Gout is a type of arthritis (joint disease), and everyone without exception is at risk of developing this disease: men and women of different ages. But, like any disease, gout does not occur just like that; it is often caused by an incorrect lifestyle. This could be smoking, drinking alcohol, that is, bad habits, due to which the content of uric acid in the body increases. As there is more of this acid in the body, it begins to accumulate in the form of crystals, which, in turn, move to places where the joints are inflamed.
In addition to bad habits, the cause may be a previous injury, frequent physical activity on gouty feet, constant wearing of high-heeled shoes, or chronic renal failure.
Symptoms of gout on the legs can be observed as follows:
Attacks of pain due to gout in the legs intensify after drinking alcohol or diuretics. The first attacks go away when taking anti-inflammatory drugs, but over time their effect becomes insufficient, and the disease spreads to other joints.
If you notice the first symptoms of gout, it is better to immediately consult a doctor to establish an accurate diagnosis. A good specialist can determine your condition based on a visual examination and your complaints. But as a rule, this is an exceptional case, and for an accurate diagnosis you need to undergo tests.
When you have gout on your legs, you most often need to do the following tests:
These tests will help the doctor assess your condition, the severity of the disease and determine the treatment method. You may also be asked to take an x-ray to know exactly the size of the inflammation and the area of damage to the joints; some specialists practice ultrasound examinations.
It is impossible to completely cure gout, but with the right approach to treatment, you will forget that you have this disease. After the examination, the doctor will definitely suggest drug treatment, which is aimed at eliminating pain symptoms, removing excess uric acid from the body, and stimulating the production of cartilage. These will mainly be painkillers and anti-inflammatory drugs.
In addition to medications, a diet must be determined: a patient with gout needs to drink as much water as possible, heavy foods must be excluded. We must not forget about giving up addiction to alcohol and other bad habits; the lifestyle should be as comfortable and beneficial for the body as possible.
An excellent addition to the treatment of gout on the legs will be auxiliary methods: massage, physiotherapy, recreational physical education and relaxation in specialized sanatoriums. There are also many folk remedies for treating gout, including the use of tinctures of turnip, garlic and celery, ingestion of celery juice and much more.
In the most severe cases of the disease (for example, with the development of fistulas), it will be necessary to resort to surgical intervention. Otherwise, the mobility of the bone will be limited due to the formations, and when taking medications and other methods of treatment, they will not disappear anywhere. Today in medicine there are effective methods for removing fistulas on the leg, for example using a laser. This is a proven and really working method, so there is no need to be afraid of such surgical interventions if doctors consider them necessary for gout on the legs in your case.
Of course, it is better to prevent a disease than to treat it later. Here are some tips to help you avoid getting gout:
Diagnosis of gout is often associated with certain difficulties, even for experienced specialists. This is explained by the fact that patients’ complaints most often relate to pain in the joints. And this can be a consequence of a variety of diseases. To increase the likelihood of making a true diagnosis, it is necessary to contact the rheumatology department. The specialists in this department have more experience working with arthritis than their colleagues. And they will be able to identify gout faster than other doctors.
To make a diagnosis, a specialist must have the results of clinical, laboratory and instrumental examinations. For some patients, the process of making a diagnosis is not associated with any difficulties. Others are faced with the fact that they have to take a lot of tests and undergo various examinations. It all depends on what caused the development of the disease and the symptoms of its manifestation.
Diagnosis of gout is divided into several stages:
Collecting information about the course of the disease is very important to make a correct diagnosis. This makes it possible to immediately exclude the presence of other diseases with similar symptoms. In a conversation with the patient, the specialist has the opportunity to find out exactly how the disease began, what symptoms were the first and in what order they appeared. As a rule, the patient manages to remember the first manifestations of the pathology. Most often it is pain and discomfort in the small joints of the hands and feet. Large joints are extremely rarely affected at the initial stage.
Another reason that causes the development of pathology may be non-compliance with the drinking regime, that is, drinking insufficient amounts of liquid during the day.
The accumulation of large amounts of urate leads to the third stage of pathology. They severely injure soft tissues, causing many unpleasant moments. In addition, the body begins to react painfully to the presence of foreign substances.
Instrumental studies are mandatory for all patients who seek help for joint pain. In the early stages of gout, this type of research provides little information, since almost no changes in tissue structure are observed. Despite this, these methods make it possible to exclude the development of other rheumatic pathologies.
When conducting research, various methods can be used:
The maximum effectiveness of ultrasound will be observed only at the acute stage. The onset of an acute attack is characterized by a noticeable expansion of the joint space, the formation of edema, and hardening of the soft tissues around the affected joint. All these changes become less noticeable within a week after the exacerbation. And by the end of the second week, there is a high probability that the ultrasound examination will not reveal any changes.
Carrying out this type of research for a chronic illness makes it possible to diagnose slight deformation of the joint surface and dislocation of inflammation. In addition, this method makes it possible to identify accumulations of urate in the kidneys and bladder.
A CT scan is a series of high-precision x-rays. This study helps to identify the exact location of inflammation and determine the degree of deformation of the diseased joint in the later stages of gout development. At an early stage during an exacerbation, the images will show a thickening of the soft tissues around the diseased joint.
