Causes, Symptoms and Treatment of Gout On Legs
What is gout?
Gout is a metabolic disease in which salts of uric acid( known as urate) are deposited in the joints. Gout is otherwise called "disease of kings", an ancient disease that was known even in the time of Hippocrates. Now gout is considered a rare disease, it affects 3 people out of 1000. And most often it affects men over the age of 40, in women it is most often manifested after menopause. Gout itself is one of the types of joint diseases caused by the deposition of salts.
All gums suffer from gout, ranging from the joints of the fingers to the joints of the toes.
It was known even in the time of Hippocrates and is called "disease of kings" because the main source of its occurrence is the excess in food and alcoholic beverages. Gout is often chronic.
Causes of gout
The cause of gout is an elevated and persistent level of uric acid in the blood. During the course of the disease, urate crystals( a derivative of uric acid) are deposited in the joints, organs and other body systems. Sodium urate crystallizes and small particles are deposited in the joints, which ultimately leads to partial or complete destruction of the joint. For the same reason, such situations are called microcrystalline.
A large amount of uric acid in the body can be for two reasons: the first reason is when healthy kidneys can not cope with the withdrawal of an unusually large amount of uric acid, the second reason is when uric acid is released in normal amounts, but the kidneys are unable to remove it.
Every year, more gout is getting sick. Doctors explain this phenomenon by the fact that in recent years people are more likely to consume food rich in purines( for example, meat, fatty fish) and a huge amount of alcoholic products. This is confirmed by the fact that during wars the percentage of people suffering from gout fell sharply due to the fact that meat products, and, especially, alcohol, it was very difficult to get.
Symptoms of gout
The symptom of gout is a common attack of gouty arthritis - it is usually an inflammation of one joint, most often it turns out to be the joint of the big toe, knee or ankle. Usually, a gout attack occurs in the early morning or at night, it manifests itself in the form of unexpected severe pressing pain in one or another joint, the affected joint swells up, the temperature in the joint area rises, the skin turns red and starts to shine. Usually during the day the pain becomes a little less, but by the night it again intensifies, the duration of a gout attack lasts from two to three days to a week, sometimes more. With a repeated attack in this inflammation, other joints may be involved, this can lead to partial destruction of the joint.
Signs of gout is the appearance on the hands or feet of unusual growths, while the level of uric acid is significantly increased. When growths, in other words, tofusi burst, a person can see whitish crystals of uric acid. The patient can feel quite intense pain in the affected areas. Such salt deposits in the joints interfere with a full life.
Possible complications of
The main and most severe complication of gout is the appearance of gouty arthritis, it is also possible the occurrence of urolithiasis, in which the resulting stones consist of urate or crystallized uric acid.
Gouty nodes , also called "tophi" - it's nothing more than conglomerates of sodium urate crystals that have the ability to be deposited in all parts of the body. And in cases where such deposits get stuck in the joints or periarticular tissues, the immune response occurs, as these deposits are perceived by the body as a foreign body, which causes the accumulation of leukocytes and begins a strong inflammation called gouty arthritis.
It is worth paying special attention to the fact that gout-stones in the kidneys can become the main cause of kidney failure and can eventually lead to death.
Pain with gout
To understand the beginning of a gout you can by sudden pain in the joint. They are accompanied by severe redness, swelling and heat."Burn" can not only hit the place, but also the area of the body in the immediate vicinity. At the same time, the body temperature can rise to 39-40 degrees. Symptoms in most cases develop within an hour. Most often, this affects the big toe. Ordinary pain medications, such as aspirin, will not help.
Pain, as a rule, begins at night and becomes, in practice, unbearable. In the daytime there is often some improvement, the pain recedes, but do not think that everything has passed. Such acute symptoms can torment the patient for about a week.
Gout in men on legs
Gout is a chronic disease. Cure it completely impossible. This ailment often manifests itself on the feet. After the onset of the disease, the symptoms may recur after six months or a year. The disease can go into a dormant state, but, without any doubt, will make itself felt. With each attack, the time between them will be reduced. Gout will return to the person more and more often.
Damaged places on the legs are often destroyed more and more, the disease can affect the neighboring joints. With a long illness over time in the affected areas, under the skin may appear peculiar hillocks, which are called "gouty nodes" or "tofusi."
