Gout is a disease that affects the joints, which mainly occurs in people after thirty-five to fifty years of age. In medical practice, there are known cases of the development of gout in children and adolescents, but they are isolated. Basically, gout is a consequence of hypertension, alcohol abuse or obesity. Due to the damage to the body by gout, the concentration of uric acid in the blood increases greatly.
Medical science classifies gout into two types – chronic and acute. The acute, rapidly developing form occurs with almost no symptomatic signs and makes itself felt only during attacks. Based on this, we can assume that the main symptom of gout is an acute attack.
In acute gouty arthritis in the human body, uric acid crystals fall out of the joints and tissues. This factor becomes a provoking factor for large accumulations of acid and the subsequent development of the joint inflammatory process. The first moments of the attack are complemented by a sharp change in mood, excitability, severe anxiety and nervousness. Sometimes a person loses his appetite and the sense of taste of food is lost. You may also experience pain in the heart, difficulty breathing, and increased blood pressure.
The attack begins unexpectedly and mainly at night. The feeling of pain becomes increasingly stronger during approximately the first two to three hours. A person feels pain even with the slightest movement. In the morning, the pain usually subsides, but most often the attack is accompanied by profuse sweating, rapid heartbeat, fever and increased blood pressure. This attack can last up to one week. Sometimes all symptoms disappear after one to two months. A second attack may occur at least three months later.
The next type of gout is its chronic form. When suffering from chronic gout, uric acids are converted into crystals, and they accumulate in granules, provoking the development of a chronic form of polyarthritis. Chronic gout is often accompanied by pathologies in the kidneys.
Tophi are crystals made from uric acid salts. Tophi can have different sizes and locations. Sometimes they are located directly in the skin, sometimes in the subcutaneous tissue, tendons and even partially on the bones. Most often, tophi are found on the ears, hands, feet and elbows. At times, tophi appear on the tongue, on the face, etc.
The chronic form of the disease often develops only after the end of the acute form of gout, since it affects the same joints. The first signs of this disease are stiffness in the joint, crunching in it during movement and pain during exercise. Over time, the joint becomes deformed and the person may have difficulty moving. In the absence of treatment, there is an absolute loss of performance in the affected joint. The chronic gouty form of arthritis is also accompanied by some sensations of pain. But the pain is not too severe, but it may not stop for several months.
Chronic gout provokes the development of pathologies in the victim’s kidneys, urolithiasis, acute kidney failure, and cystitis. Chronic gout contributes to the occurrence of many complications, so treatment therapy should begin immediately, and this requires earlier diagnosis of the pathology and careful development of the correct treatment.
Gout (gouty arthritis) is a metabolic pathology of the body in which the metabolism of purines (derivatives of uric acid) is affected, which leads to excessive deposition of uric acid salts in some tissues of the body.
It is as a result of these deposits that dysfunctions of organs and tissues are formed. Joints, kidneys and some other organs (bones, ligaments, liver) are especially affected.
Gout has been known for a long time, occurs with periods of remission and gouty attacks, most often affects middle-aged men, women suffer no more than 1-2% of all cases of gout.
The basis of gout is a genetically inherited defect in the metabolic processes of uric acid, a defect in enzymes that help its utilization and excretion, as well as defects in the system of internal synthesis of purine substances.
In addition to genetic causes, risk factors and external influences that predispose to the development of gout are no less important for the development of gout:
Secondary gout may also develop
Attacks of gout can be triggered by stress reactions to alcohol, citruses, viral infections, physical or mental stress, injuries and hypothermia, bruises, pressure fluctuations, and medications.
Most often, gout affects the kidneys and joints, therefore, we can distinguish
There are also three types of gouty disorders, based on the level of uric acid in the urine:
Gout is a chronic and progressive disease, it can occur in three successively changing stages -
Gouty arthritis occurs suddenly: at night or in the morning, burning, throbbing or tearing pain occurs in one or more joints, usually in the legs and their damage is asymmetrical.
Quite often the joint of the big toe is the first to be affected.
The lesion usually affects the foot or ankle, knees, finger joints, and elbows. There may be swelling of the veins near the joint, fever and chills.
Due to severe pain and swelling, movement of the joint is almost impossible. During the day, the pain subsides somewhat, but by night it appears again, which leads to neurosis and irritability.
After 3-4 days, the pain subsides, the joint acquires a bluish tint, and the swelling gradually subsides.
During attacks, blood tests change - inflammation is detected in the blood with accelerated ESR, high white blood cells and an increase in proteins of the acute phase of inflammation.
Attacks can occur at different times - from once every six months to several years. As gout progresses, the frequency of attacks increases, they become longer and less acute, but more and more joints are involved in the process.
