Gout - symptoms, treatment, photos, diet for gout
To the causes of the disease also include malnutrition( with a predominance in the diet saturated with purine products), excess weight, endocrine disorders in the body, certain pathologies of the circulatory system. Provoke another attack of gout can use alcohol, taking certain medications( antibiotics, diuretics), but most often the disease worsens without any specific reason, usually at night.
Symptoms of gout
Initially, the disease affects the large joints of the lower extremities, in the first place the toes suffer. Gout on the legs is a common occurrence in the life of an elderly person who, in his youth, abuses alcohol and neglects his food. The disease begins with an inflammation of the joint of the big toe. The so-called gouty arthritis is accompanied by:
- increase in joint size;
- severe pain in the site of inflammation localization;
- by local body temperature increase;
- redness covering the diseased joint of the skin.
The first attack of gout is usually short-lived, in the absence of treatment passes within a week. The second such attack can occur several years later, more rarely - decades. Such signs of gout as joint deformity, proliferation of its tissues are noted with the advanced form of the disease. To change the appearance of the joint leads to the gradual accumulation in it of salts of uric acid. In particularly neglected cases, gout becomes the cause of the patient's disability.
Treatment of gout
The basis of therapy is a special diet, aimed at reducing the diet of patients with saturated with purine products. Medications prescribed during the period of gout exacerbation help to alleviate the patient's condition, reduce the risk of complications. To eliminate the symptoms of arthritis, anti-inflammatory( nonsteroidal) drugs( Colchicine) are shown, with severe pain, pain medications.
The drugs prescribed for the treatment of gout include Uralit and Allopurinol, which help to reduce the level of uric acid in the blood by its natural excretion from the body. Regular reception of these funds allows to avoid exacerbations of the disease in the future.
Sick mud baths, applications with Dimexide are recommended for patients with acute gout. With severe deformation of the joints, surgical intervention is performed.
Treatment of gout with folk remedies
Traditional medicine in this case can be used as an auxiliary therapy. Such therapy gives, as a rule, very good results. Elimination of severe joint pain is promoted by compresses from cabbage leaves. Leaves are thoroughly washed with warm water, dried and applied to the sore spot for the night, from above covered with bandage or gauze. Long-term use of this tool( daily, for a month) helps to reduce the risk of an attack in the future.
Also folk medicine recommends in the therapy of gout to use dogrose, garlic, ginger, baking soda, decoctions of medicinal herbs( chamomile, marigold, St. John's wort, turns).Decoctions in this case can be used not only as a compress to a sore spot, but also as a drink.
gout Patients with a similar diagnosis should take a more careful look at their diet, in particular to exclude purine-saturated foods from the diet, since uric acid deposited in the joints and provoking their inflammation is a derivative of these compounds. Nutrition for gout should be organized in such a way that the body does not suffer from the lack of some of the usual food for him. For example, fat red meat should be replaced with boiled chicken breast, white bread - bran, etc.
The diet should be observed for a long time. Otherwise, the risk of gout and progression of the disease increases.
What can not be eaten with a gout
With gout, you should stop using:
- fatty meat;
- by-products( kidney, liver, language of farm animals);
- of red fish;
- of sweet carbonated water.
There are products, the use of which is acceptable, but not desirable. Chicken eggs, boiled lean meat, bread, mushrooms, cereals, peas, and beans are allowed in small quantities.
What you can eat with gout
The daily ration includes:
- vegetables. It is desirable in a boiled form, steamed, baked in the oven with a small addition of salt;
- dairy products;
- berries, mainly currants of different varieties, watermelons;
- bran, bread from bran;
- nuts, fruits and dried fruits;
- mineral water.
There are products that reduce the level of uric acid in the blood. It is primarily red and black currants, strawberries, raspberries. Also recommended for use are morsels, broths from currant leaves, dried raspberries.
Drug for gout
Drugs designed to fight gout, a lot, they all have a similar effect - reduce the level of uric acid in the blood of a person.
Traditionally, allopurinol is prescribed in the form of tablets. The drug interferes with the synthesis of uric acid in the body, contributing to the development of the enzyme xanthine oxidase, removes from it the already existing deposits of salts with urine. The drug is not contraindicated in the presence of kidney diseases, it is recommended for the prevention of gout in elderly people. Among its side effects, the greatest danger to the body is a violation of liver function and an increase in the level of sugar in the blood, but such effects in case of proper administration of the medication, as a rule, do not arise.
In the presence of significant deposits of salts of uric acid in joints, the use of drugs Solimok, Ortophen, Indomethacin( with a pronounced pain syndrome and inflammation of the joints) is indicated.
Ointment from gout
Local preparations for gout give a good therapeutic effect, their use helps to eliminate the pain symptom, reduce the inflammatory process in the patient's joint, facilitate the general condition of the patient.
In the treatment of inflammatory diseases of the joints, a 2% Diclofenac ointment based on the active ingredient diclofenac sodium is widely used. The product has a slight anti-inflammatory effect, quickly eliminates pain, is recommended for use in exacerbating gout.
