Many people are interested in what gout is and what it looks like? If you eat a lot of delicious food mixed with a fair amount of alcohol, while leading a sedentary lifestyle, then sooner or later there is a chance to find out what gout looks like.
The disease gout has been known to science for a long time. In the Middle Ages there were many rich people who could afford to eat a lot of meat, fatty foods along with alcohol. Symptoms and signs of gout have plagued such famous people as Henry VIII, Michelangelo and Charles V.
With such a pathological condition as gout (photo 1), there is a metabolic disorder. People suffering from this disease have an increased amount of uric acid in the body. The remaining uric acid turns into crystals, which are subsequently deposited in tendons, joints and cartilage. Leukocytes try to fight these crystals, but they fail, and then these white blood cells die. In this place, severe inflammation occurs, provoking an attack of gout.
There are people who are predisposed to developing gout. The disease can be triggered by excess weight, excessive consumption of protein foods and alcoholic beverages.
The onset of the disease is characterized by an increased level of uric acid, while the symptoms and signs of gout (photo 2). This stage can last for one to two years, after which the patient may experience an attack of gout. Most often this occurs at night after prolonged consumption of alcoholic beverages and protein foods.
The first signs of gout can be considered pain that is localized in the joints. Most often, gout develops on the legs (photo below). In almost half of all patients, gout occurs on the big toe.
Subsequently, the symptoms of gout in the form of acute pain reappear. This is due to the fact that uric acid settles in the joints, as well as ligaments and tendons, which leads to the appearance of nodules. They are called tophi for gout (see photo 3). Uric acid can accumulate in the kidneys, leading to the formation of stones and acute paroxysmal colic. Then renal filtration may be impaired, and subsequently - complete organ failure.
The disease gout has two forms: primary - hereditary, it is also called idiopathic gout ; and secondary, which occurs as a result of some ailments and disorders in the body (leukemia).
If no treatment is prescribed in the first stage, which passes without symptoms, then the disease begins to progress, that is, the second stage begins, the beginning of which is considered the first acute attack. In this case, the patient first learns what gout looks like.
Precious time has been lost, now the patient is prescribed appropriate treatment and diet. If attacks appear six months to a year, then they speak of a chronic course of gout . The disease is characterized by slow development; attacks are replaced by completely calm, painless periods. If the last stage of the disease occurs, degenerative changes occur in the joints and tendons. How gout manifests itself, see the article on what gout looks like on our website.
Treatment of gout is aimed at reducing the total level of uric acid in the body. Gout should be treated with medications and a diet. Treatment for gout is very long and requires patience.
In case of an acute attack of gout, it is recommended to take non-steroidal anti-inflammatory drugs, such as Voltaren, Butadione, Methindol, Indomethacin. Corticosteroids and painkillers are also effective.
To treat gout at home in the interictal period, medications are prescribed that lead to a decrease in uric acid. These drugs include Hepatocatalase, Milurit, orotic acid, Thiopurinol.
Also, in the treatment of gout, medications that increase urate excretion and uricodepressor drugs are prescribed. Benzbromarone derivatives have this effect. Uricosuric agents are also effective: Benemide, Etamid, Anturan and Ketazone.
An important component of treating gout at home is a healthy lifestyle. It is important to move a lot, play sports, and drink enough fluids (two to two and a half liters).
During treatment, a special diet for gout , allowing from 500-3000 mg of uric acid per week (depending on the severity of the disease). This condition must be observed even when there are no signs of gout. Preference is given to vegetables, fruits, yogurt, and cottage cheese. Avoid alcohol, but on special occasions a small amount of alcohol is allowed – wine is recommended.
If you lead a healthy lifestyle and follow all the doctor’s recommendations, the prognosis of the disease is favorable. If you ignore the instructions of specialists or if complications arise within several years, a person may become disabled.
Gout affects approximately three people in a thousand, with men making up the vast majority. The disease usually appears after 40 years in men and after menopause in women. Gout affects any joints of the legs and arms . Most often, gout affects the joints of the toes.
Risk factors also include arterial hypertension, diabetes mellitus, hereditary predisposition, and malnutrition. As a rule, a gout attack develops against the background of drinking alcohol (especially beer) or overeating. A rheumatologist treats gout.
The first classic description of gouty arthritis, “Treatise on Gout,” belongs to the largest English clinician of the 17th century, Th. Sydenham, who compared the pain of gout to the pain “from pinching a limb with a press.” Later, Yarrod (1883), using a thread dipped into the blood of a gout patient, discovered the fact of an increase in the level of uric acid in the blood.
In 1899, urate crystals were discovered in the joint fluid during an attack of gouty arthritis, but it was not until 1961 that MacCarty and Hollander established the role of urate crystals in the development of gouty inflammation.
Gout on the feet (gouty arthritis) is a chronic inflammatory disease of the joints of the big toes, which develops due to the retention of uric acid in the blood, leading to the deposition of uric acid salts on the joint . Gout of the legs occurs primarily in men over 40 years of age, with increased body weight and metabolic disorders.
The most common method of treating gout on the legs is medication , in which the patient is prescribed anti-inflammatory drugs. For acute attacks, the doctor may inject into the joint.
If gout of the legs affects several joints at once, the attending physician prescribes non-steroidal antibiotics for a course of treatment of 7-10 days. Since gout is caused by the deposition of uric acid salts, your doctor may prescribe medications that lower the level of uric acid in the blood.
In addition, when treating gout on the legs, physiotherapy is used, in which the diseased joint is subjected to electrophoresis or electromagnetic influence. In severe forms of the disease, the growths of the affected joint are surgically removed . Treatment of gout on the legs is accompanied by work with the patient, which is aimed at reducing body weight and restoring normal metabolism.
The disease is manifested by sudden and intense pain , redness and “heat” in the joint. Gout attacks usually occur at night. Acute pain in the affected joint can be caused even by the weight of the sheet.
