Gout of the ankle joint photo

Gouty arthritis

Gouty Arthritis

One of the diseases of modern society is gout. And although it refers to metabolic diseases, its main manifestation is joint damage. The process is very specific, characterized by a persistent and prolonged course. It can cause severe destructive processes in the joints, which requires familiarity with the true face of this enemy of mankind.


What is gouty arthritis?

Gouty arthritis is one of the types of inflammatory joint damage that is caused by the accumulation of uric acid crystals in the articular structures, its destructive effect on hyaline cartilage and periarticular tissues. This definition of the disease clearly indicates all the key mechanisms of development and manifestations of this process.

If to explain everything in order, the complex of pathological changes consists of a sequential chain:

  1. Disruption of uric acid metabolism in the direction of increasing its amount in the blood;

  2. Settling of its crystals( urates) on the surface of the hyaline cartilage of joints;

  3. Irritation and damage to joint structures with the development of an inflammatory response, which is actually called arthritis;

  4. Development of the consequences of a destructive process;

  5. Periarticular tumor-like proliferation.

For gout is also characterized by kidney damage, accompanied by the development of nephritis and urolithiasis, as urate stones are deposited in the pelvis and kidneys and ureters.

In most cases, gouty arthritis affects small joints( toes), less often - ankle and knee joints, fingers, wrist and elbow.

The disease is more susceptible to males in adulthood( 25-50 years).Manifesto of gouty arthritis can occur in an earlier period. Characteristic of a long process with a constant relapse. Predominantly affected are the small joints of the feet, less often the ankle joint.

True gout occurs rarely, the elderly are often called gout for the manifestation of arthrosis. Women suffer from it 5 times less often than men. The risk group includes men 40-50 years old and women over 60 years( at the age of postmenopause), since this disease has some connection with male sex hormones.

There are also such forms of gouty arthritis when almost all large and small joints of the upper and lower extremities are subjected to the process. With a slowly progressing course, only small joints are gradually involved in the inflammation. The disease rarely causes severe systemic reactions, although they can also occur. In addition to articular manifestations, gout is characterized by renal symptoms, which are the result of the formation of urate stones.

Medical practice knows cases of severe gout with marked intoxication and massive destructive processes simultaneously in several large joints. Fortunately, such cases occur rarely. But, nevertheless, long-term gouty arthritis sooner or later leads to a disruption of the function of the affected joint with possible disability of the patients.


Symptoms of gouty arthritis

Symptoms of gouty arthritis

There are three periods in the development of the disease:

  • Latent , when clinical symptoms are absent and the onset of the disease can be diagnosed only by elevated uric acid( hyperuricemia) in the blood;

  • Acute is recurrent when joint damage causes severe gouty attacks;

  • Chronic , in which long remission intervals are possible.

The frequency of seizures can vary from 1 time per week-month to 1-2 times per year.

The clinical picture of the disease is quite typical, which allows it to be diagnosed in time.

The first manifestations are acute and consist of:

  1. Pain in the area of ​​the joint of the big toe;

  2. Redness of the skin above the inflamed joint;

  3. Increased pain during movement;

  4. Increase in body temperature above normal digits;

  5. Unilateral defeat;

  6. Appearance around the joints that are inflamed, whitish subcutaneous growth( tofusov);

  7. Sequential periodic pain in various small joints.

On some of these manifestations of the disease it is worthwhile to stop and detail the main points. First of all, this is a manifestation of the process. The thumb suffers first in 90% of cases. If adequate medical and diagnostic measures are not taken against this background, the disease will necessarily acquire a progressive course. Gradually, other small joints will begin to inflame and hurt.

When gouty arthritis is characterized by high activity, the skin above the affected joint necessarily blushes, which is supplemented by a general temperature reaction. Prolonged course of inflammation with gout leads to the formation of tofus( subcutaneous nodules) around the joints. They are represented by elements of articular tissues and uric acid.