Scintigraphy with technetium pyrophosphate is performed only in cases where the clinical picture of the disease is uncertain and it is difficult for the doctor to draw any conclusions. To carry out the research, a special substance is injected into the blood - technetium pyrophosphate. It accumulates in areas of greatest urate deposition. Thanks to this, the specialist can determine the location of the pathological process as accurately as possible.
Laboratory tests for gout can give a specialist a lot of information about the processes occurring in the body. They make it possible to monitor how uric acid is formed and excreted at different levels. Blood and urine tests are carried out several times to be able to assess changes in their composition. In addition, these tests for gout enable a specialist to distinguish it from other diseases that have similar symptoms.
In a conversation with the patient, the doctor will explain what tests he will have to undergo. First of all, this is a general blood test. At an early stage of pathology development, the composition of the blood may not change. At the time of exacerbation of inflammation, leukocytosis may appear, that is, an increased number of leukocytes in the blood. In addition, activation of the inflammatory process provokes an increase in ESR. If the patient suffers from severe kidney pathology or disturbances in the functioning of the circulatory system, then a general blood test may show other changes.
One of the most important studies is a biochemical blood test. It is this that allows you to determine the level of uric acid in the blood and hyperuricemia. It is the definition of hyperuricemia that receives increased attention, since this indicator is a risk factor for gout. Uric acid levels should be determined before starting therapy and after treatment has begun.
Biochemical analysis makes it possible to detect an increase in the level of C-reactive protein, changes in sugar levels, an increase in creatinine, organic matter formed during the metabolic processes of proteins, and urea. The level of lipids, lipoproteins and calcium is also determined.
The test checks the levels of various enzymes and substances, which allows you to find out how other internal organs are working. In addition, it makes it possible to make a more accurate diagnosis of secondary gout.
A general urine test makes it possible to detect changes only after kidney disease. Tests can help identify whether there are urate crystals in the urinary sediment. The analysis makes it possible to determine the presence of blood in the urine, identify the albumin fraction of proteins, and columnar epithelial cells. All these changes can appear after the lesion touches the epithelium of the renal pelvis.
A biochemical urine test is performed to determine the level of uric acid. The daily dose of the substance is taken for analysis. This indicator may vary depending on the causes of gout. If there are no pathological processes in the kidneys, and filtration proceeds normally, then the increase in the level of uric acid in the urine occurs in parallel with the same level in the blood.
Synovial fluid is also taken for examination. To obtain it, a puncture of the affected joint is performed. The analysis allows us to detect an increase in the content of leukocytes and uric acid salts. The diagnosis of gout can be most confirmed by detecting sodium urate in the cytoplasm.
Research is being carried out on the content of tophi - dense subcutaneous formations. When they are opened, you can find a white pasty mass or even small white crystals. This pathology is characteristic only of gout, but this feature can only be recognized in the later stages of the development of the disease.
Diagnosing gout is complicated by the presence of other rheumatic pathologies, which are accompanied by similar symptoms and manifestations. This is about:
To facilitate the diagnostic process, it is necessary to use special criteria for differential diagnosis between these pathologies.
A disease of the joints, such as gout, has been known since ancient times and was previously called the “disease of kings”, since only stately people suffered from this disease, for whom dense and fatty foods were available. Nowadays, gout is a very common disease and affects different segments of the population.
The essence of this disease is determined by the fact that a person has a disorder of protein metabolism, and therefore uric acid is retained in the body. Over time, this acid crystallizes, destroying joints and, as a result, leading to disorganization of the musculoskeletal system.
In medicine, there are two types of gout, as a result of the influence of causative factors: primary and secondary.
Primary gout in the body can appear for two reasons:
Secondary gout is not an independent disease, but a consequence of previous diseases (psoriasis, renal failure, etc.), that is, a kind of complication.
The factors that contributed to the emergence of the causes of primary gout are mainly poor diet and bad habits. So, consuming, for example, a large amount of fatty foods, the level of uric acid in a person’s body increases, which normally functioning kidneys cannot process. Bad habits reduce the performance of all human organs, including the kidneys. Therefore, even with a normal amount of urate, its accumulation and, accordingly, deposition occurs in the body.
Since gout can be not only an independent disease, but also a complication after previous illnesses, treatment for such a disease can only be prescribed after diagnosis. Comprehensive tests for gout are prescribed, since they can determine not only the signs and stage of development of the disease, but also the cause of its occurrence. These diagnostic methods include:
During its implementation, the level of seromucoid, fibrin, sialic acids, and the presence of C-reactive protein are determined. In addition, a blood test helps determine the presence of excess urine in the body. For the male half of the population, this figure should be more than 460 µM/l, and for the female half – 330 µM/l. However, a blood test does not accurately diagnose the presence of gout, and therefore other tests are recommended.
With the help of such a study, you can determine the cause of the disease using the level of uric acid, as well as the level of acidity. If the study gives a positive result, then it will be necessary to determine the daily rate of uric acid in order to prescribe adequate treatment.
In the absence of gout, this liquid is colorless and has a consistency similar to water. If the taken synovial fluid has a different color and has become viscous, then this indicates a dysfunction of the joints. An analysis of the synovial fluid will show the level of uric acid and neutrophilic leukocytes, which will help diagnose joint disease.
