Gout – what it is, signs, symptoms,treatment regimen, nutrition and causes of gout

Gout is a chronic metabolic (metabolic) disease.
characterized by impaired purine metabolism (excessive decay
proteins) and the inability of the kidneys to expel urinary
acid. The disease usually occurs after 40 years in men
and after menopause in women. Gout affects any joints:
fingers, hands, elbows, knees, feet.

What is the disease, the causes and the first signs, and
what symptoms and treatment methods are used in the acute phase of gout in
adults – we will consider further in the article.

Gout: What is this disease?

Подагра

Gout is a type of joint disease that
which causes the deposition of uric acid salts in them. Her
called “the disease of kings”, because the disease was spread
earlier in higher circles, and most often arose due to
immoderation in food and alcoholic beverages.

Признаками подагры является появление на руках или ногах
peculiar growths, while the level of uric acid is significantly
increased

When growths, in other words, tophi burst, a person can
see the whitish uric acid crystals. Sick can
to feel quite intense pain in the affected areas. Such
salt deposits in the joints make it difficult to lead a full life.

Gout is an age-related disease. Have детей и подростков
rarely diagnosed. Usually, the first attacks in men occur to
40 years, in women after the fiftieth anniversary.

Have людей старше 60 лет заболевание встречается в 97% случаев. Have
representatives of the stronger sex the disease is more common because
their blood is initially a higher level of uric acid.

Classification

Clinical classification identifies seven forms of flow.
gout:

  • typical (classic) attack of acute gouty
    arthritis
  • polyarthritis of an infectious-allergic type,
  • subacute
  • rheumatoid-like,
  • pseudophlegmonous,
  • periarthritic and oligosymptomatic variants.

Различают 4 этапа формирования gout:

  1. The accumulation of uric acid in the body that is fixed
    elevated levels of its content in the blood.
  2. The formation of salt crystals in the joints.
  3. Aggression of immune cells against urate formations and
    inflammation of the damaged joint.
  4. Distant manifestations of gout, kidney damage, articular
    deformations.

The main manifestations of the disease at the time of exacerbation are pronounced
excruciating pains in the area of ​​the inflamed joint, its swelling and
redness. Any movement increases pain, which leads to
temporary loss of joint function

So, what is gout, if you look at the x-ray
sick? it инородные вещества – микрокристаллы уратов (солей
uric acid), which settle where there is no blood flow: in
joints, tendons. Inflammation occurs in them.

The first signs of gout

Признаки подагры невозможно спутать с другой болезнью,
so specific are its manifestations. Первые симптомы появляются
around the joint of the big toes (one or both). Exactly
этот сустав большого пальца подагра выбирает в качестве
the first target.

Signs of inflammation (in 97% of cases the joint is affected first
thumb on foot):

  • severe excruciating pain;
  • skin redness and swelling;
  • presence of whitish nodules in the joints (tophi),
    who had previously been inflamed;
  • fever;
  • признаки образования камней в почках (боли в области
    kidneys, blood impurities in the urine, etc.).

More specifically, the symptoms of gout vary by gender.
patients:

  • men have a sharp, almost unbearable pain in
    affected joint, swelling and redness of the skin.
    Заболевание прогрессирует быстрее и чаще поражает суставы
    hands
  • in women, only one joint is often affected, while neighboring
    affected by gout only in case of delayed treatment.
    In addition to the typical symptoms, women get a general malaise,
    nervousness, peeling of the skin at the site of the affected joint,
    immobility of the affected limb.

The reasons

The cause of the disease is the deposition of crystals.
uric acid (urate) in the cartilage tissue of the joint. Their накопление
leads to inflammation accompanied by severe pain
sensations.

One of the main causes of the disease is the accumulation of
body uric acid. Its chemical structure is similar to
caffeine. As a result, patients are forbidden to drink coffee and strong
tea to avoid exacerbations.

In normal amounts, the urates dissolve and are excreted by the kidneys with
urine. But with increased uric acid production of kidney work
not enough to completely evacuate the products of exchange, and some of them
the amount remains in the body in the form of dense sharp crystals,
surrounding and damaging cartilage tissue.

Uric acid can accumulate in the body due to two
main factors:

  1. Due to genetic disorders or hormonal factors,
    which are exacerbated by alcohol abuse and the wrong
    рацион power supply.
  2. Due to a metabolic imbalance either, as a result
    incorrect medication.

