Symptoms of gout in men and treatment tactics for the pathology. Gout - causes and symptoms, treatment and prevention of gout Treatment with onion soup

Even in ancient medical treatises, gout was designated as a serious disease of the “royal blood”. Noble people at all times did not observe moderation in alcohol and food. This lifestyle provoked disruption of metabolic processes in the body, contributed to the formation of uric acid crystals in the joints and led to death due to serious complications in the urinary tract. By the end of the 17th century, healers identified gout as an independent disease.

Gout is considered a serious disease that affects all organs and systems at once. Men over 35 years of age are more susceptible to the disease. At the very beginning of its development, gout affects the big toe. As it develops, the feet and hands are involved in the pathological process.

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Gouty arthritis occurs due to metabolic disorders in the body, which contribute to an increase in uric acid salts in the blood and kidneys (urate). An increase in uric acid levels is directly related to the accumulation of purines, which come from fatty meats and other animal products. With gout, the body is not able to metabolize them completely, which causes the accumulation of uric acid, as a product of their incomplete metabolism.

The formation of gout is caused by two main factors:

• healthy kidneys stop coping with excess levels of uric acid;
• diseased kidneys are unable to excrete normal amounts of uric acid.

Common causes of the disease are genetic predisposition, an irrational lifestyle, and abuse of strong alcoholic beverages and beer. A direct relationship between the occurrence of gouty arthritis and excessive consumption of alcohol and fatty, salty foods was discovered during periods of wars and economic crises. It was at this time that there was a sharp decline in the incidence of gout.

But these are not the only causes of gout:

• chronic renal failure of any origin;
• stones in the kidneys and gall bladder;
• endocrine disorders (,);
• excess body weight due to physical inactivity;
• systemic autoimmune diseases.

All this one way or another leads to metabolic disorders.

Classification and types

Gouty arthritis is classified according to several important criteria that allow us to assess the nature, severity of the disease, as well as the likelihood of complications.

Modern classification distinguishes 2 types of gout:

1. Primary or idiopathic gout. It occurs as a result of hormonal imbalances and genetic predisposition. The situation is aggravated by alcohol and aggressive food. Elements of purine breakdown influence the increase in uric acid levels.
2. Secondary gout. Occurs as a result of inhibition of the activity of metabolic processes, prolonged or uncontrolled use of antibiotics and other groups of drugs (for example, Aspirin, Niacin, diuretics, Pyrazinamide). It is a complication of provoking diseases.

The main types of gouty arthritis are:

• metabolic form – increased synthesis of uric acid;
• renal form - a sharp decrease in urea excretion by the kidneys;
• the mixed appearance is due to a moderate decrease in the evacuation of uric acid and its pronounced production.

In clinical practice, the mixed type of gout is more common. Moderate impairment of excretory function in the absence of therapy leads to gradual progression of the pathology.

Symptomatic picture

Almost all episodes of exacerbation of gout are accompanied by severe arching pain in the affected joint. The first symptoms of gout may not appear clearly, but the pathological process has already begun - sooner or later the disease will manifest itself in a clear way. The main symptoms of gouty arthritis are:

• redness of the skin in the affected area;
• swelling;
• limitation of joint mobility;
• tissue density around the site of inflammation;
• formation of tophi (spherical formations under the skin - accumulation of urates);
• joint deformation;
• renal urolithiasis.

The main localization of inflammation is the big toe. As the disease develops, lesions are noted in the ankle joint, feet, knees, wrists and phalanges of the fingers, and on the elbows.

You cannot ignore unpleasant symptoms and deliberately suppress intense pain. Lack of therapy often provokes complete destruction and immobilization of joint structures, even leading to disability of the patient.

Features of the disease may vary depending on the type of clinical manifestations:

More than one year may pass between stages 1 and 2 of gout development, so with timely diagnosis, it is possible to preserve the patient’s quality of life for many years.

Diagnostics

At the first disturbing symptoms, you should consult a general practitioner, who, if necessary, will refer you to a rheumatologist, nephrologist, or endocrinologist. The main diagnostic criteria are:

• studying the clinical and life history of the patient;
• examination and palpation of the affected limb (presence of redness, tophi, inflammatory lesions);
• biochemical blood test (urate, creatinine, urea);
• X-ray examination;
• puncture of tophi to examine cavity contents.

Additionally, an examination of the kidneys, thyroid gland, and liver may be prescribed. If the patient’s clinical history is aggravated, a full range of examinations for concomitant diseases is carried out.

Treatment tactics

Gouty arthritis is irreversible, but adequate treatment makes it possible to delay serious complications of the disease, maintain health, and ensure stable remission between exacerbations of the pathology.

Drug therapy

The prescription of drugs for the treatment of gout is determined by the achievement of two main therapeutic goals:

• pain relief;
• reducing the concentration of uric acid and its evacuation.

Both systemic and local medications are used.

The main drugs for pain relief are Indomethacin and Colchicine. For severe unbearable pain, intra-articular blockades (often Novocaine injections) are prescribed.

To accelerate the dissolution of urate crystals, uricosuric drugs are prescribed:

1. Allopurinol. Intended for oral administration. Significantly reduces urea production. Well tolerated by patients with kidney stones.
2. Febuxostat. The effect of the drug is similar to that of Allopurinol. The drug is indicated for kidney and liver diseases in a mild stage.
3. Pegloticase. The drug is available as an intravenous injection and contains enzymes that destroy the structure of urea crystals. It is used for advanced stages of gout, the course of which is already difficult to control.
4. Probenecid. An oral medication that helps the kidneys eliminate excess uric acid. Contraindicated in patients with severe renal disease, including urolithiasis.

To relieve a gout attack, various traditional methods of treatment are suitable, including self-prepared ointments and compresses. At home, you can prepare ointments and other medicinal products, apply compresses, make lotions on inflamed areas, warm up the sore leg using warm medicinal applications, only if agreed with a specialist. Otherwise, all these methods can only aggravate the pathological process.