When performing this analysis, the specialist determines the level of neutrophils in the blood, which confirms or denies the presence of inflammatory processes in the body.
This diagnostic method is mainly carried out in the presence of gout of the legs. Using the analysis and the resulting image, you can easily determine the presence of gout: the places where uric salt is deposited in the joints will be determined by white spots in the image.
With this method, crystallized deposits of uric salt are removed. Using this method, you can accurately determine the type of disease, including gout.
In order for the analyzes to give accurate and indisputable results, you should prepare for the research. A person being tested for gout should not drink alcohol, foods containing vitamin C or caffeine, or take aspirin or diuretics.
If the patient ignores this rule, the analysis will show an increase in the concentration of uric acid in the body and, accordingly, an incorrect diagnosis will be made with inappropriate treatment. If the patient has begun self-treatment and is taking medications that lower the level of urate in the body, when tested, the level of this substance will be lower than what it actually is.
In order for the analyzes to produce valid indicators, you need to adhere to the following recommendations:
Even though chronic gout cannot be cured, proper diagnosis can reduce the pain of gout, reduce the external signs of the disease, and also increase the gaps between manifestations of the disease.
Previously, gout was considered a disease of brilliant and worthy citizens and affected mainly nobles. The disease is common. In 95 cases out of 100, men are susceptible to this disease. The first signs of damage in women are observed at the age of about 50 years, in men - earlier, up to 45 years. In rare cases at a younger age.
Caused by an increase in uric acid levels, the disease progresses with an increase in purines in the blood. Since one of the indicators - uric acid - has an elevated level not only in this case, but also in other diseases, to make a diagnosis you need a comprehensive examination and clarification of what tests you need to take for gout.
This disease is systemic. It is caused by metabolic disorders in the body. The joints are the first to suffer. This is due to an increase in uric acid in them, which is deposited in a crystalline state in the tissues.
Gout is often accompanied by complications that, without proper treatment, can be fatal. The disease affects organs and tissues, which affects overall health.
Manifestations of the disease are as follows: pain, redness and swelling near the affected joint, areas of inflammation acquire hardness of the skin, and a possible increase in temperature. The resulting growth subsequently leads to deformation and limited mobility.
Contribute to the development of the disease:
Diagnostic measures include the following examinations:
Physical examinations include an examination of the patient himself, a survey to clarify complaints, a description of the first symptoms and hereditary predisposition to the disease. In this case, the doctor analyzes the factors that can provoke the development of gout and can influence its course, cancer and concomitant diseases.
Such health problems include previous surgical operations, kidney pathologies, and long-term use of certain medications. Among the reasons contributing to the development of the disease are an unbalanced diet and bad habits. What tests need to be taken and what examinations to undergo are prescribed by the doctor individually.
If there are complaints about the joints, patients are subjected to instrumental examination methods. The earlier a patient seeks help, the more accurately the disease can be diagnosed in the early stages. This examination of your health allows you to rule out the development of other health problems, including arthritis.
Examination methods include computed tomography, ultrasound, radiography and scintigraphy. Which examination needs to be completed is determined by the doctor. Thus, ultrasound is highly effective only at the stage of an acute condition. In this case, widening of the joint gap and inflammation with compaction of adjacent soft tissues are noticeable. A week and a half after the exacerbation, this study will no longer be informative.
In the chronic form of the disease, this method can reveal deformation and determine the location of inflammation. Ultrasound also reveals accumulations of urates (specific compounds formed when there is excess uric acid) in the bladder and kidneys.
Laboratory diagnosis of gout allows the doctor to obtain an informative picture of the processes occurring in the patient’s body. This makes it possible to control the formation and excretion of uric acid at all stages. Also, blood and urine tests can eliminate the likelihood of other diseases with similar symptoms.
What tests are done for gout? First, the patient will have to undergo a general blood test. At the initial stage of the disease, there may be no changes in the composition of the blood at all. With inflammation, the composition of leukocytes increases and the ESR increases. In the presence of concomitant diseases, other deviations in the composition of the blood due to gout are possible.
A biochemical blood test for gout is an important test. Due to it, hyperuricemia and the level of uric acid are established, an increase in which is characteristic of the disease. This indicator is one of the most characteristic for diagnosis. For gout on the legs, you need to take this test not only before treatment, but also after.
A blood test for gout reveals an increase in creatinine, urea, sugar and reactive protein. At the same time, the doctor analyzes the indicators for calcium, lipoproteins, enzymes and lipids. This allows you to get a fairly complete picture of the characteristics of the body, including the secondary form.
A biochemical urine test for gout is done to determine the level of uric acid. The indicator may vary depending on the causes that led to the disease. With normal kidney function, changes in the blood level of uric acid will correspond to the level in the urine.
Based on the results of biochemistry, the efficiency of the kidneys is determined. As a result of the analysis, indicators of color, density, etc. are also examined.
This research method is actively used in making a diagnosis. The joints of the hands and feet are examined. An X-ray examination of a big toe lesion gives the doctor a picture of the condition of the bones and cartilage. Tophi on the hands will be noticeable if the disease is chronic.