A similar action is possessed by the ointment Fullflex. It is worth remembering that such drugs are struggling with the manifestations of gout, but in no way hamper the progression of the disease, and therefore, as the main remedy can not be appointed.
Prevention of gout
Prevention of disease can be considered correct nutrition in youth, not abuse of alcohol, especially after 40 years. Individuals who have already been diagnosed with the same condition must be constantly under the control of specialists, regularly undergo an examination of the body. In half the cases, the neglected form of the disease leads to complications from the excretory system( renal dysfunction) and disability.
Gout: signs, treatment, symptoms, photo
Gout is a rheumatic pathology caused by the formation of uric acid salts in the joints. The signs and treatment of this disease are very detailed in our material. Disease is one of the most common types of arthritis and occurs more often in middle-aged men.
What is this disease? Gout is a chronic disease associated with a violation of uric acid metabolism, in which uric acid salts, still known as urate, are deposited in the joints.
Pathology is otherwise called "disease of kings", an ancient disease that was already known in the time of Hippocrates. Gout in the past was 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.
In our time, according to epidemiological studies conducted in Europe and the United States in recent years, up to 2% of the adult population has become gouty, and among men aged 55-64 the incidence is 4.3-6.1%.
The first signs of gout are characterized by a sharp onset with the appearance of severe soreness, redness and stiffness in the joints. Most often there is gout on the big toe, which should be treated immediately. The main recommendations for reducing the symptoms of chronic gout are adherence to treatment and lifestyle. This article on gout, symptoms and treatment of this disease, we will try to consider in detail today.
What is it? The cause of gout is the deposition of crystals of uric acid( urates) in the cartilaginous tissue of the joint. Their accumulation leads to inflammation, accompanied by severe pain. Sodium urate crystallizes and is deposited in the joints by small particles, which in the end results in complete or partial destruction of the joints.
- Abuse of certain medicines: aspirin, diuretic diuretics, cyclosporins.
- Presence of conditions and diseases in the form of diabetes, coronary heart disease, obesity.
- The use of fatty varieties of meat, seafood, carbonated and alcoholic beverages in no small degree contribute to the accumulation of purines in the body.
- The disease is more affected by men aged 30-50 years.
Gout attacks can be triggered by stressful reactions to alcohol, citrus, viral infections, physical or mental stress, trauma and hypothermia, bruises, pressure fluctuations, taking medications. At the first attack of gout, the signs are very distinct, and the treatment should be started as soon as possible in order to relieve the pain.
There are three types of disease: metabolic, renal and mixed.
- Metabolic form with the highest amount of uric acid.
- Renal form, moderate amount of uric acid with increasing salts,
- With mixed type, reduced or normal ura- tria and normal clearance are possible.
The diagnosis is made by a rheumatologist when the patient is examined and questioned. Laboratory diagnostics are also used: in a biochemical blood test, a high content of uric acid is detected.
Symptoms of gout
Arthritis of joints of lower extremities is usually observed. Often the inflammatory process involves the big toe, then the frequency of the ankle and knee joints. Less common arthritis of small joints of the hands and elbows.
With gout, the symptoms develop during an attack - it's a pain that develops fast enough, and reaches the highest sensation in just a couple of hours. Attacks happen more at night or early in the morning.
A person is not able not only to move his foot, but even a light touch of the sheet to the affected joint causes unbearable torment. The joint swells swiftly, the skin feels hot and feels red in the joint. Probably an increase in body temperature.
After 3-10 days, the attack of gout subsides with the disappearance of all signs and normalization of functions. A repeated attack happens, as a rule, three months after the first, or the disease does not manifest itself for two decades.
Chronic gout is characterized by the fact that seizures become more frequent, and intervals without symptoms are shorter.
Hyperuricemia and accumulation of urate salts with gout leads to their deposition in the kidneys with the development of:
- gouty nephritis;
- arterial hypertension followed by a transition to chronic renal failure.
In 40% of adults there is a development of urolithiasis with renal colic at the height of a gout attack, complications in the form of pyelonephritis. To avoid the effects of gout on your legs, how to treat ailment should be puzzled at once.
Treatment of acute attack
Treatment of gout involves the gradual implementation of several stages of therapy. First of all, it is very important to remove acute symptoms of the disease. Further treatment is aimed at preventing the worsening of gout symptoms in the future.
In case of a gout attack, it is necessary to provide sufficient rest for the affected joints and try to injure the joint as little as possible with clothing or shoes. In the case of intolerable pain, you can apply ice. Then it is desirable to make a compress on a sore spot with Vishnevsky ointment or dimexide.
For the relief of acute gout symptoms, doctors recommend taking colchicine or nimesil, as well as NSAIDs - diclofenac, butadione, indomethacin, naproxen. How to treat gout on the legs should be decided by the doctor, he prescribes the necessary drugs, prompts the scheme of reception and warns about side effects.
In the use of food, it is better to limit yourself, you can use liquid porridge and vegetable broth. It is recommended to drink enough water, green tea, you can also kissels, milk, mineral or plain water, but with the addition of lemon juice.
