Gout( gouty arthritis): what it is, symptoms and treatment
Gout( gouty arthritis) is a disease in which an excess of uric acid salts( urates) accumulates in the body.
This disease manifests itself in that from time to time the patient has acute attacks of gouty arthritis.
In addition, near the joints are formed special nodules - tofusi.
Who most often develops the disease?
Gout is predominantly a male disease: in the stronger sex it is more common than in women.
gout attack: salt crystals injure the tissues of
On average, for one ill gout woman there are from 3 to 7 men who are affected by this ailment.
Mostly mature and older people are ill: most often gout manifests in men after the age of 40-45 years, and in women - after 55-60 years.
This is due to the fact that female sex hormones( estrogens) have a positive effect on the exchange of uric acid in the body. When the climacterium content of estrogen decreases dramatically, then the likelihood of becoming ill with gout is significantly higher.
In addition, it is considered that there is a hereditary predisposition to arthritic arthritis: if someone from your relatives had a gout, chances are that it will arise from you( especially if you are a man) is much higher, and you arein the risk group for the development of this disease.
In addition, factors such as overweight, as well as alcohol abuse, also increase the risk of developing this disease.
In general, in the world, according to statistics, 2-3% of the population suffers from gouty arthritis( data for the USA), but for men after 40-50 years this indicator grows to 5-6%.In Russia, the incidence of gout is about 0.1-0.2%.
Why this disease occurs
how the gout arises( schema)
Because gouty arthritis is a metabolic disease, it arises in those people who have either increased intake of substances containing purines, or their excretion due to whichit's a disease.
Which products contain many purines? This is primarily meat and by-products( not for nothing, gout is also called "meat-eating disease"), as well as legumes, tea, cocoa, some fish, and especially alcohol, including beer and red wine.
People who have a lot of such foods in their diet have a high risk of getting gouty arthritis.
And when the removal of purines from the body can be difficult? Most often - because of concomitant kidney diseases, as a result of which renal filtration is reduced, and therefore - the body retains more uric acid salts than necessary, and it begins to be deposited in various tissues - both in the joint region and in the renal themselvestubules.
In addition, an additional risk factor for gout is arterial hypertension, as well as taking certain serious medicines for serious illnesses.
Symptoms of gout
The main and main sign of gout is an acute attack of gouty arthritis, which is also called a gout attack.
Inflammation of the big toe - the main sign of gout
Often such an attack is observed after a plentiful meal with alcohol. Suddenly, more often in the evening or at night, acute pains appear in one of the joints.
Most often, with an attack of gouty arthritis, for some reason the big toe is affected, but it can be another joint - for example the knee or elbow.
The joint begins to ache badly - so it can even be painful to touch the affected area( for good reason, "gout" is literally translated from ancient Greek as a "trap for the leg").The joint swells, the skin around it due to swelling acquires a purple-red hue, and the skin temperature in this area rises.
This condition( attack), if left untreated, can last up to several days and longer. But usually the patient and his relatives quickly turn to doctors who, with the help of medicines for gout, more or less successfully relieve the attack.
The heavier the course of gout, the more likely these seizures may occur. Conversely, if all the conditions are met to ensure that uric acid and its products do not accumulate in the body, then attacks of the disease can be avoided altogether.
Tofusi with gout
tofusi( photo) with gout
If a gout attack with joint inflammation and pains in it can be considered acute manifestations of this disease, tofusi is a sign of a chronic disease.
Because gout accumulates an excessive amount of uric acid salts, it is clear that these salts should be deposited somewhere. They also are postponed - in the field of various joints( at some point causing a gouty attack), in the skin in the region of the elbows, heels, and also in the area of the cartilage of the auricles.
Collecting in these places, crystalline salts gradually turn into small nodules of white color, which can be palpated in the area of small joints on the hands and feet. These nodules are called tofusi in case of arthritis arthritis.
No special damage to the body by tofus is directly applied - it only signals to the person himself, as well as to his doctor, that there is an excess of uric acid salts in the body - which means that you need to pay attention and take the necessary measures. But we will talk about this in the treatment and prevention of gout.
