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, 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 a 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 sites 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 discharged. 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, therefore, it is by no means impossible to reason on the principle of "caught-let-go".
Drug therapy for reducing uric acid level
Since the 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 region 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 calls into question 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.
However, 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 - rheumatic pathology caused by the deposition of crystals of urate salts - urate in the joints, then in the kidneys. The gout clinic is characterized by recurrent and progressive attacks of arthritis with intense pains and the formation of tofusi - gouty nodules, leading to deformity of the joints. In the future, the kidneys are affected, urolithiasis and kidney failure may develop. For the diagnosis of gout, synovial fluid is studied for the presence of urates, X-ray examination of the affected joints. Treatment of gout is aimed at stopping inflammation( NSAIDs, glucocorticoids), reducing the level of uric acid in the blood, normalizing nutrition.
At the heart of the pathogenesis of gout are metabolic disorders caused by a violation of the regulation of purine metabolism in the body and leading to the accumulation of uric acid and its derivatives - acid urate salts. Increased concentration of uric acid( hyperuricemia) in blood plasma and urate deposition is a consequence of their increased synthesis and decrease in urinary excretion. Urine microcrystals accumulate in the articular cavities with the development of gouty inflammation, as well as in the kidneys, causing nephropathy.
Gout usually affects patients after 40 years, while in men it is detected 20 times more often than in women.
In the gout clinic, renal, metabolic and mixed forms are distinguished. The renal form of gout is characterized by a decrease in the excretion of uric acid, the metabolic - by the excess of its formation;a mixed form combines moderate disorders of synthesis and removal of uric acid from the body.
Depending on the reasons leading to the development of the disease, gout may be primary or secondary. Primary gout is often due to genetic defects and hypofunction of enzymes involved in the exchange of purines and excretion of urinary salts. Gout development factors include excessive and monotonous eating patterns, increased consumption of meat and alcohol, and a low-activity lifestyle. Secondary gout is a consequence of other diseases - renal pathology with a violation of their functions, blood diseases( leukemia, lymphoma, polycythemia), psoriasis, drug therapy with cytostatics, saluretic drugs and other drugs.
The clinical classification distinguishes seven forms of gout flow: a typical( classic) attack of acute gouty arthritis, polyarthritis of the infectious-allergic type, subacute, rheumatoid-like, pseudo-reflagious, periarthritic and malosymptomatic variants.
Symptoms of gout
In the gout clinic, there are 3 phases: premorbid, intermittent and chronic.
The premorbid phase is characterized by asymptomatic uricemia and is not yet a gout. At the laboratory level, hyperuricemia is detected in 8-14% of adults. The intermittent phase of gout is characterized by episodes of attacks of acute arthritis, alternating with asymptomatic periods. To the manifestations of chronic gout form the formation of gouty nodules( tofusov), chronic course of gouty arthritis, extraarticular manifestations in the form of kidney damage( in 50-70% of clinical cases).
A classic attack of acute gouty arthritis develops in 50-80% of patients. Typically a sudden start, more often at night. The primary attack of gout is often provoked by alcohol, fatty foods, trauma, hypothermia. The attack of gout is characterized by severe pain in the area of the metatarsophalangeal joint of the first toe, febrile syndrome, swelling of the joint, gloss and hyperemia of the skin above it, a violation of the function of the joint. After 3-10 days, the attack of gout subsides with the disappearance of all signs and the normalization of functions. Repeated gouty attack can develop after several months and even years, but each time the intervals between attacks are shortened. In men, the primary attack of gout occurs more often as a monoarthritis with lesion of the foot joints, in women - oligo- and polyarthritis involving the joints of the hand.
Polyarthritis for infectious-allergic type in gout develops in 5% of patients. This form of gout is characterized by migraine pain in multiple joints, rapid regression of signs of inflammation, as in the case of the clinic of infectious-allergic polyarthritis.
