Gout - Causes, symptoms and treatment. MF.

Gout is one of the oldest diseases described in medicine. In the 5th century BC, Hippocrates called "gout"( from the Greek words "under" - foot, "agra" - the trap) acute pains in the foot. It was called "the disease of kings and the king of diseases", a disease of aristocrats, even considered a sign of genius. She suffered such famous people as Leonardo da Vinci, Alexander of Macedon, many members of the Medici family from Florence, Isaac Newton, Charles Darwin. And this list is far from complete.

Gout is a disease associated with impaired purine metabolism, which leads to an elevation in the blood of uric acid( hyperuricum) and its deposition in the tissues of the musculoskeletal system and internal organs.

In the human body, purine bases are broken down to uric acid and excreted by the kidneys. When the limit of uric acid concentration in tissues is exceeded, the deposition of its crystals in the form of sodium monoaurate in the joints, kidneys, soft tissues begins. There are clinical manifestations of arthritis( inflammation of the joint), there are formations in soft tissues( tofus), urate nephropathy( kidney damage) and nephrolithiasis( formation of kidney stones).

Changes in dietary habits and lifestyle led to the fact that in industrialized countries, 1-2% of the population suffers from gout.

Causes of gout

1. Drug administration: diuretics( thiazide diuretics), low doses of aspirin( 1g per day), cyclosporins.
2. Diseases and conditions that lead to the appearance of gout: diabetes, obesity, ischemic heart disease, arterial hypertension, metabolic syndrome, chronic renal failure, lead poisoning, organ transplantation, psoriasis, blood diseases. The intensification of gout is facilitated by intravenous contrast( with radiological examinations), trauma, surgical interventions.
3. The risk of gout is extremely high among people who are in the habit of consuming products containing a large number of purine bases( fatty meats, seafood, alcoholic drinks, carbonated drinks).
4. Gout more often develops in men( age 30-60 years), in women gout develops much less frequently and mainly in the menopausal period.

Symptoms of gout

Acute gouty arthritis begins with the lesion of one joint, most often the thumb of the foot. The emergence of acute arthritis can be preceded by heavy eating, alcohol intake, trauma, and surgical intervention. The disease develops suddenly, early in the morning there is a sharp pain, swelling and redness, the symptoms quickly increase and reach a peak within 24 - 48 hours. The pain becomes severe, patients often can not wear socks or touch a sick joint. Acute gout can be accompanied by an increase in body temperature to 38 degrees. Sharp weakness, general malaise. Even in the absence of treatment, exacerbation of gouty arthritis disappears gradually within 5 to 7 days.

Acute gouty arthritis

As the disease progresses and in the absence of adequate treatment, attacks of arthritis become more frequent and prolonged, new leg joints are involved. There is deformation of the joints due to nodular deposits and bone growths, tofusov.

Tofusi are uric acid crystals, which are deposited in the periarticular tissues, are painless, dense nodules of yellowish color. Most often located in the area of ​​the auricles, elbows, ankles, joints of hands and feet.

Gradually appears joint stiffness, which makes it difficult for patients to move. The risk of fractures is high. Each new exacerbation of gouty arthritis significantly worsens the course of the disease, contributes to the rapid development of complications.

In general, uric acid is secreted by the kidneys, the deposition of uric acid salts in the renal pelvis leads to the development of urolithiasis. Departure of stones( stones) is manifested by intense pain in the lumbar region - renal colic.

Diagnosis of gout

1. Biochemical blood test. Detection of hyperuremia: increased uric acid levels in men over 0.42 mmol / l, in women over 0.36 mmol / l. Definitions of the level of blood creatinine - for the detection of renal failure.
2. Investigation of the synovial fluid of the affected joint. When a chemical or microscopic study determines the crystals of uric acid, in the sowing there is no bacterial flora.
3. Radiography of the joints determines changes in chronic gouty arthritis.
4. Kidney ultrasound. Detection of X-ray negative stones( stones).

Radiography of the joints - gouty arthritis

Consultation: rheumatologist, nephrologist, surgeon.

Treatment of gout

Adherence to dietary recommendations is important to prevent gout exacerbation. This restriction of consumption: meat and fish products, beans, sorrel, spinach, cauliflower, raspberries, figs, chocolate, strong tea, coffee. It is forbidden to drink alcohol, especially wine and beer.

It is recommended to increase the volume of liquid to 2 liters per day, if there are no contraindications. This is cranberry juice, juices, alkaline mineral water. Gradual normalization of body weight is mandatory for the patient, as it helps to reduce the level of uric acid in the blood.

The purpose of drug treatment is to reduce pain during an attack and to treat disorders of purine metabolism.