Treatment of gout
With gout, treatment is prescribed individually and includes medications, physiotherapy methods and diet. It is necessary to take into account all the side effects of drugs in the presence of other diseases, therefore, constant medical supervision is necessary.
The basis of therapy is a special diet, aimed at reducing the diet of patients with saturated with purine products. If the patient can adhere to the prescribed diet therapy, then the formed cones on the joints will begin to disappear, and the body will recover.
The diet should include dishes boiled in water or cooked for a couple. Salt should be almost eliminated. Also contraindicated are fish and meat broths, cold meat. It is recommended the use of a large number of vegetables. They should be taken in raw form, for a variety of menus you can sometimes bake them or boil them.
To reduce the level of uric acid, antidotal drugs( sulphinperazone, alopurinol, uralite and others) are used. In combination with physiotherapy and medical products, phytotherapy is also used. Gout should be treated by a doctor, he will say exactly what can be used at home to get rid of the disease.
In order to cure gout at home and reduce the number of seizures, it is necessary to limit the consumption of food to a minimum, the cleavage of which generates a significant amount of uric acid: liver, beef tongue, mushrooms, sardines, fish caviar, beans, peas, beer. It is necessary to drink a lot of liquid - up to three liters a day.
Diet for gout
Patients with a similar diagnosis should be more attentive to their diet, in particular to exclude from the diet saturated with purine products. Here it is important to note that it is necessary to exclude both overeating and fasting, besides, one should not allow a sharp decrease in weight, this can lead to an exacerbation of the disease.
How to treat gout at home? The most correct diet for gout involves switching to a vegetarian diet or diet number 6.
It is desirable to eat:
- Vegetables, preferably in boiled form, steamed, baked in the oven with a little salt;
- dairy products;
- berries, mainly currants of different varieties, watermelons;
- bran, bread from bran;
Gout disease, or what is the best diet for gout and obesity
Cope with gout is possible only in case of rapid response and use of proper treatment. Unfortunately, not always this disease is correctly recognized. In turn, this significantly slows the beginning of the appropriate treatment, which leads to an increase in the duration of the disease state.
The correct diagnosis facilitates the treatment of gout, which must be based, first of all, on an accurate and in-depth examination by a doctor. It may happen that the symptoms are caused as a result of complications of another disease. For example, it can be:
- obesity( Note: when talking about obesity, we do not mean overweight, which can be combated by exercises and diet, and the disease requiring treatment due to a slowing of metabolism);
- infection or chronic kidney disease.
In addition, during such a survey it will be necessary to identify whether the gout is hereditary. This is extremely important for choosing the method of treatment. Laboratory studies are also of great importance for the final diagnosis. They must prove the presence of sodium monoaurate crystals in the synovial fluid( natural lubrication of the joints) and determine the level of uric acid in the serum.
So, the diagnosis of a disease like gout is a complicated process. However, in time to implement it, you can quickly get the expected results and get rid of unpleasant consequences. Only on the basis of the correct diagnosis, the doctor can apply the appropriate method of treatment.
Antipurin diet for gout
This name was given to this diet because of the chemicals - purines. They are largely responsible for the formation of crystals of sodium monouroate, which, with poor metabolism, causes gout. Regardless of which treatment method has been chosen, people suffering from gout should pay high priority to proper nutrition.
1. Diet for gout and obesity should be based on the complete elimination of salt, which retains water in the body, which contributes to the further development of the disease.
2. Do not eat stewed, baked or fried foods.
3. This diet involves consuming up to 3 liters of fluid per day. The most useful are: herbal and fruit teas, barley coffee, very weak tea and mineral water still.
4. Habitual tea, cocoa and coffee should always be excluded, as well as:
- grapes and all products from it( including wine, cognac, juice and so on);
- red apples;
- soups and broths cooked on meat;
- fried or smoked fish and meat;
5. Diet for gout and obesity also involves a high intake of fiber, which regulates metabolism in the body, and carbohydrates contribute to the removal of excess uric acid. Various cereals are rich in fiber, from which you can cook porridge: oatmeal, buckwheat and so on.
6. It is also necessary to include milk and low-fat dairy products in your menu.
7. Fruits such as cherries, cherries, apples( green), pears, currants and vegetables: "beets, onions, horseradish, tomatoes and cucumbers act as" allies "in the fight against this disease.
Phytotherapy and gout
The healing properties of plants have been known since ancient times. The first notes on this subject were left by the ancient Sumerians. Currently, phytotherapy is increasingly used to combat various diseases. It is based on the use of whole plants or parts of them, in order to effectively get rid of certain diseases.
If the observed symptoms are confirmed and, indeed, gout is detected, then it will be necessary to take the appropriate course. Typically, it is based on the admission of patients with certain drugs that contribute to the elimination of the inflammatory process and reduce the level of uric acid. Given that the use of herbs has a more gentle effect on the body than tablets and other medicines, it is understandable why many prefer it is phytotherapy.
To eliminate the causes of gout use: grass horsetail, juniper leaves, birch leaves, St. John's wort, lily of the valley. These herbs can be obtained separately or as special herbal mixtures. The latter accelerate and intensify the action due to properly selected components.