We offer you to watch an interesting video about what is gout and gouty arthritis, and how dangerous this disease is:
disease Treatment of gout can be conditionally divided into two tasks:
- cupping( interruption) of an acute attack;
- normalization of metabolism in the body, that is, treatment and prevention of the disease outside seizures.
Treatment of an acute attack of gout( acute gouty arthritis)
The first attack of gouty arthritis is best treated at the hospital
. As often the first manifestation of gout, unfortunately, usually becomes a developed gouty attack, its treatment is usually carried out in a hospital - in the rheumatology department of the hospital.
This is necessary not so much to cure this attack, but how to conduct a full-fledged examination and make the correct diagnosis. After acute arthritis of the joint can be with a variety of diseases - infectious or reactive arthritis, as well as with other ailments.
After the diagnosis of "gouty arthritis" is set, there is usually no need for repeated hospitalizations.
So, what medicines do doctors use to take a gout?
1. Non-steroidal anti-inflammatory drugs
NSAIDs, including all known diclofenac, ibuprofen, naproxen and other agents. These drugs are good at both pain relief and effective reduction of inflammation in the affected joint. They are prescribed in certain dosages according to the scheme, and anti-inflammatory drugs are an important component of the complex treatment of a gouty attack.
Note: Non-steroidal anti-inflammatory drugs do not treat gout really: they are needed in order to reduce the severity of its symptoms - pain and inflammation in the joints. Do not try to treat gouty arthritis yourself with NSAIDs, consult a doctor!
treatment of this disease should be prescribed only by the doctor
Colchicine is a medicine that can reduce inflammation in acute gouty attacks and restore the function of the sick joint.
This drug is prescribed by a special scheme and is taken every few hours for 1-1.5 days - until the severity of the attack does not go down or when it becomes clear that you need to use another medicine.
In those cases when colchicine did not have a therapeutic effect( as it sometimes happens), the doctor prescribes hormonal drugs that suppress inflammation - glucocorticoids. This group of drugs includes such drugs as methylprednisolone and betamethasone. They are usually administered topically as injections into the joint area.
Using this or that means, doctors manage to defeat a gouty attack already within one and a half to two days from the beginning. But, as you know, treating an acute attack of gout is only part of the therapy.
Another interesting and useful video about this disease is the fragment of the program "Live Healthily" with Elena Malysheva:
Treatment of the disease outside of seizures
As this form of arthritis is a metabolic disease and arises from the increase in the amount of urate in the body,will be aimed at reducing the content of these substances in the body.
For this, during the interictal period, the doctor prescribes medications to the patient that reduce the formation of uric acid salts( eg, allopurinol) in the body, as well as drugs that increase the excretion of these substances from the body.
Diet for gout
In fact, it is difficult to name any other disease, in the treatment of which nutrition is so important.
therapeutic diet is an important element of the recovery of
Even if you after the first attack of arthritis received this disappointing diagnosis, then, following the right diet and taking medications, after a while you will be able to give up medicines only due to the fact that you will comply with the rules of therapeutic nutrition. And it, unfortunately, is not so simple, considering what foods can not be eaten with this disease.
Thus, on the anti-gouty diet, it is necessary to exclude red meat and its products, meat by-products( kidneys, liver, heart), fatty fish, legumes, sharp and salty cheeses, and also alcoholic beverages( this concerns cognac,beer, champagne and sweet dessert wines).Learn more about what you can, and what you can not eat with this disease, you can read in the article Therapeutic diet for gout.
Despite the fact that gout is accompanied by a painful attack of arthritis, remember that this disease with timely access to a doctor is successfully treated, and not only medicamental, but also folk remedies.
Therefore, if you find symptoms of gout listed in this article, do not suffer pain, consult a doctor, and very soon mobility and health will return to your joints again!
The appearance of pain in the joints is an occasion to immediately consult a doctor who will exclude other arthritic conditions - systemic lupus erythematosus and rheumatoid arthritis, which have symptoms similar to gout.
Fig.: joint damage in systemic lupus erythematosus
A set of diagnostic methods for the detection of this disease include:
- blood test , which will show whether the urate level is elevated. Although there are cases in which the crystals of uric acid are contained in the blood at a normal level, but gout occurs.