A recurrent attack of gout is usually preceded by a tingling sensation in the affected joint. If gout is not treated, attacks become more frequent and periods of exacerbation last longer. Arthritis takes root in more and more joints, often affecting the kidneys and urinary tract.
It is customary to count the onset of gout from the first attack of arthritis, which marks the beginning of intermittent gout. It is characterized by alternating acute attacks and remissions; During the latter, the person feels completely healthy. Several years may pass between the first and repeated attacks, but more often they recur 1-2 times a year . As the disease progresses, the “light intervals” between attacks become shorter.
In typical cases (50–65%), the first metatarsophalangeal joint is affected with the development of acute monoarthritis. The characteristic localization of gout may be due to the fact that it is in these joints that degenerative-dystrophic changes in cartilage occur earlier and most often, which predisposes to urate deposition.
In 15–20%, gout debuts with damage to other joints of the legs: II–IV metatarsophalangeal, ankle, knee and, as an exception, joints of the hands (hence the name of the disease, which in Greek means “foot trap” - podos - foot, leg; argo – trap). In 5% of cases, a polyarticular onset of the disease is observed.
Gouty arthritis is based on the periodic “loss” of crystals of uric acid salts from the tissues of the joint into its cavity. Any joint can be affected, but the most common are the joints of the lower extremities, especially the feet, and the ankle.
During the first attack of gout, inflammation of the joint of the big toe is observed in half of the cases. A gout attack usually begins at night. Provoking factors may be:
Rapidly increasing pain, swelling of the joint and surrounding tissues occur, and redness of the skin over the joint often appears. Body temperature may rise. Acute arthritis due to gout usually goes away (even without treatment) in a few days, and with significant severity - in a few weeks.
A second attack of gout develops in most patients 6-24 months after the first, but in some patients this period of time is much longer (sometimes reaching 10-20 years). Over time, the frequency of acute gout attacks increases in the absence of treatment.
Gouty tophi are painless nodular formations ranging in size from a few millimeters to 1-2 cm, located mainly under the skin near the elbow joints, auricular cartilage, and Achilles tendons.
Tophi are painless, although inflammation may gradually occur in the adjacent periarticular bursae (bursitis) or tendons (tenosynovitis), which causes pain. Sometimes tophi open outward, releasing white contents with a consistency reminiscent of cottage cheese. Tophi can also be located in internal organs (for example, heart valves).
Descriptions of gout symptoms
The diagnosis of gout is based on the presence of two of the following criteria:
In addition to studying the level of uric acid in the blood, it is necessary to determine its daily excretion in the urine, examine the condition of the kidneys (general urine test, level of creatinine and urea in the blood, Rehberg test, and preferably an ultrasound examination of the kidneys and urinary tract).
Treatment of gout consists of the following areas:
The first step in treating gout is pain relief. Patients suffering from gout should know a list of measures that can reduce pain during an exacerbation:
The following drugs are used:
When seeking medical help and persistent pain, intra-articular administration of steroid drugs and intravenous injection of Colchicine are possible.
Colchicine is very effective for emergency use. An alkaloid of plant origin prevents the crystallization of urates; it must be administered within the first 12 hours after the onset of a gout attack.
Reducing the content of uric acid compounds in the body is considered the main, most important direction in the treatment of gout. It is advisable to carry it out for recurrent gout with frequent (more than once a year) repeated attacks of arthritis.
Therapy is carried out continuously (for life), only then can it lead not only to a halt in the development of the disease, but also to its regression, and in some cases, to the practical recovery of the patient.
Reducing the content of uric acid compounds is achieved in the following ways:
Agents that block the synthesis (formation) of uric acid:
They are prescribed to all patients with gout.
Drugs that accelerate the excretion of metabolites and uric acid itself through the kidneys:
They are used with caution when gout is combined with urolithiasis.
Medicines that dissolve uric acid:
Physiotherapeutic procedures help to finally stop inflammation in the joints due to gout. They are prescribed exclusively after drug reduction of arthritis symptoms.
What methods are used:
The last resort in treatment is surgery to remove tophi. They rarely resort to it, only in cases when:
As we have already written, various forms of gout are the result of accumulation of acidic waste in the joints. They destroy cartilage and cause joint inflammation. Unfortunately, the joints are a place from which the blood removes waste with great difficulty.
There are still no effective drugs for treating this disease, so it is treated with painkillers, anti-inflammatory drugs, which most often being acidic themselves, can deplete the joint. This is only a temporary, unfortunately not very effective treatment for the disease. By recognizing the fact that the main cause of these diseases is the high level of acidic waste in the body, and the accumulation of salts in the joints is the answer to this, methods of treating such diseases can be more easily identified. This is the alkalization of the body and thereby the removal of acidic waste.
Therefore, we recommend that people suffering from this disease drink alkaline water (“Water of Life”), as it is one of the best ways to treat gout. “Water of Life” (ph 7-14) - has antioxidant, immunostimulating, detoxifying properties, normalizes metabolic processes, stimulates tissue regeneration (increases DNA synthesis and stimulates cell growth and division by increasing the mass transfer of ions and molecules through membranes), improves trophic processes and blood circulation in tissues.
This water is used in Austria, the USA, Germany, India, Israel, and this water is also used by the health care system of countries such as Japan! In this country, after ten years of research, already in 1996 the Ministry of Health approved a water activator (devices for obtaining “Living” and “Dead” water) as a medical device for improving health. These devices are now used all over the world.
In Russia it is also possible to purchase these devices. The clear leader is the Iva-1 device. This activator makes 2 types of water: alkaline and acidic water, and the latest modification Iva-2silver also makes silver water. We advise you to purchase this device.