Summary of the
In summary, gout is a rather unpleasant disease, the main symptom of which is severe inflammation and sharp stitching pains in the joints. To cure this disease quickly and without consequences, besides traditional methods of treatment, it is necessary to use the gifts of nature and necessarily proper nutrition. The anti-purine diet itself in gout eliminates many unpleasant symptoms, having a general positive effect on the human body.
Gout on legs: symptoms, causes, treatment, diet for gout
Gout is a disease that occurs as a result of impaired purine metabolism, which are involved in the process of creating DNA.As a result, the blood levels of uric acid increase( hyperureukemia).Uric acid begins to be deposited in the tissues of the musculoskeletal system and in internal organs. Due to this, there is a restriction in the movements, and acute attacks of pain occur.
Causes of gout
Affects gout predominantly men!
- The use of certain medicines: aspirin, diuretic diuretics, cyclosporins.
- Presence of conditions and diseases in the form of diabetes mellitus, coronary heart disease, obesity, blood diseases, organ transplantation, psoriasis, chronic renal failure, metabolic syndrome, lead poisoning. Exacerbations of gout cause trauma and surgical intervention.
- People who eat foods with a high content of purine bases are at risk of developing the disease. The use of fatty varieties of meat, seafood, carbonated and alcoholic beverages in no small degree contribute to the accumulation of purines in the body.
- Strikes gout predominantly in men between the ages of thirty and fifty, but recently women are affected, most often during the menopause.
- A significant role in the occurrence of gout is heredity. If the right lifestyle and healthy diet are observed, the disease can be preserved in a latent, latent form, but in case of adverse effects, its development begins.
There are two forms of gout: primary and secondary .The primary form arises independently as a result of the accumulation of purines. Secondary - as a consequence of other diseases and taking medications.
Symptoms of gout
The manifestation of gout is expressed in seven different stages. Each of these stages has its own symptoms:
There are seven stages in the development of the gout
Acute gout. The most frequent attacks of acute gout occur at night. The main symptoms: weakness in the arms and legs, trembling, arthralgia, headaches, subfebrile condition. The joint of the metatarsal phalanx of the thumb on the leg swells, the skin of the finger assumes a bluish-red color, becomes shiny and firm. In the joint of the toe, there is a sharp pain. The finger loses its motor ability. The body temperature rises to thirty-eight degrees. The onset of pain and seizures continues for three to ten days. Then comes the period of calm from one month to two years. At this time gout on the legs may not manifest itself.
Subacute gout. Basically manifested as a monoarthritis - a disease of one joint. Most often there is gout on the toes. Pain is expressed in a weak form. Basically, gout on the big toe is localized.
Rheumatoid gout. The defeat of various joints and the appearance of painful attacks, lasting for hours or days. Often there is gout of the knee, expressed by a constant aching pain.
Pseudophlegnoma gout. Expressed in mono-displays of arthritis. The attack is susceptible to any joint and surrounding tissues. The body temperature reaches thirty-eight degrees. In addition, there is inflammation of the patient joint, fever, leukocytosis.
Gout by type of allergic infectious polyarthritis. Quite a rare form of gout. Manifestations are similar to manifestations of polyarthritis, but the pain does not have a clear location and arises in different joints. And the inflammation manifests very quickly and have a bright crimson color.
Malosymptomatic gout stage. With a similar manifestation, the joint becomes inflamed, but the pain syndrome is almost not felt. Often the manifestation of gout begins with an inflammation of the bones on the legs.
Arthritic gout. With the arthritic form of gout, the pain concentrates in the tendons, especially the pain covers the heel tendon. It becomes denser and increases in size. In the absence of treatment, chronic polyarthritis develops with gouty manifestations. With arterial shape, the joints and muscles of the legs deform. The pain syndrome is initially manifested by attacks, then goes into a chronic form.
Symptoms of chronic gout form are tofusi - visible solid nodes in the joints. They appear after five years of the disease. Gouty attacks can be associated with kidney disease. This greatly increases the pressure and a severe headache occurs. The contrast between the healthy tissue and the tissue affected by the disease is particularly clear.
Treatment of gout
Tofusi - visible solid nodes in joints
Drug treatment of gout on the legs is to stop the pain syndrome and restore the purine metabolism. In case of an acute attack of gout, the patient must comply with bed rest and complete rest. The patient's leg should be placed on a hill and ice is applied, after the pain is reduced, a warming compress is applied. When treating seizures, non-steroidal anti-inflammatory drugs are used. The drug and the recommended dose is prescribed by a doctor.
To reduce the level of uric acid, antidotal drugs( sulfin-perazone, alopurinol, uralite and others) are used. How to treat gout on the legs should decide the doctor. The drug is chosen by a doctor and is used for many years.
When tofusov emerges surgical treatment to remove them. This is due to the fact that the tofus formed can not dissolve during drug treatment and severely limit the motor ability of the joints.
As applications for physiotherapy, applications from a dimexide solution are used. They relieve pain in acute attacks and have an anti-inflammatory effect. In the absence of pronounced attacks, applications of ozocerite, paraffin, and therapeutic mud are used. This greatly improves the function of patients with joints and reduces the number of urates. Good results are obtained by the intake of mineral-alkaline waters, mud therapy, balneotherapy.