Other methods of treatment are physiotherapy, herbal medicine, and staying in a sanatorium at a resort. Physiotherapy is appropriate only during a calm period of gout, since during an exacerbation it can cause worsening.

Nutrition

Nutrition for gouty arthritis is an important component of adequate treatment. The diet must be followed by patients for life. The following foods are not allowed to be eaten:

Drinking alcohol and smoking are not allowed. Even a small dose of alcohol can worsen your overall health and accelerate the exacerbation of gout.

Allowed products are flour products (bread, pastries, pasta), fresh vegetables, fruits (especially citrus fruits), sour-milk products, low-fat fish and poultry, honey, mineral waters, berry decoctions, unsweetened compotes.

Gouty arthritis cannot be cured completely, but every patient can restore metabolic processes, maintain the integrity of the joint and normalize the synthesis and excretion of uric acid.

It is important to understand that the disease will not stop on its own, even if episodes of exacerbations become rare. Every day, destructive processes occur inside the joint that change the morphology and structure of the joint. The main complication of the disease is.

If kidney function declines, patients may require lifelong replacement therapy - hemodialysis or a donor organ transplant.

Prevention

Preventive measures are based on maintaining a correct lifestyle: sports, nutrition, timely treatment of current diseases. People over 40 years of age should be especially careful about their health. Mineral water, plenty of clean drinking and proper nutrition help to quickly cleanse the body. Against this background, the accumulation and crystallization of uric acid is practically impossible.

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At the end of the 17th century, an English clinician who suffered from gout for more than 30 years classified it as a separate disease and very accurately described the clinical picture of an acute attack of gouty arthritis in his work “Treatise on Gout” ( "Tractatus de podagra et hydrope"). In it, he compared the pain of gout with the pain “from squeezing a limb with a press” and described the patient’s sensations comparable to how “a huge dog dug its fangs into a finger.” In 1679, a Dutch scientist first described the microscopic structure of uric acid crystals.

In 1848, the English physiologist (Alfred Baring Garrod, 1819-1906), using a thread dipped into the blood of a patient suffering from gout, discovered and described the fact of an increase in the content of .

The first scientific works of the French doctor relate to the field of gout: “Damage to cartilage in gout” ( Les alternatives des cartilages dans la gouite, 1858), “Gouty deposits (tophi) in the outer ear of gouty people” ( Les concrétions tophacées de l'oreille externe chez les goutteux, 1860), “Changes in the kidneys with gout” ( Les alternatives du rein chez les goutteux, 1864), “On gout and lead poisoning” ( Les rapports de la goutte et de l'intoxication saturnine, 1864).

In 1899, the presence of urate crystals was discovered during an attack of gouty arthritis. In 1961, MacCarty and Hollander identified the role of urate crystals in the occurrence and development of gouty inflammation.

Historically, from and until the 20th century, gout primarily affected rich and noble people, which is why it was called “the disease of kings,” “the disease of the rich,” and “the disease of aristocrats.” It was thought to be associated with excess weight, overeating (especially meat consumption) and excessive consumption of alcoholic beverages. For example, in 1739, the Frenchman Eugene Moucheron published a brochure entitled “On noble gout and its accompanying virtues,” in which he praised gout and noted that it is a disease of kings, princes, outstanding commanders, intelligent and gifted people, and He also gave examples of crowned heads, political figures, and artists who suffered from gout. A new outbreak of interest in gout arose at the beginning of the 20th century, when Henry Havelock Ellis (1859-1939) published a book in 1927 entitled “The History of the English Genius.” In it, the author touched on the topic of gout and gave examples of 55 famous outstanding Englishmen who suffered from it. In 1955 the work “ The origin of man", published in the magazine "", in which he described the increased frequency of gout among geniuses and explained it by the fact that uric acid is structurally very similar to methylated purines:, and, which are stimulants of mental activity, having a stimulating effect on higher brain functions, in particular, attention span and ability to concentrate. Orovan pointed out that uric acid in all developed animals, with the exception of humans, is broken down under the action of an enzyme produced in the liver to , but in primates, due to the absence of uricase, it remains in the blood

Epidemiology

The frequency of gouty arthritis in different populations varies and ranges from 5 to 50 per 1000 men and 1-9 per 1000 women, and the number of new cases per year is, respectively, 1-3 per 1000 in men and 0.2 per 1000 in women. Over the past decade [ ] the incidence of gout has increased .

An acute attack of gout in adolescents and young adults is rare and is usually mediated by a primary or secondary defect in uric acid synthesis.

Etiology

Factors in the development of the disease

There are a number of risk factors that contribute to the occurrence and development of gout in certain individuals.

Risk factors for developing gout include:

• increased intake into the body, for example, when consuming large amounts of red meat (especially offal), certain types of fish, cocoa, tea, chocolate, peas, lentils, fructose, alcohol (especially beer, which contains a lot of uric acid precursors);
• an increase in the amount of purine nucleotides during general catabolism (for example, during antitumor therapy; massive in people with autoimmune diseases);
• inhibition of the excretion of uric acid in the urine (for example, in renal failure);
• increased synthesis of uric acid with a simultaneous decrease in its excretion from the body (for example, with alcohol abuse, shock, with glucose-6-phosphatase deficiency);
• hereditary predisposition (the nature of inheritance is still not completely clear).

Pathogenesis

The pathogenesis of the disease is based on an increase in blood levels. But this symptom is not a disease, since it is also observed with other diseases (blood diseases, tumors, kidney diseases, etc.), extremely high physical overload and eating fatty foods.

There are at least three main elements in the occurrence of gout:

• accumulation of uric acid compounds in the body;
• deposition of these compounds in organs and tissues;
• the development of acute attacks of inflammation in these affected areas, the formation of gouty granulomas and gouty “bumps” - tophi, usually around the joints.