This is due to the fact that the body begins to perceive large salt deposits in the joints on the legs as a foreign body, the immunity begins to inevitably react - to accumulate leukocytes, after which a strong inflammation begins. Sometimes tofusov burst and out of them stand out whitish dust - crystals of uric acid.
Often gout develops in old age. In men, it occurs much more often and at an earlier age. The male population is susceptible to this disease by the age of 40.It should be noted that women begin to suffer from gout closer to 55, mainly after menopause, when the amount of estrogen, female hormones, is sharply reduced in the body. Children and young guys are practically not prone to gout. There are rare exceptions, in cases of hereditary impairment of uric acid metabolism.
The role of uric acid in the development of gout
This disease severely impairs metabolism. Purines enter the human body with food, but they are also produced by him. Next, purines are split into uric acid, which is excreted by the kidneys. In people with gout, the content of this uric acid is much higher than normal. Excess uric acid is deposited in those tissues where there is no blood supply. There, crystals are easier to gain a foothold.
The joints, cartilage and tendons are the most affected. As a result of this disease, not only these places, but also the kidneys suffer. Most often with gout develops urolithiasis, with a lower probability of the patient may suffer from renal colic.
This can occur for two reasons: if the uric acid is produced too much and the kidneys do not cope with the output volume, so it must be deposited in the human body. And the second reason is that the amount of uric acid is normal, but the kidneys can not remove it.
However, an elevated uric acid content in the body is not the only cause of gout. Here, several other factors play a decisive role: excessive nutrition, fatty food, overweight, sedentary lifestyle and hereditary predisposition.
What should I do if I have an acute attack of gout?
Even with adherence to recommendations, an acute attack will not be instantaneous. But this will significantly reduce the time during which the disease will torment the person. Mainly you need to observe strict bed rest. Painful limbs are best kept in an elevated position, for example, to lay a pillow under them.
In case of intolerable pain, ice can be applied. Then it is desirable to make a compress on a sore spot with Vishnevsky ointment or dimexide. In the intake of food, it is better to restrict yourself, you can use liquid porridge and vegetable broth. But drink is worth as much as possible alkaline drinks, for example, a decoction of oats, jelly, milk, mineral water or plain water, but with the addition of lemon juice( lemon juice dissolves uric acid deposits with rheumatism and gout).You need to drink at least 3 liters a day.
Any painkillers will not help. You can take modern anti-inflammatory drugs without steroids. If you took any preventive measures prescribed by your doctor, then the procedure should be continued.
Preventing exacerbations of gout
Most often gout appears in places where the joint was injured. Therefore, treat such places with caution. Do not wear narrow and uncomfortable shoes, as it can severely damage the big toe, which so "loves" gout. Mainly to prevent the onset of gout attacks, diet and balanced nutrition are used.
The way of life will have to be completely revised, making it healthy. You should reconsider your taste preferences. Recommended diet number 6, which helps reduce the body's uric acid and urate. Strictly limited, or even excluded, products containing urine bases - the main source of urate. But poor purines, and therefore allowed milk, cheese, eggs, vegetables, fruits and cereals will not leave you hungry. The patient's diet should contain whole grains, eggs, vegetables, fruits, dairy products with low fat content.
In food should restrict the intake of meat, fish, caviar, mushrooms, legumes. In addition, you need to limit consumption: smoked meat, marinade, anchovies, cauliflower, asparagus, sorrel, chocolate. Such a diet will lead to normalization of body weight and significantly reduce the burden on the joints during an exacerbation of gout.
More information on what you can eat and what not, as well as other features you can find here
Alcohol and smoking inhibit the excretion of uric acid from the body. Consequently, its crystals are more deposited in the joints. For prevention, alcohol should be completely excluded, especially beer, and also quit smoking. It is not recommended to drink tea, coffee, cocoa. In addition to dieting, it is worth doing at least once a week a fasting day with the use of a mono-product.
First of all, small joints are affected. Therefore, it is worth paying special attention to the development of their mobility. Attention should be concentrated on those areas where there are attacks of pain. Daily it is necessary to do gymnastics for joints. At first, it will be unusual, because the joints are harder to be mobile because of the deposits. It is recommended to be more often on air and to make walks.
Mineral water for gout
Mineral waters perfectly contribute to removing unnecessary purines from the body. Prefer alkaline and organic substances. They can be attributed primarily to Narzan, Essentuki and Borjomi. Remember that any liquid should be consumed at least 2.5 liters per day.