Articular cartilage is gradually destroyed, and so-called "piercers" are formed in the bones adjacent to the joint - cavities filled with sodium monoaurate crystals. Also, crystals of uric acid salts can be deposited in the surrounding tissues and directly under the skin above the joint in the form of whitish dense knots - tophi. Nodular deposits and bony growths lead to significant changes in the appearance of the foot. In the absence of treatment, the result can be a complete loss of ability to work and self-service ability.

In women, the disease is much easier than that of men. Attacks are not so strong and sharp, tofuses and piercers are extremely rare. Therefore, it may be difficult for women to differentiate gouty arthritis with arthrosis.


Causes of gouty arthritis

The etiology of the disease is not fully understood. The main risk factors for its occurrence include:

  • Hereditary predisposition;

  • Improper diet: excessive abuse of meat products, sausages, chocolate, strong coffee and tea, alcohol.(Earlier gout was called "aristocrat's disease");

  • Presence of concomitant diseases, such as heart failure, hemoblastosis, kidney disease, hormonal abnormalities;

  • The use of certain medicines: remedies for high blood pressure, diuretics, cytostatics, etc.

There are also primary and secondary gouty arthritis:

  • Primary gout develops as a result of a combination of genetic predisposition and a large consumption of purines with the products listed above;

  • Secondary gout occurs due to the presence of listed diseases and medication.

Accumulation in the joint cavity of microcrystals of sodium urate can occur asymptomatically for a long time until some factor provokes an acute attack: physical exhaustion( prolonged walking), trauma, infection, stress, hypothermia, fasting or consumption of a large number of "purine" productsin combination with alcohol.


Diagnosis of arthritic arthritis

The key point of diagnostic procedures is the detection of sodium urate crystals in the joint synovial fluid, both during an attack and during a remission. Synovial fluid for analysis can be taken from any large joint, even if it is never prone to inflammation, for example, from the knee. To study can be taken the contents of tofus or any other biological material.

Hyperuricemia( high uric acid in the blood) in combination with periodic inflammation of the joint of the big toe is not considered a confirmation of gout, it is only a marker of violating the purine metabolism. Many people with hyperuricemia do not have gout.

With prolonged course of the disease, it makes sense to conduct an X-ray study. At the early stage of the disease, there are no characteristic changes. Then on X-ray images there are signs typical of gout: destruction of cartilage, defects of the end sections of bones, piercers.

When developing gout on the upper limbs, it is difficult to differentiate it with other joint diseases: rheumatoid arthritis, osteoarthritis, etc.


Diet for gouty arthritis

Given that gout is a consequence of malnutrition, it can not be fully cured without clearfulfillment of necessary dietary recommendations. That is why gouty arthritis in most cases has a progressive course. But I would like to focus the attention of patients on the importance of such a therapeutic event, as diet therapy. According to the medical nomenclature, it refers to the diet table No. 6.

The most important principle of is the elimination of products that are a source of purines. Indeed, during their disintegration, a powerful release of uric acid occurs, which does not have time to bind and be excreted from the body. Its approximate composition is given in the table.


Can

Can not be

  • Wheat and rye bread;

  • Vegetarian, dairy and cereal soups: cabbage soup, borsch, okroshka, milk noodles;

  • Any cereal, except oatmeal;

  • Boiled beef, chicken, turkey, rabbit meat - 2-3 times a week;

  • Low-fat varieties of fish in boiled form - 2-3 times a week;

  • Eggs - 1 pc.in the day, cooked in any way;

  • Natural milk, cottage cheese, fresh cheese, sour-milk products( kefir, curdled milk, sour cream);

  • Cereals and pastas cooked in any way;

  • Potatoes, beets, carrots, tomatoes, sweet peppers, zucchini, cucumbers, eggplant, pumpkin, cabbage;

  • Any fruit and berries other than those listed in the above list;

  • Jam, honey, jelly;

  • Nuts;

  • Cinnamon, vanilla;

  • Non-fermented tea and coffee with milk;

  • Vegetable and fruit juices, lemon and cranberry juice, green, mint and lime tea, broth of wild rose;

  • Vegetable and butter;

  • Alkaline mineral water( you can sometimes add soda to drinking water);

  • It is allowed to drink wine without exacerbations.