The acute form occurs when there is blood in the blood. stable
increased concentration of uric acid – more than 60 mg / l. Deviations
from this norm can provoke:

  • systematic overeating;
  • addiction to fatty meat food;
  • obesity;
  • physical passivity, immobility;
  • genetic predisposition.

Gout – especially age-related disease. Almost all elderly
people from 65 years old show signs of this disease. And in children and
young people gouty changes are fixed in exceptional
cases.

The main risk factors for exacerbation of gout are:

  • male;
  • age over 50 years;
  • skeletal muscle weakness;
  • obesity;
  • alcohol intoxication;
  • fluctuations in blood pH;
  • reduction of uric acid kidney.

Симптомы подагры и фото

Clinic of the disease depends on the degree of progression of the pathology.
The following classification of gout is adopted:

  • Stage 1 of the disease – asymptomatic in 80% of cases,
    detected only by urinalysis when the level of uric acid
    increased;
  • Stage 2 – salt in the joints cause acute pain;
  • 3rd, chronic stage – crystallizing urates deform
    joints, form stones in the internal organs.

Symptoms of gout include:

  • Sudden and severe pain in the joint;
  • Stiffness and swelling;
  • Redness;
  • Compaction of tissue around the outbreak;
  • More than half of patients with primary disease
    is the big toe.

The pain arises not so much from the “mechanical injury” crystals
surrounding tissues how much from penetrating the joint and making
directly in it a huge number of “inflammatory
substances. ” That is, the cause of the pain during an arthritic attack is not
mechanical (sharp crystals), and chemical (irritating
substances).

тофус на руках при подагре

A characteristic sign is the appearance of gouty tophus.  it
deposition of uric acid crystals in soft tissue as indicated
on the picture

Gout on the finger

How does the attack begin?

Before an attack, patients tend to feel absolutely
healthy, but many note the tingling sensation in the affected
joint. Many marked fatigue,
irritability.

  1. As a rule, the disease begins with an attack of so-called.
    gouty arthritis. Initially, the inflammatory process affects
    only one joint.
  2. Usually, the big toe is affected first (less often –
    ankle or knee joint).
  3. The attack most often begins at night or in the morning.
  4. The pain appears suddenly; she has a oppressive character and
    characterized by high intensity.
  5. The affected joint quickly swells, and in its projection is noted
    hyperemia of the skin and a local increase in temperature.

Repeated gout attack develops in most patients through
6-24 months after the first, but for a number of patients this period of time
much more (sometimes reaches 10-20 years). With time
incidence of acute gout attacks when untreated
is growing.

подагра на ногах

The occurrence of gout in the legs

The clinical picture of the acute phase of gout:

  • The appearance of severe pain in the joint;
  • Pain occurs most often during the night or early
    in the morning;
  • The appearance of edema in the place of the joint and around it;
  • Increased body temperature;
  • Loss of appetite, chills, general deterioration.

Most often, at first, pain manifests itself only in one joint –
обычно первым страдает большой палец на ноге  (подагра
thumb), at least – knee or ankle.

Complications

Hyperuricemia and accumulation of urate salts in gout causes
to their deposition in the kidneys with development:

  • nephropathy;
  • gouty nephritis characterized by proteinuria,
    micro hematuria, cylindruria;
  • hypertension with subsequent transition to chronic
    renal failure.

40% of patients develop urolithiasis with
renal colic at the height of a gout attack, complications in the form
pyelonephritis.

What diseases can be taken for gout?

What other diseases occur according to a scenario similar to gout?
Especially this information will be useful to those who are accustomed to set themselves
diagnosis, using reference books or information from the Internet.

  • septic (purulent) arthritis.
  • pyrophosphate arthropathy;
  • reactive arthritis;
  • rheumatoid arthritis;
  • остеоартроз (часто сочетается с подагрой);
  • псориатическим артрит (воспаление суставов в сочетании с
    skin disease – psoriasis).

Diagnostics

If the joints at least once made themselves felt – contact a doctor
required And it doesn’t matter how quickly the attack passed and
how strong was the pain. Otherwise, you can bring the matter to
disability.

What doctor treats gout? Rheumatologist. At the first reception he
will conduct an external examination of the joints, diagnose the condition
the patient.

Direct diagnosis is made on the basis of clinical and
paraclinical (laboratory and instrumental) examinations. Have
some patients do not take long to diagnose
others have to undergo a series of tests and surveys.

In the diagnosis of gout can distinguish the following steps:

  • history (patient survey);
  • assessment of the clinical picture of the disease;
  • instrumental studies;
  • laboratory research.