Symptoms and course of the disease

The complete natural evolution of gout goes through four stages:

• asymptomatic hyperuricemia;
• acute gouty;
• intercritical period;
• chronic gouty deposits in the joints.

1. With chemical or microscopic detection of uric acid crystals in synovial fluid or urate deposition in tissues.

2. If two or more of these criteria are present:

• clear and/or observation of at least two attacks of painful swelling of the joints of the extremities (attacks, at least in the early stages, should begin suddenly with severe pain; full clinical symptoms should occur within 1-2 weeks);
• a clear history and/or observation of a gout attack (see above) affecting the big toe;
• clinically proven tophi; a clear history and/or observation of a rapid response to, that is, a decrease in objective signs of inflammation within 48 hours after the start of therapy.

X-ray examination is not included in the list of mandatory diagnostic tests, but it can show tophi crystal deposits and bone damage due to repeated inflammation. X-rays may also be useful in monitoring the effects of chronic gout on the joints.

Detection of hyperuricemia is not sufficient to establish a diagnosis, since only 10% of people with hyperuricemia have gout.

Diagnostic criteria for gout (WHO 2000)

I. The presence of characteristic crystalline urates in the joint fluid.

II. The presence of tophi (proven) containing crystalline urates, confirmed chemically or by polarization microscopy.

III. The presence of at least 6 of the 12 characteristics below:

• history of more than one acute attack of arthritis;
• maximum inflammation of the joint already in the first day;
• monoarticular nature of arthritis;
• hyperemia of the skin over the affected joint;
• swelling or pain localized in the first metatarsophalangeal joint;
• unilateral damage to the joints of the arch of the foot;
• nodular formations resembling;
• hyperuricemia;
• unilateral lesion of the first metatarsophalangeal joint;
• asymmetric swelling of the affected joint;
• detection on radiographs of subcortical cysts without erosions;
• lack of flora in the joint fluid.

The most reliable signs are acute or, less commonly, subacute arthritis, the detection of crystalline urates in the synovial fluid and the presence of proven tophi. Urate crystals look like rods or thin needles with broken or rounded ends, about 10 microns in length. Microcrystals are found both freely lying and in.

Differential diagnosis

Treatment

Patients with gout, newly diagnosed or in the period of exacerbation of the disease, are subject to inpatient treatment in specialized rheumatology departments of regional or city hospitals. Patients with gout in the disease, subject to the appointment of adequate therapy, can be supervised at their place of residence in district clinics. The approximate duration of treatment in an inpatient setting (specialized rheumatology departments) is 7-14 days, subject to the selection of adequate effective therapy and improvement of clinical and laboratory signs of the disease.

To date, modern pharmacology has not been able to present a single drug that would be universal at the same time and could really solve the issue of treating gout.

Treatment for gout includes:

1. whenever possible, rapid and careful relief of an acute attack;
2. prevention of relapse of acute gouty arthritis;
3. prevention or regression of complications of the disease caused by the deposition of monosodium urate crystals in the joints, kidneys and other tissues;
4. prevention or regression of associated symptoms, such as, or;
5. prevention of the formation of uric acid kidney stones.

Treatment for an acute attack of gout

For acute gouty arthritis, anti-inflammatory treatment is carried out. Most often used. It is prescribed for oral administration, usually at a dose of 0.5 mg every hour or 1 mg every 2 hours, and treatment is continued until: 1) the patient’s condition improves; 2) there will be no adverse reactions from the gastrointestinal tract or 3) the total dose of the drug will not reach 6 mg due to the lack of effect. Colchicine is most effective if treatment is started soon after symptoms appear. In the first 12 hours of treatment, the condition improves significantly in more than 75% of patients. However, in 80% of patients, the drug causes adverse reactions from the gastrointestinal tract, which may appear before clinical improvement or simultaneously with it. When taken orally, the maximum plasma level of colchicine is reached after approximately 2 hours. Therefore, it can be assumed that its administration at 1.0 mg every 2 hours is less likely to cause the accumulation of a toxic dose before the therapeutic effect appears. Since, however, the therapeutic effect is related to the level of colchicine in leukocytes and not in plasma, the effectiveness of the treatment regimen requires further evaluation.

With intravenous administration of colchicine, side effects from the gastrointestinal tract do not occur, and the patient's condition improves faster. After a single administration, the level of the drug in leukocytes increases, remaining constant for 24 hours, and can be determined even after 10 days. As an initial dose, 2 mg should be administered intravenously, and then, if necessary, repeat the administration of 1 mg twice with an interval of 6 hours. When administering colchicine intravenously, special precautions should be taken. It has an irritating effect and, if it enters the tissue surrounding the vessel, can cause severe pain and. It is important to remember that the intravenous route of administration requires care and that the drug should be diluted in 5-10 volumes of normal saline solution, and the infusion should be continued for at least 5 minutes. Both oral and parenteral administration of colchicine can suppress bone marrow function and cause alopecia, liver cell failure, mental depression, seizures, ascending paralysis, respiratory depression and death. Toxic effects are more likely in patients with liver or kidney pathology, as well as in those receiving maintenance doses of colchicine. In all cases, the dose of the drug must be reduced. It should not be prescribed to patients with neutropenia.

For acute gouty arthritis, other anti-inflammatory drugs are also effective, including etoricoxib, etc.