Computed tomography allows you to conduct a high-quality study using a series of precise X-ray images. At the same time, the degree of joint deformation and the localization of the inflammation zone are determined with high accuracy. Even at the initial stage of the disease, tissue compactions near the joint will be visible. An X-ray examination is necessary to determine the diagnosis and exclude the possibility of developing other diseases that can also affect the joints.
To clarify the diagnosis in the early stages, the patient may be prescribed scintigraphy. Such a study helps in establishing a diagnosis when the picture of the disease is blurred. The procedure consists of introducing a special substance into the blood - technetium pyrophosphate, which has the ability to concentrate in places where urate is deposited.
Joint puncture with collection of synovial fluid allows you to determine the level of uric acid salts and leukocytes. If sodium urate is detected in the cytoplasm, then gouty pathology is confirmed.
When studying dense formations under the skin, pasty contents or crystalline substances are detected, which makes it possible to prescribe these tests to patients if a disease is suspected. The puncture is performed without anesthesia, which may affect the reliability of the study of the contents of the joint.
Synovial fluid is comprehensively examined according to many parameters. Among other things, attention is drawn to the entry of phagocytes, indicating inflammation. In this case, the level of lymphocytes is reduced, and the level of neutrophils is increased.
Diagnosis of the disease, including urine, blood and other tests, can be difficult due to the presence of other diseases that have similar symptoms. An accurate diagnosis can only be made by a doctor after a comprehensive examination.
Gout may not manifest itself for a long time. Although even one of the symptoms characteristic of the disease should alert a person and, at a minimum, prompt him to visit a doctor for additional examination. What tests are taken in this case, and what should be done to properly prepare for them?
Degree of development of bursitis
The increased content of uric acid and the inability of the kidneys to completely remove it from the body lead to the accumulation of salts (urates) on the joints. As a result of this, tophi (nodes) are formed, which become inflamed and can lead to complete loss of limb mobility. A similar disease is called gout and manifests itself in the form of:
In this case, the growth can be quite large and lead to joint deformation and immobility of the leg. The cause of the disease is the following factors:
Nutrition plays a very important role in the development of gout.
With the help of differential diagnosis of gout, you can accurately determine the problem and not confuse it with similar diseases. In this case, the doctor diagnoses the degree of neglect of the inflammatory process. There are 7 stages of gout development:
To accurately determine the disease, you need to donate blood for examination. There are certain tests for gout that a patient must undergo. Typically the patient is prescribed the following:
A biochemical urine test will help determine the level of uric acid in the body. Based on the results of this study, it is determined how correctly the patient’s kidneys are functioning. An equally important examination is the analysis of synovial fluid and puncture of tophi (nodes). This research method is prescribed in rare cases. During this procedure, a puncture of the joints is taken. If there is no microbial flora in the liquid and crystals of monosodium urates are present, then the person is sick. When tophi are punctured, uric acid salts are determined.
It is necessary to donate blood and urine correctly so that the readings are not distorted. Ultrasound and radiography should be performed after all other studies. If the procedure is carried out earlier, gout will be incorrectly diagnosed, because the blood tests will be completely distorted. Some substances can affect high levels, and therefore should be completely abandoned before the examination. These include alcohol, aspirin, vitamin C, diuretics, and caffeine. It is important to follow the recommendations of doctors in order to get true results:
What tests are done for gout?
Gout develops after excessive accumulation of uric acid. This process occurs during changes occurring in purine metabolism. When kidney activity is impaired, an imbalance in metabolism begins. This causes the accumulation of sodium salts in the blood. Their increased level leads to crystallization. The resulting crystals cause damage to organs and tissues. Gout is accompanied by kidney and urinary tract disease and arthritis. Tests for gout will help find out the exact picture of what is happening.
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Tests for gout are prescribed by a hepatologist, nephrologist, internist, rheumatologist, oncologist and gynecologist. You can see the accumulation of crystals during an ultrasound examination of the genitourinary system. To confirm the diagnosis, you need to take a urine test for gout, synovial fluid and blood.
With a long course of the disease, they cause inflammatory processes in the periarticular bursae and tendons, accompanied by pain. A tophi puncture biopsy is needed to confirm the diagnosis.
The blood test may be distorted if the biomaterial for research was taken after examinations such as radiography or ultrasound examinations. There are a number of substances that can show better results than what is actually available.
These include:
Special-purpose drugs lower its level.
In order for the results to show the true state of the body, generally accepted requirements must be observed.
Tests will help you make a correct diagnosis and begin treatment. The disease cannot be completely cured, but a correct lifestyle and following the doctor’s instructions can increase periods of remission.
It is not difficult to completely restore JOINTS! The most important thing is to rub this into the sore spot 2-3 times a day.
Currently, medicine has everything necessary to diagnose gout. The diagnosis is made taking into account the patient’s complaints, medical and life history, visual examination data, laboratory diagnostics and other research methods.
Typically, the patient complains of sudden, acute pain in the joint, most often in the first metatarsophalangeal. As a rule, severe pain occurs at night, after a heavy feast and drinking alcohol. The joint turns red, swells, and becomes hot to the touch. The first attack is stopped relatively quickly. But over time, the effectiveness of anti-inflammatory drugs decreases, interictal periods shorten, and other joints are involved in the process.
