Moscow. Talk show “Let them talk.” In this studio we discuss true stories that cannot be kept silent about.
Today in our studio we have the Hermit Agafya Lykova , everyone knows her firsthand! She began to flash across all central channels due to her unusual fate. Agafya Lykova is the only living representative of a family of Old Believers hermits. This family managed to maintain longevity and perfect health for many centuries, living in the taiga, far from civilization, medicines, and doctors. Using the power of nature and its gifts, they had truly heroic health and incredibly stable immunity. After the whole of Russia learned about Agafya, our program began to receive thousands of letters from viewers asking: “Ask Agafya Lykova to tell her some secret recipe of her family.” All the letters were in the same vein - everyone wanted to receive at least a small recipe that would help improve or maintain health. Well, if TV viewers ask, then you need to find out her recipes and secrets of longevity. After all, thousands of Russians cannot be wrong - if they ask, it means it will help!
— Hello Andrey and dear audience. Probably, I would hardly have agreed to give out the recipe of my ancestors if I had not known how many people in Russia, and throughout the world, suffer from osteochondrosis and terrible joint pain. Perhaps my ancient recipe will help get rid of such diseases once and for all.
— Our editors and cameramen came to you in the taiga. It was -29 outside, it was terribly cold, but you didn’t care! You were standing in light clothes, with a scarf on your head and on one shoulder holding a rocker with two 10-liter buckets filled with water. And you, after all, are already 64 years old. We were amazed: standing in front of us was an elderly woman who simply glowed with longevity and health.
Walking into the house, we saw that you were preparing some kind of mixture similar to cream. Can you tell us more details?
“My father and my mother knew family recipes, which they received from their parents, and they received from theirs. Many of my recipes are hundreds of years old; my entire generation has been treated with them. All these recipes are recorded in this book.
- Agafya, tell me, what was the last thing you managed to win? You are the same person as all Russians. In any case, could anything be bothering you?
— Yes, of course, I suffered from many diseases, but I got rid of them very quickly, since I have my “family recipe book . The last thing I was suffering from was pain in my joints and back. The pain was terrible, and the dampness in the room only aggravated my illness. My legs and arms couldn’t bend and ached a lot. But I got rid of this disease in 4 days. I have my great-grandmother’s recipe for this disease. So be it, I’ll tell it to you, let the people get rid of their ailments.
After these words, Agafya opened her old book with recipes and began to dictate the composition to us. Below we will talk about how to cure arthrosis in 4 days! In the meantime, let's talk about the remaining dialogue with Agafya:
- What is this product and how to use it correctly?
- This cream is based on Altai deer antlers - a valuable substance that is extracted only once a year from deer antlers. They are mined in only one place, in northwestern Siberia. In the spring, the Altai deer sheds its antlers, and local residents go to the taiga in search of them. Based on maral antlers, I prepare a cream for joint pain, bruises and sprains. Thanks to the healing properties of the substance, local residents in the 19th century destroyed almost the entire population of Altai deer. Therefore, industrial production of antlers is impossible.
-Thank you, Agafya. Many Russians will now get rid of joint pain forever.
This interview was done on June 10, 2016, and we thought for a long time about how to share the recipe, because you can’t just buy and cook the composition of the cream. The cream contains unique components that are very difficult to find. Therefore, we handed over the recipe to the cream manufacturer so that this product would be available to everyone. The manufacturer's product is fully certified and proven to be effective by the Federal State Institution Research Institute of Orthopedics. Our editors and our channel fully vouch for the effectiveness of Artropant and the fact that the composition fully complies with Agafya Lykova’s recipe. To order Artropant, according to Agafya’s recipe, click here
Thank you very much for the recipe and the opportunity to buy Artropant! I’ve been using it for 3 days now and my joints have really stopped bothering me!
It’s so good that ancient recipes have been preserved! I've had enough of these pills! My mother uses the cream. She is 68, and she has more than enough health. Although just recently she complained of severe pain in the lower back and elbows! And now she’s simply unrecognizable! Thanks to your channel for the report!
How long does Artropant last? Pay immediately?
It’s easy to pay, there are instructions and options. It took me 4 days to get the cream to Tyumen! The wait was worth it, as I've been using it for 5 days now. My bones hurt a lot, now they don’t bother me at all! Thanks to the TV channel!
Is it suitable for general health of the body?
I treat muscle pain with it. Improvement began already on day 2. I highly recommend this cream to everyone!
This is what traditional medicine can do! Damn the drugs! Fortunately, the cream costs a penny relative to the treatment itself!
Reactive arthritis (ReA) is an inflammatory lesion of the joints that develops after certain infections (genitourinary, intestinal, nasopharyngeal). The symptom complex, including arthritis, conjunctivitis, urethritis or cervicitis, colitis and characteristic skin lesions, is called Reiter's syndrome. There are two variants of ReA - urogenital and enterocolitic.