  • Meat, fish, mushroom boiling broth;

  • Pork, lamb;By-products( kidneys, liver, brains);

  • Sausages( especially liverwood), ham;

  • Studen;

  • Fatty fish types( mackerel, sardines, mackerel, herring, cod,

  • Any canned food, smoked meat, salted and spicy dishes;

  • Seafood( shrimp, anchovies);

  • Salted and spicy cheese, brynza;

  • White mushrooms and champignons;

  • Baking

  • Bean cultures( peas, beans);

  • Salad: lettuce, spinach, sorrel;

  • Rhubarb, radish, cauliflower, asparagus, lentils;

  • Raspberries, figs;

  • Cocoa, chocolate, strong coffee and tea;

  • Alcohol( cognac, whiskey, beer);

  • Pepper, mustard, horseradish;

  • Salt.

How? There is much that is forbidden, but there are also enough products for a normal healthy diet. The main thing to remember is the prevention of excess. If it happened that a person could not resist eating the forbidden food, it is advisable to immediately take the appropriate drugs thatderive or bind products of uric acid metabolism.

Sample menu for gout for the week

Sample menu for gout for the week

Monday:

  • Breakfast: cottage cheese with fruit jelly, coffee with milk;

  • Lunch: Tomato juice;

  • Lunch: vegetable rice soup, bread, compote;

  • Snack: apple, not strong tea with marmalade;

  • Dinner: potato pancakes, green tea.

Tuesday:

  • Breakfast: cereal in milk, rye bread, pineapple juice;

  • Lunch: pear, walnuts;

  • Lunch: Braised rabbit, vegetable stew, compote;

  • Snack: Orange juice;

  • Dinner: a sandwich with cheese, tea with milk.

Wednesday:

  • Breakfast: Carrot cutlets with sour cream, mors;

  • Lunch: Banana;

  • Lunch: Vegetarian borscht with sour cream, broth of wild rose;

  • Snack: grapefruit, tea with jam;

  • Dinner: pumpkin casserole, green tea.

Thursday:

  • Breakfast: boiled egg, sandwich with cheese, tea with lemon;

  • Lunch: a glass of cherry juice;

  • Lunch: Trout baked with potatoes, vegetable salad with butter, mors;

  • Snack: Kefir, pastille;

  • Dinner: Muesli with nuts, mors.

Friday:

  • Breakfast: buckwheat porridge boiled on milk, green tea;

  • Lunch: baked apples with honey and nuts;

  • Lunch: vegetable salad, boiled rice, bread, orange juice;

  • Snack: tomato juice;

  • Dinner: stewed potatoes, fresh vegetable salad, a glass of skim milk.

Saturday:

  • Breakfast: fried eggs, a piece of rye bread, jelly;

  • Lunch: peach juice, almonds;

  • Lunch: soup on broth from lean meat, broth of a dogrose;

  • Snack: banana;

  • Dinner: cereal soup, cheese sticks, tea with milk.

Sunday:

  • Breakfast: corn porridge on milk, coffee with milk;

  • Lunch: kefir, pastille;

  • Lunch: vinaigrette, bread, mors;

  • Snack: apple;Dinner: boiled tuna with fresh or stewed vegetables.

After a year of treatment, with satisfactory health and no relapse, severe dietary restrictions can be removed. In this case, you can choose: either continue to adhere to the diet and reduce the dosage of medications taken or even cancel them, or continue taking medications and allow some relaxation in the diet.


How to treat gouty arthritis?

How to treat gouty arthritis

For many decades, official medicine has not come up with anything new in the treatment of gout and gouty arthritis. The entire treatment process also consists of two stages: the removal of inflammation and maintenance of anti-relapse therapy.

When an exacerbation or initial occurrence of gouty arthritis occurs:

  1. Administration of non-steroidal anti-inflammatory drugs. Indomethacin, ibuprofen( imeth, nurofen), movalis, rheumoxicam are most effective for gout. It is good to use their step-by-step designation with step-by-step application of injection forms with replacement by tablets;

  2. The use of the drug colchicine - a specific anti-inflammatory drug for gout;

  3. Topical application of ointments based on NSAIDs: indomethacin, diphylliph, doloben, remisid;

  4. Lotions and compresses based on a semi-alcoholic solution or dimexide in 25% concentration;

  5. Physiotherapeutic procedures: paraffin and other thermal procedures, laser therapy, magnetotherapy, exercise therapy, massage, gymnastics.