Seeing such a clinical picture, one may suspect that a person is having an attack of gout; further diagnostics will confirm or rule out the diagnosis.
In a general blood test during an attack, an increase in the number of neutrophils with a shift to the left and an acceleration of ESR will be observed. Protein and oxalates may be present in the urine. A biochemical blood test will reveal an increase in the content of uric acid, seromucoid, sialic acids and some other indicators. Needle-shaped crystals of uric acid salts are found in the synovial fluid.
Gout is characterized by a special X-ray picture: the formation of tophi in the tissues, destruction of cartilage, and the occurrence of marginal bone erosions. With gouty nephropathy, chronic renal failure can be detected. The drug colchicine can be used not only for treatment, but also for diagnosing gout. The rapid effect of taking it in acute arthritis indicates the presence of this disease, because the drug is very specific.
In 1961, the “Roman criteria” were adopted for diagnosis:
The diagnosis of gout is made if the diagnosis reveals two or more of the above points.
The American Rheumatology Association has proposed 12 diagnostic criteria:
The diagnosis is reliable in the presence of six of the twelve signs, and/or in the presence of urate crystals in the synovial fluid and/or in tophi.
Everyone knows that disease is easier to prevent than to treat. Gout can be called a disease of eating behavior, so its prevention should first of all change a person’s lifestyle and taste habits. First of all, it is necessary to limit the consumption of foods rich in protein (meat, fish, meat and fish broths, legumes, sorrel, cauliflower, etc.). You should also normalize your body weight. This will help improve metabolism in general, and protein metabolism in particular, and will also significantly reduce the load on the joints of the legs during an attack of the disease. Rapid weight loss can cause an increase in uric acid in the blood and trigger a gout crisis. Therefore, weight loss should occur gradually. Alcohol inhibits the removal of uric acid from the body, thus increasing its content in the blood. It should be completely eliminated from use.
Preventive measures also include the following factors:
Prevention of gout should be aimed not only at the patient himself, but also at close relatives, because it is quite difficult to change your own lifestyle if everything in the family remains the same.
The psychological status of the patient is of great importance. As a rule, people prone to gout have a cheerful, friendly and sociable character, high sexual activity, and hard work to the point of workaholism. An attack of gout puts a person to bed, and he suffers not only from pain, but also from forced inactivity, trying by any means to restore his working capacity as quickly as possible. He does not have time to change his lifestyle towards healthy eating and eliminating bad habits. Therefore, for gout, psychological methods of influence are used not only as prevention, but also as treatment. The patient's motivation for a healthy lifestyle comes to the fore.
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Treatment for acute gouty arthritis and chronic gout is different.
For gouty arthritis, anti-inflammatory drugs are mainly used.
If attacks of gouty arthritis occur 2 times a year or more often, the doctor may decide to prescribe medications that reduce the level of uric acid in the blood for an indefinite period. Correctly selected treatment of the disease leads to a decrease in the frequency of attacks of arthritis and resorption of tophi. In addition, urolithiasis does not progress during treatment.
Like many centuries ago, gout more often chooses its victims among people with a high standard of living. Here is a portrait of a typical “gout”: an active, pleasure-loving middle-aged man with good income, often holding a leadership position, very temperamental (usually choleric). Women get gout about 10 times less often.
“The disease of kings”, gout refers to metabolic diseases, its causes are a violation of the metabolism of purine bases: guanine and adenine - compounds that are part of the DNA and RNA of all living organisms, an increase in uric acid in the blood due to these disorders and a predisposition to crystal formation.
Uric acid is a white powder that is poorly soluble in water. An increase in the concentration of uric acid in the blood leads to its deposition in tissues in the form of a salt - monosodium urate. The process of deposition of monourate crystals in tissues, including joints, causes an acute attack of the disease.
Causes of gout can also include:
An attack can be triggered by visiting a sauna, traveling to hot countries (due to dehydration), joint injury, or hypothermia.
Poor lifestyle as a cause of gout includes:
One can even say that, despite hereditary factors and individual characteristics of the body, gout is a disease of an incorrect lifestyle, the causes of which lie in the consciousness of a person, in his attitude both to himself and to the world around him. Therefore, an important component of the treatment of this disease is precisely changing a person’s habits and worldviews.
One of the ancient and most effective methods of treating gout is diet. Galen also recommended that people suffering from this disease eat moderation and limit alcohol intake. Of course, it is unlikely that it will be possible to normalize protein metabolism with the help of a diet alone, but even without following nutritional recommendations it is difficult to count on the success of treatment.
It should be remembered that when cooking meat and fish, half of the purine bases they contain goes into the broth. Therefore, meat and fish broths, jellied meat, and sauces must be excluded from the diet.
Excessive intake of proteins into the body leads to an increase in uric acid in the blood, the end product of their breakdown, which is an important link in the pathogenesis of this disease. Therefore, first of all, the menu for gout involves limiting protein foods. The protein content should not exceed 1 g per 1 kg of the patient’s body weight. The permissible amount of table salt is no more than 5-6 g per day. This means that you need to cook food without salt, and you can add a little salt while eating. The recommended amount of fluid is about 2-2.5 liters per day (if there are no contraindications from the heart or kidneys). Foods for gout should contain a large amount of vitamins.