The subacute variant of the gout current is characterized by a typical localization of pain in the first metatarsophalangeal joint and moderately expressed signs of lesion. In subacute gout in young patients, the development of mono- or oligoarthritis of medium and large joints is possible.
The rheumatoid-like form of gout is distinguished by primary interest of the joints of the hands in the form of mono- or oligoarthritis.
In pseudo-reflux-type gout, monoarthritis of various locations with inflammation of the joint and paranasal tissues, fever is observed. At the clinic, this option resembles the course of phlegmon or acute arthritis.
Malosymptomny variant of the gout current is characterized by a mild, worn out symptomatology - a small pain, weak flushing of the skin in the affected area.
For the periarthritic form of gout, lesions of the burs and tendons( often calcaneal) are common, with joint joints. In the future, the phenomena of chronic gouty polyarthritis with lesions of the joints of the legs, their defoguration and stiffness;deformation of articular tissues, bony proliferation;contractures, a crunch in the knee and ankle joints, incomplete dislocation of the fingers. Against this background, gout attacks continue with the possible development of gouty status - non-subsiding exacerbation of arthritis with chronic inflammation of the parasynthetic tissues due to their infiltration with salts. As a result of severe gout attacks, patients lose their ability to work and physical activity.
With prolonged anamnesis of gout( longer than 5-6 years) and hyperuricemia of high degree, there are specific signs - tofusi or gouty nodules, which are a cluster of urate crystals in soft tissues. Favorite sites of tofus locate are the ears, subcutaneous tissue of forearms, elbows, fingers, feet, legs, thighs. During attacks of gout, tofu can be opened with an outflow of whitish discharge.
Complications of gout
Hyperuricemia and accumulation of urate salts with gout leads to their deposition in the kidneys with the development of nephropathy;Gouty nephritis, characterized by proteinuria, microhematuria, cylindruria;arterial hypertension with the subsequent transition to chronic renal failure.
In 40% of patients there is a development of urolithiasis with renal colic at the height of a gout attack, complications in the form of pyelonephritis.
Diagnosis of gout
Patients with suspected gout are advised by a rheumatologist and urologist.
General clinical analysis of blood outside the gouty attack is not changed;in the period of attack there is a neutrophilic shift to the left, an increase in ESR.A biochemical blood test with exacerbation of gout reveals an increase in uric acid, fibrin, seromucoid, sialic acids, haptoglobin, γ- and α2-globulins.
On radiography of joints, characteristic changes are revealed in chronic gouty polyarthritis. Radiological picture reveals the presence of osteoporosis, against which background the centers of enlightenment in the region of epiphyses and joints up to 2-3 cm in size are determined;with a deep neglect of the process - the destruction of the bony epiphyses with their replacement by the accumulation of urate masses. Specific signs of gout on radiographs are determined after 5 years from the manifestation of the disease.
For articular fluid, joint puncture is performed. Microscopic analysis of synovial fluid in gout shows the presence of microcrystals of sodium urate in it. In the study of punctate tofusov crystals of uric acid are found. During ultrasound of the kidneys, urate calculi are determined.
Diagnostic gout markers are:
- microcrystalline urates in the synovial fluid;
- laboratory-confirmed tofusi with the deposition of crystalline urates;
- has at least six of the following signs: a history of more than one acute attack of arthritis;maximum signs of inflammation of the joint in the acute phase;redness of the skin over the inflamed joint;monoarticular type of lesion;pain and swelling of the I metatarsophalangeal joint on one side;one-sided nature of the defeat of the arch of the foot;tofus-like nodules;asymmetrical swelling of the joint;hyperuricemia;X-ray-detectable subcortical cysts without erosion;lack of growth of microflora in joints of articular fluid.
Treatment of gout
The main principle of gout therapy is to control the content of uric acid by suppressing its production and accelerating excretion from the body.