Instructions for the use of drugs for gout
Gout is a metabolic disease in which uric acid salts (known as urate) are deposited in the joints. Gout, otherwise known as the “disease of kings”, is an ancient disease that was known back in the time of Hippocrates. Now gout is considered a rare disease, affecting 3 people out of 1000. And most often it affects men over the age of 40; in women it most often appears after menopause. Gout itself is one of the types of joint diseases, the cause of which is salt deposition.
Gout affects all joints, from the joints of the fingers to the joints of the toes.
It was known back in the time of Hippocrates and is called the “disease of kings” due to the fact that the main source of its occurrence is excess in food and alcoholic beverages. Gout is often chronic.
Gout is caused by elevated and persistent levels of uric acid in the blood. During the course of the disease, urate crystals (a derivative of uric acid) are deposited in joints, organs and other body systems. Sodium urate crystallizes and is deposited in small particles in the joints, which ultimately leads to partial or complete destruction of the joint. For the same reason, such situations are called microcrystalline.
There can be a large amount of uric acid in the body for two reasons: the first reason is when healthy kidneys are unable to remove unusually large amounts of uric acid, the second reason is when uric acid is released in normal quantities, but the kidneys are unable to remove it.
Every year there are more and more people suffering from gout. Doctors explain this phenomenon by the fact that in recent years people have increasingly consumed foods rich in purines (for example, meat, fatty fish) and huge amounts of alcohol. This is confirmed by the fact that during the wars, the percentage of people with gout decreased sharply due to the fact that meat products, and especially alcohol, were very difficult to get.
A symptom of gout is a common attack of gouty arthritis - this is, as a rule, inflammation of one joint, most often it is the joint of the big toe, knee or ankle. Typically, an attack of gout occurs in the early morning or at night; it manifests itself in the form of unexpected severe pressing pain in one or another joint, the affected joint swells, the temperature in the joint area rises, the skin turns red and begins to become shiny. Usually during the day the pain becomes a little less, but by night it intensifies again; the duration of a gout attack lasts from two to three days to a week, sometimes more. With a repeated attack, other joints may become involved in such inflammation, which can lead to partial destruction of the joint.
Signs of gout are the appearance of peculiar growths on the hands or feet, and the level of uric acid is significantly elevated. When the growths, otherwise known as tophi, burst, a person may see whitish crystals of uric acid. The patient may feel quite intense pain in the affected areas. Such salt deposits in the joints make it difficult to lead a full life.
The main and most severe complication of gout is the appearance of gouty arthritis; it is also possible that urolithiasis occurs, in which the stones formed consist of urate or crystallized uric acid.
Gouty nodes, also called “tophi,” are nothing more than conglomerates of sodium urate crystals that have the ability to be deposited in all parts of the body. And in cases where such deposits get stuck in the joints or periarticular tissues, an immune reaction occurs, since these deposits are perceived by the body as a foreign body, which causes the accumulation of leukocytes and severe inflammation, which is called gouty arthritis.
It is worth paying special attention to the fact that kidney stones caused by gout can become the main cause of kidney failure and can ultimately lead to death.
You can tell about the onset of gout by sudden pain in the joint. They are accompanied by severe redness, swelling and heat. Not only the affected area can “burn,” but also areas of the body in the immediate vicinity. In this case, body temperature can rise to 39-40 degrees. Symptoms in most cases develop within an hour. Most often, the big toe suffers from this. Regular painkillers such as aspirin will not help.
The pain usually begins at night and becomes almost unbearable. In the daytime, some improvement is often observed, the pain subsides, but you should not think that everything has passed. Such acute symptoms can torment the patient for about a week.
Gout is a chronic disease. It is almost impossible to cure it completely. This disease most often manifests itself on the legs. After the onset of the disease, symptoms may recur again after six months or a year. The disease may go into a dormant state, but, without any doubt, it will make itself felt. With each attack, the time between them will decrease. Gout will return to a person more and more often.
Damaged areas on the legs often become more and more destroyed, and the disease can also affect neighboring joints. With a long-term illness, over time, peculiar bumps may appear under the skin on the affected areas, which are called “gout nodes” or “tophi.”
This happens due to the fact that the body begins to perceive large salt deposits in the joints of the legs as a foreign body, the immune system inevitably begins to react - accumulate leukocytes, after which severe inflammation begins. Sometimes tophi burst and release whitish dust - uric acid crystals.
Gout often develops in old age. In men it occurs much more often and at an earlier age. The male population is susceptible to this disease by the age of 40. It should be noted that women begin to suffer from gout closer to 55, mainly after menopause, when the amount of estrogens, female hormones, in the body sharply decreases. Children and young men are practically not susceptible to gout. There are rare exceptions, in cases of hereditary disorders of uric acid metabolism.
This disease severely disrupts metabolism. Purines enter the human body with food, but are also produced by the human body. Purines are then broken down into uric acid, which is excreted by the kidneys. In people with gout, the content of this uric acid is significantly higher than normal. Excess uric acid is deposited in tissues where there is no blood supply. It is easiest for crystals to gain a foothold there.
Joints, cartilage and tendons are most susceptible to this. As a result of this disease, not only these places, but also the kidneys suffer. Most often, with gout, urolithiasis develops; with a lesser likelihood, the patient may suffer from renal colic.
This can happen for two reasons: if too much uric acid is produced and the kidneys cannot cope with the amount of excretion, so it has to be deposited in the human body. And the second reason is when the amount of uric acid is normal, but the kidneys cannot remove it.
However, high levels of uric acid in the body are not the only cause of gout. Several other factors also play a decisive role: overeating, fatty foods, excess weight, sedentary lifestyle and hereditary predisposition.
Even if you follow the recommendations, an acute attack will not go away instantly. But this will significantly reduce the time during which the disease will torment a person. Mainly you need to observe strict bed rest. It is best to keep sore limbs in an elevated position, for example, by placing a pillow under them.