Chronic gout forms areas of tophi - these are nodular accumulations of salts in the tissues approximately 5-7 years from the onset of the disease.
Tophi appear inside the ears, in the area of the joints of the hands and feet, elbows, knees, their sizes can be from a couple of millimeters to a pea or more. As it progresses, the joints change, causing deformations, curvatures, limited mobility and pain when moving.
In addition to the joints, the kidneys are affected. The changes are stronger, the higher the level of uric acid and urate in the urine, and the longer the disease.
So-called urate nephropathy occurs with inflammation of the kidney tissue, release of salts, deposition of sand and stones and the formation of urolithiasis.
Periods of renal colic occur with lower back pain, nausea and vomiting, and secondary pyelonephritis may also develop, with fever, leukocytes in the urine, symptoms of dysuria and a general serious condition.
Urates can be deposited not only in the renal pelvis, but also in the kidney tissue, its cortex and medulla, this leads to gradual atrophy of kidney function and the development of renal failure.
There may be damage to the tendons with the deposition of salts in them, which results in redness and swelling in the tendon area, severe pain and difficulty moving.
The risk of developing coronary heart disease is also higher, and some patients become severely obese.
The basis of the diagnosis is typical attacks of gout with damage to the joints. The data is supplemented by blood tests with signs of acute inflammation, urine tests with high levels of urate and uric acid, creatinine, and detection of urate salts in joint puncture.
For primary diagnosis, a study of the joint fluid is necessary. During gout attacks, it is transparent, its viscosity is reduced, there are up to 75% leukocytes in it, and uric acid crystals are found.
For long-term gout
It is mandatory to conduct an x-ray to detect certain signs in the clinic:
Rest and cool wraps are very important in the treatment of acute gouty arthritis.
An important place is occupied by colchicine, prescribed 0.5 mg every hour until the arthritis subsides, or until the appearance of side effects (vomiting, diarrhea), but not less than 6-8 mg/day.
To treat an acute attack of gout, colchicine is used for no more than a day.
Indomethacin, ibuprofen, naproxen, piroxicam are usually used in large doses and for a short course (2-3 days). Particular caution should be exercised in case of concomitant diseases of the liver and kidneys, especially in elderly patients.
Treatment with anti-gout drugs is carried out in case of primary gout for life, in case of secondary gout - depending on the reversibility of the situation that provokes the development of gout.
With reduced excretion of urates, preserved kidney function and the absence of urinary stones, it is possible to use allopurinol + benzbromarone, taken 1 tablet 1 time / day, probenecid.
Allopurinol is considered a generally accepted uricostatic (i.e., blocking urate production) drug.
Allopurinol is prescribed at a starting dose of 100 mg/day. followed by a gradual increase in dose to 300 mg/day. in 3-4 weeks.
With increased excretion of uric acid in the urine and/or gouty kidney damage, allopurinol is preferred.
More detailed article on nutrition for gout here
Products that should be avoided:
Foods whose consumption should be limited:
Food products that can be consumed without restrictions:
Gout is a chronic, progressive disease; complete cure cannot be achieved, but the disease can be brought into a state of long-term remission.
Attacks are usually treated within 2-4 weeks, but can occur once every six months or more often, so taking drugs that reduce the level of uric acid and its salts can even be lifelong.
Find out your probable illnesses and which doctor you should go to.
Rheumatic pathology provoked by a violation of uric acid metabolism is called “idiopathic gout.” The disease is characterized by acute arthritis, which can smoothly turn into a chronic form. In addition, gout is accompanied by kidney damage.
The disease is more common in men over 40 years of age. Women suffer from gout less often, but they also get sick, mainly during menopause. Gout in children is very rare and is hereditary.
Idiopathic gout develops as a result of a high concentration of uric acid crystals. Accumulations occur in the joints and periarticular tissue. The leading role in this process is played by purines - organic compounds that can be found in almost all products.
After purines break down, uric acid appears in the body. A huge amount of purines enters the body with alcohol and fatty foods. If a person is healthy, uric acid is excreted by the kidneys without delay.
But when kidney function is impaired, and the patient continues to eat foods rich in purines, uric acid is produced in excess (hyperuricemia) and is poorly excreted from the body. Excess fluid gradually turns into crystals and is deposited on the joints. This is how arthritis develops in adults and children.
Depending on the cause of origin, the disease is divided into types. Gout can be primary or secondary. Primary is idiopathic gout, which occurs under the influence of pathological genes.