Code according to the international classification of diseases ICD-10:
Statistical data. Occurs after bacterial dysentery in 2.5% of cases, after urogenital infection - in 0.8%. The predominant age is 20–40 years. The predominant gender is male (men suffer 20 times more often from urogenital and 10 times more often from enterocolitic variants of ReA).
Etiology • Urogenital infections: Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae • Gastrointestinal: Shigella flexneri Ib and IIa, Shigella sonnei, Campylobacter jejuni, Salmonella typhimurium, Salmonella enteritidis, Salmonella heidelberg, Salmonella choleraesuis, Yersinia pseudotuberculosis, Yersinia enteroc olitica.
Genetic aspects. HLA B27 Ag is detected in 63–75% of cases.
Pathogenesis. The trigger infection activates T lymphocytes (in peripheral arthritis - mainly CD4+, in cases of damage to the sacroiliac joints and spine - mainly CD8+. The main substrate of sacroiliitis, spondylitis, dactylitis is inflammation of not so much articular, but periarticular tissues.
• Onset of illness. ReA often debuts at a young age. During or 1–3–6 weeks after urethritis or intestinal infection, any of the clinical signs of the disease may appear.
• Urogenital debut: acute cystitis, in women - vaginitis, cervicitis; in men - urethritis, balanitis, balanoposthitis, prostatitis. Nonspecific urethritis can be asymptomatic and manifest only by laboratory changes in the initial portion of urine.
• Enterocolitic debut: diarrhea.
Re A often debuts at a young age. 1-3 weeks after urethritis or intestinal infection, any of the clinical signs of the disease may appear. symptoms do not occur simultaneously. Nonspecific urethritis can be asymptomatic and manifest only by laboratory changes in the initial portion of urine.
• Enterocolitic onset of diarrhea. rheumatology, 2001, No. 4, p. rheumatology, 2001, No. 4, p. Rheumatology, 1997, chapter 11, p. Alieva D. Candidate of Medicine Zholobova E. Molochkov V. Godzenko A.
S. Chistyakova E. The immune response is manifested by the production of antibodies circulating in the blood and synovial fluid. In this case, general reactions are expressed in the form of fever 380-390, leukocytosis, acceleration of ESR to 40-45 mm/hour. A long-lasting elevated level of antibodies indicates the presence of an infectious agent, on the one hand, and the persistence of microbial antigens in tissues and synovial fluid, on the other. In addition, numerous literature data indicate the importance of genetic predisposition 2,4,5,6,7.
The authors note a close relationship between Re A and one of the antigens of the major histocompatibility complex - HLA-B27. The start of lycopid therapy was preceded by the prescription of a macrolide for 5 days - lycopid, then 10 days - macrolide + lycopid. Moreover, the association of HLA-B27 with urogenic arthritis is observed in 80-90% of cases, with postenterocolitic arthritis - in 56%. The clinical effect occurs at 5-6 weeks of treatment. Clinical variants of reactive arthritis in children. The duration of the course is individual, but not less than 2 months. Abstracts of the All-Russian Congress “Pediatric Cardiology 2002”, M.
Thus, when carrying out complex therapy for Re A in children, one should take into account the biological characteristics of the infectious agent, evaluate the nature of its interaction with the macroorganism, and synchronize treatment with the activity and nature of the course, severity, and dynamics of the inflammatory process in the joints. Literature 1. M. Akbarov S. RMJ, 1999, No. 8, p.
Added: 11/28/2014, 10:42 Author: CrashPush Category: Pressure
Gout is a disease characterized by impaired purine metabolism and the deposition of urate crystals in the form of uric acid in various tissues. This disease has been known to medicine since ancient times; it is often called the “disease of kings,” since most aristocrats suffered from gout due to eating large amounts of meat and wine.
Approximately 2% of the world's population suffers from gout. Recently, the incidence of this arthropathy has increased, which is due to physical inactivity, overeating, and drinking large amounts of alcohol. Mostly men (80-90%) of working age are affected.
Depending on the causes of the disease, gout can be primary or secondary. Primary gout always develops in individuals who have a genetic predisposition to impaired purine metabolism. In most cases, people are not aware of this “feature” of their metabolism.
If an organism that is prone to the deposition of uric acid crystals is exposed to provoking environmental factors, it will most likely develop gouty polyarthritis.
Very often, gout is secondary in nature and develops against the background of other pathological conditions:
Since gout is a disease of the whole body, and not just the joints, many organs and systems are involved in the pathological process, but most often the disease manifests itself as gouty arthritis. According to ICD 10, gout falls under category M 10.
Gouty arthritis, or gout, is a disease that develops through metabolic disorders when the amount of uric acid, as well as its salts, increases. When the concentration reaches certain amounts, uric acid crystals begin to deposit in some tissues and organs.