Treatment of gout
The diagnosis of "gout" means that a person will have to significantly change his lifestyle and constantly take medication, because it is unfortunately impossible to achieve a complete cure for this disease. However, timely treatment starts allows you to take gout under control, reduce painful attacks to a minimum and hedge against serious complications.
The main principle of treating gout is to control the level of uric acid in the body. For medical treatment should contact a doctor-rheumatologist. Its prescriptions will be aimed at reducing the volume of uric acid and its rapid removal from the body. Only a qualified specialist can prescribe medications that, with possible concomitant diseases, do not cause the greatest harm to health.
Most often, doctors prescribe for non-steroidal anti-inflammatory drugs for 1-2 weeks, such as methindole, diclofenac, butadione, indomethacin, naproxen. To quickly reduce the concentration of uric acid in the body, allopurinol, orotic acid, thiopurinol, hepatocatalcil, milurite can be prescribed. To stop acute signs of gout, doctors recommend taking colchicine.
Drug therapy for gout is aimed at solving two main problems:
Reducing the level of uric acid in the patient's body;
Coping with acute inflammation and pain relief.
The earlier the patient undergoes the examination, reconsiders his habits and proceeds to treatment, the more likely it is to achieve a stable remission. Without adequate therapy, gout rapidly progresses, especially in patients of mature and advanced age, so it is by no means impossible to reason on the principle of "caught-let-go".
Drug therapy for the reduction of uric acid level
Since the root cause of gout is precisely the excess of uric acid, the solution of this problem in 90% of cases leads to the cessation of attacks of excruciating pain and allows you to count on a comfortable life in the future.
To reduce the level of uric acid in the body, the following drugs are used:
Allopurinol is a synthetic analogue of hypoxanthine. This substance inhibits the activity of the enzyme xanthine oxidase, responsible for the transformation of human hypoxanthine into xanthine, and then xanthine to uric acid. Thus, Allopurinol reduces the concentration of uric acid and its salts in all body environments, including blood, plasma, lymph and urine, and also promotes the gradual dissolution of already accumulated urate deposits in the kidneys, soft tissues and joints. However, this drug has a number of serious side effects and greatly increases the excretion of xanthine and hypoxanthine with urine, therefore Allopurinol is contraindicated in patients with severe renal failure. Nevertheless, for the majority of patients with gout, it remains to this day a preparation of the first order. Cost: 80-100 rubles per packing 30-50 tablets;
Phoebusostat( Ulorik, Adenurik) is a selective xanthine oxidase inhibitor that, unlike Allopurinol, does not affect other purine and pyramidal enzymes of the human body, besides it is excreted not by the kidneys, but by the liver. Phoebusostat is a relatively new drug for the treatment of gout, it is not produced in Russia, and in Western Europe and the United States it has undergone numerous clinical trials and has shown excellent results. Febuksostat for three months completely dissolves accumulations of crystals of salts of uric acid in the area of fingers and elbows and effectively prevents their repeated formation. Can be used by patients with concomitant renal pathologies. It costs a drug not cheap - an average of 4500 to 7000 thousand rubles, depending on the country of origin;
Peloticase( Pegloticase, Krystexxa) is an infusion solution of enzymes that rapidly dissolve urate crystals( deposits of uric acid salts).It is used intravenously twice a month to stabilize the condition of patients with severe gout, which are not helped by traditional drugs. Anaphylactic shock is possible during the procedure. This is a very expensive drug that is produced exclusively abroad and is sold on order;
Probenecid( Santuril, BeneMid) is a drug that prevents re-absorption of uric acid in the renal tubules and enhances its excretion in the urine. Probenecid was originally used in complex antibacterial therapy to reduce the damage to the kidneys with antibiotics. But then it began to be prescribed for chronic gout and hyperuricemia( increased uric acid in the blood).It is important to understand that Probenecid enhances the excretion of uric acid, rather than suppresses its synthesis. Therefore, the treatment of gout with this drug is advisable only at the stage of remission. If you prescribe Probenecid to a patient with an acute inflammatory process, this will lead to active dissolution of already accumulated urates, an increase in the level of uric acid in the plasma, and, as a result, to attacks of excruciating pain. To avoid this risk, the first months of treatment with Probeecid gout are accompanied by additional hormonal and anti-inflammatory therapy. It costs a drug from 3500 to 7500 rubles.