In other words, the disease is hereditary, such as knee dysplasia, and the classification takes this into account
Secondary gout develops as a consequence of hyperuricemia. In turn, hyperuricemia appears as a result of:
Predisposition to the disease is inherited, that is, its development is influenced by a genetic factor. But it is not the only one; there are other reasons as a result of which a person gets gout:
The development of the disease occurs in several stages, each of them has its own clinical picture. The first stage (premorbid period) is characterized by an increase in the concentration of uric acid in the blood.
The disease at this stage develops without pronounced clinical signs. Therefore, the formulation of the diagnosis occurs only after a preventive urine test. But in the overwhelming majority of patients, the disease is diagnosed already at the stage of acute gouty arthritis.
Acute gouty arthritis (secondary gout) is the next stage of the disease. At this stage, the patient begins to experience attacks characteristic of gout.
They usually occur unexpectedly and begin in the morning and night hours.
Arthritic gout at the initial stage of development affects only one joint. Often the first attacks of gout appear in the metatarsophalangeal joint of the big toe. However, there are situations in which other joints (elbow, knee, ankle) are affected first.
At the beginning of the attack, the pain is moderate, but gradually it intensifies, after which the affected area swells and turns red. The patient's body temperature rises. After just a couple of hours, the pain becomes unbearable and covers the entire lower limb. The joint becomes immobile.
The duration of gout attacks is usually 2-3 days. But in some cases they can take up to 10 days. When the attack passes, the pain gradually subsides, and the function of the affected joint returns completely.
Over time, gout spreads to other joints, the intervals between attacks shorten, and the duration of pain, on the contrary, increases. If the patient, after diagnosis, does not begin to receive adequate treatment in a timely manner, the disease will develop into a relapsing form.
The next attack of gout can be expected within a year.
Acute recurrent arthritis over time turns into a chronic form of gout. Attacks become more frequent, more and more new joints are involved in the disease, although the pain dulls over time. The affected joints become deformed, take on an irregular shape, and their size increases. Natural joint mobility disappears.
If the disease continues for a very long time, the patient develops tophaus chronic gout. This disease is characterized by the formation of tophi nodules. These nodules consist of deposits of uric acid salts. There is connective tissue around the tophi.
Tophi nodules resemble white-yellow bumps of a cartilaginous structure and are most often formed on the toes and hands, nasal cartilage, elbows and ears. Chronic tophi gout is more mild than the previous stages of the disease.
Formulating a diagnosis becomes possible only after the doctor examines the patient; examine his medical history; will exclude other diseases that are similar in clinical picture. These diseases include:
In order to verify the correctness of the diagnosis, the doctor prescribes laboratory diagnostics, which consists of a number of biochemical studies:
If the test results do not allow an accurate diagnosis, the patient may be prescribed a skeletal x-ray. Based on the image, tophi and asymmetric changes in the joints can be identified. X-rays are also prescribed in cases where the doctor has every reason to suspect that the patient has a special form of arthritis, called “calcium gout.”
This disease is characterized by the fact that calcium phosphate, rather than uric acid salts, is deposited. But calcium gout has all sorts of manifestations that can be mistaken for true gout. The calcium form of the disease is diagnosed in the presence of cartilaginous formations in the joints. Such growths are easy to detect on an x-ray.
To make a correct diagnosis, a special study of the joint fluid can be used. It is carried out using a polarizing microscope.
Thanks to this research, it is possible to identify calcium phosphate crystals. Their presence indicates that the patient has a calcium form of gout.
It is impossible to completely get rid of the disease, but the disease can be successfully controlled. Treatment with medications, a special diet, physiotherapeutic procedures and therapeutic exercises provide the opportunity to minimize the severity and frequency of gout attacks.
The effectiveness of therapy depends on the stage of the disease. At the initial stage, when gouty arthritis has not yet developed, but high levels of uric acid have already been diagnosed, the main treatment method is the use of a specific diet. The patient's diet should consist of fermented milk foods and vegetables. And these products should be excluded from the menu:
At an early stage, treatment of the disease can prevent the development of chronic and recurrent forms of gout. In addition to a special diet and giving up bad habits, the patient must take drug therapy, which is aimed at improving kidney function.
Thanks to this, it is possible to normalize the concentration of uric acid and prevent its crystallization
When gout has crossed the stage of arthritis, the patient is prescribed medication. To stop gout attacks, steroidal anti-inflammatory drugs and colchicine, a herbal medicine, are used.
Colchicine reduces the severity of pain and the duration of gout attacks.
In the stage of exacerbation of the disease, the patient is prescribed physiotherapeutic procedures that help stop the attack:
To prevent a relapse of a gout attack, the patient is prescribed drug therapy aimed at normalizing the concentration of uric acid. For this purpose, uricodepressant and uricosuric drugs are used.