Fresh white cabbage and sauerkraut have proven themselves well. All kinds of salads, first and second courses are prepared from cabbage. Fresh leaves can be applied to swollen joints on the legs and arms in the form of compresses, which helps reduce pain and inflammation. It is difficult for a person accustomed to eating large amounts of meat to change his habits. Therefore, recipes for gout can be varied with soy products. “Steaks” and “entrecotes” made from soy can to some extent satisfy the physiological craving for meat and at the same time replenish the body’s protein reserves.
For the treatment of gout, M.I. Pevzner proposed diet No. 6. Its chemical composition is as follows:
Dishes for gout are steamed, or the products are used boiled.
If the patient is obese, it is recommended to carry out so-called fasting days once a week. Normalization of body weight is one of the main goals of diet therapy for this disease. The menu for such a fasting day may consist of:
There can be many recipes. The main thing is that the diet for one day does not contain prohibited foods, but consists of 1-2 permitted ones.
Diet for gout during an attack should be even more strict. Excessive intake of fatty and meaty foods flavored with alcohol can lead to a gouty crisis. During the period of pronounced manifestations of the disease, the main principle of the diet becomes maximum unloading - a fasting day. On such a day, the patient should receive a sufficient amount of fluid (mineral water, vegetable and fruit juices, especially lemon juice with water). You cannot eat anything during the day, and the next day you are prescribed a regular anti-gout diet high in vitamins (mainly dishes from vegetables and fruits).
Sometimes a gout attack occurs when it is not possible to immediately see a doctor. You can try treatment with folk remedies, of which there are many.
Gout can be successfully treated with bee products. A good effect is achieved by introducing bee venom into acupuncture points, as well as into points corresponding to the bladder meridian along the spine on the side of the affected joint.
Traditional recipes for the treatment of gout are aimed at ridding the body of excess uric acid, reducing inflammation in the affected joint and normalizing metabolism.
To reduce the concentration of uric acid in the blood, various herbs are used in the form of decoctions, infusions and juices:
Eggplants can be used for the same purpose.
Herbal treatments are also used to relieve inflammation in the joints.
There is a known method of treatment with bees. A glass of dead bees (dead dried insects) is infused in a liter of vodka in a dark place for two weeks. Strain and rub the sore spots.
Honey is widely used to treat the disease.
Treatment with honey is usually carried out for one to two months.
Gout subsides with combined treatment of bee products with medicinal herbs.
Iodine has long been used to treat gout. Take a bottle with 10 ml of iodine and add 5 aspirin tablets to it. The resulting solution, which becomes colorless, is applied to the affected areas before going to bed and put on warm socks or gloves at night.
You can try to treat gout at home using foot baths with iodine. To do this, add 3 teaspoons of baking soda and 9 drops of iodine to three liters of water. Baths are taken before bedtime for one and a half to two weeks.
Gout has been known since ancient times, so traditional medicine has accumulated a lot of ways to combat this scourge. Traditional recipes for gout include treatment with cereal straw and activated carbon, iodized salt and lard, onion soup and propolis. They say that gout can be cured in two weeks by making fresh fish compresses at night. Also, sore joints can be treated with the following ointment: butter heated to foam is poured with alcohol in a 1:1 ratio. The alcohol is set on fire, and when it burns out, the ointment is ready.
Since ancient times, gout and rheumatism have been treated at home with apple cider vinegar, which is taken in the morning mixed with honey and boiled water. Lemons and garlic minced through a meat grinder are also mixed. The mixture is poured with boiled water for a day and a quarter glass is taken every morning.
One of the folk methods is to treat gout using millet, ground into flour, brewer's yeast and table salt. The mixture of these products is spread on a cloth and compresses are made on the legs, changing the dough after two hours. In this case, be sure to stay warm.
Treatment of gout with traditional methods does not replace the means of official medicine, diet, or lifestyle changes. Only complex treatment can give positive results.
Being a metabolic disease, gout can be very insidious and lead to serious complications. The most dangerous of these is kidney damage. Unfortunately, sometimes it is gouty glomerulosclerosis and the presence of urate kidney stones that make it possible to diagnose royal disease. The severity of kidney damage determines the prognosis. In 20% of cases, renal failure that develops as a result of the disease leads to death. Arterial hypertension of nephrogenic origin occurs in 40% of patients. Urolithiasis with the formation of X-ray negative urates in the kidneys occurs in approximately 20% of cases.
Complications of gout are also manifested by gradually developing osteoporosis, the appearance of tophi in various tissues. Tophi are local accumulations of monosodium urate. Most often they occur in the skin of the fingers, in the area of the feet, knee and elbow joints, on the wings of the nose and ears, as well as in internal organs: kidneys, on heart valves, in the walls of blood vessels, in the pericardium.
If the first attacks of gout pass quickly and easily, then in the future, in the absence of adequate treatment, it becomes increasingly difficult to cope with them. One of the main points of treatment is to reduce the level of uric acid in the blood. If this is not achieved, the joints will become increasingly deformed due to urate deposition, over time other joints will become involved, the tophi form of gout will form, and the arthritis will become chronic. It must be remembered that tophi occur not only in joints, but also in other tissues, which can lead to dysfunction of various organs and their systems. Therefore, you should not wait for the consequences of gout; it is necessary to be treated not only correctly, but also on time.