Treatment of gout with decongestants and pain medications
Symptomatic treatment of gout is to stop seizures, relieve edema and pain, and is performed with the following drugs:
Colchicine( Colchicum, Colchimine) is an alkaloid, is released from the poisonous plants of the Melantie family. The most common source of colchicine is autumn autumnal. Colchicine inhibits the formation of leukotriene, stops the cell division of granulocytes, prevents the movement of leukocytes to the focus of inflammation and prevents urates( salts of uric acid) from crystallizing in the tissues. This drug acts as an emergency aid, and is recommended for admission in the first twelve hours after the onset of an acute attack of gout. It is necessary to drink immediately two tablets of Colchicine, an hour later - another, and then one tablet three times a day for a week. The drug very often causes unwanted reactions from the gastrointestinal tract - nausea, vomiting, loose stools. The average price of Colchicine in pharmacies is from 1,000 to 2,000 rubles;
Glucocorticoids( Cortisone, Hydrocortisone, Prednisone, Prednisolone) are synthetic analogues of human corticosteroids, that is, hormones produced by the adrenal cortex. Preparations of this group break the chain of natural reactions of the body to the interference of allergens, chemicals, bacteria, viruses and other foreign elements. Glucocorticoids quickly stop inflammation, but suppress immunity, so hormonal treatment of gout is advisable only if the expected benefit exceeds the potential risk. The cost of synthetic steroid hormones varies from 30 rubles( the oldest drug is Prednisolone), up to 1500 rubles( Cortisone);
NSAIDs( Aspirin, Analgin, Diclofenac, Ibuprofen) - Non-steroidal anti-inflammatory drugs are called so in order to emphasize their difference from hormones. However, the action of drugs in this group is somewhat similar to that of glucocorticoids. NSAIDs are non-selective inhibitors of cyclooxygenase, the enzyme responsible for the synthesis of thromboxane and prostaglandins. Thus, these drugs also suppress inflammation, but, unlike synthetic corticosteroids, do it more slowly, and are not immunosuppressants. For symptomatic treatment of gout, Diclofenac and Ibuprofen are most often used, the average cost is 10-30 rubles, the price of a popular generic( drug with the same active substance) Nurofen can reach 150 rubles.
How to prevent gout attacks?
To minimize the risk of new gout attacks, follow a few simple rules:
If possible, do not subject the joint to any load, periodically fix it in a raised position and apply ice for 15-30 minutes 2-3 times a day until the painsubsides;
Do not overuse aspirin, which can cause a jump in uric acid levels in the blood and aggravate the symptoms of gout;
Regularly measure the level of uric acid - it should not exceed 60 mg / l;
Every day, devote more than half an hour to physical education: walk, ride a bike, jog, dance, swim. In the morning, do exercises. Regardless of age and weight, patients with gout should give themselves daily physical exercise - sport works with gout more effectively than any medicine;
Drink at least two liters of clean water a day. So that the kidneys can excrete uric acid from the body, they need water first of all - not the liquid that the kidneys still need to filter( coffee, tea, juice), namely pure water. Without enough water, even healthy kidneys can not cope with the cleansing of the body;
Hand over the blood test to determine the level of the most important minerals and vitamins, and, if necessary, supplement the diet with a good vitamin and mineral complex. It is especially important for patients with gout to provide themselves with vitamin C;
Do not drink carbonated drinks with sodium benzoate and powdered juices with fructose, completely discard alcohol;
Revise your diet in favor of vegetables, fruits and cereals, eat no more than 120 grams of animal protein a day, avoid offal and fatty sausages.
On the topic: From the pains of gout can also see popular folk remedies
The newest data on the treatment of gout
According to the latest data, obesity is most likely to predispose to gout caused by excessive consumption of fatty foods of animal origin. At risk, lovers of sausages, wursts, bacon and hamburgers. It is the excess of proteins that leads to the excess of uric acid, and the extra weight creates an increased strain on the joints and, thereby, accelerates the development of the inflammatory process.
American scientists have also established a direct link between deficiency of calcium and ascorbic acid and the development of gout. With age, these important substances for the body begin to be missed even by those people who lead a healthy lifestyle and do not complain about excess weight. Therefore after forty years it is necessary to annually be examined and take multivitamins prescribed by the doctor.
Recently, a new drug, suppressing the synthesis of uric acid - Benzobromarone, has been developed. Now there are active clinical trials of this drug, and in some Western countries it has already been allowed and put on stream. But before the novelty rests on the domestic pharmaceutical market, it is likely that a lot of time will pass.