A diet is prescribed that excludes consumption of fish and meat broths, meat of animals, kidneys, liver, lungs, alcohol. The diet includes a restriction on legumes and vegetables( beans, peas, beans, spinach, sorrel, radish, eggplant, asparagus, cauliflower), mushrooms, caviar, some fish species( sardines, Baltic herring, etc.).With gout, the calorie requirement is met by carbohydrate food, so patients should control their weight. In moderation, eggs, cereals, lean fish, lamb, beef can be eaten. With gout it is required to limit the salt load and intake of a sufficient volume of liquid( up to 3 liters per day).
The medical approach to gout therapy is aimed at arresting acute gouty attacks, their prevention in the future, prevention of urate deposition in the joints and kidneys.
For the reduction of gout attacks, NSAIDs( indomethacin), vegetable alkaloids( colchicine), local ointments and gels are used. As antiresidivnoy therapy for gout is appointed colchicine in small doses or antihyperuricemic drugs. The goal of treating gout is to reduce the concentration of uric acid in the blood 2 times lower than the norm required for dissolving urate crystals. To activate the excretion of uric acid, uricosuric drugs are prescribed: pro-benefic, sulphinpyrazone, azapropion, benzbeteron. The means inhibiting the production of uric acid include milurite, allopurinol.
At an atypical form of gout, which proceeds with the accumulation of intra-articular effusion, its puncture evacuation is performed.
Conducting sessions of extracorporal hemocorrection is aimed at reducing the concentration of uric acid and urate salts, suppressing inflammation and reducing the dosage of the drugs taken.
Physiotherapy and spa treatment for gout is performed in the remission phase. Conducting the UFO area of the joint in the acute phase in a number of cases helps to stop the onset of gout.
Prognosis for gout
Timely recognition and the initiation of rational treatment give predictably favorable results. The factors aggravating the prognosis of the gout are young( up to 30 years) age, a combination of urolithiasis and urinary tract infections, weighed somatic anamnesis( diabetes mellitus, arterial hypertension), progression of nephropathy.
Prevention of gout
The need for gout prevention should be considered in chemotherapy as well as in patients with the threat of decay and necrosis of the tumor. From the first day of the chemotherapy course, the appointment of hypo-ricerchemic drugs( allopurinol) is necessary.
Prevention of new exacerbations of gout depends on compliance with water-salt regime, diet, body weight control. In the presence of relatives suffering from gout, other family members are advised to monitor the level of uric acid.
Gout - Causes and Symptoms, Treatment and Prevention of GoutGout is characterized by sudden, severe bouts of pain, redness and swelling of the joints.
Gout can affect any person. Men get sick more often than women, but after menopause women become the most susceptible to this disease.
An acute attack of gout can awaken a person at night by feeling that his joints are burning with fire. Affected joints are hot, swollen, and any strain on them can cause severe pain.
Fortunately, gout is effectively treated, and there are many ways to fight this disease.
Causes of gout
Gout occurs when urate salts, the so-called urates, accumulate in the form of crystals in the joints. This leads to inflammation and severe pain during gout attacks. Urat crystals are formed when the patient has elevated uric acid level in the blood - one of the metabolic products. The body produces uric acid during the cleavage of purines that make up food such as meat, anchovies, herring, asparagus, mushrooms, etc.
Normally, uric acid is filtered by the kidneys and excreted in the urine. But in some cases, the body produces too much uric acid, and displays too little. This leads to the accumulation of urate in the body, the deposition of needle crystals in the joints and other organs and tissues.
Risk factors for gout
The risk of developing gout increases significantly with a high level of uric acid in the blood. Factors increasing the uric acid content include:
1. Lifestyle .
Excessive consumption of alcohol and a diet rich in purine substances.
2. Diseases .
Hypertensive disease, diabetes mellitus, high cholesterol( hypercholesterolemia) and narrowing of the arteries( arteriosclerosis) increase the risk of gout.