- take a sample of tissue( under local anesthesia) or intraarticular fluid( the procedure is very painful, but necessary) for the presence of needle crystals of urates in them.
- X-ray studies of , showing gouty bone injuries and tofusi.
The diagnosis of "gouty arthritis" is based on anamnesis and clinical examination of the patient.
Video: how gout-affected joints of the extremities look like
What provokes gout? Since the disease is directly associated with hyperuricemia, the lack of treatment leads to the accumulation of excess uric acid salts in the body and subsequent changes in internal organs( primarily in the kidneys).
In a quarter of all cases, gout patients with kidney disease develop kidney disease and kidney failure.
Other possible complications of gout are:
- appearance of gouty kidney( tissue damage);
- complete renal failure;
- erosive-destructive polyarthritis;
- marked atherosclerosis.
Tired of chronic pain in joints? You can remove the symptoms with an ointment with anti-inflammatory effect. Learn more about this here.
Methods for treating gout ↑
An integrated approach is important in the treatment of gout. An indispensable condition is the normalization of the balance of the metabolic process, the restoration of kidney function and the administration of medications.
The general plan of treatment includes the removal of pain and constant intake of necessary medications in order to avoid repeated attacks and prevent subsequent deposition of urates.
For the treatment of acute attacks, colchicine is used, after which the pain subsides for 12 hours and disappears completely in 48 hours.
Non-steroidal anti-inflammatory drugs( ibuprofen, diclofenac, indomethacin, etc.) are used to relieve pain.
Photo: colchicine for the treatment of gout
Corticosteroids( eg, dispropan), which are potent anti-inflammatory drugs, are also widely prescribed for treatment.
In addition, prescribed drugs that excrete uric acid( usually it's allopurinol).
There is also a treatment of gout with ointments that have a local anesthetic and anti-inflammatory effect.
It should be remembered that medical therapy, conducted in a timely manner, can solve the problem of gout once and for all.
In addition, to stop the attacks of the disease apply compresses with 50% dimexide solution, which has a pronounced analgesic and anti-inflammatory effect.
To do this, mix 1 tablespoon.dimexide solution with 1 tbsp.water and ampoule of novocaine or analgin, compress on the affected joint for 30-40 minutes. Typically, the course of treatment with a solution of dimexide is 10-20 procedures.
This type of therapy helps to remove acute attacks of the disease.
The most commonly used:
- ultraviolet irradiation of the affected area, for example, the knee joint, which can help even before the appearance of swelling and redness, i.e.stop the approaching gout attack
- treatment with ultrasound : thus, the patient's joint is resorptive, analgesic and anti-inflammatory.
- laser therapy : the laser destroys the accumulation of salts in the joints( so-called tofusy).
- phonophoresis with hydrocortisone( sometimes combined with ultrasound therapy): helps to weaken the inflammatory process, increase lymph and blood circulation and accelerate the excretion of salts from the affected tissues.
Photo: hardware treatment of gout
Particularly helps with the treatment of a combination of chronic gouty arthritis with osteoarthritis.
Homeopathic remedies China, Sabina, Colchicum, Berberis are used for the treatment of this disease.
They can correct minor deformities, remove swelling, and also correct related disorders.
The necessary drug is selected individually by a specialist homeopath.
In the remission period of the disease heat treatment is applied:
- applications with mud;
This treatment reduces the pain, the severity of the inflammatory process and improves the function of the joints.
Photo: treatment of gout with mud
Also often as a method of rehabilitation prescribed spa treatment, including balneotherapy( iodine-bromine, radon, sodium chloride and hydrogen sulfide baths).
- to improve microcirculation and circulation in tissues;
- enhanced kidney and liver function;
- normalization of lipid metabolism in the body.
In complex treatment can additionally apply the reception of alkaline mineral water and diet food.
Surgically, joint puncture is often performed with the simultaneous introduction of intra-articular corticosteroids.
Sometimes, urate deposits are removed quickly, large gouty nodes( especially in fistula and skin ulceration).
Photo: Gouty tofus
Shockwave therapy destroys kidney stones, which are then excreted in the urine.
