Gout - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Musculoskeletal System.

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

Gout - a disease associated with the violation of purine metabolism, which leads to an increase in blood uric acid (giperurekimii) and its deposition in tissues of locomotor system and internal organs.

In humans, the purine bases are broken down into uric acid by the kidneys and excreted.When the limit is exceeded the concentration of uric acid in the tissues begins leaving her crystals as sodium monourata in the joints, kidneys, and soft tissues.There are clinical manifestations of arthritis (joint inflammation), educatio

n appear in the soft tissues (tophi), urate nephropathy (kidney disease) and nephrolithiasis (kidney stones).

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

Causes of gout

1. Medication: diuretics (thiazide diuretics), low-dose aspirin (1g a day), cyclosporine.
2. Diseases and conditions that lead to the appearance of gout: diabetes, obesity, coronary heart disease, hypertension, metabolic syndrome, chronic renal failure, lead poisoning, organ transplantation, psoriasis, diseases of the blood.Increase gout contributes to intravenous contrast administration (with X-ray examination), trauma, surgery.
3. The risk of gout is extremely high in people who have the habit of eating foods containing large amounts of purine bases (fatty meats, seafood, alcoholic beverages, soft drinks).
4. Gout is more common in men (age 30-60 years), women gout develops much less often and mostly in the menopausal period.

Symptoms of gout

Acute gouty arthritis begins with the destruction of the joint, most commonly the big toe.Occurrence of acute arthritis may precede excessive consumption of food, alcohol, trauma, surgery.The disease develops suddenly, occurs early acute pain, redness and swelling, symptoms grow rapidly and reach a peak within 24 - 48 hours.Pain becomes pronounced, patients often can not wear socks or touch the affected joint.Acute gout may be accompanied by an increase in body temperature to 38 degrees.Severe weakness, general malaise.Even in the absence of treatment exacerbation of gouty arthritis disappears gradually within 5 - 7 days.

Acute gouty arthritis

As the disease progresses, and the absence of adequate treatment of arthritis attacks are becoming more frequent and prolonged, involved new leg joints.Appears joint deformation due to nodular deposits and bone growths, tophi.

tophi - is the uric acid crystals that are deposited in the periarticular tissues are painless, dense nodules of yellowish color.The most often located in the area of ​​the ears, elbows, ankles, joints of the hands and feet.

gradually emerging joint stiffness, making it difficult to move patients.Great risk of fractures.Each new exacerbation of gouty arthritis worsens the disease, contributes to the rapid development of complications.

mainly uric acid excreted by the kidneys, the deposition of uric acid salts in the renal pelvis leads to development of urolithiasis.Passage of calculi (stones) is manifested by intense pain in the lumbar region - Renal colic.

diagnosis of gout

1. Biochemical analysis of blood.Identification giperurekimii: increased uric acid levels in men over 0.42 mmol / L in women more than 0.36 mmol / l.Determining the level of serum creatinine - to detect renal failure.
2. The study of synovial fluid of the affected joint.The chemical or microscopic examination determined uric acid crystals in the crop is no bacterial flora.
3. Radiography of the joints determines the changes in chronic gouty arthritis.
4. renal ultrasound.Identify rentgennegativnyh calculi (stones).

Radiography joints - gouty arthritis

Consultation of rheumatologists, nephrologists, surgeons.

Treatment of gout

important to prevent aggravation of gout is the observance of dietary recommendations.This restriction of the use of: meat and fish products, legumes, spinach, cauliflower, raspberries, figs, chocolate, strong tea and coffee.It is forbidden the use of alcohol, especially wine and beer.

recommended to increase fluid intake to 2 liters per day, if there are no contraindications.This cranberry juice, juice, alkaline mineral water.The gradual normalization of body weight is required for the patient, since it helps reduce uric acid levels in the blood.

aim of drug treatment is to reduce pain during an attack and treatment of disorders of purine metabolism.

During an acute attack of gout patient is recommended complete rest, especially the sick limb.Should be given the exalted position of the foot, to attach to diseased joints ice pack, and then pain subsided - a hot compress.nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat an attack.The drug, the dose, dosing frequency, duration recommended by the attending physician.