The following are used in diagnosing gout. methods:

  • biochemical blood test (there is an increased level
    uric acid; due to the study of creatinine in the blood
    determines the relevance of renal failure);
  • radiography (topical changes in the joints in the
    the framework for treating the chronic form of gouty arthritis);
  • study of synovial fluid taken from the joint
    affected by a missing bacterial
    флоры и наличия кристаллов uric acid;
  • HaveЗИ (в исследовании изучаются почки на предмет наличия в них
    stones).

The diagnosis of gout is established based on the presence of two
criteria of the following:

  • the content of uric acid in the blood is higher than 416.4 μmol / l in men
    and above 356.9 micromol / l in women;
  • the presence of tophus;
  • detection of uric acid crystals in synovial fluid
    or tissues;
  • acute transient arthritis.

Gout Treatment

Complex gout therapy should be step by step. It consists
from three stages:

  1. relief of acute attack (gouty arthritis);
  2. медикаментозная коррекция избытка uric acid;
  3. diet and prevention of recurrent exacerbations.

When gout treatment is carried out at home. Acute
seizure is an indication of strict bed rest
mode. Extremity, the joints of which are affected by inflammatory
process, it is advisable to keep in a raised position, putting
something soft under them (a rolled-up blanket or pillow).

Principles of treatment with drugs:

  • Therapy with special drugs, the action of which is directed
    to reduce hyperuricemia, you can not start during the exacerbation
    diseases.
  • These tools take a long time, over the years, making small
    breaks (no more than 4 weeks) during the normalization of the content
    uric acid in the blood.
  • When selecting drugs it is extremely important to consider the type of violation.
    exchange of purines (mixed, metabolic, renal).

Drug therapy for gout is aimed at resolving
two main tasks:

  • Reducing the level of uric acid in the patient;
  • Relief of acute inflammatory process and removal
    the pains.

The sooner the patient passes the examination, he will review his
habits and begin treatment, the greater the likelihood of achieving
lasting remission.

  1. Allopurinol. Allopurinol can reduce the number of
    exacerbations of gouty arthritis, simultaneously eliminating the risk
    education in the urinary tract urate stones. Minimum effective
    the dose of the drug is selected individually for each patient,
    to reduce possible side effects.
  2. Febuxostat – acts like allopurinol. Recommended
    for use by patients with kidney and liver damage
    mild degree.
  3. Pegloticase is an intravenous solution containing
    enzymes that dissolve uric acid crystals. Used when
    progressive, difficult to control gout.
  4. Probenecid – taken orally, promotes accelerated
    excretion of uric acid by the kidneys.

When gouting attack first stop its manifestations:

  • rest;
  • cold on the joint;
  • NSAIDs (Naproxen, Diclofenac) in tablets or injections;
  • in severe cases, intraarticular injection
    glucocorticosteroids or in / in Colchicine.

Course treatment to prevent relapses:

  • NSAIDs (level inflammation, affect the gastrointestinal tract);
  • corticosteroids (with long-term use reduce immunity and
    thinning bone tissue);
  • Colchicine (affects the blood and gastrointestinal tract);
  • vitamins C, P (contribute to the removal of urates);
  • urikodepressivnye means (Allopurinol, Orotic acid)
    reduce the concentration of uric acid, are prescribed at
    hyperuricoemia;
  • urikozurichesky means (Ketazon, salicylates) improve
    evacuation of uric acid from the body when its excretion rate
    less than 3.56 mmol / day.

Physiotherapy

Physiotherapeutic procedures help to completely stop
inflammation in the joints of gout. They are appointed exclusively after
медикаментозного уменьшения симптомов артрита. In acute
during the period of illness, any methods of physiotherapy are categorically
contraindicated.

What techniques are used:

  • paraffin and ozokerite applications,
  • healing mud
  • HaveВЧ,
  • magnetic therapy
  • electrophoresis
  • phonophoresis of drugs.

Gout Surgery

The extreme measure in the treatment – the operation to remove
tophus. They rarely resort to it, only in those cases when:

  • Urats deposits are very large;
  • The treatment is not effective – tophi not
    dissolve;
  • Tofusa sprouted in soft tissue;
  • Deformities of the joint are so great that it is assumed
    destruction.

Early recognition and the initiation of rational treatment gives
prognostically favorable results. Aggravating factors
prognosis of gout, are a young (under 30) age, a combination
urolithiasis and urinary tract infections,
burdened somatic history (diabetes, arterial
hypertension), progression of nephropathy.