In combination with physiotherapy and medical products, phytotherapy is also used. A wonderful effect gives the use inside of infusions of cowberry or black currant and blueberries.
Diet for gout
Of great importance is nutrition for gout legs. When treating any form of gout on the legs, strict adherence to the diet is necessary. From the daily diet should be excluded products with a high content of purines.
Products requiring exception: lungs, liver, brains, kidneys, young meat and chicken meat, fish and meat broths, alcoholic and carbonated drinks.
Restricted products: fish, crustaceans, caviar, cauliflower, radish, mushrooms, asparagus, beans, spinach, sorrel, eggplant.
The intake of calories in the body should be provided by consumption of carbohydrates. You can eat small amounts of cereals and flour dishes, eggs, beef, lamb, lean fish. At the same time meat and fish are used in boiled form, no more than three times a week in the amount of two hundred and fifty grams per serving. To maintain the vitamin balance is recommended reception of broths from lemon, dogrose, apples, black currant.
With gout, you can without limit use of dairy and cereal products, vegetables, fruits and berries, nuts, melons, watermelons, spices.
In addition to adherence to the diet, drinking is necessary. Gout requires an abundance of alkaline drink. To do this, a variety of berry and fruit compotes or mineral water with a high content of alkali.
With timely detection of the disease and timely on-going comprehensive treatment, gout is treated quite successfully. The main thing with the slightest symptoms of gout is to consult a qualified specialist who knows how to cure gout on his legs correctly, and exactly follow the recommendations for taking medications and changing the diet.
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Gout: photos, symptoms and treatment of gout in men and women
Gout is a systemic disease that affects the entire body, a disease in which crystals of the salt of uric acid - sodium monourate are deposited in various tissues. In this case( in the presence of provoking factors) in patients with elevated levels of uric acid in the blood serum inflammation of the joints develops.
Who is the most affected with gout?
It is believed that the classic portrait of a patient with gout is a large middle-aged man, wealthy enough to regularly eat good red wine and young meat. I remember English kings and dukes, our compatriots - the emperors Peter I and Anna Ioannovna. But research convincingly proves: the incidence of gout is determined not only by the diet and well-being of patients. It is estimated that at least 3% of the adult population of the world suffer from this ailment. What is true, then the truth: men suffer from gout at times more often: one woman receiving treatment for gout, there are 7 men with this disease. The disease begins in men much earlier: at the 40-year limit, while the peak incidence of gout among women falls to the age of over 60 years. It is believed that this is due to the natural level of hormones that promote the excretion of uric acid from the body, and protect the female body from a variety of different troubles.
The main cause of gout
It has long been determined that the main cause of gout is hyperuricemia - an increase in the level of uric acid in the serum. This happens if: the
- patient has an increased body weight. As is known, the causes of obesity( leading to an increase in the level of uric acid) - is a change in the composition of food and nutrition culture, with the ubiquitous "dominance" of simple carbohydrates, sweet drinks, the predominance of sedentary lifestyles;
- concomitant diagnosis - hypertensive disease;
- , the patient suffers from a disease accompanied by hyperuricemia( eg, psoriasis);
- the patient often takes alcohol;
- has a genetic predisposition to increased production of uric acid or a reduced rate of its excretion( such conditions are rare and usually occur at a young age - up to 30 years);
- , the patient "abuses" products containing a large number of compounds and precursors of salts of uric acid. Traditionally, they include, in addition to "red" meat( beef, veal, lamb, rabbit), and also by-products( liver, kidneys, heart, tongue) and broths from them. From fish products, tuna, anchovies, trout, squid, mussels and herring fall into the "risk zone", turkey and goose from poultry. Dangerous in terms of development of gout, all kinds of smoked meat, sausages, sausage, ham, eggs, especially fried. Not at all harmless are all legumes, whole grains, mushrooms, cauliflower, spinach, asparagus, coffee, chocolate, and even, according to some authors, ice cream and pastries. Old doctors called gout - "disease of kings", "disease of abundance";
- in connection with concomitant diseases prescribed medications that have the side effect of increasing the concentration of uric acid. Determine whether the drug increases the level of uric acid, it is quite simple: just look at the instructions for the use of the drug. More often than others, hyperuricemia is caused by anticancer drugs, diuretics( diuretics) and beta-blockers( a group of drugs used to treat hypertension).If the patient receives treatment from an oncologist, then drugs aimed at reducing uric acid are usually prescribed "automatically", and the development of gout in this group of patients can be avoided. With the rest of the drugs, things are much more complicated. One of the most "popular" among domestic therapists diuretics is furosemide. This drug acts quickly and powerfully, producing a diuretic effect, in connection with which its appointment for a long period is not recommended. Nevertheless, it is not uncommon for patients to take furosemide for several months or even years, as prescribed by the therapist or, more often, at their own will. Against the backdrop of this "treatment" gout develops with characteristic signs and possible rather serious complications.