Uricosuric drugs act on the kidneys and improve their excretory capacity. If the patient has kidney problems or signs of nephropathy, this group of drugs is contraindicated for him. Uricodepressants are needed to inhibit the synthesis of uric acid.
When there is a lull between attacks, physiotherapeutic treatment is used, the main focus of which is to reduce the duration and frequency of gouty attacks:
Plasmophoresohemosorption is an innovative method of treating gout. This procedure removes uric acid from the blood. For this, modern medical devices are used. If the situation is advanced and out of control, the doctor may prescribe surgical removal of uric acid deposits to the patient.
Additional methods of treating idiopathic gout include a strict diet and a regime of drinking plenty of fluids with an alkaline solution. In addition, treatment of gout involves physical exercise, which is necessary to restore motor activity of the affected joints.
If the patient is overweight, correction of body weight and treatment of diseases associated with obesity (vascular atherosclerosis, diabetes mellitus) are required.
Gout is a disease that occurs as a result of a disorder of protein metabolism in the body. With gout, the level of uric acid in the blood increases (hyperuricemia). Gout is sometimes called the “disease of kings” because in the past the disease mainly affected rich people who could afford to consume large quantities of wine and meat. At the first stage of gout development, uric acid compounds accumulate in the body. Subsequently, these compounds are deposited in tissues with the subsequent development of attacks of inflammation. As the disease progresses, gouty granulomas and gouty “bumps” are formed - tophi, located around the joints.
The main cause of gout is elevated levels of uric acid in the blood. Uric acid is deposited in the form of crystals in joints and internal organs, which provokes the development of an inflammatory process in the body. The accumulation of large amounts of sodium urate in the joint ultimately leads to the destruction of the latter.
An increased level of uric acid in the blood is possible for two main reasons: when too much uric acid is produced and healthy kidneys simply do not have time to remove it all; when kidney function is impaired and they are unable to completely remove uric acid salts.
According to medical observations, the number of patients with gout is steadily increasing. Doctors explain this phenomenon by the fact that people began to consume a lot of meat foods (which are rich in purines) and alcohol. In addition, it is known that obesity, which is caused by excessive consumption of meat products, is a powerful factor in the development of gout.
Recently, American scientists have established a direct connection between a lack of calcium and ascorbic acid and the development of gout. With age, there is a deficiency of these substances in the body, which only contributes to the deposition of uric acid in the body.
There are three types of disease:
The metabolic type is characterized by a high content of uric acid and its crystals in the urine (uraturia), but the kidney function is not impaired. The renal type of gout is characterized by relatively low levels of uric acid in the urine, but renal function is affected. With the mixed type, reduced or normal uraturia and normal clearance are possible.
Characteristic symptoms of gout: severe inflammation of the joint (usually the big toe, knee), redness of the skin, local increase in temperature in the area of the affected joint, joint destruction.
An acute attack of gout usually begins at night with a gradual increase in pain in the joints over several hours. In the morning the pain subsides somewhat. Often attacks are accompanied by increased heart rate, chills, increased body temperature and profuse sweating. In typical cases, a second gout attack occurs several months after the first. Sometimes the disease does not appear for decades.
Chronic gout is the next stage in the development of the disease, when urate crystals accumulate in the tissues in the form of granules. The joints and kidneys are most affected.
Accumulations of uric acid salt crystals in tissues are called gouty nodes (tophi). Favorite locations for tophi are the hands, feet, ears, tongue, and scrotum.
The main symptoms of chronic gout: stiffness of movement, crunching in the joints, loss of joint function, severe prolonged pain in the joints. Chronic gout is usually accompanied by cystitis, urolithiasis, and acute renal failure.
It is forbidden to eat foods rich in purines: meat and meat by-products (kidneys, heart, brains, liver), fatty fish, salted and fried fish, canned meat and fish, lard, sharp and salty cheeses, soups with meat, fish, chicken , mushroom broth, legumes (peas, lentils, beans, soybeans, beans). Alcoholic drinks (beer, sparkling and dessert wines, cognac drinks) are contraindicated. It is recommended to drink plenty of fluids (up to 2–3 liters per day). During an attack of gout, you should provide rest to the affected joints and try to reduce contact of the affected joint with clothing or shoes. Drinking alkaline, low-mineralized sodium bicarbonate waters is recommended (Essentuki No. 17, No. 4, Borjomi, Truskavetskaya, Luzhanskaya, Mirgorodskaya, Polyana Kupel, Kvasova).
The diagnosis is made by a rheumatologist during examination and interview of the patient. Laboratory diagnostics are also used: a high level of uric acid is detected in a biochemical blood test. Sometimes a puncture (puncture) of the joint is performed, followed by examination of the synovial fluid. X-ray diagnostics are informative.
