can treat at home, the tests showedall normal