3. Medications .
The use of thiazide diuretics( hydrochlorothiazide), a common treatment for hypertension, can increase the level of uric acid in the blood. The same goes for acetylsalicylic acid( Aspirin), which is often used to prevent the formation of thrombi.
4. Weighed down family history of .
If other members of the family suffered from gout, then the probability of this disease increases many times.
5. Age and gender of the .
Gout occurs more often in men than in women. But, as already mentioned, after menopause in women, the risk increases significantly. Men get gout mainly at the age of 40-50 years, and women - after 50 years.
Symptoms of gout
Symptoms of gout are almost always acute, suddenly - often at night, and without any precursors. These include:
1. Intense joint pain. Gout is usually affected by a large joint on the big toe, joints of the foot, knees, elbows, wrists. Severe pain can disturb the patient within 12-24 hours after the appearance.
2. Prolonged discomfort. After the pain subsided, the discomfort in the joints can bother from a few days to several months. Subsequent seizures may last longer, and seize new joints.
3. Inflammation, redness and swelling. Affected joints can look large, swollen and red - these are typical signs of severe inflammation.
When should I seek medical help from a doctor?
If a patient experiences sudden, intense pain in the joints, you should immediately seek medical help. In the absence of timely treatment, the disease can lead to worsening pain and joint deformities. In addition, pronounced inflammation and joint pain can speak not only of gout. This may be, for example, a sign of infection in the joint.
Diagnosis of goutAssays that can help in the diagnosis of gout include:
1. Joint fluid analysis. A doctor can take a sample of joint fluid from the affected joint. Then the liquid is studied under a microscope to determine the characteristic crystals of urate in it.
2. Blood tests. In blood samples of a patient with gout, an elevated uric acid level can also be detected. But blood tests can be deceptive. Some people have a constantly elevated uric acid level in the blood, but they never get sick with gout.
Treatment of gout
Treatment of gout is usually medicated. The choice of specific drugs will depend on the severity of the disease, the health of the patient and many other factors. Drugs used to treat gout include:
1. Non-steroidal anti-inflammatory drugs, or NSAIDs. These drugs help to remove inflammation and fight pain. OTC-free NSAIDs include iburofen( Ibuprom, Nurofen, Imet).For prescription NSAIDs include diclofenac sodium( Voltaren, Olfen), indomethacin( Metindol), etc. It should be remembered that this group of drugs is associated with an increased risk of gastrointestinal bleeding, the formation of a stomach ulcer and other complications.
2. Colchicine, highly valued by physicians in many Western countries. It is a plant alkaloid with a cytostatic effect. It has the property of inhibiting inflammation and immune reactions. Very effective for the treatment of exacerbations of gout. The drug is strictly prescription.
3. Corticosteroid hormones. These are such drugs as triamcinolone, dexamethasone, prednisolone, etc. They inhibit the inflammatory process. Can be used both in the form of tablets, and in the form of injections( including intra-articular).They have a powerful effect, but are associated with a risk of many side effects. Appointed only by a doctor. Drugs for the prevention of complications of gout:
1. Drugs that block the production of uric acid. These are preparations of a group of inhibitors of xanthine oxidase, like allopurinol( Lopurin, Aloprim) and fębuksostata( Ulorik).These drugs effectively inhibit the production of uric acid, lower its level in the blood, reduce the risk of exacerbations. Side effects may include skin rash and impaired blood counts. Febuksostat can disrupt liver function.
2. Drugs that improve the excretion of uric acid. Probenecid( Probalance) increases the ability of the kidneys to excrete uric acid from the body. This reduces the risk of exacerbations, but the level of uric acid in the urine increases( this is normal).Side effects include rash, stomach pain and kidney stones.
Alternative Medicine and Gout
Traditional treatment of gout does not always go as efficiently as one would like, so some patients try all sorts of unconventional methods. Before choosing a traditional medicine, it is worth consulting with your doctor.