Indomethacin can be prescribed for oral administration at a dose of 75 mg, after which the patient should receive 50 mg every 6 hours; treatment with these doses continues the next day after the symptoms disappear, then the dose is reduced to 50 mg every 8 hours (three times) and to 25 mg every 8 hours (also three times). Side effects of indomethacin include gastrointestinal disturbances, sodium retention, and central nervous system symptoms. Although these doses may cause side effects in up to 60% of patients, indomethacin is generally easier to tolerate than colchicine and is probably the drug of choice for acute gouty arthritis. Drugs that stimulate the excretion of uric acid are also ineffective during an acute attack of gout. In acute gout, especially when colchicine and non-steroidal anti-inflammatory drugs are contraindicated or ineffective, systemic or local (i.e. intra-articular) administration of glucocorticoids is beneficial. For systemic administration, whether oral or intravenous, moderate doses should be given over several days as glucocorticoid concentrations decrease rapidly and their effect ceases. Intra-articular administration of a long-acting steroid drug (for example, at a dose of 15-30 mg) can stop an attack of monoarthritis or bursitis within 24-36 hours. This treatment is especially advisable if it is impossible to use a standard drug regimen.

Diet

Traditional dietary recommendations include limiting consumption and alcohol. Foods high in purines include meat and fish products, as well as tea, cocoa and coffee. It has also recently been shown that weight loss achieved by moderate restriction of carbohydrates and energy-dense foods in combination with a proportional increase in protein and unsaturated fatty acids resulted in a significant reduction in uric acid levels and dyslipidemia in patients with gout.

see also

Notes

1. Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018.
2. Disease Ontology release 2019-05-13 — 2019-05-13 — 2019.
3. Gout / V. G. Barskova // Peru - Semi-trailer. - M.: Great Russian Encyclopedia, 2014. - P. 524. - (: [in 35 volumes] / chief ed.

Gout is a chronic disease associated with a violation of uric acid metabolism - an increase in the level of uric acid in the blood and the deposition of crystals of sodium salt of uric acid (urates) in the tissues, which is clinically manifested by recurrent acute arthritis and the formation of gouty nodes (tophi).

Gout has been known since ancient times, but the first and detailed description was made in 1685 by T.

Sydenham in his book "Treatise on Gout". It was later noted that in patients with gout the level of uric acid in the blood increases (hyperuricemia); in the 19th century, scientists discovered urate crystals in the joint fluid during an acute attack of gout.

However, only in the middle of the 20th century did experts establish the role of sodium salt crystals (urates) in the development of an acute attack of gout.

Gout is a fairly common disease. According to epidemiological studies conducted in European countries and the FSA, in recent years, up to 2% of the adult population has suffered from gout, and among men aged 55-64 years, the incidence of gout is 4.3-6.1%.

In Europe and the SSA, patients with gout make up 0.1-5.8% of all patients with RB.

In recent years, all countries have seen an increase in the incidence of gout. So, in Finland, according to N.

Isorriaki ii conv. , the number of registered cases of gout has recently increased 10 times, in Germany - 20 times.

However, information about the prevalence of gout is incomplete due to late diagnosis. Gout is diagnosed on average 4.8 years after the first attack.

According to our data, during the 1st year of the disease, the diagnosis of gout was established in only 7% of patients.

The spread of gout in the most developed countries is associated with significant consumption of foods rich in purines (meat, fish) and alcoholic beverages. This is confirmed by the fact that there was a sharp decrease in the incidence of gout during the Second World War, when meat consumption was significantly reduced.

Gout affects mainly men. The first attack of gout can occur at any age, but in most cases after 40 years of age. In recent years, there has been a slight increase in cases of gout at a young age (20-30 years). In women, gout usually begins during menopause.

Normal uric acid metabolism. In the human body, uric acid is the end product of the breakdown of purines.

The reserves of uric acid in the body are normally 1000 mg with a renewal rate of 650 mg/day, i.e. Every day 650 mg of uric acid is removed from the reserves and the same amount is replenished.

Since uric acid is excreted from the body by the kidneys, it is important to know its clearance, i.e. the volume of blood that can be cleared from excess uric acid in the kidneys in a minute.

Normally it is 9 ml/min.

Gout is not only a very common disease, but also one of the oldest diseases once described in medicine. For example, Hippocrates defined it as acute pain in the foot (“under” means “leg” in translation from Greek, while “agra” in translation means “trap”). What is noteworthy is that such a common disease today was previously considered nothing less than the “disease of kings”, while at the same time it was attached to a very significant role - the “king of diseases”. Moreover, its association with this or that peculiarity of sick people did not end there, because gout was also considered as a disease of aristocrats, and the disease also came under the definition of one of the signs of genius.

It is not without reason, and apparently, as evidence to support this specificity of facts, there is evidence that Alexander the Great and Leonardo da Vinci, representatives of the Medici family, Darwin, Newton suffered from gout... This list could be continued, which, however, in any case will reduce the information to one fact that is certainly relevant today: despite some selectivity of this disease, today it is “available to everyone.”

That is why we will consider in detail the symptoms of gout and those features that are generally relevant to the disease.

Causes of gout

The cause of gout is a persistent and elevated level of uric acid in the blood. During the course of the disease, urate crystals are deposited in organs, joints and other body systems.

Sodium urate crystallizes and is deposited in the joints in small particles, which ultimately leads to complete or partial destruction of the joints.

For this reason, such situations are called microcrystalline.

A large amount of uric acid in the body occurs for 2 reasons: the first is when healthy kidneys cannot cope with the removal of large amounts of uric acid, the second is the release of uric acid in a normal amount, but the kidneys cannot remove it.

Every year more and more people suffer from gout. Doctors explain this phenomenon by the fact that people have recently been more likely to eat foods that are rich in purines (for example, fatty fish, meat) and large amounts of alcohol.

This confirms that the percentage of people suffering from gout decreased sharply during wars due to the fact that alcohol and meat products are difficult to obtain.

Gout symptoms

Gout is characterized by a common attack of gouty arthritis - usually inflammation of a joint, often the joint of the big toe, ankle or knee.

As a rule, an attack of gout occurs at night or early in the morning; it is manifested by severe pressing unexpected pain in the joints, swelling of the affected joint, increased temperature in the joint area, redness and glossiness of the skin.

The pain during the day is slightly less, but by night it intensifies again; the duration of a gout attack lasts from 2-3 days to a week, sometimes longer.