In some cases, with significant destruction of cartilage after removal of tophi, resort to reconstructive surgery of the joints( arthroplasty).
Treatment by the method of Dr. Bubnovsky
The method of Dr. Bubnovsky uses therapeutic exercises and kinesitherapy.
A specially selected set of exercises makes the musculoskeletal system function normally, as a result of which it is possible to get rid of gout and pain accompanying it.
Video: joint exercises for Bubnovsky
New in the treatment of gout
To date, innovations in the treatment of the disease are:
- the creation of new drugs from the class of non-steroidal anti-inflammatory drugs: Celebrex, Arkoksia, Nimesulide fulflex, etc., which are much milder on the gastrointestinal tractthe intestinal tract than their predecessors.
- application of hardware purification of blood from uric acid( plasmaphoresogemosorption).This new method of treatment is considered sparing and is carried out on special medical equipment.
Photo: preparation Celebrex
Nutrition is an integral part of gout treatment, it includes compliance with a special regimen.
Menu for gout should be changed.
So, it is necessary to reduce to a minimum:
- meat products, including the liver( only lean beef is allowed)
- fish products, including seafood( only low-fat large fish are allowed)
- consumption of legumes, sorrel, eggplant, cauliflower, mushrooms, radish
- consumption of chocolate
- quantity of marinades, canned food, salted varieties of cheese
In addition, it is necessary to reduce the amount of milk, butter and eggs consumed.
Alcoholic beverages for gout should be completely ruled out.
The amount of carbohydrate food increases in the diet:
Gout: causes, symptoms, treatment and prevention, photo
Also the risk factors for the development of gout can be taking certain medications such as diuretics( diuretics), lowering thyroid hormone levels.
What are the symptoms of gout?
A large joint at the base of the big toe( the first metatarsophalangeal joint) is the most common site for gouty attacks. However, any other joint can be affected. Often the joints of the ankle, knees, wrists, fingers and elbows are affected.
Patients with a gouty attack suffer from a rapid onset of pain in the affected joint, followed by swelling, redness, and marked sensitivity. Some patients experience such intense pain that even a light touch of the sheet to the joint can be excruciating. These painful attacks can last from a few hours to several days. In the case of chronic inflammation, the attack can last for several weeks. Unfortunately, patients with gout have the risk of repeated attacks of gouty arthritis.
Thigh gum on the foot
The large joint at the base of the big toe( the first metatarsophalangeal joint) is the most common site of gouty attack. However, joints of the ankle, knees, wrists, fingers and elbows are often affected.
Gout of the fingers of the hand
In case of repeated attacks of gout or long-term cases in the joints, inflamed bumps of tissues may form. These hillocks are called tofusi.
Elbow Gland Knuckle
Some of the larger joints in the body have a fluid-filled sac that acts as a shock absorber and is called an articular bag. The joint bag also helps the mechanics of joint motion. If gout causes inflammation and swelling of the joint bag, it is called bursitis.
What procedures are used to diagnose gouty arthritis?
Gout is usually diagnosed by a physician based on the location of the inflamed joint and an anamnesis of the presence of similar non-traumatic bouts of pain and swelling. The most reliable( but not always necessary) analysis for confirming gout is arthrocentesis.
Arthrocentesis is a procedure in which a synovial fluid is withdrawn from the inflamed joint with a needle and a syringe using a sterile technique and a local anesthetic( for example, lidocaine).The liquid is sent to a laboratory where it is analyzed for the presence of uric acid crystals.
How is gout diagnosed?
The intra-articular fluid obtained from arthrocentesis is analyzed in the laboratory under a microscope for the presence of uric acid crystals. Fluid analysis can also rule out other causes of inflammation, including bacterial infection.
What are uric acid crystals like?
Needle-shaped crystals of uric acid are best viewed under a microscope.
How to prevent a gout attack?
The best way to prevent gout attacks is to maintain a good water balance. Drink plenty of water throughout the day. Good hydration also reduces the risk of kidney stones or the development of kidney disorders due to accumulation of uric acid.