Treatment of the disease itself includes the following components:

  • Compliance with diet( normalization of purine metabolism);

  • The use of medicines that reduce the synthesis of urate;

  • Elimination of the causes of hyperuricemia.

To eradicate the problem completely, you need to work on its basis - excess uric acid. To this end, they are assigned:

  • Allopurinol. Refers to preparations that reduce the production of uric acid in the body. Its analog is the zilorik;

  • Probenecid. Promotes excretion of uric acid crystals in the urine, which reduces the appearance of gout. The drugs of this group include sulffinipasone, etebenecid, anturane;

  • Urikozyme. Provides immediate destructive effects on the already existing urate crystals in the body.

Allopurinol( Allupol, Purinol, Remid, Milurit), referring to the drugs of the first group, is most preferable. Indications for its use are high hyperuricemia( over 0.6 mmol / l), frequent acute attacks of arthritis, the presence of tofus, kidney failure. The initial dose is 300 mg / day. In case of inefficiency, it is increased to 400-600 mg / day, and when significant results are achieved, they gradually decrease. The maintenance dose is 100-300 mg / day, depending on the level of hyperuricemia.

Allopurinol helps to relieve seizures and soften tofusov, normalization of uric acid. In the first week of its administration, a slight exacerbation of symptoms is possible, therefore at this stage of therapy it is combined with anti-inflammatory drugs, low doses of colchicine or NSAIDs. If a gout attack occurs for the first time, and Allopurinol has never been taken before, you absolutely can not start taking it to reduce pain. If the attack occurred against the background of taking Allopurinol, you should continue taking it in the same dosage. In the treatment of allergic reactions( skin rash) are possible.

Drugs of the second group are of less importance in the treatment of gouty arthritis. They are not used with a high content of uric acid in the blood, with nephropathy and kidney failure. Sulfinpirazone is taken at 200-400 mg / day in 2 divided doses with a lot of alkaline liquid. An additional contraindication is gastric ulcer.

Probenecid( benzoic acid derivative) is prescribed at 1.5-2.0 g / day. Benzoic acid is found in cranberries, as well as in cowberry and its leaves. Therefore, cranberry and cowberry broths and fruit drinks are very useful for patients with gout.

Drugs of different groups can be combined with each other, however, as mentioned above, with severe kidney pathology, uricosuric agents are contraindicated. Also, they can be used only after complete relief of an attack of acute arthritis, otherwise one can provoke another exacerbation. During treatment with drugs of this group, daily water intake should be at least 2.5-3 liters.

Treatment is prolonged( from several months to several years), breaks in treatment usually lead to relapses. If all medical recommendations are followed, the condition of patients is normalized within the first month. It is recommended to carry out monthly monitoring of the level of uric acid and, depending on the results of the tests, adjust the dosage of the drugs. The main therapy can be supplemented with physiotherapy, massage, exercise therapy.

If you are overweight, it is recommended to lose weight, because there is a connection between excess weight, increased synthesis of urates and their reduced excretion by the kidneys. Also, you should stop taking thiazide diuretics to lower your blood pressure and aspirin. These drugs increase the body's uric acid content and can trigger an attack.

During exacerbations, the load on the affected joint should be minimized. In addition, you can make ice packs several times a day for 5-7 minutes.

Only an integrated treatment approach, which includes anti-inflammatory therapy, local effects, diet and medications that affect uric acid metabolism, can help fight gouty arthritis.

Author of the article: PhD of medical sciences Volkov Dmitry Sergeevich, surgeon

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Gout

Gout is one of the most common types of arthritis( inflammation of the joints) and occurs more often in men( mostly middle-aged).Gout occurs more often in men( mostly middle-aged) than in women.
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Causes of

The onset of the disease is closely related to the amount of uric acid that occurs as a result of processing certain foods rich in purines in the body.