In case of unbearable pain, you can apply ice. After which it is advisable to apply a compress to the sore spot with Vishnevsky ointment or dimexide. It is better to limit your food intake greatly; you can consume liquid porridges and vegetable broths. You should drink as many alkaline drinks as possible, for example, oat decoction, jelly, milk, mineral water or plain water, but with the addition of lemon juice (lemon juice dissolves uric acid deposits in rheumatism and gout). You need to drink at least 3 liters per day (in the absence of kidney disease).
Any painkillers will not help. You can take modern anti-inflammatory drugs that do not contain steroids. If you have taken any preventative medications prescribed by your doctor, you should continue taking them.
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Most often, gout appears in places where the joint has been injured. Therefore, treat such places with caution. You should not wear narrow and uncomfortable shoes, as they can seriously damage the big toe, which gout loves so much. Diet and a balanced diet are mainly used to prevent gout attacks.
Your lifestyle will have to be completely reconsidered and made healthy. You should reconsider your taste preferences. Diet No. 6 is recommended, which helps reduce uric acid and urates in the body. Products containing purine bases, the main source of urates, are strictly limited, or even completely excluded. But milk, cheese, eggs, vegetables, fruits and cereals that are poor in purines and therefore allowed will not leave you hungry. The patient's diet should contain whole grains, eggs, vegetables, fruits, and low-fat dairy products.
In food, you should limit your intake of meat, fish, caviar, mushrooms, and legumes. In addition, you need to limit your consumption of: smoked meats, pickles, anchovies, cauliflower, asparagus, sorrel, chocolate. Such a diet will normalize body weight and significantly reduce the load on the joints during an exacerbation of gout.
You can find detailed information about what you can and cannot eat, as well as other features, here
Alcohol and smoking inhibit the removal of uric acid from the body. Consequently, its crystals are deposited more in the joints. For prevention, you should completely eliminate alcohol, especially beer, and also quit smoking. Drinking tea, coffee, cocoa is not recommended. In addition to the diet, it is worth doing a fasting day at least once a week with the use of a mono-product.
Small joints are primarily affected. Therefore, it is worth paying special attention to the development of their mobility. Attention should be concentrated on those areas where there are attacks of pain. It is worth doing gymnastics for your joints every day. At first, this will be unusual, because it is increasingly difficult for the joints to be mobile due to deposits. It is recommended to spend more time outdoors and take walks.
Mineral waters are excellent for removing unnecessary purines from the body. Give preference to alkaline and organic waters. These include primarily Narzan, Essentuki and Borjomi. Remember that any liquids should be consumed at least 2.5 liters per day.
A diagnosis of gout means that a person will have to significantly change their lifestyle and constantly take medications, because, unfortunately, it is impossible to achieve a complete cure for this disease. However, timely treatment can bring gout under control, reduce painful attacks to a minimum and protect against severe complications.
The main principle of gout treatment is to control the level of uric acid in the body. For drug treatment, you should consult a rheumatologist. His prescriptions will be aimed at reducing the volume of uric acid and eliminating it from the body as quickly as possible. Only a qualified specialist can prescribe medications that, given possible concomitant diseases, will not cause the greatest harm to health.
Most often, doctors prescribe non-steroidal anti-inflammatory drugs, such as methindole, diclofenac, butadione, indomethacin, naproxen, for 1-2 weeks. To quickly reduce the concentration of uric acid in the body, allopurinol, orotic acid, thiopurinol, hepatocatazal, and milurite can be prescribed. To relieve acute signs of gout, doctors recommend taking colchicine.
Drug therapy for gout is aimed at solving two main problems:
Reducing the level of uric acid in the patient’s body;
Relief of acute inflammatory process and pain relief.
The sooner the patient undergoes examination, reconsiders his habits and begins treatment, the greater the likelihood of achieving stable remission. Without adequate therapy, gout progresses quickly, especially in mature and elderly patients, so it is in no case possible to reason on the principle of “it catches it and lets it go.”
Since the root cause of gout is precisely excess uric acid, solving this problem in 90% of cases leads to the cessation of attacks of excruciating pain and allows you to count on a comfortable life in the future.
The following medications are used to reduce uric acid levels in the body:
Allopurinol is a synthetic analogue of hypoxanthine. This substance inhibits the activity of the enzyme xanthine oxidase, which is responsible for the transformation of human hypoxanthine into xanthine, and then xanthine into uric acid. Thus, Allopurinol reduces the concentration of uric acid and its salts in all environments of the body, including blood, plasma, lymph and urine, and also promotes the gradual dissolution of already accumulated urate deposits in the kidneys, soft tissues and joints. However, this drug has a number of serious side effects and greatly increases the urinary excretion of xanthine and hypoxanthine, so Allopurinol is contraindicated in patients with severe renal failure. However, for most gout patients it remains the first-line drug to this day. Cost: 80-100 rubles per package of 30-50 tablets;
Febuxostat (Uloric, Adenuric) is a selective xanthine oxidase inhibitor, which, unlike Allopurinol, does not affect other purine and pyramidine enzymes of the human body, moreover, it is excreted not by the kidneys, but by the liver. Febuxostat is a relatively new drug for the treatment of gout; it is not produced in Russia, but in Western Europe and the USA it has undergone numerous clinical trials and shown excellent results. Within three months, Febuxostat completely dissolves accumulations of uric acid salt crystals in the fingers and elbows and effectively prevents their re-formation. Can be used by patients with concomitant renal pathologies. The drug is not cheap - on average from 4,500 to 7,000 thousand rubles, depending on the country of origin;
Pegloticase (Krystexxa) is an infusion solution of enzymes that quickly dissolve urate crystals (deposits of uric acid salts). It is used intravenously twice a month to stabilize the condition of patients with severe gout who do not respond to traditional medications. Anaphylactic shock is possible during the procedure. This is a very expensive drug, which is produced exclusively abroad and sold to order;
Probenecid (Santuril, Benemid) is a drug that prevents the reabsorption of uric acid in the renal tubules and increases its excretion in the urine. Probenecid was originally used in complex antibacterial therapy to reduce the damage caused to the kidneys by antibiotics. But then they began to prescribe it for chronic gout and hyperuricemia (increased levels of uric acid in the blood). It is important to understand that Probenecid enhances the excretion of uric acid, and does not suppress its synthesis. Therefore, treatment of gout with this drug is advisable only at the stage of remission. If you prescribe Probenecid to a patient with an acute inflammatory process, this will lead to the active dissolution of already accumulated urates, an increase in the level of uric acid in the plasma, and, as a result, to attacks of excruciating pain. To avoid this risk, the first months of gout treatment with Probenecid are accompanied by additional hormonal and anti-inflammatory therapy. The drug costs from 3,500 to 7,500 rubles.