Unfortunately, it is impossible to completely get rid of gout, but modern treatment allows you to keep the disease under control, preventing acute attacks of gout and preventing the disease from progressing. A person with gout will have to radically change their lifestyle and constantly take special medications.
Drug therapy for gout is aimed at reducing the level of uric acid in the blood and stopping the inflammatory process caused by crystals of urate salts.
Currently, the following types of drugs are used to reduce the level of uric acid in the blood:
To eliminate the inflammatory process and pain syndrome in gout, the following types of drugs are used:
Patients with gout must definitely change their lifestyle, which consists of following the following rules and recommendations:
Complications from the joints include the development of gouty arthritis and joint deformities.
Kidney complications: development of gouty kidney, which leads to acute or chronic renal failure; urolithiasis, hydronephrosis, acute and chronic pyelonephritis. Renal changes can provoke arterial hypertension.
If there is a family history of gout, the risk of the disease should be taken into account and the level of uric acid in the blood should be regularly monitored. It is also necessary to maintain a normal weight, since gout often occurs in obese individuals. Proper nutrition and limiting purine-rich foods play an important role in preventing the disease.
In the human body, the kidneys serve as a cleanser. Food products that enter the human body are not always environmentally friendly, which adversely affects the functioning of these organs. Thus, it is not surprising that kidney pathologies occur in almost every third person. One of these diseases is chronic renal failure (CRF), which requires special attention and approach to treatment. How is chronic renal failure treated and is it worth sounding the alarm when making such a diagnosis?
Two vital functions are performed by these small filters, weighing no more than 200 grams. First, the kidneys control the homeostasis of water and acid-base balance. Secondly, natural filters remove waste products from the human body. These functions are carried out thanks to the blood flow passing through them; by the way, the amount of blood passing through the kidneys is 1000 liters per day, it’s scary to even think about this figure.
Renal failure is severe abnormalities in the functioning of the kidneys. Their functions lose stability and balance, which leads to the inability to fully filter contaminated blood, which spreads throughout the body and disrupts the functioning of all organs and systems.
Kidney failure can be acute or chronic. The acute form, despite the speed of development, is treatable, while in the slowly progressing chronic form, it is impossible to restore lost functions.
However, today medicine can offer treatment for chronic renal failure, which will improve the patient’s quality of life and relieve serious consequences. Life despite chronic renal failure continues, although it requires a serious approach to your health.
The disease is usually classified into stages:
As a rule, if a person’s tests show a characteristic clinical picture for 5 years, he is diagnosed with chronic renal failure. Manifestations of the disease can be extremely unpleasant and require mandatory treatment. Life despite chronic renal failure can have a completely normal course for a person, provided that he follows all the doctor’s recommendations.
Symptoms that are predominant to all of the above signs are subject to separate consideration. These include:
The following symptoms indicate that the disease has progressed and poses a serious danger to the patient’s life. These signs include:
Kidney failure can occur due to many reasons:
Most often, chronic renal failure develops in people who suffer from chronic pyelonephritis or glomerulonephritis, congenital renal pathologies or diabetes mellitus.
Kidney failure always develops due to the gradual death of nephrons, the main working components of the organ. The death of one nephron automatically increases the load on the remaining ones, which leads to their gradual changes and death.
Even the fact that the compensatory capabilities of the kidneys are quite high (even 10% of the remaining nephrons can control the water-electrolyte balance) is unable to prevent pathological processes that occur at the very beginning of the development of chronic renal failure. Scientists have proven that in case of kidney failure, the metabolism of more than 200 substances is disrupted in the human body.
Life despite chronic renal failure must have a good quality, therefore treatment of this pathology must be carried out without fail.
What methods and medications will be used to treat renal failure directly depends on the stage of the disease and concomitant pathologies.
At the latent stage of renal failure, patients may not experience any symptoms, so treatment in this case is rarely carried out.
If a patient is diagnosed with chronic renal failure at a compensated stage, in this case radical treatment measures are used, including surgery to restore the outflow of urine. Timely treatment of the compensated stage of chronic renal failure has every chance of its regression to the initial stage. However, in the absence of proper treatment, the compensatory capabilities of the kidneys are gradually exhausted, and the next stage begins.
With chronic renal failure in the intermittent stage, surgery is usually not performed. Too high a risk. In this case, detoxification methods and nephrostomy are used. If kidney function is restored, then most likely the patient will be allowed to undergo radical surgery.
Terminal or severe renal failure is accompanied by loss of potassium, sodium, water from the body, metabolic acidosis, and azotemia. Therefore, only well-planned treatment can restore lost functions and prolong life despite chronic renal failure.