When the attack is repeated, other joints are involved in such inflammation, which can lead to partial destruction of the joints.

Gout manifests itself with the following symptoms: peculiar growths appear on the legs or arms, and the level of uric acid increases significantly. When the growths (tophi) begin to burst, a person may notice whitish crystals of uric acid.

Quite intense pain may appear in the affected areas. Such salt deposits in the joints interfere with a full life.

Possible complications

Gout mainly affects men!

Poor nutrition - excessive consumption of protein foods.

Signs and symptoms of gout

The first phase of gout occurs without symptoms; the level of urate in the body gradually increases, which can subsequently lead to gout. This stage lasts a very long time, up to 25 years or more.

The second phase is acute gouty arthritis. The first symptoms of gout at this stage are pain and swelling near the affected joint, as well as a rise in body temperature.

Gout symptoms

Gout manifests itself in seven different stages. Each of these stages has its own symptoms:

There are seven stages in the development of gout

Salt deposition causes a gradual change in the joint, which manifests itself in the following:

• The area around it swells due to the inflammatory process;
• The skin turns red and begins to shine;
• Joint mobility decreases;
• Touching the painful area and moving the joint causes pain;
• Painful sensations may become constant and intensify at night;
• An increase in temperature is felt in the area of ​​the affected joint.
• The accumulation of urate leads to the gradual formation of characteristic painful lumps on the small joints of the legs and arms.

Acute attacks of the disease last from 2 to 7 days.

Attacks may recur periodically, and the disease takes on a chronic form. Prolonged inflammation leads to changes in cartilage tissue and joint deformation, which can lead to complete immobility.

Gouty arthritis occurs more often and more severely in men.

Diagnosis of the disease

Enlargement of the joint of the big toe does not necessarily indicate the presence of such a disease in a person. In addition, gout has similar symptoms to joint diseases such as rheumatoid arthritis and osteoarthritis.

Diagnosis of gout

1. Biochemical blood test.

Detection of hyperurecemia: increased uric acid levels in men over 0.42 mmol/l, in women over 0.36 mmol/l. Determination of blood creatinine level - to identify renal failure.

2. Examination of the synovial fluid of the affected joint.

Chemical or microscopic examination reveals uric acid crystals; there is no bacterial flora in the culture. 3

X-rays of joints determine changes in chronic gouty arthritis. 4

Ultrasound of the kidneys. Identification of X-ray negative calculi (stones).

X-ray of joints - gouty arthritis

Consultation: rheumatologist, nephrologist, surgeon.

When diagnosing, the frequency of recurrent attacks is taken into account.

The diagnosis is made based on:

1. 1) Monosodium urate crystals found in the synovial fluid and the absence of microorganisms in it;
2. 2) Confirmed tophi using chemical studies or polarization microscopy;
3. 3) 6-12 signs of gout: radiological, laboratory, clinical;
4. 4) Hyperuricemia, asymmetric inflammation of the joints;
5. 5) X-ray shows subcortical cysts without erosions.

Treatment with iodine

Treatment of this pathology is based on several stages. It is not possible to completely get rid of gouty arthritis; the disease can be stopped.

It is necessary to implement preventive measures to avoid the development of complications. The scheme of how to treat gout depends on the severity of the disease, symptoms and consists of the following areas:

1. Treatment of acute attacks of gout.
2. Actions aimed at reducing the content of uric acid compounds.
3. Treatment of concomitant diseases and complications.
4. Therapy of chronic polyarthritis.

All patients who suffer from this disease should know how to relieve a gout attack. The main goal of treatment comes down to relieving acute symptoms by eliminating harmful foods and medications. Exacerbation of gout is relieved as follows:

1. It is necessary to drink up to 2.5 liters of alkaline drink.
2. Provide the patient with complete rest.
3. Compresses are applied to the affected joint. Used for pain relief and inflammation Dimexide in solution.
4. For relief, non-steroidal anti-inflammatory drugs are used: Diclofenac, Naproxen, Indomethacin, Piroxicam.
5. Colchicine and Nimesil help relieve pain and inflammation.

The patient has to undergo comprehensive treatment; in addition to following a diet, it is necessary to use medications. For example, for the treatment of chronic gout and the prevention of attacks, antihyperuremic medications (Allopurinol, Thiopurinol) are used together with diet therapy.

The first stage of treatment is always aimed at eliminating pain and swelling. Drug treatment of gout is carried out using:.

• drugs that have an analgesic, anti-gout effect;
• non-steroidal anti-inflammatory drugs;
• in the absence of positive dynamics, corticosteroid injections are prescribed.

Drugs for the treatment of gout

Medicines of the first group are aimed at reducing pain and removing inflammation from the affected joint. NSAIDs – non-steroidal anti-inflammatory drugs, as a rule, the patient is prescribed:

• Indomethacin;
• Diclofenac;
• Naproxen.

Colchicine is a gout medicine that is prescribed to a patient if the above pills do not work or cannot be taken for some reason. The medicine is obtained from the herb “autumn crocus”.

The medicine does not have an analgesic effect; the action of the drug is aimed at reducing the ability of uric acid crystals to provoke an inflammatory process in the lining of the joint.

This property helps relieve pain.

The last group is corticosteroids, which belong to hormonal drugs. They are used only in the treatment of severe types of gout, if other medications do not help. The drugs are injected in short courses, because long-term use of them can cause:

• muscle weakness;
• obesity;
• weakened immunity;
• osteoporosis;
• thinning of the skin;
• bruises.

Medicine allows parallel treatment of gout with folk remedies at home in consultation with the attending physician. This fits into the method of complex treatment of the disease.

The use of folk remedies is another way to reduce the level of uric acid in the body. You can use the following recipes:.