It is also known about the experimental development of new non-hormonal anti-inflammatory drugs that directly affect the protein interleukin, which provokes gouty inflammation of the joints and tissues. But the exact timing of the appearance of these drugs in a free sale is difficult to call.
Allopurinol: Pros and Cons
The most popular drug for treating gout, Allopurinol, is increasingly being sharply criticized by modern doctors, since the large number of side effects and complications associated with its regular use raises questions about the advisability of such therapy. According to statistics, an average of one in two hundred and sixty patients with gout Allopurinol provokes sudden death as a result of renal coma or cardiac arrest.
Nevertheless, the largest international study of Allopurinol, the results of which have recently been published in the scientific journal Annals of the eumatic Diseases, proves the high effectiveness of the drug, moreover - the ability to prevent the onset of death. This study certainly does not disprove the presence of side effects and high risk for the kidneys, and does not negate the need for new development. But we must admit that Allopurinol is still a first-line drug in the treatment of gout, at least because of good knowledge, reliability and affordable price.
Scientists have tracked the fate of 5,927 patients who received Allopurinol on a regular basis and the same number of patients treated with gout with other drugs that reduce uric acid levels. It turned out that the mortality in the first control group was 19% lower than in the second, and such results persist throughout the life of patients. That is, Allopurinol is still the most effective and safe drug, both for the treatment of acute, first-diagnosed gout, and for maintaining normal health in elderly patients with chronic disease.
Author of the article: Candidate of Medical Sciences Volkov Dmitry Sergeevich, surgeon
Gout( gouty arthritis): what is it, symptoms and treatment
Gout( gouty arthritis) is a disease in which there is an accumulation in the body of excess saltsuric acid( urates).
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 tissues
On average, one woman who suffers from gout is from 3 to 7 men, who are affected by this disease.
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, gouty arthritis suffers from 2-3% of the population( data for the United States), but for men after 40-50 years this figure grows to 5-6%.In Russia, the incidence of gout is about 0.1-0.2%.
Why this disease arises
how the gout arises( schema)
Because gouty arthritis is a metabolic disease, it arises in those people who have either increased the 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 strongly - so that 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 such attacks 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
tofuys( 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 in the body, 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, salt crystals 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 - and this 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 in 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, how many to conduct a full-fledged examination and to put 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 drugs. 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.
Please 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 a sick joint.
This drug is prescribed according to a special scheme and is taken every few hours for 1-1.5 days - until the severity of the attack goes to zero or when it becomes clear that you need to use another medicine.
In those cases when colchicine did not have a therapeutic effect( as 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 these or other 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 attacks
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 the right nutrition is so important.
therapeutic diet is an important element of
recovery Even if after a first attack of arthritis you 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 observe the rules of therapeutic nutrition. And it, unfortunately, is not so simple, considering what foods can not be eaten with this disease.
So, on the anti-gouty diet, it is necessary to exclude red meat and its products, meat by-products( kidneys, liver, heart), fatty fish, bean cultures, sharp and salty cheeses, as well as 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!
How gout manifests itself in different stages: symptoms and treatmentThe development of gout is caused by a metabolic disorder, as a result of which salts of uric acid( otherwise - sodium urate) are deposited as crystals in joints and soft tissues.
This chronic condition is known since ancient times and was once called "disease of kings", as the prerequisites for its development were immoderation in food and alcoholic beverages.
To date, gout is rare - in 3 people out of a thousand.
The most common symptoms of gout occur in men: is about 95%, most susceptible to the age of 40 years .In women, gout symptoms are rare and can occur after menopause.
Any joints can be exposed to gout: from fingers of fingers to toes.
Although it is considered a joint disease, the lesion affects a number of tissues and organs and causes serious damage to the entire human body.
Causes of the disease
The underlying cause of gout is a high, non-decreasing level of uric acid in the blood .
As a result, its derivatives - sodium urate crystals - are deposited in organs, soft tissues, joints and other systems. As a result, the joint begins to collapse.
Among the prerequisites for the accumulation of uric acid in the body can be called two:
- kidneys can not cope with the conclusion of a large accumulation of uric acid;
- uric acid is produced in a standard amount, but the kidneys are not able to withdraw it.