A little more about uric acid
If the concentration of this substance in the blood exceeds the permissible limits( more than 320 μmol / l), a complex chemical reaction is triggered, and crystals begin to form from the acid, in the people they are also called "sand".It is these crystals, deposited in the joints, skin cells and other organs, and cause gout - "disease of kings".
What happens in the joint?
Pain in the joints arises not so much from the "mechanical trauma" of the crystals of the surrounding tissues as from the penetration into the joint and the production of a large number of "inflammatory substances" directly in it. That is, the cause of pain in gouty attacks is not mechanical( acute crystals), but chemical( irritants).Attracted by "inflammatory substances"( they are called mediators of inflammation), immune cells penetrate into the joint, which, on the one hand, produce even more mediators; on the other, they begin to destroy their own joint structures, accepting them for "attacking foreign agents."This is a brief description of the development of an autoimmune reaction in gouty arthritis.
Classification of gout
Currently, it is common to distinguish acute gouty arthritis, interictal period and chronic gout.
1. Acute gouty arthritis
This is the main clinical, that is, visible to the eye, the manifestation of gout. It is believed that acute gouty arthritis, or gouty - one of the most painful conditions in rheumatology. Symptoms of a gouty attack are so vivid that they were at one time the inspirers of artists to create masterpieces that survived the centuries. Pain in gouty attacks occurs at night or in the early hours, and is so strong that the patient is not able not only to move his foot, but even a slight touch of the sheet causes unbearable anguish. Without treatment, acute gouty arthritis lasts no more than 10 days, but in almost 100% of cases, patients still seek medical help. Most often, patients get to see surgeons complaining of pain similar to drilling, raspryaniyu, burning in the first( large) toe, and the classic "folk" painkillers like analgin to the patient does not help. Trying to take a warm foot bath only intensifies the suffering.
In search of an effective analgesic, both patients and surgeons are often able to make a lot of mistakes, starting with the appointment of unimaginable combinations of analgesics in huge doses, ending with the use of antibiotics and local( cutaneous) agents( gels, ointments) - ineffective, but costly. True gout in everyday practice is not so common, but many doctors have the idea that allopurinol is treated with this ailment( we will talk about this a little later).But the fact that it is absolutely impossible to prescribe allopurinol in the acute period of the disease is usually forgotten. Moreover, allopurinol is able to aggravate the course of a gouty attack, and if the patient has already taken this drug at the time of exacerbation, it should be abolished as soon as possible for the entire "painful" period.
Another common mistake in treating an acute gouty attack is the patient's refusal to eat. As is known, most often the "gouty attack" is provoked precisely by the error in the diet. In search of relief, the patient is ready to switch to "bread and water", or even starve, just to get rid of the pain. This is fundamentally wrong, and can adversely affect both the general condition of the patient, and the work of the kidneys, the heart.
Wishing to save the patient from suffering as soon as possible, physicians often prescribe physiotherapy( UHF, magnetotherapy, thermal procedures), without considering the almost total uselessness, and sometimes the harm of such tactics during the attack.
2. Interictal period of the disease
Gout leads to an attack on the body gradually. It is a mistake to believe that this problem is limited to joints. Urat crystals - the smallest needles - are deposited in many organs, primarily in the kidneys, forming stones, disrupting the work of these vital organs. The patient may be disturbed by renal colic, manifested by pain in the lower back, abdominal pain, vomiting, pain and rezi when urinating. Sometimes the severity of the pain is such that it requires hospitalization, or surgery to remove the stones. With insufficient treatment and accumulation of uric acid and its salts, the disease goes so far that the heart is affected, with the development of heart failure.
3. Chronic tofusnaya gout
Tofusi are soft formations, tubercles, "bumps", filled with urate crystals. Most often, the tofus are located on the back( external) surface of the fingers, the auricle, elbows, knees. But tophi can be hidden, that is, located inside the body: in the region of the joints, for example. Such "depots" of crystals can not be seen without additional methods of examination - radiography and ultrasound.
Diagnosis of gout
The diagnosis of gout is based on three pillars: examining the patient and talking to him, laboratory and instrumental methods of research.
A classic picture of a gouty attack - painful at feeling, red sometimes to blue, hot, swollen large( first) toe. The patient may notice an increase in body temperature, chills. Almost half the time, the first gouty attack becomes the last, but in the remaining 50% of cases the course of the disease becomes chronic. With such a long process and repeated attacks, there are problems from other joints: the thumb of the second leg, the ankle, knee joints, the joints of the brushes. The polyarthritis( inflammation of many joints) develops.
It is interesting that in recent years there has been an increasing departure from this classic picture, so juicy described in the literature. Increasingly, gout occurs with an initially large number of affected joints. In addition, over the past 20 years, many patients have gout from the first days of a protracted nature, the exacerbation of the disease again and again, and the pain is still intense, regardless of the number of seizures.
The blood test is general clinical ( mainly an increase in the rate of erythrocyte sedimentation( ESR) - a sign of inflammation and an increase in the level of leukocytes) and biochemical( an increase in uric acid is detected, and signs of concomitant diseases - diabetes, liver diseases,renal failure and others).It should be remembered that the concentration of uric acid in the blood serum, which is determined by biochemical analysis, at the time of an attack can be normal!