1. Fir cones will help cleanse your joints. Pour hot boiled water over the unopened fruit and leave overnight. Then drink the resulting decoction before meals 30 minutes 3 times a day. You can drink this liquid until complete recovery.
2. Chamomile decoction is considered a good folk remedy. Pour 100 g of flowers into 10 liters of water, in which 20 g of salt were previously diluted. After this you need to take baths with this solution.
3. Bay leaves are good for cleansing joints. Pour 5 g of plant into 1.5 cups of water. Boil the liquid for no longer than 5 minutes, then cover with a lid and wrap in a towel for three hours. Drink the resulting decoction throughout the day.

The main principle of gout treatment is to control the level of uric acid in the body. To carry out drug treatment, you need to contact a rheumatologist.

His prescriptions are aimed at reducing the amount of uric acid and its rapid removal from the body. Only qualified specialists can prescribe medications that do not cause greater harm to health if there is a possible concomitant illness.

Doctors often prescribe non-steroidal anti-inflammatory drugs for 1-2 weeks, such as diclofenac, indomethacin, methindol, butadione, naproxen. To quickly reduce the concentration of uric acid in the body, orotic acid, hepatocatazal, allopurinol, thiopurinol, and milurite can be prescribed.

To relieve acute symptoms of gout, the use of colchicine is recommended.

Gout is a rather unpleasant disease that my sister suffered from. I rarely see her, but somehow I wanted to visit her.

When I arrived at her place, I was very surprised that she walked around the house and garden barefoot. At first I thought that she decided to have the operation, but it turned out that she was cured with the help of traditional medicine.

I didn’t believe that folk recipes could be so effective. And of course, I asked her for recipes, there were two of them - for external and internal use.

The internal remedy is made from the roots of red madder. 1 tsp these roots are poured with boiling water (1 glass), infused, or better yet, boiled for ten minutes in a water bath. The infusion is taken half a glass in the morning and evening.

The matter with external agents is a little more complicated. First, three bottles of valerian tincture and a bottle of triple cologne are mixed and left to infuse overnight.

Then this mixture is applied to the affected areas overnight, i.e. protruding bones using cotton wool. After a few days, the joint will twist and itching may occur.

The main thing is the desire to be treated and a lot of patience.

As a result, my sister treated her gout with these folk remedies until she noticed that she had no pain and the bone was smaller. It turns out that folk recipes can replace the surgeon's knife.

Savior from the forest

One woman and her friend went into the forest one summer to pick berries. She had collected a lot of things, but on the way back her leg became swollen and her thumb turned black.

They thought that they would not be able to even reach the road, but suddenly they saw an elderly woman with a staff. How a savior appeared in a fairy tale.

She immediately noticed the problem, whispered over the sore finger, after which the pain went away, and then she said what she needed to do to make everything heal.

It was necessary to pour iodized salt (500 g) into a saucepan, add a small amount of water and boil until the water evaporates. After the water has boiled, add medical Vaseline or chicken fat (200 g) and mix everything.

A compress is made from the resulting solution overnight. It is better to lay the solution on a woolen cloth, securing it with a bandage.

However, in addition to using the ointment externally, you can also take a linden decoction internally.

Recipe No. 1. This method is well suited for the treatment of classic gout, which is more common on the extremities. Iodine works great on wounds of various sizes, as well as such growths on the skin. To increase its effectiveness, you can use aspirin.

10 mg of iodine is measured, in which five aspirin tablets are dissolved. With direct interaction of the 2 components, the liquid begins to lose its dark brown color.

The mixture is ready when the iodine is completely discolored. The resulting mixture is used to treat the legs or arms 2 times a day - morning and evening.

Recipe No. 2. There is another way to treat gout at home, based on iodine.

You can do special iodine baths. To do this, mix 3 drops of iodine, 1 tsp.

l. soda and 1 liter of clean warm water.

Place your feet in the resulting mixture and hold for 15 minutes. Usually, three liters of product is enough for the first time.

This treatment lasts 10 days. During this time, the growths disappear without a trace.

Mustard against gout

At home, gout can be easily cured with a special paste. To prepare it, take mustard powder, 1 tsp.

l. honey and regular baking soda.

The components mix well, the resulting mixture is applied to the affected joints, which must first be steamed. The limbs are wrapped on top with plastic film and secured with bandages.

This compress is left on the skin overnight. Treatment must be continued for at least 2 weeks, doing the procedure every day.

For successful treatment of gout, it is very important to follow the simplest rules of a healthy diet. You should limit the consumption of fish and cape, sorrel and cauliflower, and exclude spinach.

Chocolate, coffee, berries, figs and strong green tea can be consumed in the 1st half of the day in small quantities. It is also mandatory to exclude various wines and beer from the diet.

Instead, it is necessary to significantly increase the amount of clean water consumed.

You can drink freshly squeezed juices and not very sweet fruit drinks, alkaline mineral water. The patient with such a diet will begin to lose weight, which has a positive effect on the treatment of gout.

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Compliance with dietary recommendations is important to prevent gout exacerbation. This is a restriction on the consumption of: meat and fish products, legumes, sorrel, spinach, cauliflower, raspberries, figs, chocolate, strong tea, coffee.

The consumption of alcohol, especially wine and beer, is prohibited.

It is recommended to increase the volume of fluid you drink to 2 liters per day, unless there are contraindications. These are cranberry juice, juices, alkaline mineral waters. Gradual normalization of body weight is mandatory for the patient, as it helps reduce the level of uric acid in the blood.

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

During an acute attack of gout, the patient is recommended to rest completely, especially on the affected limb. You should put your foot in an elevated position, apply an ice pack to the sore joint, and after the pain subsides, apply a warm compress.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat an attack. The drug, its dose, frequency of administration, and duration are recommended by the attending physician.

To achieve a stable decrease in uric acid, which prevents the progression of gout, anti-gout drugs (alopurinol, sulfinperazone, uralit, etc.) are used.

These drugs are used for a long time (years). The required drug is selected by the attending physician individually for each patient, depending on age, concomitant diseases, and the level of uric acid in the blood.