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Normally uric acid is excreted by the kidneys in the urine. However, in patients with gout uric acid or too much is formed, or it is poorly excreted by the kidneys, as a result, the body accumulates its surplus. When uric acid is too much in the body, it begins to be deposited in the joints in the form of tiny crystals, which leads to inflammation and pain. It should be borne in mind that there is no clear connection between the level of uric acid in the blood and the development of gout - in some cases, attacks of gout develop in people who have uric acid levels within normal limits.

An increase in the level of uric acid in the body can be associated with impaired renal function, as well as with the use of certain medications.

Symptoms of gout

There is acute pain, swelling and redness of the joint( usually one or two).This acute condition( it is often referred to as by gout ) can last for several days or weeks( if not treated). The attack of gout often occurs at night, the joint becomes hot to the touch and very sensitive even to light touches.

Very often the joints of the thumb on the foot are affected, but other joints( ankle, knee, fingers and hands) may be involved. In some cases, joint tendons become inflamed at the same time.

Complications of

If attacks of gout occur frequently and for a long time, it can lead to serious damage to the joints and to a restriction of their mobility. In some cases, white nodules( tophi) are noted under the skin of the joints or around the auricle, which are a cluster of uric acid crystals.

What you can do

You should consult a doctor to make a precise diagnosis. The sooner you go to the doctor, the sooner the treatment will begin. With properly selected therapy, exacerbation of gout occurs after 1-2 days. If you really have gout, then, in addition to meeting all the prescriptions of a doctor, you should follow a very strict diet.

You should not eat( especially during an exacerbation) all products rich in purines: meat by-products( heart, kidneys, liver, brains, etc.), fatty fish( especially during the exacerbation period), salted and fried fish, canned foodmeat and fish), sharp and salty cheeses, red meat and products from it, lard, soups on meat, chicken, fish, mushroom broth;smoked meat products, beans( lentils, peas, beans, beans, soybeans).

You should not drink alcohol that increases the uric acid content and worsen its excretion by the kidneys( beer, cognac drinks, fizzy and dessert wines).

It is recommended to drink plenty of water, green tea.

When attacks gout , 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.

Keep track of your weight. However, any program for weight loss should be carried out under the supervision of a doctor, tk. A sharp weight loss can lead to an exacerbation of gout.

Be sure to tell your doctor about all medications that you are taking.

What the doctor can do

The physician should make a diagnosis by conducting various additional studies( including a blood test and determining the level of uric acid).With prolonged gout, an X-ray examination of the joints may be required.

The doctor will prescribe drug therapy during the period of exacerbation, give recommendations on the diet and the regime of physical activity and motor activity.

Based on the results of the additional studies, the doctor will select a treatment aimed at reducing the level of uric acid in the blood. Keep in mind that drugs prescribed during the period of exacerbation are not intended for long-term use and, as a rule, do not affect the level of uric acid.

Prevention of gout

If your family has cases of gout, then you are at risk. In this case, it is recommended to monitor the level of uric acid in the blood regularly, and also try to stick to a healthy lifestyle. Gout often occurs in individuals with high body weight and high blood pressure. Proper nutrition with the restriction of meat and other purine-rich foods plays a crucial role in the prevention of gout.

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Gout, gouty arthritis: symptoms, signs and treatment

Gout , or gouty arthritis is a disease in which a metabolic disorder occurs in the body and salts of uric acid are deposited in the joints. This is a very unpleasant, but easily amenable to treatment of disease.

occurs with gout relatively infrequently. Although the very word "gout" I hear almost every day. For example, most grandmothers call "gout" arthrosis of the big toe. Usually they say: "My leg has grown gout."

In fact, gout, although striking all the same big toes, is most often the lot of men. In women, gout( real, true gout) is several times less common.

Earlier, some 100 years ago, gout was generally considered exclusively a male disease. But in our time, due to the fact that women began to eat better, there are more meat and sausages, gout began to occur more often than, for example, a century ago.