How to remove an attack of gout?

  1. In an acute attack, rest is recommended, especially
    concerns affected limb.
  2. The foot is provided with a slightly elevated position, on
    the diseased joint can be applied ice, replacing it, after remitting
    warming compress
  3. Anti-inflammatory drugs are used to treat an attack.
    non-steroid drugs (NSAIDs), a specific drug, as well as its
    dosage, frequency of use and duration are determined
    by the attending physician.

Снять воспаление, и облегчить боль на руках и ногах можно
with the help of compresses. Aspirin in the amount of 5 tablets combined with
iodine volume of 10 ml. The tool should be applied to the feet and placed.
in heat. Manipulation is recommended 2 times a day.

After removing an acute attack of gout you need to do a comprehensive
treatment. The complex treatment of gout includes:

  • Medical method;
  • Physiotherapy;
  • Massage.

In order to control the health of gout and
to prevent the occurrence of detailed attacks, you need to:

  • constantly undergo biochemical blood tests for
    содержания в ней солей uric acid;
  • if necessary, make puncture of intraarticular fluid;
  • fully comply with doctor’s instructions and gouty
    diet

Nutrition

Для составления рациона питания на каждый день следует
consult a specialist who, taking into account the stage of development of the disease
and the presence of chronic pathologies
разработает таблицу допустимых и запрещенных продуктов
power supply.

Nutrition:

  • You can not: eat a lot of meat, offal, fish, mushrooms, legumes.
    The rich broths, caviar, smoked meats and canned foods are forbidden,
    jelly. Coffee, tea, cocoa, chocolate are not recommended. Excluded
    alcohol, especially beer.
  • You can: milk and dairy products, eggs, chicken, vegetables, cereals,
    macaroni, nuts.
  • Нужно пить как можно больше жидкости, желательно 2,5-3
    liters per day. it может быть просто вода, минеральные воды, лучше
    alkaline, such as Slavyanovskaya and Smirnovskaya, berry and citrus
    juices

Diet for gout, as you already hopefully understood, is the most important
part of the treatment. Complex therapy of this disease also includes
drugs, and physiotherapy. Their
prescribes a doctor individually for each patient, given the severity
gout, the presence of concomitant diseases.

The use of folk remedies at home

Before using folk remedies for gout, be sure to
consult your doctor.

  1. 15-20 g (about 1 tbsp. Spoon) of chopped celery root
    boil 0.4 liters of boiling water, insist until the infusion has cooled,
    to filter. Dosage: drink 0.5 glass 3 times daily before meals.
    (in 20-30 minutes).
  2. Chicory. 2 teaspoons of chicory pour 200 ml of boiling water and
    insist 4 to 5 hours. Infusion drink half a cup 2 – 3 times a day
    before meals. Chicory is also effective in controlling hyperuricemia.
  3. Useful for gout and foot bath with iodine. K 3 l warm
    water add 3 tsp. sodium bicarbonate (edible soda) and 9 drops
    iodine. Regular procedures with this type of treatment contribute to
    reduce the amount of salt deposits.
  4. For grinding, you can apply the tincture of chamomile and elderberry.
    Dry plants pour a glass of boiling water and insist 2 hours.
    Filtered product should be treated affected.
    plots.
  5. The roots of madder red. Need one teaspoon of these roots
    pour a glass of boiling water and let it brew, but rather boil it on
    water bath for 10 minutes. Take the infusion in the morning and evening by
    half a cup.

Prevention

The main tool for the prevention of gout remains compliance
diet, which was mentioned above. However, in addition to dietary
nutrition is important to avoid other risk factors.
it поможет удлинить периоды ремиссии, избежать обострений или
loosen them.

Prevention подагры включает:

  • Monitor nutrition, do not abuse foods high
    purine content.
  • Do sport. Do not expose the body to heavy loads.
    Ходьбы, утренней пробежки и легких упражнений
    abound. The main thing is that the joints do not get big
    load.
  • Drink plenty of fluids, which contributes to timely and
    full removal of excess uric acid from the body.
  • When sedentary work try to compensate for the shortcomings.
    activity regular workouts. Additionally it will help
    get rid of extra pounds that load the joints.
  • Abandon narrow and uncomfortable shoes and clothes. Such items
    harmful to the joints.

Now, you know what the disease is, what are the characteristic signs
and treatment methods for gout. Stay healthy and stay tuned
your health constantly!

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