Study of the joint( synovial) fluid .This procedure can be quite unpleasant, but it is as a result of an articular puncture( puncture) that the doctor will be able to obtain with sufficient accuracy the answer to the question: "What exactly happened?" The joint puncture significantly alleviates the patient's condition, because, firstly, from the jointremoves excess fluid, causing a sense of pressure from within and containing a large number of "inflammatory substances."Secondly, in the articular cavity, in the absence of contraindications, a medicinal preparation that rapidly removes signs of inflammation is introduced. The resulting liquid is collected in a test tube and sent to a laboratory for analysis and microscopy. If crystals of monoaurate of sodium of characteristic sizes and shapes are found, the diagnosis can be considered "in the pocket".
Analysis of the contents of the tofus .If there are soft formations accessible for examination and taking material( like bubbles or warts), usually a rheumatologist tries to get their contents for analysis. When viewed with the naked eye, what stands out from tofus, resembles cottage cheese remotely, and with microscopy the same crystals are found as in the synovial fluid.
Radiography .The radiologist can answer the following questions: are we dealing with a gout? If so, how far did the disease go? Is there another pathology of the joints, against which gout was played?
Ultrasound examination of joints .In the case of gout, this is a much less informative way than radiography. Currently, new methods are being developed that could help determine the presence of deposits of uric acid crystals in the joints. In the meantime, the ultrasound doctor can only determine whether arthritis really does take place, how much fluid is in the joint, and whether we can take it for analysis, whether there are traumatic injuries of soft joint tissues that could "disguise" under a gouty attack.
What diseases can I take for gout?
What other diseases occur according to the scenario similar to gout? Especially this information will be useful to those who are accustomed to making a diagnosis, using directories or information from the Internet.
- septic( purulent) arthritis .This condition can be preceded by any cutaneous or "general" infection, trauma or microtrauma of soft tissues around the joint. Almost always septic arthritis is accompanied by an increase in body temperature. The diagnosis is refined with the help of the same articular puncture, and already by the appearance of the received fluid the doctor will make a preliminary conclusion about the diagnosis.
- pyrophosphate arthropathy ( it will be described below);
- reactive arthritis .This disease is a response to the presence of any pathogens in the body, and is treated, respectively, together - by a rheumatologist and infectious disease specialist.
- rheumatoid arthritis is a chronic autoimmune disease of an unknown nature, affecting mainly women, unlike gout;
- osteoarthritis ( often combined with gout);
- psoriatic arthritis ( inflammation of the joints in combination with skin disease - psoriasis).
Treatment of gout
It is accepted to share non-drug( non-drug) and drug treatment.
Non-pharmacological treatment includes dietotherapy, the use of orthopedic drugs and joint relief, as well as lifestyle adjustments. Not every patient, accustomed to not limiting himself in nutrition, passive leisure, or traveling by private transport, is ready to change habits for his own health. And, nevertheless, it is extremely important to adjust the patient to the implementation of recommendations, which, in fact, are half the success.
Treatment of gout has two main areas: reducing pain during gout and reducing risk or completely preventing new attacks by reducing the deposition of urate salts. To achieve this goal, anti-inflammatory and anti-hyperuricemic( that is, directed against increasing the concentration of uric acid in the blood) are used.
- Non-steroidal anti-inflammatory drugs
The undoubted advantages of this group of drugs are that they start to act quickly, and exactly where it is required - in the inflamed joint. It is very important to remember that increasing the dose does not necessarily lead to a greater effect. The anti-inflammatory effect will remain the same, but the harm from such "tactics" will be much greater, because with the increase in the dose the probability of development and the severity of side effects increase. The most effective and safe in this group, according to international studies, is etorikoksib, he is arkoksia.
Another plus of non-steroidal anti-inflammatory drugs is the ability to penetrate the central nervous system. What is it for? The fact is that if a person experiences pain in remote areas of the body, then the signal about this immediately enters the brain and can enhance the subjective sensation of pain, and, therefore, multiply the sufferings of the patient. Further, the "cascade" reacts to pain: heart palpitations, vasoconstriction, release of stress hormones, elevation of blood pressure. .. The use of non-steroid medications helps to reduce or prevent these effects.
This medicine is currently rarely used, although its effectiveness in gout is unquestionable. In most patients, it causes stool disorder and nausea, a sense of metallic taste in the mouth. Nevertheless, his appointment is resorted to, if for any reason the reception of non-steroidal anti-inflammatory drugs becomes impossible. It is important that severe damage to the kidneys, heart, liver and mucous membrane of the gastrointestinal tract - strict contraindications to the appointment of colchicine.
The purpose of this group of drugs is a difficult and responsible decision. Preparations of steroid hormones, or steroids( prednisolone, metipred) are prescribed in cases when non-steroidal anti-inflammatory drugs do not help, and colchicine is either ineffective or unavailable. In the treatment of steroids, such careful monitoring of the patient's condition is required, that the doctor often thinks ten times what will assign these effective, but not very indifferent to the body means. Among the side effects( they are also called undesirable), the effects of such therapy are called increasing blood pressure, increasing blood glucose, a tendency to bleed, the risk of damage to small vessels of the eye, ulcers of the gastrointestinal tract. .. and this is not a complete list. Recall that gout more often affects patients who are obese, who initially enter the risk group for many of the conditions listed above, multiply this by the side effects of steroids and get a pretty sad, in terms of prognosis, picture.