Read also about the symptoms of gout.
Being a chronic disease, gout is characterized by periods of exacerbation and remission, so symptoms will depend on its phase.
An attack of the disease is accompanied by the following symptoms:
The pain syndrome associated with this disease is extremely intense. There is even a proverb that if you squeeze a joint as much as possible in a vice, you will get rheumatism, and if you then turn the screw one more time, you will get gout. As a rule, a person calmly goes to bed after a pleasant evening at the festive table, and in the middle of the night he is woken up by pronounced pain in his big toe. The pain of gout is so intense that it has been compared to a dog digging its fangs into a finger. The so-called “sheet symptom” is characterized by severe pain, when it is impossible to tolerate even a light touch of the bed linen.
A symptom specific to royal disease is local accumulations of uric acid salts called tophi (gouty nodes), which were first described by Galen. These nodes are yellowish, painless formations ranging in size from 2-3 millimeters to 1-2 cm. They are localized mainly in the subcutaneous tissue above the joints of the feet and hands, elbow joints, in the area of the ears, Achilles tendons, on the extensor surface of the thighs, legs, forearms, forehead and other places. Typically, tophi are formed when the disease lasts more than five years and when there is a high level of uric acid in the blood. During attacks, the contents of the nodes can become liquid and be released through the resulting fistulas. By itself, in the remission phase, such a nodule does not hurt, but over time, nearby tissues, periarticular bursae, and tendons are involved in the inflammatory process, which may be accompanied by the appearance of pain.
Laboratory diagnostics reveal an increase in the blood levels of uric acid, sialic acids, seromucoid, and C-reactive protein may be positive. In the general blood test at the time of the attack, an acceleration of ESR and neutrophilic leukocytosis with a shift to the left are noted. Salts of uric and oxalic acid can be detected in urine. In the synovial fluid there are leukocytes and urate crystals in the absence of infectious agents.
With a long course of gout, x-rays reveal a characteristic picture: cystic clearing in the bones, signs of osteoporosis, narrowing of joint spaces, marginal growths - osteophytes.
In addition, it should be noted that gout most often affects men who are active, cheerful and cheerful in nature. This is due to the fact that uric acid has an effect on the body similar to caffeine and theobromine, i.e. stimulates vital activity. Often the illness of kings is accompanied by excess weight, which can be explained by the tendency of such people to gourmet, love of noisy feasts, impaired metabolism and a generally unhealthy lifestyle.
During a conversation with the patient, the specialist has the opportunity to find out whether his family members have had cases of gout. It is heredity that plays an important role in the pathogenesis of this disease. In addition, identifying these factors greatly simplifies diagnosis.
The conversation also touches on the topic of illnesses suffered by the patient in the past. Of great importance are:
In a conversation with a specialist, questions will be raised regarding the patient’s lifestyle, diet, and tendency to bad habits.
For example, the presence of a large amount of meat products in the diet, drinking alcoholic beverages, smoking, and excessive physical activity give every reason to assume the development of gout.
The clinical picture is a combination of all the symptoms of the disease and changes in the patient’s condition over time. For an experienced specialist who constantly monitors the patient, an accurate diagnosis of gout is possible even without the results of clinical studies.
When assessing changes in the patient’s condition, the doctor is guided by the stage of development of gout. Thanks to regular medical examinations, three main stages in the development of pathology can be distinguished:
At the initial stage of the disease, the patient may not experience any discomfort for a long time. But it is precisely this that, over time, provokes the development of the second stage. In rare cases, gout can occur without changes in uric acid levels.
The second stage of the disease may manifest as the first symptoms, which will force a person to see a doctor. This stage is characterized by the penetration of urates into the soft tissues - small crystals of sodium and potassium salts of uric acid.
The development of the disease over a long period of time has a negative impact on the kidneys.
The choice of diagnostic method should be made by a specialist. With pronounced symptoms and typical manifestations of the disease, an instrumental method for diagnosing gout may not be necessary.
X-rays are prescribed in the early stages of pathology to exclude the presence of other ailments that cause inflammation of the joints. With gout, no significant transformations are observed. Only photographs taken during the chronic form of the disease make it possible to determine the diagnosis.
This method makes it possible to diagnose gout even at the earliest stages of its development, when there are no obvious foci of inflammation.
These studies can identify the accumulation of urate in other places:
Diagnosis of the disease is carried out by a specialist and includes laboratory tests in the form of a blood test, biochemical determination of indicators inherent in gout in the legs, studying the amount of uric acid, microscopy of synovial fluid.
Diagnosis of gout allows you to determine the level of urate salts in the renal pelvis, the amount of protein, casts, and red blood cells in a urine test. A general clinical blood test is prescribed by a doctor during an acute attack of the disease, and biochemical indicators indicate the presence of fibrin, stem acids, haptoglobin, and urea in the patient’s blood serum.
Patients donate not only urine and blood, but also undergo an X-ray examination to determine the pathology of gouty arthritis. X-ray signs indicate the age of the inflammatory process.