The main causes of increased accumulation of uric acid are:
- increased intake of purine bases( in particular, unlimited consumption of fatty fish, meat, alcohol, etc.);
- decrease in the amount of excreted uric acid;
- increase in catabolism of purine nucleotides.
Genetic predisposition implies the presence of all kinds of enzymopathies, i.e., diseases that cause a reduced amount of certain enzymes in the body.
Especially in cases where they are important for the correct metabolism of purine bases.
Increased intake of the purine bases
In a significant amount, purine bases are transformed, including the formation of uric acid, as a result of, which the kidneys do not have time to purge from the body.
The most purine-containing products:
- meat and meat by-products;
- oily fish;
- concentrated broth;
- cooking fats;
- bean cultures.
Of course, not necessarily the use of these products will lead to gout, but under certain conditions they can create a favorable background for its development.
Decreased urinary output of urinary acid
This is usually the case for people with chronic kidney disease.
In these cases, gout is a consequence of a primary disease, eliminating which, you can cope with unpleasant consequences.Dandelions are an excellent remedy for joint diseases. How to prepare a tincture of dandelion for joints and other recipes in an article on the topic.
The medicine Fullflex needs to know how to apply, so as not to harm the body. Instructions for use, patient reviews and other useful information that will help you with the choice of dosage and method of admission.
Increase catabolism of purine nucleotides
Catabolism implies the breakdown of complex compounds into simple compounds.
With respect to gout, the catabolism of purine bases leads to the formation of uric acid.
The reason for this can be not only food, but directly the body, since every cell contains human purine bases. When the cell "dies", they get into the blood and disintegrate.
The increase in the catabolism of purine nucleotides may be temporary, or may be a consequence of severe chronic diseases.
As examples of the reasons for the enhanced catabolism of purine nucleotides, the following can be named:
- reception of pesticides( drugs aimed at stopping the growth of young cells);
- hemolysis( destruction of erythrocytes), etc.
How does the disease manifest itself?Gout symptom - is the standard attack of gouty arthritis , i.e.there is inflammation of one of the joints, manifested as a tumor, severe pain, fever and redness of the skin in the area of inflammation.
Most often, seizures are of a morning or night time duration of 2 to 7 days. Relapses can be manifested already with the involvement of other joints, leading to the destruction of the affected joint.
The main signs of gout:
- with a disease appear peculiar growths( otherwise - "tofuses");
- also significantly elevated levels of uric acid in the body.
If the tofus burst, you will see light crystals of uric acid. Since the formations are perceived by the body as a foreign body, accumulation of leukocytes occurs in the sites of node formation and an inflammation called "gouty arthritis" develops.When gout is often in the kidneys, stones are formed, leading to kidney failure, and then - until the fatal outcome.
Specific signs and symptoms are inextricably linked to the stage of gout.
Stage one is premorbid
At this stage the disease has such symptoms:
- itching of the skin;
- predisposition to diseases of the gastrointestinal tract;
- increase in body weight.
At this stage, characterized by acute attacks.
Chronic stage - the most unpleasant
If the disease becomes chronic, signs begin to manifest in all body systems:
- formation of tofus;
- development of urolithiasis;
- severe redness of the skin;
- limitation of joint mobility and other characteristic features.
Complex of therapeutic measures
Thus, when the first signs of gout are manifested, treatment should be started immediately, in order to prevent the transition of the disease to a chronic stage.
For therapeutic purposes, an integrated approach is required, involving the identification and impact on the pathological chain, i.e. medical professionals should determine the root cause of the disease and prescribe appropriate treatment.
However, it should be borne in mind that in some cases( for example, with fermentopathy) only symptomatic treatment is possible.
Treatment of gout embodies the following methods:
- taking anti-inflammatory drugs;
- use of anti-gouty drugs;
- compliance with the diet;
- application of local treatment methods;
- use of traditional medicine.
Thus, if the family has a case of gout disease, it is worthwhile to be on the alert, adhere to a healthy lifestyle and appropriate nutrition, and periodically monitored by monitoring the level of uric acid in the blood.
The decisive prophylaxis for the development of gout is to limit the consumption of foods rich in purines of .
The onset of joint pain 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.
Figure: 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 level of urate is increased. 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, urolithiasis and kidney failure develop with gout patients.
Fig.: urolithiasis of
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 of 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 to avoid repeated attacks and prevent subsequent deposition of urates.