First of all, treatment is aimed at restoring nephron function, for this purpose the following methods are used:
To enhance the excretion of nitrogen metabolism substances, the patient may be prescribed physiotherapeutic procedures:
Kidney failure must also be treated with drugs that bind protein metabolites. Such a remedy is, for example, Lespenefril. Enterosorbtion is also an effective method of treating renal failure, for example, with the drug Polyphepan.
To eliminate hyperkalemia, laxatives and cleansing enemas are used. Thus, conditions are created in the body that interfere with the absorption of potassium into the intestines, as a result of which it leaves the body faster.
As for antibiotics for kidney failure, their use is best avoided. The difficulty lies in the fact that the impaired functioning of the kidneys does not allow these substances to be removed from the body in a timely manner, as a result of which they move through the vessels for a long time. Thus, antibiotics can have not only a therapeutic, but also a toxic effect on the body.
Today, the “nursing process” service is very popular for chronic renal failure. Patients who have end-stage renal failure require constant monitoring by medical staff. This is due to the severe course of the disease and the likelihood of severe complications.
For patients who are not being treated for renal failure with hemodialysis, nurses perform siphon enemas and gastric lavage.
This is how the stomach is washed
Regardless of the treatment methods for kidney failure, the diet must be strictly followed. To do this, you need to know simple ways to do it:
Alternative treatment is a good addition to the main treatment of chronic renal failure. It is important to note that such methods will be more effective in the early stages of the disease.
To reduce the progress of chronic renal failure, it is recommended to use the following recipes:
Traditional methods of treatment will help increase the patient’s immunity, which will give strength to fight the disease and lead a quality life despite chronic renal failure.
Very often, when treating this disease, patients are prescribed daytime tranquilizers (Rudotel or Mazepam).
Physical activity perfectly replenishes the reserves of necessary energy, but a sedentary lifestyle just contributes to the appearance of constant fatigue. Daily exercise, sports, and long walks help reduce blood pressure, normalize weight, and help eliminate anxiety and depression. Sitting less in front of the computer or watching TV, go out of town into nature more often. For this disorder, a course of physical therapy is also prescribed in combination with hydrotherapy (oxygen baths and contrast showers) and massage of the whole body or collar area, as well as paravertebral massage with elements of manual therapy (massage along the spine using reflex-segmental massage techniques, aimed at eliminating pain and improvement of the body’s vegetative functions). This effect has an activating and relaxing effect on the body, relieves fatigue and tension.
To achieve the maximum therapeutic effect, diet therapy, in particular therapeutic fasting, is often prescribed. Proper nutrition improves metabolic processes in the body, promoting increased physical and intellectual activity, and also improves overall well-being. Therefore, to treat this disorder, it is important to review your eating habits.
Poor quality or insufficient sleep is one of the causes of chronic fatigue. Our body requires an average of seven to eight hours of good sleep. If you are overcome by insomnia, it is important to discard all disturbing thoughts; before going to bed, walks in the fresh air are recommended, and limit the consumption of invigorating drinks. Under no circumstances should you take sleeping pills; they can cause addiction to the body.
Psychological problems are a common cause of this disease. Try to reconsider your lifestyle, solve problems as they arise, do not accumulate them, as constant worries deplete your energy reserves, causing chronic fatigue. At least once a week you should disconnect from all your problems, do nothing and just have a good rest.
To relieve fatigue and tension, a massage using essential oils is recommended. Mix a tablespoon of almond or grape oil with four drops of lavender oil and the same amount of lemon oil. Or mix three drops of lavender oil or ylang-ylang oil with two drops of Roman chamomile oil and a tablespoon of almond or grapeseed oil.
Traditional medicine in the fight against chronic fatigue recommends the use of such soothing herbs as echinacea, licorice root, tenacious bedstraw, valerian root, motherwort, ginseng.
The term “gout” refers to a chronic systemic disease associated with metabolic disorders of special substances - purines, which occurs with an increase in the level of uric acid in the blood, recurrent acute inflammation of the joints and the formation of gouty nodes - tophi - in the tissues. If left untreated, the disease sooner or later leads to dysfunction of the joints and kidneys.
You will learn about why gout occurs, what symptoms it is accompanied by, the principles of diagnosis and treatment tactics for this pathology in our article. But first, we suggest that you familiarize yourself with brief epidemiological data.
Some interesting facts:
Uric acid in the human body is formed by the decomposition of special substances - purines. Its reserves are about 1000 mg, and daily 650 mg are excreted from the body and the same amount enters.
Some purines enter the body with food, while others are synthesized in the body from other substances.