Symptomatic treatment of gout consists of relieving attacks, relieving swelling and pain, and is performed using the following drugs:
Colchicine (Colchicum, Colhimine) is an alkaloid isolated from poisonous plants of the melanthium family. The most common source of colchicine is the autumn crocus. Colchicine inhibits the formation of leukotriene, stops cell division of granulocytes, prevents the movement of leukocytes to the site of inflammation and prevents urates (uric acid salts) from crystallizing in tissues. This drug acts as an emergency treatment and is recommended for use in the first twelve hours after the onset of an acute attack of gout. You need to take two tablets of Colchicine at once, an hour later - another, and then one tablet three times a day for a week. The drug very often causes undesirable reactions from the gastrointestinal tract - nausea, vomiting, loose stools. The average price of Colchicine in pharmacies is from 1000 to 2000 rubles;
Glucocorticoids (Cortisone, Hydrocortisone, Prednisone, Prednisolone) are synthetic analogues of human corticosteroids, that is, hormones produced by the adrenal cortex. Drugs in this group break the chain of natural reactions of the body to the intervention of allergens, chemicals, bacteria, viruses and other foreign elements. Glucocorticoids quickly relieve inflammation, but suppress the immune system, so hormonal treatment of gout is advisable only when the expected benefit outweighs the potential risk. The cost of synthetic steroid hormones varies from 30 rubles (the oldest drug is Prednisolone) to 1,500 rubles (Cortisone);
NSAIDs (Aspirin, Analgin, Diclofenac, Ibuprofen) - non-steroidal anti-inflammatory drugs are so called in order to emphasize their difference from hormones. However, the action of medications in this group is partly similar to the action of glucocorticoids. NSAIDs are non-selective inhibitors of cyclooxygenase, an enzyme responsible for the synthesis of thromboxane and prostaglandins. Thus, these drugs also suppress inflammation, but, unlike synthetic corticosteroids, they do so more slowly and are not immunosuppressants. For the symptomatic treatment of gout, Diclofenac and Ibuprofen are most often used, the average cost is 10-30 rubles, the price of the popular generic (a drug with the same active ingredient) Nurofen can reach 150 rubles.
To minimize the risk of new gout attacks, follow a few simple rules:
If possible, do not subject the sore joint to any stress, periodically fix it in an elevated position and apply ice for 15-30 minutes 2-3 times a day until the pain subsides;
Do not overuse aspirin, which can cause spikes in uric acid levels in the blood and worsen gout symptoms;
Regularly measure your uric acid level – it should not exceed 60 mg/l;
Every day, devote at least half an hour to physical education: walk, ride a bike, jog, dance, swim. Be sure to do exercises in the morning. Regardless of age and weight, patients with gout should give themselves feasible physical activity every day - sports are more effective against gout than any medicine;
Drink at least two liters of clean water per day. In order for the kidneys to remove uric acid from the body, they first need clean water. Without enough water, even healthy kidneys cannot cope with cleansing the body;
Get a blood test to determine your levels of essential minerals and vitamins, and if necessary, supplement your diet with a good vitamin and mineral complex. It is especially important for gout patients to provide themselves with vitamin C;
Do not drink carbonated drinks with sodium benzoate and powdered juices with fructose, completely avoid alcohol;
Review your diet in favor of vegetables, fruits and cereals, consume no more than 120 grams of animal protein per day, avoid offal and fatty sausages.
On the subject: For gout pain, you can also see popular folk remedies
According to recent data, obesity, caused by excessive consumption of fatty foods of animal origin, most strongly predisposes to gout. Fans of sausages, sausages, bacon and hamburgers are at risk. It is the excess of proteins that leads to excess uric acid, and excess weight creates increased stress on the joints and, thereby, accelerates the development of the inflammatory process.
American scientists have also established a direct connection between calcium and ascorbic acid deficiency and the development of gout. With age, even those people who lead a healthy lifestyle and do not complain about being overweight begin to lack these essential substances for the body. Therefore, after forty years, it is necessary to be examined annually and take multivitamins prescribed by your doctor.
Recently, a new drug has been developed that suppresses the synthesis of uric acid - benzobromarone. Active clinical trials of this medicine are currently underway, and in some Western countries it has already been approved and put on stream. But before the new product settles on the domestic pharmaceutical market, it will probably take a long time.
It is also known about the experimental development of new non-hormonal anti-inflammatory drugs that act directly on the protein interleukin, which provokes gouty inflammation of joints and tissues. But it is difficult to name the exact timing of the appearance of these medicines on the public market.
The most popular drug for the treatment of gout, Allopurinol, is increasingly being sharply criticized by modern doctors, since a large number of side effects and complications with its regular use call into question the appropriateness of such therapy. According to statistics, on average, in one out of two hundred and sixty patients with gout, Allopurinol provokes sudden death as a result of renal coma or cardiac arrest.