When large tophi are formed, tissue ulceration, or the presence of fistulas, surgical treatment is recommended - removal of tophi, since they can no longer resolve when taking anti-gout drugs, and can significantly limit the function of the joints.

Treatment of gout comes down to relief of acute attacks, drug treatment, diet and prevention of repeated exacerbations.

Relief of an acute attack:

• prescribe abundant alkaline drink 2-2.5 l/day) and complete rest;
• apply compresses using Dimexide in solution - 50% for pain relief and against inflammation;
• stop the attack with non-steroidal anti-inflammatory drugs: Indomethacin, Diclofenac sodium, Naproxen, Piroxicam;
• relieve pain and inflammation with Nimesil and Colchicine;

On the first day of treatment, the dosage of the drugs is increased, then reduced to the average therapeutic dose. You must adhere to the medication regimen in accordance with your doctor’s recommendations and take into account contraindications. For example, contraindications to the use of Colchicine are severe damage to the kidneys and liver, stomach ulcers

and duodenum.

Relief of an acute attack is possible with pyrazolone and indole drugs: Reopirin, Butadione, Phenylbutazone, Ketazone. In cases of increased drug resistance, Prednisolone is added to treatment.

Take 20-30 mg/day at first, then the dose is reduced. At the same time, Butadione and Indocid are taken in small doses.

Uric acid is removed from the body by Allopurinol and a specially selected diet.

To treat gout in the period between attacks at home, they eliminate hyperuricemia, relapses of gout attacks, prevent damage to internal organs, restore impaired joint function with the help of complex therapy, including medications, diet, physical influences and spa treatment.

It is important not to use long-term drug treatment for gout at home for mild attacks or when the diagnosis is questionable. For the first two days, Colchicine (1 mg/day) or Indomethacin (75 mg/day) should be used.

Before taking anti-gout drugs, the type of impaired purine metabolism is determined. It can be metabolic, renal or mixed.

Uricostatics inhibit the formation of uric acid, for example, Allopurinol: daily dose - 100-900 mg, which depends on the degree of hyperuricemia. For mild cases – 200-300 mg, for moderate cases – 300-400 mg, for severe cases – 600-900 mg/day.

In two days you can reduce the level of uric acid by 2-3 times. The drug is used constantly because it does not have stability and duration of action.

A break is taken in the summer for 1-2 months due to the appearance of a variety of plant-based products on the menu.

Uricosuric drugs inhibit tubular reabsorption of uric acid compounds and increase production, so they are prescribed for renal hyperuricemia.

Treatment: Etamide, Benzbromarone, Probenecid (Benemid) and salicylates - 4 g/day. Most often they are treated with Allamaron; it is easy to take - 1 tablet once a day.

and has few side symptoms.

Uric acid stones are dissolved and new ones are prevented with the drug Uralit (Magurlit, Blemaren).

If, after reading this article, you think that you have symptoms characteristic of this disease, then you should

consult a rheumatologist.

Tophi - visible hard nodules in the joints

Drug treatment for gout in the legs involves relieving pain and restoring purine metabolism. During an acute attack of gout, the patient should remain in bed and completely rest.

The sore leg must be placed on a hill and ice applied; after the pain has subsided, a warm compress is applied. Non-steroidal anti-inflammatory drugs are used to treat attacks.

To reduce the level of uric acid, anti-gout drugs (sulfinperazone, alopurinol, uralit and others) are used. How to treat gout on the legs should be decided by the doctor. The drug is chosen by a doctor and used for many years.

A significant role in the treatment of gout is played, first of all, by patient compliance with diet. It is important to limit the consumption of fish and meat products, sorrel, legumes, cauliflower, coffee, chocolate, raspberries, figs, tea, spinach, sorrel, and legumes.

You should not drink alcoholic beverages, especially beer and wine.

The volume of fluid consumed daily should be increased to two liters in case there are no contraindications in this regard. Juices and cranberry juice, alkaline mineral waters can be considered as options.

Complications of gout

Early disorders of purine metabolism are reversible, subject to timely diagnosis and treatment, but at the stage of chronic gout with damage to organs (heart, brain, kidneys), the prognosis of the disease is unfavorable.

Kidney damage develops in 30-50% of patients with gout. With a persistent increase in uric acid levels, every 4 patients with gout develop chronic renal failure.

Gout is manifested by the following complications:

1. 1) Gouty glomerulosclerosis and urate kidney stones. Nephropathy, gouty nephritis, and pyelonephritis develop.
2. 2) Impaired kidney function due to impaired purine metabolism (gouty kidney). In the presence of arterial hypertension and diabetes mellitus, it develops acute kidney failure.
3. 3) Gouty arthritis and destructive polyarthritis with joint deformation.
4. 4) Osteoporosis (thinning of bone tissue).
5. 5) Formation of tophi on joints or soft tissues: on the wings of the nose, in the auricle, fingers, feet, in internal organs - heart, kidneys, etc.

Gout may accompany

coronary heart disease

and arterial hypertension.

Prevention and prognosis

Prolonged attacks may result in complete recovery. The prognosis is favorable and depends on the level of hyperuricemia and adequate treatment. People can remain able to work for many years and their quality of life does not suffer.

Prevention comes down to following a diet, avoiding fasting, using diuretics, long-term use of drugs that dissolve uric acid salts (Uralita), and using sanatorium-resort treatment.

You can apply compresses to the joints from a mixture of valerian (3 bottles) and cologne (or vodka) - 200 ml. The compress is insulated with a woolen scarf. After an exacerbation, the condition will improve.

Diet for gout

You can effectively reduce the amount of uric acid compounds using a gout diet. The main task is to exclude from the diet foods that contain a lot of purine bases. This group includes:

• kidneys;
• language;
• liver;
• brain;
• fatty fish;
• meat of young animals;
• sprats;
• canned food;
• sardines;
• smoked meats

Meals for gout may include small amounts (up to 300 g) of boiled meat per week. It is known that purine compounds pass into the broth during cooking, so the patient should not consume such soups.