Avoid spirits or use them in very small quantities if you have had gout attacks in the past. Alcohol disrupts the metabolism of uric acid in the body and can lead to its accumulation( hyperuricemia).If levels of uric acid grow in your body, it can accelerate the development of gouty joints.
Additional prevention methods
Foods rich in purines, such as seafood or meat by-products( liver, kidney, brain) can lead to the development of a gouty attack. The organism turns purines into uric acid, which, in turn, leads to the development of gouty attacks.
Overall, weight loss is also a way of preventing gout. Foods low in fat and calories, in combination with regular exercise, can reduce the likelihood of an attack of gout.
Medication for gout
Gout is a very painful disease. Anesthetics and anti-inflammatory drugs are the basis of gout treatment. To reduce inflammation of the joints, non-steroidal anti-inflammatory drugs( NSAIDs), colchicine and corticosteroids are used.
Other drugs, such as probenecid( which helps the body remove excess uric acid) and allopurinol( which reduces the amount of uric acid produced in the body) are used to control the underlying metabolic disorders that cause hyperuricemia and gout. These drugs reduce elevated levels of uric acid in the blood.
What has the future prepared for gout?
Research is continuing to find new strategies for the prevention of gout. New drugs are being developed to eliminate the presence of high levels of uric acid in the body and reduce the likelihood of developing painful gout attacks.
Gum: symptoms, effective treatment, photo and diet
When the joint begins to accumulate the salt of uric acid, the disease begins, which is called gout .From the Greek language, the term gout can be translated as a "foot trap".It can be noted that the disease has always amazed a lot of celebrities, but even if you translate it into a description of gout, you can immediately note that this person is full, sexually active and with a high content of growth hormones in the body.
The main risk group for gout is men after 40, but this ailment also occurs in women. With gout and kidneys stop coping with uric acid and are not able to remove it from the body in the right amount. As a result, the acid begins to accumulate in the blood of a person. A high content of uric acid leads to attacks of arthritis, in addition, this also leads to the formation of kidney stones, and in a particularly severe case, the onset of kidney failure. As a rule, gout is localized and affects the joints of the hands, knees, elbows and toes, the latter remain the most common site of gout.
Gout attacks can be conditionally divided into acute and remission periods. In this case, between seizures may take several years. However, gradually the disease more and more seriously affects the body, and the time between attacks gradually decreases, in the end between the attacks there are months and even weeks.
Mostly, gout can develop in people with diabetes, genetic predisposition, and arterial hypertension.
Symptoms of gout
The first symptom of the onset of gout is pain, which develops quite rapidly, and reaches the highest sensation in just a couple of hours. Attacks happen more at night or early in the morning.
In addition to pain, the patient suffering from gout experiences such symptoms as severe heat in the area of the affected joint, he may be feverish, and the joint swells and swells as shown in the photo, in addition, the joint mobility decreases sharply. Pain syndrome can last for several hours. It is very important to start gout treatment in a timely manner and not delay with the decision to start therapy, in the end, not only the number of symptoms will increase, but also the arteritis will spread to other joints, plus the risk of kidney disease and the entire genitourinary system is seriously increased.
Diagnosis of gout
The gout is difficult to diagnose in the sense that it can be difficult to separate from other diseases that affect the joints. Basically, the diagnosis is made on the basis of a visual examination of the problem joint, as well as the results of a blood test. The basis for accurate diagnosis is the study of articular fluid, which shows the content of uric acid.
Procedure of extraction of articular fluid is quite common, and is carried out under local anesthesia. The doctor uses a special syringe, which pumps out the liquid. It is this procedure that gives the most accurate information about the content of uric acid in the joint and the level of spread of the disease.
In addition, to confirm the diagnosis, doctors resort to the use of X-rays, with the help of roentgenology, it is possible to accurately find tofus formations that are localized around the joints. This makes it possible to understand how damaged the bone is, and how far the inflammation has spread.
Treatment of gout
If the diagnosis of gout is given to a person for the first time, then treatment always involves hospitalization. The patient is placed in the rheumatology department. In addition to the first diagnosis, with a rather acute manifestation of gout, a person should also be hospitalized for outpatient treatment. If there is a period of remission, then being on a stationary observation is not washed out, it is enough to undergo scheduled examinations with a rheumatologist and nephrologist. However, these routine examinations are mandatory, and help in time to determine the onset of the acute stage, an increase in the content of uric acid and the spread of primary inflammation.