In the blood, uric acid is found in the form of free sodium urate. Normal values for its level are 0.3-0.42 mmol/l for men, and for women – 0.24-0.36 mmol/l. Concentrations of the substance above these numbers are regarded as hyperuricemia. In such patients, the risk of developing gout in the future is increased.
For many years, hyperuricemia can occur without any symptoms, without manifesting itself in any way, but sooner or later it will most likely develop into gout.
As mentioned above, the processes of secretion of uric acid and its entry into the body are normally balanced. Sometimes disturbances in these processes occur, which lead to increased levels of uric acid in the blood. In particular, these may be excessive formation (entering the body from the outside) and/or insufficient excretion of uric acid in the urine.
Depending on the mechanism of development, primary and secondary hyperuricemia are distinguished.
This pathology is considered the cause of the development of primary gout. This is an inherited abnormality of purine metabolism. This fact is confirmed by the fact that gout often develops in relatives, and every 5th family member of a person with gout has an increased level of uric acid in the blood.
Risk factors for primary hyperuricemia are:
As a rule, this condition is caused by insufficiency of kidney function, which reduces the rate of excretion of uric acid salts from the body. Hyperuricemia can also be detected in the following diseases and conditions:
Gout itself develops against the background of prolonged hyperuricemia. In response to high levels of uric acid in the blood, the body reacts by deposition of its salts (urates) in tissues and increased excretion of this substance in the urine.
Urates are deposited mainly in the area of cartilage, joints and structures that form them, in the skin and kidneys, disrupting their functions.
Their deposition in the structures of the kidney is especially dangerous - gouty nephropathy.
An acute attack of gout develops in people who have been suffering from hyperuricemia for a long time. Provoking factors contribute to this:
These factors cause a sharp increase in the level of uric acid in the blood, the loss of small crystals of sodium urate into the joint cavity - this provokes the development of acute inflammation of the joint tissue.
Manifestations of this pathology are:
The course of gout is divided into 3 stages:
Let's look at each of them in more detail.
It is characterized by a sudden onset, usually affecting only one joint. It contains all the signs of inflammation - redness of the skin, swelling, dysfunction and intense, rapidly increasing pain.
Arthritis develops under the influence of provoking factors (they are listed above), mainly at night or early in the morning, without treatment it lasts up to 10 days, then it goes away on its own (this is a characteristic feature of this pathology).
In the majority of patients (9 out of 10 cases), the first attack of gouty arthritis occurs with damage to the first metatarsophalangeal joint of the foot.
Without treatment, attacks gradually become more frequent, and each subsequent attack is more severe than the previous one, involving new joints.
Gouty arthritis in people of different ages and gender occurs with the following features:
During the period between attacks of acute arthritis, patients with gout feel satisfactory and do not have any unpleasant symptoms. If during the first attack of gouty arthritis the patient did not receive treatment, it is very likely that he will develop a second attack within a year, and in almost all of these patients acute arthritis recurs within 2 years. With each subsequent attack, the period between them becomes shorter, and the arthritis itself becomes more and more severe.
As the name suggests, the disease at this stage is characterized by the deposition of tophi in the tissues, the development of a chronic form of arthritis, kidney stones and renal failure.
Tophi are found on the ears, in the area of the elbows and knee joints, under the skin or intradermally on the fingers, and less often in any other part of the body, including on the internal organs. Their sizes range from the head of a pin to a small apple. Tophi are painless. In some cases, ulceration of the skin over the tophi occurs and a white thick mass is released from them.
In some patients, tophi appear at the initial stage of the disease. So, this is typical for juvenile gout; it also occurs with blood cancer, renal failure and in elderly women taking diuretics.
The greatest danger is from kidney complications. Prolonged hyperuricemia will sooner or later lead to chronic nephropathy or kidney stones. In patients, blood pressure increases, renal function is impaired, sclerosis of the renal structures develops, and protein appears in the urine.
The patient is examined, as a rule, in a hospital, where he is hospitalized for suspected acute gouty arthritis. In order to confirm the diagnosis, he will be prescribed:
Experts have developed criteria, the totality of which allows a patient to be diagnosed with gout.
A. Uric acid crystals were found in the joint fluid.
B. Tophi are determined to contain uric acid (which is confirmed by research).
B. At least 6 of the 12 signs listed below are present:
If a particular patient has points A, B and at least 6 of point C, the doctor diagnoses him with “gout”.
Some diseases have a similar course to gout, in particular acute gouty arthritis. They should be distinguished from each other, since the treatment measures for each of them are usually different.