However, the largest international study of Allopurinol, the results of which were recently published in the scientific journal Annals of the eumatic Diseases, proves the high effectiveness of the drug, moreover, the ability to prevent death. This study certainly does not refute the presence of side effects and high risk for the kidneys, and does not negate the need for new developments. But we have to admit that Allopurinol is still the first-line drug in the treatment of gout, if only because it is well studied, reliable and affordable.
Scientists tracked the fate of 5927 patients who regularly took Allopurinol, and the same number of patients treated for gout with other drugs that lower uric acid levels. It turned out that mortality in the first control group was 19% lower than in the second, and such results persisted throughout the life of the patients. That is, Allopurinol still remains the most effective and safe drug, both for the treatment of acute, newly diagnosed gout, and for maintaining normal well-being in elderly patients with a chronic form of the disease.
Author of the article: Dmitry Sergeevich Volkov, candidate of medical sciences, surgeon
IT IS IMPORTANT TO KNOW! The only remedy for JOINT PAIN, arthritis, arthrosis, osteochondrosis and other diseases of the musculoskeletal system, recommended by doctors! Read more.
Gout is a polyetiological disease. This means that there are several causes of gout and each individually can become a factor in the development of the disease.
Among them are the following reasons:
Thus, the answer to the question, “gout, what is it?” next. Gout is a severe pathology with many development factors.
People at risk for developing gouty arthritis include:
Important! People at risk should carefully monitor their health and follow the rules of prevention, which will be discussed below.
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.
Gout, the signs and treatment of which will be discussed further, has a specific development mechanism. The mechanism is based on the entry of urate salts into the bloodstream. With the blood flow they are carried to the joints and tissues, where, under the influence of a favorable environment, they are deposited and crystallized, destroying the joint capsule and the soft and bone structures adjacent to it. As a result, inflammation occurs, and special bumps are formed at the site of the lesion - tophi.
The urate salts themselves are produced from special purine substances, which enter the body with food: meat, as already mentioned, alcohol, fish, lard, nuts, etc. A healthy body is able to regulate the amount of uric acid, but if there are concomitant diseases , the kidneys, like the entire excretory system, simply cannot cope. This is fraught with the development of gouty arthritis.
Signs of gout are very characteristic if we are talking about a far-advanced process (starting from the 2nd stage of development).
Symptoms of gout include:
The intensity of pain varies from patient to patient. Particularly severe pain is observed during an acute process and during periods between remissions.
The pain intensifies in the evening and morning, until noon (from approximately 20.00 to 12.00), when the patient’s physical activity is minimal.
The intensity and strength of the manifestation of gout symptoms depends on the stage of formation of the disease. There is the following classification of stages of the disease:
There are many symptoms of gout. Most of them appear in the second stage. On the fourth, their flow becomes continuous, although less intense.
Diagnosis begins with correct self-diagnosis. This does not mean that you should diagnose yourself. We are talking about paying attention to your own physiological processes and sensations. If you experience pain, you should see a doctor immediately. Gout is a complex disease and its diagnosis and treatment requires an interdisciplinary approach. Therefore, a number of doctors treat gout:
Everyone is responsible for their own manifestation of the disease. So, a surgeon should be visited as the very first measure. It will help you decide on further examination. The orthopedist is responsible for normalizing the function of the joint, the urologist, nephrologist and endocrinologist help fight the root cause - the transformation of purine into uric acid. At the initial appointment, the doctor will ask questions regarding the patient’s condition: what hurts, how it hurts, etc. This is called anamnesis.
Based on the medical history, the primary diagnosis is made. After this, the diagnosis itself begins. Both laboratory and instrumental methods are informative.
Laboratory methods include:
Instrumental studies are typical:
In combination, these methods are sufficient for high-quality and complete diagnostics. A blood test and ultrasound are usually sufficient.
There are several treatments for gouty arthritis. As a rule, conservative therapy is sufficient in the early stages. Its core is drug treatment (treatment with drugs). The basis of therapy is painkillers, analgesics, decongestants, diuretics and uricosurics.
Prescribed, respectively, to combat swelling, inflammation and pain. This is symptomatic therapy, it is not intended to combat the source of the disease, but helps to relieve painful attacks, relieving swelling and inflammation. This includes analgesic drugs (Analgin, etc.), non-steroidal anti-inflammatory drugs, like Ketorol, Nise, etc. Also diuretic drugs. They should be used with caution, since there is a high risk of developing kidney complications.
Innovative methods of treating gout include taking anti-gout drugs: Allopurinol, Febuxostat, Probenecid, Pegloticase. In combination with diet, they give amazing results in the treatment of gouty arthritis.
Allopurinol is a powerful, modern drug. Its action is based on preventing the transformation of purine into uric acid (in particular, chemical processes should not be delved into). This drug is suitable for most gout patients. The main disadvantage of this medicine is its side effects. But in this case, the contraindications are relative. The drug is prohibited only for persons suffering from severe renal failure.
The diet is based on reducing the concentration of purines entering the body. For these purposes, it is recommended to avoid foods rich in these substances:
All other products can be consumed without fear.
Traditional methods of treating gout should be viewed critically and skeptically. Not all recipes work; moreover, some can make the situation worse.
Important! Taking alcohol tinctures is strictly prohibited; if there is a desire to be treated with folk remedies, local therapy is recommended.
Iodine nets applied to the affected area, infusions of birch buds, and compresses from raw potatoes help well. Otherwise, it is recommended to be treated in the traditional way.
Complications of gout are associated with high concentrations of urate. Complications of gout are:
In order to avoid complications, it is recommended that at the first manifestations similar to gout, you consult a doctor, starting with a surgeon.
With timely treatment, the prognosis is favorable for both life and ability to work. Problems can only begin if you ignore the obvious manifestations of the disease. However, this is unlikely: the intensity of the pain is so high that even the most undisciplined, malicious “patients” are sent to the doctor.