To date, modern medicine has never been able to provide a single drug that would be universal, and could really address the issue of treating gout. Nevertheless, it is possible to control almost completely the attacks of the disease with the help of a diet and the right way of life.
From what the medicine offers as preparations for treatment, it is possible to note medicamentous agents of anti-inflammatory sense, such as Kolhitsin, Indometacin. In the complex must be present painkillers, and drugs that can reduce the production of uric acid. Sometimes treatment may require the use of corticosteroids, which are designed to change the acidity of urine, which reduces the risk of kidney stones.
Modern technical equipment of hospitals makes it possible to use in the treatment of blood purification, which is called plasmaphoresogemosorption. However, the deposition of salts of uric acid can be removed and surgically. However, most importantly, it is correction of the disease in terms of weight and treatment, because gout is never the only problem, and the patient still suffers either diabetes mellitus or atherosclerosis.
And here a very important role is played by a diet that allows you to significantly reduce the weight of the patient by severely restricting the consumption of carbohydrates and foods high in calories. It is recommended to increase the intake of food rich in proteins, all this will help reduce the level of uric acid in the body. However, the diet in more detail below.
Disease First of all, with gout, you need to start eating and you need to distribute your day so that meals are 4. It's important to note that you need to eliminate both overeating and fasting, and you should not allow a sharpweight loss, it can lead to an exacerbation of the disease.
The diet should include a lot of liquid, and its intake during the day should be at the level of 1.5-2 liters, and during periods of exacerbation of the disease, you need to drink three liters of water. And it can be as non-carbonated water, and various compotes, fruit drinks, tea.
From the diet will have to exclude offal and meat broths, canned fish, fried seafood and caviar. We will completely abandon the consumption of legumes and spices. Naturally, under total prohibition for gout, any alcohol, coffee and strong tea.
The most high-quality diet for gout involves switching to a vegetarian diet. Vegetable soups, decoctions. Nevertheless, it is possible, and necessary, to eat meat, but strictly dietary - chicken, rabbit, turkey. Consumption and chicken eggs are allowed. Milk is well diluted with water and cooked on it with porridge.
Vegetables can be consumed in any quantity, and almost all kinds. It is very important to limit salt intake.
And at the heart of everything, we can say that the diet No. 6 always works, and this is:
- Eliminating foods high in purine;
- Restriction of salt intake;
- More dairy products, and liquids;
- Reduction of fats and proteins;
- Meat or fish should be boiled.
Gout: photos, symptoms and treatment of gout in men and women
Gout is a systemic disease that affects the whole body, in which crystals of the uric acid salt - sodium monoaurate - 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 - hypertension;
- , the patient suffers from a disease accompanied by hyperuricemia( eg, psoriasis);
- the patient often takes alcohol;
- has a genetic predisposition to increased production of uric acid or a reduced rate of its excretion( such conditions are rare and usually occur at a young age - up to 30 years);
- , the patient "abuses" products containing a large number of compounds and precursors of salts of uric acid. Traditionally, they include, 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 start to form from the acid, in the people they are also called "sand".It is these crystals, deposited in the joints, skin cells and other organs, and cause gout - "disease of kings".
What happens in the joint?
Pain in the joints arises not so much from the "mechanical trauma" of the crystals of the surrounding tissues as from the penetration into the joint and the production of a large number of "inflammatory substances" directly in it. That is, the cause of pain in gouty attacks is not mechanical( acute crystals), but chemical( irritants).Attracted by "inflammatory substances"( they are called mediators of inflammation), immune cells penetrate into the joint, which, on the one hand, produce even more mediators; on the other, they begin to destroy their own joint structures, accepting them for "attacking foreign agents."This is a brief description of the development of an autoimmune reaction in gouty arthritis.