To achieve a stable reduction of uric acid, which prevents the progression of gout, used antipodagricheskie drugs (allopurinol, sulfinperazon, Ural, etc.).These drugs are used for a long time (years).Selects the desired drug doctor for each patient individually, depending on the age, concomitant diseases, blood uric acid levels.

When forming large tophi, ulceration at the tissue, the presence of fistulas recommended surgical treatment - removal of tophi, as they can no longer disappear when taking antipodagricheskih drugs, and can greatly limit the function of the joints.

Physiotherapy gout

In the acute period of application used Dimexidum solution on the affected joint.It has analgesic and anti-inflammatory action.Before the procedure is carried out on samples Dimexidum sensitivity (the presence of an allergic reaction), 24 hours after the start of the sample procedure.For applications use 30-50% Dimexidum solution (diluted net dimexide boiled water).Cloth soaked in the solution, put on the affected joint.First, the duration of the procedure is 10 minutes later it was increased to 2 hours.The remission used with mud baths, paraffin, ozocerite, which contributes to improving joint function, decreases in content of urate them.

In remission patients demonstrated a spa treatment.The state of health of patients, the disease had a beneficial effect corrective measures: diet, intake of alkaline mineral water, balneotherapy, mud therapy.

Herbal medicine for gout

The combined treatment with diet and drugs antipodagricheskimi used herbal medicine.Infusion of leaves cranberries (1 / 2stakana 3 times a day).Infusion of leaves of black currant (½ cup 4-5 times a day).The infusion is prepared: 1 tablespoon of dried leaves in 500 ml boiling water, to insist 2 hours, strain.Apply fruit blueberries.

diet for gout

from the diet is necessary to eliminate or minimize foods and dishes that contain large amounts of purines, because purines formed from uric acid.

Products, which consumption should be excluded: liver, kidneys, brain, lungs, meat of young animals, chicken, meat and fish broth.Patient with gout should refuse reception of alcohol, since it inhibits the renal excretion of uric acid, and thus contributes to its concentration in the blood.

Products, which consumption should be restricted: legumes (beans, peas, beans), spinach, eggplant, radishes, cauliflower, asparagus, mushrooms, shellfish, eggs, fish (Baltic herring, sardines, etc.).Permissible big fish.

body's need for calories for gout should be met mainly due to carbohydrates.In small amounts in the diet may be present eggs, flour and cereal meals, lean fish, beef, lamb.Fish and meats should be eaten boiled, not more than 2-3 times a week.One serving should be no more than 250 g During the attack of arthritis fish and meat should be completely deleted.The food should contain the required amount of vitamins, so useful broth hips, lemons, apples, black currant.Without limitation, you can use milk and dairy products, grains (breads, cereals, bran), most vegetables (potatoes, carrots, cabbage, cucumbers, tomatoes, squash, onions, carrots, beets, radishes, celery), nuts, watermelon, cantaloupe,berries and fruits, spices.It is known that a cherry, strawberry, currant, and other dark red and blue berries reduce the concentration of uric acid in the blood are therefore useful for gout in any form.In the absence of kidney and heart disease need to drink plenty of alkaline (2-2.5 liters per day), well suited for this purpose fruit and berry compote, alkaline mineral water.

prevention of gout

Patients suffering from gout, observed rheumatologist and internist (family doctor).Twice a year, they undergo a comprehensive examination (determination of the levels of uric acid, creatinine).Renal ultrasound and X-rays of the joints is performed 1 time per year.


Complications Early reversible disorders of purine metabolism, subject to timely diagnosis and treatment, but at the stage of chronic gout with the defeat of organs (heart, brain, kidneys) unfavorable prognosis.Renal disease occurs in 30-50% of patients with gout.When persistent elevations of uric acid levels in every 4 patients with gout develop chronic renal failure.

Doctor's consultation on gout

or questions: Why when taking drugs comes antipodagricheskih aggravation?
Answer: At the beginning of treatment antipodagricheskimi drugs (usually allopurinol) may be acute gouty arthritis as a result of excretion of uric acid from the body tissue depots.Therefore, for the prevention of NSAID should be administered at the same time.

Q: How long should I take antipodagricheskie drugs, if the level of uric acid to normal?
Answer: Antipodagricheskie drugs are taken for a year, then you can make a break for 2 months (with normal uric acid in the blood), subject to the diet.

therapists Vostrenkova I.N