You should limit the amount of table salt to 7 g per day. In order not to break this rule, it is better to cook all dishes without it, and then add salt to each portion.

It is necessary to exclude or minimize foods and dishes containing large amounts of purines from the diet, since uric acid is formed from purines.

Products that should be avoided: liver, kidneys, brains, lungs, meat of young animals, chicken, meat and fish broths. A patient with gout should avoid drinking alcohol, as it inhibits the excretion of uric acid by the kidneys and thus increases its concentration in the blood.

Products whose consumption should be limited: legumes (beans, peas, beans), sorrel, spinach, eggplant, radishes, cauliflower, asparagus, mushrooms, crustaceans, caviar, fish (Baltic herring, sardines, etc.). Large fish acceptable.

Nutrition for gout of the legs is of no small importance. When treating any form of gout on the legs, strict adherence to the diet is necessary. Foods high in purines should be excluded from the daily diet.

Products requiring exclusion: lungs, liver, brains, kidneys, young meat and chicken, fish and meat broths, alcoholic and carbonated drinks.

Why do celebrities suffer from gout, a disease dating back to Hippocrates? Yulia Nachalova showed how gout changed her appearance. For several years now, the singer has been forced to wear gloves at public events, because 3 years ago Yulia was diagnosed with gout, which caused complications, and ugly bumps grew on the girl’s hands. Apparently, in the time that has passed since the diagnosis, Yulia has come to terms with her new feature and stopped being shy about it, because the other day she posted a series of videos on Instagram in which she does not hide her hands. History of gout. Gout is an ancient disease, its first mention occurred during the time of Hippocrates, about 2400 years ago. Hippocrates was the first to describe the symptoms of the disease, and saw the connection between the onset of the disease and excessive food consumption. In addition, it was found that young people and eunuchs do not suffer from gout; the disease occurs in mature men and women after menopause. In the 5th century BC. e. The first patient with gout was described, after which the disease began to be diagnosed in many ancient cities of Europe. In the 4th century BC. e. first described a case of gout in women, the disease was much more common in men. Claudius Galen, a Roman physician and philosopher, was the first to describe tophi - these are compactions that arise due to the deposition of uric acid salts (urates). These dense balls around the joint indicated a long course of the disease and a high concentration of urates in the blood. Galen treated his patients with diet and exercise therapy, quite successfully. In 1776, it was discovered that the cause of the disease was the deposition of uric acid in the joints, and in the next century, medicine was first used to treat the pathology. The drug colchicine is still prescribed and helps reduce uric acid levels in the body and prevent gout attacks. Why is gout the disease of kings? Nowadays, true gout is quite rare, but in ancient times the disease was common among the wealthy population. Even in the time of Hippocrates, the pathology was described as the “disease of kings”, because the main cause of its occurrence was considered to be the consumption of meat and wine in large quantities. Poor people and ordinary people could not afford to eat large amounts of meat, they moved and worked a lot, which is an excellent prevention of gout. In our time, it has been found that gout is associated with a persistent increase in uric acid in the blood. This condition is possible in two cases: if the body produces too much uric acid, and the kidneys do not have time to remove it, or vice versa, if the acid level is within normal limits, but the kidneys do not remove it. The royal disease gout can be provoked by the following negative factors: passive lifestyle; alcohol abuse; daily consumption of foods that increase the level of uric acid - meat and offal, yeast, including brewer's yeast, fish, porcini mushrooms, etc. genetic predisposition; endocrine diseases; gastrointestinal pathologies; oncological diseases. The insidiousness of the disease is that if it is not dealt with, after 3-4 years it irreversibly destroys the kidneys. Therefore, treatment and prevention of gout is extremely important. Prevention of the development of the disease and its features: Prevention of the development of gout should begin, first of all, with the patient following a certain diet. The requirements of such a diet can be presented as follows. It is recommended to control the calorie content of dishes, eat more fruits, vegetables, cottage cheese, yogurt. It is better to give preference to bread made from wholemeal flour. It is necessary to increase the amount of fluid consumed to 2.5 liters per day, since it dilutes the concentration of uric acid in the blood. In addition, water will support the functioning of your kidneys and prevent the formation of kidney stones. Alcohol increases the crystallization of uric acid and its deposits. If you have symptoms of gout, avoid beer and other strong drinks. You need to limit your salt intake. Follow dietary recommendations, even if there is no pain. Often, following these simple rules eliminates the symptoms of gout. Prevention and treatment of gout is impossible without exercise. Take up fast walking, cycling, swimming, and gymnastics. Treatment and prevention of gout are the activities of several specialists: therapist, urologist, neurologist, rheumatologist. It is useful to take a test to determine the level of uric acid in the blood twice a year. The most effective way to prevent gout is to eat right and not abuse alcohol. sources.

Gout is a metabolic disorder that leads to the deposition of uric acid salts in the joints. As a result, symptoms such as inflammation and swelling of the joints on the fingers, redness, high temperature, but most importantly - acute pain, which makes any physical activity impossible.

Celebrities are not immune to this diagnosis. The winner of the Russian show “” struggled with progressive gout for several years. On March 16, 2019, a celebrity suffered from cardiac arrest amid numerous complications and an abscess due to an injured leg.

Previously, this disease was considered a disease of kings and geniuses. Famous people who suffered from this disease are in the material.

flickr.com

The commander and ruler of Macedonia consumed a lot of wine and meat, which became the cause of gout. The day before his death, the king drank 8 liters of wine, and the next day his stomach was twisted by terrible cramps after the first glass. A few hours later he was gone.

Wikipedia "

An integral attribute of the image of the Tramp, who conquered all the screens of classic Hollywood, is a cane. Few people know that the creator and performer of this legendary role also experienced problems with his legs during his lifetime. The artist struggled with gout.