In addition, gout in women began to occur more often due to the use of certain drugs, primarily - drugs for high blood pressure. Some drugs to reduce high blood pressure with prolonged use lead to an increase in the concentration in the body of uric acid. But all the same, in men gout shows itself much sharper and "more aggressive", since the concentration of uric acid is significantly influenced by male sex hormones.

Below I will tell you about symptoms of , signs of and treatment of gout , as well as what diet should be adhered to in this disease.

Symptoms of gout

"Classic" gout refers to a group of arthritis. It develops in people who have a hereditary predisposition to this disease. And a potential patient may not even suspect about his heredity.

Say, if his parents or relatives lead a healthy lifestyle, do not abuse alcohol and eat right, then the disease may not manifest themselves and will last a lifetime only in a latent, latent form. And our potential patient, who is predisposed to this disease, will provoke a disease only if he leads a lifestyle that is not quite healthy( from the point of view of the propensity to gout).

So, a typical gout is often( but not always) a full man who abuses either alcohol or so-called "purine food": meat, meat soups, smoked foods, fish-salted foods, by-products( liver, kidneys), beans,beans, chocolate, grape wine.

Abuse of these products leads to increased formation of uric acid in the blood, which in turn forms a poorly soluble salt of sodium urate. When the concentration of uric acid in the blood reaches the limit level, its salts in the form of microcrystals are deposited in the joint cavity, forming there a kind of "depot".

The presence of microcrystals of urate sodium in the joint cavity is for him a serious irritant. But nevertheless, crystals can be asymptomatic for a long time in the joint - until any provocation( physical overload, stress, prolonged fasting or, on the contrary, search of "purine products" and alcohol) provokes an acute gouty attack, that is,a gout attack. It is regular acute attacks of gout - the main sign of this disease. Symptoms of Gout

The first attacks of gouty arthritis are almost always short-term. The attack usually begins suddenly, most often at night. Most joints are inflamed( sometimes one, sometimes both).Less commonly, the thumbs on the hands, knee, ankle, elbow joints, calcaneal tendons and rarely - wrist joints are inflamed.

The pain is such that, according to the stories of my patients, I want to literally "climb on the wall" from her. The affected joint swells, reddens, the skin above it becomes bright red or purplish and hot to the touch. Even a slight touch to the inflamed joint or the slightest movement in it causes unbearable pain.3-4 days the patient is suffering, when suddenly the attack passes, as if nothing happened.

However, after a while, the pain also repeats itself suddenly. And, if at the beginning of the disease intervals between attacks are long enough, from one to eight months, and the seizures themselves are short, then everything changes with time. Attacks are becoming more durable, and the intervals between them are shorter.

Eventually, there comes a time when the pain in the joints becomes permanent, and the intervals between attacks are practically absent. This condition is called "gouty status", or chronic gouty arthritis. In chronic gouty arthritis, the articular cartilage is destroyed, and special defects are formed in the bones adjacent to the joint - piercers, which are a cavity filled with microcrystals of urate sodium.

In addition, sodium urate crystals can be deposited even under the skin, forming whitish solid nodules, filled with a gritty mass. Such nodules are called tofus, and most often they are located on the auricles or near the joints. Sometimes tofusi break through and through the formed fistula crystals of uric acid are allocated. Fortunately, usually within a few days after the tofus breakthrough, the wound heals without consequences.

In addition to the above troubles, gout, especially neglected, is almost always accompanied by the deposition of urate in the kidneys, which leads to urolithiasis, and sometimes to inflammation of the kidneys( pyelonephritis).

It's important to know! Female gout options usually flow much softer. Women rarely have acute gouty attacks, far toffee and punching in bones are much less common. Most often, female gout shows itself as blurred chronic pain in the knee or ankle. And to guess that this is not an arthrosis, an experienced doctor can only by the strong puffiness of the inflamed joint, uncharacteristic for arthrosis.

Diagnosis of gout

Assuming the presence of gouty arthritis in the patient( and in classical cases it is quite easy), a competent rheumatologist or arthrologist will send the patient to the x-ray of the hands and feet, as well as a biochemical blood test.