Classification of gout
Currently, it is common to distinguish 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 painkiller, both patients and surgeons are often able to make a lot of mistakes, starting with the appointment of inconceivable combinations of analgesics in huge doses, ending with the use of antibiotics and local( cutaneous) agents( gels, ointments) - ineffective, but costly. True gout in everyday practice is not so common, but many doctors have the idea that allopurinol is treated with this ailment( we will talk about this a little later).But the fact that it is absolutely impossible to prescribe allopurinol in the acute period of the disease is usually forgotten. Moreover, allopurinol is able to aggravate the course of a gouty attack, and if the patient has already taken this drug at the time of exacerbation, it should be abolished as soon as possible for the entire "painful" period.
Another common mistake in treating an acute gouty attack is the patient's refusal to eat. As is known, most often the "gouty attack" is provoked precisely by the error in the diet. In search of relief, the patient is ready to switch to "bread and water", or even starve, just to get rid of the pain. This is fundamentally wrong, and can adversely affect both the general condition of the patient, and the work of the kidneys, the heart.
Wishing to save the patient from suffering as soon as possible, physicians often prescribe physiotherapy( UHF, magnetotherapy, thermal procedures), without considering the almost total uselessness, and sometimes the harm of such tactics during an attack.
2. Interictal period of the disease
Gout leads to an attack on the body gradually. It is a mistake to believe that this problem is limited to joints. Urat crystals - the smallest needles - are deposited in many organs, primarily in the kidneys, forming stones, disrupting the work of these vital organs. The patient may be disturbed by renal colic, manifested by pain in the lower back, abdominal pain, vomiting, pain and rezi when urinating. Sometimes the severity of the pain is such that it requires hospitalization, or surgery to remove the stones. With insufficient treatment and accumulation of uric acid and its salts, the disease goes so far that the heart is affected, with the development of heart failure.
3. Chronic tofus gout
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 erythrocyte sedimentation rate( ESR) - a sign of inflammation and an increase in the level of leukocytes) and biochemical( an increase in uric acid is detected, and signs of concomitant diseases - diabetes, liver diseases,renal failure and others).It should be remembered that the concentration of uric acid in the blood serum, which is determined by biochemical analysis, at the time of an attack can be normal!
Study of the joint( synovial) fluid .This procedure can be quite unpleasant, but it is as a result of 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;
- osteoarthrosis ( often combined with gout);
- psoriatic arthritis ( inflammation of the joints in combination with skin disease - psoriasis).
Treatment of gout
It is accepted to share non-drug( non-drug) and drug treatment.
Non-pharmacological treatment includes dietotherapy, the use of orthopedic drugs and joint relief, as well as lifestyle adjustments. Not every patient, accustomed to not limiting himself in nutrition, passive leisure, or traveling by private transport, is ready to change habits for his own health. And, nevertheless, it is extremely important to adjust the patient to the implementation of recommendations, which, in fact, are half the success.
Treatment of gout has two main areas: reducing pain during the gout attack and reducing the risk or completely preventing new attacks by reducing the deposition of urate salts. To achieve this goal, anti-inflammatory and anti-hyperuricemic( that is, directed against increasing the concentration of uric acid in the blood) are used.
- Nonsteroidal anti-inflammatory drugs
The undoubted advantages of this group of drugs are that they start acting quickly, and exactly where it is needed - in the inflamed joint. It is very important to remember that increasing the dose does not necessarily lead to a greater effect. The anti-inflammatory effect will remain the same, but the harm from such "tactics" will be much greater, because with the increase in the dose the probability of development and the severity of side effects increase. The most effective and safe in this group, according to international studies, is etorikoksib, he is arkoksia.
Another plus of non-steroidal anti-inflammatory drugs is the ability to penetrate the central nervous system. What is it for? The fact is that if a person experiences pain in remote areas of the body, then the signal about this immediately enters the brain and can enhance the subjective sensation of pain, and, therefore, multiply the sufferings of the patient. Further, the "cascade" reacts to pain: heart palpitations, vasoconstriction, release of stress hormones, elevation of blood pressure. .. The use of non-steroid medications helps to reduce or prevent these effects.
This drug is currently rarely used, although its effectiveness in gout is unquestionable. In most patients, it causes stool disorder and nausea, a sense of metallic taste in the mouth. Nevertheless, his appointment is resorted to, if for any reason the reception of non-steroidal anti-inflammatory drugs becomes impossible. It is important that severe damage to the kidneys, heart, liver and mucous membrane of the gastrointestinal tract - strict contraindications to the appointment of colchicine.