So, differential diagnosis should be carried out with the following diseases:
The patient can receive treatment on an outpatient basis or in a rheumatology hospital. So, indications for hospitalization are:
Treatment measures are carried out with the aim of:
The patient should be aware of the need to eliminate risk factors for hyperuricemia and repeated attacks of acute arthritis (he should lose weight, avoid intense physical activity, stop drinking alcohol, and so on). He also needs to be informed about the symptoms of relapse of the disease, the consequences of refusing treatment, the side effects of medications and the need to quickly eliminate the symptoms of an attack of acute arthritis.
In addition, the doctor recommends that the patient follow a diet. It involves excluding from the diet (or at least reducing consumption) foods high in purines (such as meat and offal, fatty fish, spices, legumes, cauliflower, strong tea and coffee, alcohol and others). The calorie intake and the amount of carbohydrates eaten are also reduced. Products containing polyunsaturated fatty acids are added to the diet.
Treatment should be started as early as possible, preferably in the first hours of arthritis development. For this purpose, non-steroidal anti-inflammatory drugs are used, and if they are ineffective, glucocorticoids are used locally or systemically. Previously, colchicine was used to relieve attacks of gouty arthritis, but in recent years this drug has become virtually unavailable due to the frequent development of side effects and the high risk of complications.
It is necessary because it prevents the development of repeated attacks of acute gouty arthritis and prevents the development of gout complications.
Indications for treatment are:
Antihyperuricemic therapy is prescribed to the patient for life. The target concentration of uric acid in the blood during treatment is 400 µmol/L or less. During an attack of arthritis, therapy is not started, but if an attack occurs during treatment, the antihyperuricemic drug is not discontinued.
Against the background of properly administered antihyperuricemic treatment, the concentration of uric acid in the blood serum is normalized, attacks of acute arthritis occur less and less frequently, tophi decrease in size and gradually disappear, and urolithiasis does not progress. As a rule, significant improvement is observed in almost all patients after six months to a year of continuous use of the drug.
In the vast majority of cases, in order to reduce the level of uric acid in the blood, the patient is prescribed allopurinol.
Begin therapy with a low dose – 50 mg/day. Once every 2 weeks, the uric acid level is analyzed and, in the absence of positive dynamics, the dose of the drug is increased until normouricemia is achieved. The normal rate is considered to be a decrease in the concentration of uric acid in the blood serum by 10% from the initial level per month. The effective dose of the drug is individual for each patient and varies from 100 to 900 mg per day or even more.
Since allopurinol can have a damaging effect on the kidneys, treatment is carried out under the control of creatinine clearance. If the latter decreases to 30 ml/min or less, the dose of allopurinol is reduced.
If a patient stops taking allopurinol, the concentration of uric acid in his blood serum returns to initial values very quickly - within 3-5 days.
Allopurinol is a serious drug. Taking it is associated with the development of a number of side effects. However, for patients with gout it is simply necessary. That is why treatment should be carried out exclusively under the supervision of a doctor.
Allopurinol analogues are:
Sometimes gout patients are prescribed medications that stimulate the excretion of uric acid in the urine. The most common drug in this regard is losartan. It is especially recommended to take it in patients whose hyperuricemia is caused by taking diuretics (hypothiazide and others). Uricosuric drugs also include anturan, ketazone, probenecid, acetylsalicylic acid and some others.
Patients receiving therapy with the above drugs are monitored at the dispensary, which means:
Gout is a chronic disease associated with impaired purine metabolism, which is progressive and, if left untreated, leads to a number of complications. Its course can be divided into 3 stages: acute gouty arthritis, interictal gout and chronic (tophus) gout.
The diagnosis is based on clinical data, the results of a general blood test, analysis of synovial fluid, the contents of tophi and X-ray data of the affected joints.
Treatment consists of general recommendations (elimination of risk factors, diet), lifelong use of drugs that reduce the level of uric acid in the blood serum, and during an acute attack of arthritis - the use of non-steroidal anti-inflammatory drugs or glucocorticoids.
Unfortunately, it is impossible to recover from this pathology. However, its course is favorable in almost all patients who began receiving antihyperuricemic treatment in a timely manner at an early stage. The most common complication of gout is urolithiasis (formation of stones in the urinary tract) - it develops in 20-50% of patients. And renal failure, which occurs against the background of uncontrolled hyperuricemia, causes death in 19-25% of people suffering from gout.
If you suspect gout, especially in the case of inflammation of the big toe joint, you should consult a physician. After the initial diagnosis, the patient is referred to a rheumatologist. As the disease progresses and nephropathy develops, consultation with a nephrologist is necessary. Urolithiasis is a reason to be examined by a urologist or surgeon.
Specialists from the Kyiv Regional Clinical Hospital talk about the causes, symptoms and principles of treatment of gout (Russian - Ukrainian):