For the treatment of acute attacks, colchicine is used, after which the pain decreases within 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
Also widely used for treatment are corticosteroids( for example, dispropan), which are powerful anti-inflammatory drugs.
In addition, prescribed drugs that excrete uric acid( usually, it's allopurinol).
There is also a treatment for 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 tbsp.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.
Most often 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 joints( so-called tophi).
- 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 hardware treatment when combining 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 preparation 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( iodide-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 promptly remove urate deposits, large gouty nodes( especially in fistulas 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 tofus, resort to restorative joint surgery( 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:
- creating 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.
The menu for gout should be changed.
So, it is necessary to reduce to a minimum:
- meat products, including liver( only lean beef is allowed)
- fish products, including seafood( only lean large fish are allowed)
- consumption of legumes, sorrel, eggplant, cauliflower, mushrooms, radish
- consumption of chocolate
- number of pickles, 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 same amount of carbohydrate food increases in the diet:
Gout: treatment, symptoms, photos. Diet for gout
• Surgical manipulation.
Signs and Symptoms of
The first signs of gout begin with a lesion of the big toe joint on the lower limbs. Appears tumescence, pain, which tends to build up, redness of the skin and hyperthermia in the lesion. Even the symptoms of gout are expressed by the fact that it is difficult for a sick joint to move and it is impossible to touch it due to severe pain.
We should not exclude the fact that in rare cases, mainly in women, the disease can begin with joint damage on the upper limbs and spread to other small joints. Gout may be accompanied by symptoms of general intoxication - temperature, chills, increase in leukocytes in the blood, etc., making it difficult to diagnose.
The disease has a favorable prognosis and can pass independently without therapeutic intervention. But if after the subsidence of a gout attack subsides, the pain syndrome persists, it indicates the presence of the underlying disease, which requires additional examination.
Repeated attack of gout
After the debut of the disease can pass from 1 to 10 years, for which the symptoms experienced in gout are almost forgotten. Repeated relapses of the disease will occur each time with a significant decrease in the period of remission and with worsening of the signs of gout with each exacerbation. Gradually, neighboring joints will be affected, and the disease will acquire a migratory character.
The inflammatory process in the primary joint will expand with the involvement of the joint bag and ligament apparatus in the process. Gradually, because of excessive formation of urate and settling them on the surface of the joints, nodes - tofusi are formed. In the absence of treatment for gout on the surface of tofusov, there will be manifestations from which a pasty substance is released.
Treatment of the disease
Treatment of gout is divided into medicamental and not medicamentous. Drug treatment consists of the following principles:
1. Urgent correction of gout attack.
2. Achieving a therapeutic effect to prevent the development of complications( destruction of the articular surface, development of tofus and renal damage).
3. Identify and eliminate the causes of triggering the appearance of gouty arthritis.
Gout may be present in the human body and for a long time not to be seen. Therefore, when the first symptom appears, it is necessary to consult a doctor with a view to the prompt occurrence of remission.
Treatment of gout with medicines. Elimination of a gout attack is performed by several groups of drugs:
- Colchicine; - Non-steroidal anti-inflammatory drugs( NSAIDs); - Glucocorticoids.
The drug is selected individually, depending on the severity of the condition and the effectiveness of the previous treatment. Some NSAIDs may be prescribed as an anesthetic.
Home treatment for gout is also made up of several items:
1. Preventing obesity; 2.Decrease in urate production by diet; 3.Cold and rest on the affected joint; 4.Control of fluid intake.
When you reach the period of remission, do not forget about dieting with gout. Meals should be regular and moderate, becauseovereating and hunger strikes can provoke a new gouty attack.
What should be on the menu:
• Meat - lean meat( rabbit, chicken), seafood • Spices and sauces - tomato, sour cream, milk sauces, vanillin, cinnamon, bay leaves, citric acid • Drinks - chicory, green tea, juice, kvass,mors • Dessert - pastille, marshmallow, marmalade, jam • Fruits - apricots, oranges, apples, pears • Vegetables - aubergines, potatoes, cucumbers, carrots, zucchini, white cabbage • Dairy products - brynza, low-fat cheese and cottage cheese• Other - eggs, whole grains, vegetable oil, white and black bread.
What can not be eaten with gout:
• Meat - by-products, fatty meat • Legumes - beans, beans, peas, soy, lentils • Spices - pepper, horseradish, mustard • Drinks - coffee, alcohol, cocoa, strong tea;• Dessert - chocolate, cream, cake • Vegetables - cauliflower, asparagus, celery, spinach, pepper, radish, rhubarb • Dairy products - salty and spicy cheese, milk • Other - mushrooms, buns, animal fat, creambutter.