When the gout is started, the doctor will easily detect on the X-ray images of the hands and feet the characteristic gouty "piercers" in the periarticular bones. A blood test will show an increase in the level of uric acid. If this increase is clearly expressed and is combined with the presence of "piercers" in the bones and characteristic gouty symptoms, the diagnosis is considered reliable, and then we only need to choose the right treatment.

The problem, however, is that if you do uric acid analysis at the time of the attack( and it is usually at this time that the patient consults the doctor), then such an analysis may not record any deviations. That is, at the time of an attack, the level of uric acid in the blood can turn out to be normal( because at the time of an attack the maximum amount of uric acid goes to the inflamed joint).

Therefore, it is necessary to measure the level of uric acid in the blood several times, including interictal periods. But this is often not enough patience for patients with gout. As soon as the next attack "comes to naught," they often again completely stop thinking about their health.

Meanwhile, without proper diagnosis and without proper treatment, gout can lead to very undesirable consequences not only for the joints, but also for the kidneys.

Continuing the topic, I want to note that, despite the frequent mention of the term "gout" in literature and in conversations, in fact it turns out that the correct diagnosis of patients with gout is not always and often with great delay. Sometimes you have to deal with monstrous diagnostic errors.

For example, one of my patients at the time of the attack, surgeons managed to diagnose "gangrene of the big toe," and amputated a gouty finger with a gout. Literally in 3 weeks he had a big thumb on the other leg, and the patient was going to amputate him too! Fortunately, the man guessed that this time it would be necessary to consult another doctor, and turned to me for help. On examination, it became immediately clear that the patient did not have gangrene, but classical gout. I prescribed a colpicine for the patient, and the attack was eliminated literally in one day! From the imaginary gangrene, the next day there was no trace left.

Another patient for seven years was treated for arthrosis, despite the fact that his joints were inflamed with attacks, alternately, about once a month, and the inflammation never stayed longer than 5-7 days. The most surprising thing in this story was that the patient in numerous blood tests taken from a vein, uric acid just off scale. She was above the norm more than 2 times! But the doctors over and over managed not to pay attention to this. And they continued to bend their line. In one of the attacks, a man even managed to operate his knee and removed a completely healthy meniscus. But the operation, of course, did not bring any relief to the patient. The knee periodically continued to become inflamed along with other joints.

Only after the man came to see me and put in front of me a pile of tests, where the constant increase in the level of uric acid was clearly read, the patient was finally picked up adequate anti-gouty treatment. And already a month after the beginning of treatment, gout attacks, for the first time in all past years, began to come to naught. And then stopped at all.

Treatment of gout

Having diagnosed the patient, I usually without any irony say: "Congratulations, you have gout."I really do not sneer, because of all the possible diagnoses this one is one of the most favorable. Gout is very easy to treat and does not represent a particular difficulty for a competent specialist.

Although here, as often happens, there is a "spoon of tar in a barrel of honey".Yes, gout is treated very well, but many patients with gout do not want to accept the conditions that are necessary for recovery - as "conditions" is the rejection of those foods( and alcohol) that caused metabolic disorders. And when I tell patients that to get rid of the disease, I must give up my favorite foods and alcohol, I often just do not want to hear. Because every time I have to patiently explain that without a diet there can be no question of recovery - no matter what "steep" drugs are not used. Another thing is that in many cases the diet is a temporary measure, and if certain conditions are met, after a year or two severe restrictions can be canceled.

Drug therapy gouty arthritis consists of two components: treatment of an acute attack and therapy of the actual gout.

Non-steroidal anti-inflammatory drugs( voltaren, ibuprofen, movalis, nimulide, etc.) are successfully used to stop acute gouty attacks, or a short-acting special antidotal agent called colchicine. Locally on the affected joint, you can put a vodka compress.

Preparations for arresting an acute attack do not last long, with a short three to seven-day course. And directly for the therapy of gout, in the absence of contraindications, for several months or years, use the drug that reduces the formation of uric acid in the body - purinol, the same allopurinol .

Compliance with the diet and the use of purinol( allopurinol) leads to the normalization of patients during the first month of therapy. Although the first week, against the background of therapy with purinol or allopurinol, there may even be an exacerbation of the disease. But then the attacks become weaker and happen less and less, and eventually stop at all.