Some methods are not just useless, but also dangerous in certain cases. They remain "alternative" because science has not yet found convincing evidence of their effectiveness and safety.
The following are alternative methods of treating gout that are relatively common in the West, and for which a certain amount of factual information has already been collected:
1. Coffee .
Some studies have found a link between taking coffee and lowering the level of uric acid. Other studies do not confirm this. Many doctors forbid taking coffee with gout, because it contains purine substances.
2. Vitamin C with .
Food supplements containing vitamin C can lower the level of uric acid in the blood. Nevertheless, the use of vitamin C for the treatment of patients with gout has not been seriously studied. It is known that megadoses of vitamin C lead even to an increase in the level of uric acid in the blood, but small doses, most likely, will not harm anyone. So the data is contradictory, and the choice remains for the patient and his doctor.
3. Cherry .
These delicious fruits can lower the level of uric acid in the blood, but whether they affect the symptoms of gout - remains unknown. Some nutritionists recommend taking more cherries, blueberries, grapes, raspberries with gout. But the question remains open.
Other alternative therapies include techniques such as relaxation, deep breathing techniques, meditation, etc. These methods are, of course, aimed not at correcting the metabolism, but in combating the pain and discomfort that accompany gout.
Complications of gout
Patients with gout can develop serious conditions such as:
1. Recurrent seizures. Some patients are constantly experiencing exacerbations of this disease - several times a year. In this case, correct preventive treatment and normalization of nutrition is necessary.
2. Deposition under the skin and in various organs of accumulation of salt of uric acid. This leads to the formation of skin nodules called tofas. Tofy can affect the fingers, feet, elbows, ankles. They are usually painless, but can become swollen during exacerbations.
3. Kidney stones. Crystals of uric acid can accumulate in the kidneys, leading to the formation of urate stones. Special drugs will help prevent the formation of stones, as well as "dissolve" the ones already available.
Prevention of gout
Along with medical treatment( but not in its place!), The patient can try to change the diet, which will also benefit. The American Association of Dieticians( ADA) recommends the following changes in the diet for the prevention of gout:
1. To consume large amounts of fluids. American doctors recommend using at least 2-4 liters of fluid per day. And half of this liquid must be clean water. It is necessary to limit sweet drinks, such as lemonades, syrups, etc. .
2. It is strictly forbidden to drink alcoholic beverages. If, of course, a person is not able to give up drinking, you can talk with your doctor about the "maximum" alcohol that can be given to the patient. It must be remembered that alcohol not only worsens the course of gout, but also increases the risk of its occurrence, especially in men.
3. Balanced power. In the diet should be more fruits, vegetables, whole grains and low-fat dairy products.
4. You need to get proteins from foods that are low in fat, such as tofu or eggs. It will also protect against increased cholesterol.
5. Limit the consumption of meat, fish and poultry. A small amount of these products in the diet is allowed, but it should not exceed 110-170 grams per day.
6. Maintain a healthy body weight. It is necessary to develop a diet in which the patient will not go beyond normal weight limits.
This will not only improve overall health, but also relieve the joints that are affected by gout.
Gout is a common type of arthritis( inflammation of the joints) and occurs more often in men( mainly middle-aged).
Gout - symptoms, treatment, prevention, causes, early signs. Gout occurs more often in men( mostly middle-aged) than in women.
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.
Normally, uric acid is excreted by the kidneys in the urine. However, in patients with gout or uric acid is too much 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 intake of certain medications.
Symptoms of gout
There is acute pain, swelling and redness of the joint( usually one or two).Such an acute condition( it is often called gout attack ) can last for several days or weeks( if no treatment is given). 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.
If attacks gout occur frequently and for a long time, it can lead to serious damage to the joints and to limiting 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 diagnosis. The sooner you go to the doctor, the sooner the treatment will begin. With properly selected therapy, exacerbation of gout takes place 1-2 days later. 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.
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.