Synovial fluid is taken from the joint capsule to determine sodium urate crystals. To make a diagnosis, the doctor determines the composition of the contents of the tophi.
To take the tests, you need to do a little preliminary preparation. You should not engage in intense training or heavy physical work on the eve of the study; smoking and drinking alcohol are prohibited.
The patient will have to temporarily stop taking medications. For blood biochemistry, 5-10 ml of fluid from the cubital vein is donated. Tests are taken in the morning; on the eve of the test, stressful situations must be avoided.
The results are interpreted by a doctor. The urea rate is up to 8.7 mmol/l. Gout is characterized by an increase in its level, which indicates impaired renal function, followed by the development of renal failure. Creatinine normally reaches a value of 115 mmol/l. Its low level is characteristic of kidney pathology and is a specific indicator of the disease.
Uric acids appear in large quantities during the development of urate stones in the kidneys. Gout is accompanied by additional pathology of many organs, therefore a biochemical blood test establishes:
Uric acid causes serious changes in metabolism, causing the development of gout. An acute attack of the disease is accompanied by a change in the number of neutrophils, which are an indicator of the development of a chronic inflammatory process. Normally, their number in the general analysis is 45-70% of all leukocytes, and during an acute attack, activation of neutrophils is observed.
The leukocyte formula shifts to the left, but its change depends on the age characteristics of the patient. When the formula shifts to the left during an acute attack, the number of mature neutrophils increases and young myelocytes appear. Neutrophils are closely related to the increase in the total number of leukocytes in the patient’s blood.
In the case of an acute process, the number of lymphocytes in the blood decreases. Lymphocytes form the immune status of the patient, regulate and coordinate the work of the entire immune complex, releasing special protein regulators - cytokines.
With the concomitant development of rheumatoid arthritis, the patient's number of monocytes in the blood increases.
The study of the biological fluid of the patient’s body is a highly informative process and is mandatory for a patient suffering from gout. The analysis helps to adjust the prescribed treatment and determine:
The presence of chemical indicators is taken into account:
Normally, the color of urine is straw-yellow, the specific gravity is 1010-1022 g/l. In the event of renal failure, the relative density of urine decreases to less than 1010 g/l.
The reaction of urine is studied: the normal pH is 5.5-7.0. An increase in the alkaline reaction to pH>7 is observed with kidney disease in the late stages of gout development.
Normally, there are no nitrites in the urine; their formation occurs as a result of exposure to bacteria, when urine stagnates in the detrusor. An increase in nitrates is characteristic of asymptomatic gout.
The norm of leukocytes in urine analysis is 0-3 in the field of view, and an increase in their number is associated with the development of the inflammatory process and the formation of stones in the ureter. Uric acid and urates are present in acidic urine and accompany the development of the acute phase of gout.
The procedure is widely used to diagnose the disease. The examination includes fluoroscopy of the joints of the hands and feet. In modern medicine, diagnosing the disease using x-rays allows us to determine the condition of tophi and destroyed areas of damaged bones.
Diagnosis of gout on the big toe using x-rays reveals damage to the cartilage and bone tissue. In the image, the doctor can see tophi on the hands that form in the chronic phase of the disease.
If the patient is prescribed CT and MRI, the feasibility of conducting advanced methods of examining tophi should be discussed with the doctor.
During the study, the presence of defects in several layers of bones and an increase in the shadow of the joint are observed. In the photograph, the defect in the bone on which the affected joint rests is 5 mm in diameter.
Synovial fluid in its chemical composition resembles blood plasma, but contains a special substance - hyaluronic acid. Normally, the composition of biological fluid includes cells such as:
The cholesterol content in the liquid is 3.8±0.4 mmol/l.
The diagnosis of gout is confirmed by studying changes in the synovial structure. The method is quite informative and accessible for laboratory use. The study is carried out by performing a puncture of the joint cavity. Anesthesia is not used during the intervention, since novocaine negatively affects the chromatin contained in the cell nucleus.
A further study of the liquid is carried out under a microscope and, on the recommendation of a doctor, a bacteriological and bacterioscopic analysis of the contents of the joint capsule is prescribed. Set parameters:
Synovial fluid may be cloudy and yellow-green in color. With reduced viscosity, it flows in a stream from the tip of the needle. The normal pH of the liquid is 7.3-7.6.
Red blood cells, destroyed cells, neutrophils, and leukocytes are found in the contents of the effusion. The presence of phagocytes indicates activation of the inflammatory process in gout.
To determine the degree of inflammation, a synoviocytogram is performed.
The process occurs with an increased number of neutrophils to 50-93%, a decrease in the content of lymphocytes to 0-8%. In the chronic course of the disease, the cytogram remains within normal limits. Crystals of sodium urate and calcium phosphate located inside the cells are installed.
Effective methods for studying the biological environments of the patient’s body are an informative document for diagnosing gout.
Types of gout
In addition to blood, the patient’s urine is also examined. A general urine test is performed to determine gouty nephropathy. If the urine is brown or rusty in color, this means that it contains a large amount of salts (urates). If the diagnosis is not carried out in a timely manner, complications are possible in the form of the development of secondary pyelonephritis with an increased content of leukocytes, mucus and salts. With the development of urolithiasis, red blood cells and a high level of protein are recorded in the biological material.