And after about a year, with the well-being of my ward, I allow some indulgence in his regime. I ask the patient what he would like to cancel - a diet or taking medication, because we can limit ourselves to something else. If the patient is already accustomed to a diet, then there is no point in breaking it. In this case, it is better to reduce the dose of medications taken or to abolish them altogether.

If the patient with difficulty endures restrictions in nutrition, then you can abandon the diet, but continue to take medication. However, the use of drugs will take several years - which, in general, is not terrible, since purinol( allopurinol) rarely causes any side effects and is generally well tolerated by patients.

Article of Dr. Evdokimenko © for the book "Arthritis", published in 2004.Edited in 2011. All rights reserved.

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Gouty arthritis: how to treat and the causes of

Gouty arthritis( gout) is a disease associated with a metabolic disorder in the body in which uric acid salts( urates) are deposited in the joints. This is a very unpleasant, but fortunately, easily treatable disease.

In our time, gouty arthritis is relatively rare, while the word "gout" itself we hear almost every day. For example, many old grandmothers are called "gout" of arthrosis of the foot or big toe. In fact, although the disease affects all the same big toes, for the most part it is the lot of men. In women, this type of arthritis is much less common and manifests itself less sharply and "aggressively".This is due to the fact that the concentration of uric acid is significantly affected by male sex hormones, which women, for obvious reasons, are deprived.

The photos of gouty arthritis located in the article will allow you to get acquainted with the course of the disease in more detail, including with the stage of acute gouty arthritis.

Gouty arthritis: the causes of

Gout is primarily associated with a metabolic disorder in the body, and food( in particular, meat), consumed in excess, only aggravates the course of gouty arthritis, the cause of this is not, as many believe.

Predisposing factors of the disease:

  • obesity, sedentary or sedentary lifestyle,
  • weighed down,
  • hypothermia,
  • taking certain medications.

In some diseases, gouty arthritis can be secondary, for example, with heart defects( congenital and acquired), lead toxicity, certain types of leukemia, diuretics, riboxin, aspirin, etc.

Gouty arthritis: symptoms

Gout is strikingtwo systems in the body - urinary and musculoskeletal. The joints suffer the most - they start to worry first. It is noteworthy that at the initial stage of the disease the symptoms of gouty arthritis in the form of pain can occur irregularly and occur every 2-3 months. In women, the symptoms usually appear milder, and the seizures are less painful. Affected, as a rule, the joints of the big toes, ankle, knee and elbow. Less common are interphalangeal and wrist joints of the fingers. The affected area swells, the skin over it acquires a crimson color. After the first attack of gouty arthritis, the symptoms may disappear within 3-4 days. However, gout will continue to destroy the tissues of the body. Over time, the pain will begin to increase, and breaks between attacks - shrink.

Specific accumulations of salt crystals under the skin( tofusi) may also occur. They have the form of nodules whitish in color and are located in the area of ​​the auricles or joints. With the development of the disease, the accumulation of urate in the kidneys increases. This leads to the development of urolithiasis and kidney failure. If you do not deal with this issue in time, the disease will develop into acute gouty arthritis, which is much harder to cure.

If there is a suspicion of gout, you need to perform a biochemical blood test, as well as an x-ray of hands and feet. The diagnosis is confirmed if there are characteristic lesions of the joints, as well as an elevated uric acid content in the blood. Blood tests must be performed during periods of acute illness and between them.

Gouty arthritis: treatment of

Treatment of gouty arthritis should be performed under the supervision of a doctor and with the delivery of( periodic) urine and blood tests. It includes, first of all, drug therapy, diet, as well as the use of antidotal drugs, which help to remove urate and uric acid from the body. In addition, gouty arthritis shows nutrition full and correct, the use of vitamins, as well as a good and full rest.

The diet for gouty arthritis is inherently gentle enough, because it simply does not allow the use of harmful products that contribute to the development of the disease.

Nowadays, the treatment of gouty arthritis with folk remedies has become very popular. Such treatment, as a rule, involves various means grown on the "garden bed".Here are some of the most effective products:

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