- Decreased uric acid level
All well-known allopurinol is used for this purpose. Sometimes patients who "put" themselves a diagnosis with the help of neighbors or the Internet, independently start taking this drug. It should be noted that the dosage is selected individually, small doses are often ineffective, while the patient does not prescribe a large dose. .. That is why the treatment with allopurinol should be carried out under medical supervision. So, allopurinol is prescribed:
- with frequent attacks( at least 1 time in 3 months);
- with an increase in the level of uric acid and concomitant damage to the joints;
- for serious abnormalities in kidney function;
- for kidney stones;
- for the deposition of uric acid crystals in soft tissues;
- in the treatment of antitumor drugs.
Diet for gout
Products that contribute to the occurrence of gout have already been mentioned. What can you eat and drink to a patient with a gout or high uric acid in the interictal period?
From the first dishes you can recommend vegetarian soups, such as borsch or vegetable or potato. Meat, as already mentioned, is strictly limited - it's a chicken or a duck. Permissible "lean" varieties of fish( cod, pollock), not more than 3 times a week, in a moderate amount( maximum 200 g per reception).Whole milk is not recommended, you should give preference to lactic acid foods( kefir, cottage cheese, fermented baked milk, young cheeses).As a side dish, boldly choose any cereal or pasta, bread is not limited( within reason, remember the danger of excess weight!).
Vegetables and fruits, except raspberries, spinach and cauliflower, are allowed all, preferably in boiled or raw form, fried - not welcome. It is allowed to take in food any nuts and dried fruits, from sweets you can treat yourself to honey, molasses, pastille, nuts. It is useful to add enough olive oil to food.
From beverages are allowed light green tea, juices, fruit drinks, compotes. Ideally, such a diet should be followed not only during an attack of gout, but also throughout the illness, while there is an increase in the level of uric acid in the blood.
Lifestyle of the patient with gout
After elimination of the pain syndrome, the doctor must ensure that the level of uric acid remains safe for the patient, and the dosage of allopurinol is correctly selected. For this purpose, the level of uric acid is regularly determined using a biochemical blood test. At the beginning of treatment it is necessary to do this every 2-4 weeks, then every 6 months. If the optimal dose of medicine is selected, the patient follows a diet, returns to physical exercises, does not face gout attacks, does not need to take painkillers and anti-inflammatory drugs, the dose of allopurinol can be slowly reduced under the supervision of a doctor. Practice shows that it is possible to completely abolish it quite rarely. Unfortunately, in the overwhelming majority of cases, patients who have abolished allopurinol are forced to return to it after a second gouty attack.
Almost all patients with gout survive to advanced years, suffering more from concomitant diseases than from joint pain. But it is also known that almost half develop nephrolithiasis( kidney stones), and kidney failure.
As already mentioned, gout refers to a group of diseases caused by impaired calcium metabolism in the body. The same group includes the disease associated with deposits of calcium pyrophosphate salts, or pyrophosphate arthropathy. These two diseases are so similar that they are treated as one large section - crystalline arthropathies.
This disease occurs equally often in women and men of advanced age, and among patients older than 85 years, according to research, half have this pathology. The disease occurs under the guise of osteoarthritis, gout or rheumatoid arthritis.
Typically, the development of pyrophosphate arthropathy is accompanied or preceded by a chronic disease( eg, diabetes, thyroid disease) or the patient has ever suffered a joint injury.
When an elderly patient calls with pain complaints more often in large joints( most often knee joints), the doctor will first prescribe a radiograph. If a "double line" of the joint space is found on the X-ray, the so-called phenomenon of chondrocalcinosis. In addition, the proof of the diagnosis of pyrophosphate arthropathy is the detection of special crystals when examining the joint fluid under a microscope. If the joint is inflamed, then this fluid, as in the case of gout, is obtained by puncturing the joint with a syringe. Further, it is only the laboratory. If the articular fluid for analysis can not be obtained, this can significantly complicate the diagnosis.
Treat or not treat?
Pyrophosphate arthropathy detected by accident( for example, during radiography) is not treated if there are no symptoms of inflammation of the joints. If there is arthritis( ie, swelling, redness, changes in skin temperature over the joint), and all other reasons for the appearance of these signs are excluded, excess fluid from the joint is removed with a syringe, then steroids are injected into the joint and cold applications( bandages) are applied. Further, course treatment with non-steroidal anti-inflammatory drugs is prescribed. Short courses of steroid hormones or colchicine are rarely prescribed. And of course, the main role is played by the treatment of concomitant diseases, which caused the deposition of crystals in the joints. Important also non-medicinal methods, such as physiotherapy exercises, physiotherapy, more often with the use of cold( in the absence of contraindications), wearing orthosis and others.