Preventive measures are simple. It is enough to follow simple rules:
Thus, gout is a relatively silent but destructive disease. In order not to miss the moment, it is important to listen to the signals of your own body. If you experience even something remotely resembling the symptoms of gout, do not put off visiting a doctor.
Gout can be called an indicator of an unhealthy lifestyle (poor diet, low physical activity). An increase in uric acid in the blood occurs due to:
The disease can also develop against the background of:
The main symptoms are localized in the area of the joint affected by salts. Gouty arthritis manifests itself with a characteristic picture that is difficult to confuse with another disease. Deposited salts when exposed to a provoking factor (tight shoes, errors in diet) provoke bright inflammatory symptoms (gout attack). Immune cells begin to perceive salt crystals as foreign and send white blood cells to fight them.
A gout attack lasts from several hours to 2-4 days. Even without treatment, the attack gradually subsides as phagocytes begin to eat urate crystals and fight inflammation. At first, the periods between attacks can last several years, but the lack of adequate comprehensive treatment leads to further development of crystallization, involvement of other joints in the process and more frequent exacerbations. Even during a period of temporary improvement, a growth is visually detected on the joint; as it increases, mobility is increasingly limited.
Gout on the legs, accompanied by a characteristic brightness of the manifestation, is diagnosed based on:
Gout should be differentiated from diseases:
Therapy for gout aims to:
- complete rest, elevated position of the affected joint;
- a heating pad with ice (warming procedures are indicated only after the attack has stopped);
- compresses with a 50% Dimexide solution (a 24-hour sensitivity test is required);
- NSAIDs (Diclofenac, Naproxen, Indomethacin), tablets or injections are used;
- intravenous administration of Colchicine (in severe cases);
- glucocorticosteroids if there is no effect.
— preventive courses of Colchicine (negatively affects the gastrointestinal tract and blood composition).
— taking enterosorbents that normalize the activity of the gastrointestinal tract;
— vitamin therapy (vitamins C and P help dissolve and remove urates from the body);
- uricodepressive drugs that reduce the formation of uric acid (Orotic acid, Thiopurinol, Allopurinol) are used in the metabolic type;
- uricosuric drugs that increase the excretion capacity of uric acid through the kidneys (salicylates, Benemide, Etamid, Anturan, Ketazone) are used for renal type.
Important! Uricouretics are contraindicated in chronic renal failure, gastrointestinal pathology, and liver diseases. Prescriptions for medications, dosage and duration of medication are prescribed by the attending physician.
High hyperuricoemia (increased levels of uric acid in the blood) and its low excretion in the urine (less than 3.56 mmol/day) requires the combined use of drugs from both groups of anti-gout drugs (Allamaron), doses are selected by the attending physician on an individual basis. The medicine is used for 1 year followed by a 2-month break.
Important! Although treatment with traditional methods can significantly affect the removal of urate from the body and prevent exacerbation, treatment at home without the consent of the attending physician is fraught with negative consequences. Bay leaves should be used especially carefully.
What not to eat if you have gout:
What can you eat if you have gout:
The diet involves a significant reduction in fat, limiting sodium intake from food, sufficient intake of vitamins and replacing animal proteins with plant proteins.
Approximate gout menu for the day (diet No. 6)
In the morning on an empty stomach: 100 ml of warm mineral water or rosehip decoction.
Breakfast: porridge with milk, fruit salad, juice, tea with lemon;
Lunch: vegetable soup, vegetable cutlets, cottage cheese dishes, vermicelli, milk jelly.
Afternoon snack: egg, carrot juice.
Dinner: vegetable salad, jelly.
At night: kefir, tea with milk.
Food for gout should be taken in small portions, avoiding overeating. Weekly fasting days help remove toxins and urates, and also speed up metabolic processes.
The prognosis for gout is favorable provided complex treatment is provided and the patient is committed to a long-term fight against the disease. Prohibited foods, avoiding them, walking, running and other physical activity will not give the disease a chance to actively manifest itself.
The small joint at the base of the big toe is the most common site of an acute gout attack. Other joints that may be affected include the ankles, knees, hands, fingers and elbows. Acute attacks of gout are characterized by a rapid onset of pain in the affected joint, followed by warmth, swelling, redness and severe tenderness. The soreness can be so intense that even the touch of a blanket to the skin over the affected joint can be unbearable. Patients may develop fever with acute gout attacks. These painful attacks usually subside within a few hours to a few days, with or without treatment. In rare cases, the attack may last for several weeks. Most patients experience repeated attacks of arthritis over the course of years.
Uric acid crystals can be deposited in tiny fluid-filled sacs (bursae) around the joints. These urate crystals can cause inflammation in the bursae, leading to pain and swelling around the joints, a condition called bursitis. In rare cases, gout leads to a chronic type of joint inflammation that resembles rheumatoid arthritis.
In chronic (tophus) gout, nodular masses of uric acid crystals (tophi) are deposited in various soft tissues of the body. Although they are most often found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, tophi nodules can appear anywhere on the body. They have been found in unexpected areas such as the ears, vocal cords or (rarely) around the spinal cord!
- nature of nutrition (predominance in the diet of meat products, fish, vegetable protein (legumes, mushrooms), alcoholic beverages). Eating high-calorie foods;
— provoking factors for repeated attacks, in addition to a violation of the diet, are physical activity, hypothermia or overheating of the joints (visiting a sauna).
Treatment of gout should be aimed at:
To lower the level of uric acid in the body, which is actually the primary source of the development and attacks of gout, you can use the following means:
Other means: mineral waters (alkaline) - Borjomi, Essentuki, Narzan.
Swelling of the legs and attacks of acute pain that occur with gout can be relieved by the following means:
To stop the inflammatory process: Glucocorticoids (hormones) - Hydrocortisone, Cortisone, Prednisone. This group of drugs is prescribed by a doctor only for severe attacks and rapid development of gout. It is not recommended to make decisions on the use of these hormones on your own!