During an acute attack of gout, the patient is recommended complete rest, especially a sick limb. It should be given an elevated position of the foot, attach a blister to the joint with ice, and after the abatement of pain - a warming compress. For treatment of an attack non-steroidal anti-inflammatory drugs( NSAIDs) are used. The drug, its dose, the frequency of reception, duration is recommended by the attending physician.

To achieve a persistent reduction in uric acid, which prevents the progression of gout, antipodal drugs( alopurinol, sulpharperazone, uralite etc.) are used. These drugs are used for a long time( years).The necessary drug is chosen by the attending physician individually for each patient, depending on the age, concomitant diseases, the level of uric acid in the blood.

In the formation of large tophi, with ulceration of the tissues, the presence of fistulas, surgical treatment is recommended - the removal of tofus, since they can no longer dissolve when taking antipodal drugs, and can significantly limit the function of the joints.

Physiotherapy for gout

In an acute period, applications of a dimexide solution on the affected joint are used. It has an analgesic and anti-inflammatory effect. Before the beginning of the procedure, samples for sensitivity to dimexide( the presence of an allergic reaction) are conducted, after 24 hours after the procedure begins procedures. For applications, a 30-50% solution of dimexide is used( dilute pure dimime with boiled water).A napkin soaked in a solution is put on a sick joint. Initially, the duration of the procedure is 10 minutes, later it is increased to 2 hours. In the period of remission apply applications with mud, paraffin, ozocerite, which improves the function of joints, reduces the urate content in them.

In the period of remission, patients are shown sanatorium treatment. On the health status of patients, the course of the disease has a beneficial effect of health activities: diet food, intake of alkaline mineral water, balneotherapy, mud therapy.

Phytotherapy for gout

In complex treatment with diet and antidotal drugs, phytotherapy is used. Infusion of leaves of cranberries( 1/2 glasses 3 times a day).Infusion of leaves of black currant( ½ cup 4-5 times a day).Infusion is prepared: 1 tablespoon of dry leaves for 500ml of boiling water, 2 hours, drain. Apply the fruits of blueberries.

Diet for gout

From the diet it is necessary to exclude or minimize foods and dishes containing large quantities of purines, since purines form uric acid.

Foods that need to be excluded: liver, kidneys, brains, lungs, meat of young animals, chickens, meat and fish broths. A patient with gout should refuse to take alcohol, as it inhibits the excretion of uric acid by the kidneys and thus helps to increase its concentration in the blood.

Foods that need to be restricted: beans( beans, peas, beans), sorrel, spinach, eggplant, radish, cauliflower, asparagus, mushrooms, crustaceans, caviar, fish( Baltic herring, sardines, etc.).Large fish are allowed.

The need for calories for gout should be met mainly by carbohydrates. In small quantities, the diet can contain eggs, flour and cereal dishes, low-fat fish, beef, lamb. Fish and meat dishes should be eaten in boiled form, not more often 2-3 times a week. One portion should not be more than 250 g. During an attack of arthritis, fish and meat must be completely ruled out. Food should contain the necessary amount of vitamins, so the broths of dogrose, lemons, apples, black currants are useful. Without restrictions, you can consume milk and dairy products, cereals( bread, cereals, bran), most vegetables( potatoes, carrots, cabbage, cucumbers, tomatoes, pumpkin, onions, carrots, beets, radish, celery), nuts, watermelons, melons,berries and fruits, spices. It is known that cherries, strawberries, currants and other dark red and blue berries reduce the concentration of uric acid in the blood, so are useful for gout in any form. In the absence of diseases of the kidneys and the heart, an abundant alkaline drink( 2-2.5 liters per day) is necessary, fruit and berry compotes, alkaline mineral water, are suitable for this purpose.

Prevention of gout

Patients suffering from gout are observed by a rheumatologist and a therapist( family doctor).Twice a year, they undergo a comprehensive examination( determination of the level of uric acid, creatinine).Kidney ultrasound and joint radiography are performed once a year.

Complications of gout

Early abnormalities in purine metabolism are reversible, provided timely diagnosis and treatment, but at the stage of chronic gout with organ damage( heart, brain, kidneys) the prognosis of the disease is unfavorable. Kidney damage develops in 30-50% of patients with gout. With persistent increase in the level of uric acid in each 4 patients with gout develops chronic renal failure.

Consultation of a doctor on gout

Question: Why does an antidepressant drug get worse?
Answer: At the beginning of treatment with antipodal drugs( more often allopurinol), acute gouty arthritis can occur due to the excretion of uric acid from the tissue depots of the body. Therefore, in order to prevent, it is necessary to prescribe simultaneously NSAIDs.

Question: How long should I take antidotal drugs if the level of uric acid is normal?
Answer: Anti-gouty drugs are taken within a year, after which you can take a break for 2 months( with normal uric acid in your blood), provided that you follow a diet.

Doctor therapist Vostrenkova IN