The purpose of this group of drugs is a difficult and responsible decision. Preparations of steroid hormones, or steroids( prednisolone, metipred) are prescribed in cases when non-steroidal anti-inflammatory drugs do not help, and colchicine is either ineffective or unavailable. In the treatment of steroids, such careful monitoring of the patient's condition is required, that the doctor often thinks ten times what will assign these effective, but not very indifferent to the body means. Among the side effects( they are also called undesirable), the effects of such therapy are called 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
For this purpose, well-known allopurinol is used. Sometimes patients who "put" themselves a diagnosis with the help of neighbors or the Internet, independently start taking this drug. It should be noted that the dosage is selected individually, small doses are often ineffective, 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 promote gout are already mentioned. What can you eat and drink to a patient with a gout or high uric acid in the interictal period?
From the first dishes you can recommend vegetarian soups, such as borsch or vegetable or potato. Meat, as already mentioned, is strictly limited - it's a chicken or a duck. Permissible "lean" varieties of fish( cod, pollock), not more than 3 times a week, in a moderate amount( maximum 200 g per reception).Whole milk is not recommended, you should give preference to lactic acid foods( kefir, cottage cheese, fermented baked milk, young cheeses).As a side dish, boldly choose any cereal or pasta, bread is not limited( within reason, remember the danger of excess weight!).
Vegetables and fruits, except raspberries, spinach and cauliflower, are allowed all, preferably in boiled or raw form, fried - not welcome. It is allowed to take in food any nuts and dried fruits, from sweets you can treat yourself to honey, molasses, pastille, nuts. It is useful to add enough olive oil to food.
From soft drinks are allowed weak 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 the pain has been eliminated, the physician must ensure that the level of uric acid remains safe for the patient, and the dosage of allopurinol is matched correctly. For this purpose, the level of uric acid is regularly determined using a biochemical blood test. At the beginning of treatment it is necessary to do this every 2-4 weeks, then every 6 months. If the optimal dose of 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 repeated gouty attack.
Almost all patients with gout survive to advanced years, suffering more from concomitant diseases than from joint pain. But it is also known that almost half develop nephrolithiasis( kidney stones), and kidney failure.
As already mentioned, gout refers to a group of diseases caused by impaired calcium metabolism in the body. The same group includes the disease associated with deposits of calcium pyrophosphate salts, or pyrophosphate arthropathy. These two diseases are so similar that they are treated as one large section - crystalline arthropathies.
This disease is equally common in women and men of advanced age, and among patients older than 85 years, according to research, half have this pathology. The disease occurs under the guise of osteoarthritis, gout or rheumatoid arthritis.
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 appeals with pain complaints more often in large joints( most often knee joints), the doctor will first prescribe radiography. If a "double line" of the joint space is found on the X-ray, the so-called phenomenon of chondrocalcinosis. In addition, the proof of the diagnosis of pyrophosphate arthropathy is the detection of special crystals when examining the joint fluid under a microscope. If the joint is inflamed, then this fluid, as in the case of gout, is obtained by puncturing the joint with a syringe. Further, it is only the laboratory. If the articular fluid for analysis can not be obtained, this can significantly complicate the diagnosis.
Treat or not treat?
Pyrophosphate arthropathy detected by accident( for example, during radiography) is not treated if there are no symptoms of inflammation of the joints. If there is arthritis( ie, swelling, redness, changes in skin temperature over the joint), and all other reasons for the appearance of these signs are excluded, excess fluid from the joint is removed with a syringe, then steroids are injected into the joint and cold applications( bandages) are applied. Further, course treatment with non-steroidal anti-inflammatory drugs is prescribed. Short courses of steroid hormones or colchicine are rarely prescribed. And of course, the main role is played by the treatment of concomitant diseases, which caused the deposition of crystals in the joints. Important also non-medicinal methods, such as physiotherapy exercises, physiotherapy, more often with the use of cold( in the absence of contraindications), wearing orthosis and others.