Do not use: Aspirin and salicylic acid preparations, because they contribute to the retention of uric acid in the body.
Treatment of patients with gout is aimed primarily at reducing the content of uric acid compounds, including uric acid, in the patient’s body. This can largely be achieved with the help of special diet No. 6 (Table No. 6), which is used for gout. It is necessary to exclude foods rich in purine bases from the diet. These include all offal (liver, kidneys, brains, tongue). meat of young animals, fatty meats and fish, canned food, smoked meats, herring, sprats, sardines.
Only 200-300 grams of lean boiled meat per week is allowed. Since when cooking meat and fish, up to 50% of the purine bases they contain goes into the broth, the patient should not eat meat and fish broths. Limit table salt (up to 6-7 grams per day). This means that you need to cook food without salt and only add salt to ready-made dishes at the rate of half a teaspoon of salt per day. Eliminate refractory fats (lamb, pork) from your diet, as they slow down the release of uric acid by the kidneys. You can eat butter, ghee (limit up to 10 grams per day for obese people), and vegetable oil.
Although the vast majority of purines come from animal products, they are also found in many plant foods. These are fresh legume pods (peas, beans, lentils), mushrooms, spinach, cauliflower, as well as coffee, tea, cocoa, chocolate. They should also be limited. And vice versa, it is necessary to widely use purine-poor milk, dairy and lactic acid products, eggs, potatoes, bread, and cereals in the diet.
When treating gout, you need to eat more raw vegetables from those that are allowed to you, as well as berries and fruits. Citrus fruits are preferable among fruits due to their pronounced alkalizing effect. Berries and fruits can be eaten both raw and cooked. For a long time, many doctors, and after them patients, were very wary of tomatoes. Even now there is an opinion that the benefits from them are much less than the harm, and this is associated with the high content of organic acids in tomatoes. However, research in recent years has shown that there is no reason for a negative attitude towards tomatoes. They do contain a lot of organic acids, but primarily such as citric and malic acids, which the body certainly needs. The content of oxalic acid in tomatoes is very small: about 8 times less than in beets or potatoes. And there are ten times less purines in tomatoes than in meat, fish, beans, and peas. Modern nutritional science claims that tomatoes are even beneficial for those who suffer from various disorders of purine metabolism.
All patients, regardless of body weight, are recommended to have fasting days once a week. There are many unloading options: vegetable (1.5 kilograms of vegetables in any culinary preparation), fruit (1.5 kilograms of apples or oranges without peel), cottage cheese (400 grams of cottage cheese and 0.5 liters of kefir), milk or kefir (1.5 liter of kefir or milk). The fasting diet contains very few dietary purines and thus has a very beneficial effect on metabolic processes in the body.
On any fasting day, the amount of liquid you drink should not be less than 1.5 liters. Drink the same amount of liquid on regular days. Fruit, berry, and vegetable juices (for obese people - natural without sugar), milk, weak tea, alkaline mineral water such as Borjomi are recommended. On the day of fasting, drink only tea and mineral water.
In no case should patients with gout undergo even short-term courses of complete fasting, which are so fashionable now. And here's why: already in the first days of fasting, the level of uric acid in the blood increases, which can contribute to the development of a painful attack.
If gout is combined with obesity, which is observed quite often, it is necessary to follow a reduced (reduced calorie) diet. In this case, the diet is limited to the foods that I have already mentioned above, as well as sugar, sweets, cakes, pastries, flour dishes, as well as everything fatty.
Diet for gout is the most important part of treatment. Complex therapy for this disease also includes medications and physiotherapeutic procedures. They are prescribed by the doctor individually to each patient, taking into account the severity of gout and the presence of concomitant diseases.
- In the morning on an empty stomach, 0.5 hours before meals, eat 2 glasses of fresh strawberries (strawberries), after lunch - 1 glass and at night 2 glasses. At the same time, do not eat meat, sour or salty. The course of treatment is 2 months.
- 4 tbsp. Pour 4 cups of boiling water over spoons of dried strawberries. Leave for 1.5 hours, drink 1 glass an hour before meals and before bed. Thus, during the day you need to drink 4 glasses. Don't eat sour or salty foods. The course of treatment is 40 days.
- 2 tbsp. Pour a glass of vodka over spoons of lilac flowers. Leave in a dark place for a week. Take 50 drops of tincture 3 times a day before meals.
- 3 tbsp. spoons of St. John's wort pour a glass of boiling water. Leave for 2 hours, then strain. Drink 1/3 glass 3 times a day before meals. The course of treatment is 1-2 months. Used for chronic gout.
- Compresses made from equal parts of iodine, castor oil and ammonia relieve pain. Make compresses daily.
- Take 1 part castor oil and 2 parts denatured alcohol. Apply a cloth soaked in this mixture to your foot overnight. The pain and the lump on the big toe go away. Rub on sore spots for rheumatism.
- Rub the roots and leaves of the forest violet, apply to your thumb. Gouty bumps soften.
— Pain reliever for gout, heel spurs, joint pain: lilac flowers should be withered. Cut into pieces 1-1.5 cm long, put in a liter or larger jar, use a masher to make 1/3 of the jar; Fill with vodka so that it covers the lilac, close tightly, and leave in the dark for 10 days. Rub in for pain.
- An ointment that is prepared as follows also relieves pain: pour vinegar essence into one raw egg (in the shell), close tightly and place in a dark place for 10-12 days. Then add 150-200 g of butter and mix. Steam your leg for 10 minutes. Then, holding your foot over the steam, smear the bone with a wooden stick so that the ointment melts. Make a compress with this ointment for the night. Repeat the procedure for 2 weeks. Take a break for 2 weeks and do it all over again. All bumps will disappear.