It is the proper nutrition for gout that will allow you to forget about this problem for a long time. Very often, various relief products are included in the treatment of gout, which help to reduce weight and normalize the metabolism. To such discharges carry:
1. Curd-kefir diet. Unloading consists of 400 gr.low-fat cottage cheese and 500 ml.kefir during the day;
2. Fruit and vegetable diet. Is the most optimal and sparing. You can use 1.5 kg per day.any permitted vegetables and fruits;
3. Kefir unloading is a heavy type of diet that allows the use of up to 2 liters.kefir for a day.
Folk treatment of .Despite the mass of positive feedback in favor of unloading diets, you should not self-medicate and choose such kind of discharge without the permission of the doctor. It is also possible to supplement the basic treatment of gout with folk remedies. Here are some recipes that are used at home:
- Infusion of cranberry leaves - 1 tbsp each.several times a day;
- Nettle juice - 1 tsp each3 times a day;
- Decoction of birch leaves - use on?glass 3 times a day;
- Treat affected joints with animal fat, cover with cellophane and wrap up with a downy shawl. It is best to do this procedure at night;
- Herbal foot baths made from sage, chamomile, oat straw, etc. Baths should not be hot, tk.it will strengthen the inflammatory process.
Excessive use of the above products increases the risk of getting gouty, so it is recommended to reduce this use to a minimum.
It should be noted that the blame is not only excessive consumption of purines, but also their difficult elimination. This problem occurs in patients with kidney disease. Of course, the improper functioning of the kidneys leads to the delay of uric acid salts, the accumulation of which will soon lead to the appearance of gout symptoms in men.
Symptoms of the disease
No disease can develop without clearly manifested symptoms, with no exception and gout symptoms in which men are expressed quite well.
- First of all, it should be noted an attack of gouty arthritis. This definition was awarded sharply appearing pain syndromes in the joint area. Most often they are caused by the use of meat products shortly before this, as well as by leaning on alcoholic beverages. Basically, such pains begin to manifest at night.
- The most pronounced symptom is deformity of the joint of the big toe, however gout can affect both the knee joint and the ulnar joint. During this period there is a strong aching pain, which prevents a person from even touching the affected area even slightly. Among other things, the affected area begins to swell, there is redness of the skin, while the temperature in this area is greatly increased.
Timely contact with a doctor
In men, such signs of gout should necessarily lead to the idea of an immediate visit to the doctor. It goes without saying that if the disease is started, the duration of such attacks will be several days, or even the longest. Quick access to a doctor allows you to remove the attack in the shortest period of time and relieve the patient's condition. It is worth noting that the frequency and duration of seizures can talk about the stage of the disease and encourage the patient to visit a doctor.
Treatment of the disease
It's no secret that the emerging signs of gout in men should indicate the immediate initiation of treatment. Like any other disease, gout treatment is done in a complex way. First of all, it is aimed at restoring metabolism and normalizing kidney function. It is important to remember that the use of antipyretic, analgesic and other medicines should be carried out exclusively according to the doctor's recommendation.
The initial stage of the disease is cured by the use of medicines and visits to various physiotherapy sessions. During this period, the body begins to receive the necessary nutritional status, dietary supplements and other useful components that contain collagen. It is worth noting that the mineral complexes during the period of such treatment are completely excluded.
In order to eliminate the symptoms of gout in men, the patient must prescribe analgesics. Among other things, the patient is prescribed the use of non-steroidal anti-inflammatory drugs. In the absence of a positive effect, steroid preparations are acceptable, however, on the recommendation of a doctor.
Mandatory in the treatment package includes visiting sessions of therapeutic gymnastics, as well as therapeutic massage. The last two options are effective enough to affect the disease and promote an early cure for it. Among other things, the doctor can be appointed and stretching, as a result of which it is possible to relieve the burden on the joints by stretching the bones. Such a procedure is carried out with the help of special devices and is only permissible under the supervision and appointment of a doctor. Independently resort to it is contraindicated.
In particularly difficult cases, doctors prescribe an operative intervention, the possibility of which is discussed in advance with the patient. This treatment option is carried out in those cases when no other treatment can produce the proper result and the disease continues to progress.