The limbs (joints and feet) begin to suffer first; damage to the upper limbs is less common. An inflammatory reaction begins in the affected area, after which gouty arthritis develops.
The reasons why the disease occurs are not precisely known. Supposed reasons are:
For a long time the disease was called “the disease of the aristocrats.” Men over 40 and women in menopause are especially susceptible to it.
This disease is characterized by three periods:
The disease is dangerous because it can be accompanied by symptoms of general intoxication due to the increased content of inflammatory mediators. The person feels chills, weakness, and malaise. However, the diagnosis is not very difficult to establish. A blood test needs to be done.
How to cure joint pain
I want to tell my story of how I was able to overcome my arthritis of the knee joints and osteochondrosis of the lower back. I’m not a doctor, I won’t explain how I was cured. I'll just tell you how it was.
I am 62 years old, retired. Before retirement, he worked in the blast furnace shop at the Lipetsk Metallurgical Plant. First as a forge worker, and then for the last 10 years as a safety engineer. Anyone familiar with the profession of a forge knows that it is very different from the profession of a steelmaker. They are now cooking steel in converters - sit and press levers and buttons. And we are all doing it the old fashioned way. If necessary, we will pry with a shovel, and sometimes with a crowbar. Near the stove the heat is terrible and drafts are blowing, be healthy. That's where I pushed my knees and lower back.
Constant pain does not have the best effect on your appearance. I have lost a lot over the past 3 years.
It’s good, at least because of his seniority he retired at 50 and transferred immediately. There was no longer any strength to endure. For the last year I have been on painkiller injections. I was lucky - a job as a safety engineer turned up. The work is much easier and not near the stove. The gentle regimen initially had a beneficial effect on my sores. The pain subsided, and I even stopped taking painkillers for a while. But about three years before my final retirement, I had a domestic injury. While fishing, I opened my leg really well. And, apparently, the painful shock, and then the use of painkillers, upset the fragile balance - severe pain in the knees and lower back appeared again.
Because of the injury, my arthritis began to progress rapidly.
I don’t even want to remember these three years. It was absolute hell! In the morning my wife injected me with diclofenac, then I gave the injection at work, and in the evening my wife gave me another injection. Tell me why you didn’t retire? Helped my son. His son was born, but he also lost his job. So we had to drag it out.
For the last year I’ve just been walking with a cane. And before the next medical examination, I wrote a statement on my own. I definitely wouldn't have passed it.
Based on my extensive experience in joint diseases, I can say that doctors know mainly about chondrosamine. Well, they can also prescribe hydrocortisone or diprospan.
And due to the fact that I often had to inject diclofenac to relieve pain, stomach pain appeared. I had to add more bismuth subnitrate to protect the gastric mucosa.
During the time until I found a truly effective remedy, I had punctures 4 times to remove the fluid. And the last time when this liquid was removed, pus had already started to appear. The doctor said that most likely I will have to have an operation - we need to do endoprosthetics. Instead of my unusable knee joints they will put titanium ones. I found out later. Even if this prosthetics goes well, you will still have to walk with a stick. And surgery on two joints costs at least 4 thousand dollars. This is if you install German prostheses. Ours will cost $1000 less, but they have more complications. In a word, I thought deeply.
I thought hard about my future fate
A specific disability was shining. And you can’t raise that kind of money right away.
My wife and I sat and thought (she’s a real good guy!) and decided to agree to the operation. At sixty-one, life doesn’t end, but money, that’s what money is for, to be spent.
And I owe this miracle to my wife. She had a girlfriend from school years, the wife of a city official. And the man also suffered from knees, just like me. Well, maybe a little less.
One day my wife is walking through the city and a car stops next to her. This official comes out from there and with such a springy young gait, and even quickly, goes to the store.
On the same day, Ira (wife) called her friend and began asking how her Konstantin managed to heal his knees? It seems that he did not go to the operation. And they don’t run like they did after surgery.
My wife Ira saved me, for which I am very grateful to her
It turned out that it was all about a new American drug - Arthropant. Igor, through his connections, got him from Moscow and literally got on his feet in 10 days. I say again - IN 10 DAYS!
My wife and I were happy, but also depressed. The drug has not yet been sold in our country. And we couldn’t even imagine how to order it in the States, where almost everything is by prescription. In short, we continued to prepare for the operation.
And then, a month and a half later, Ira’s friend calls and says that her Konstantin said that it seems that Arthropant cream has passed or is being certified in Russia. My wife directly begged her friend to find out more, and it turned out that she passed! And it has already begun to be sold, so far only through the official website. I was probably one of the first to order!
I began to use this cream, applying it to my miserable knees and lower back. And you know, the cream started to help! At first I thought that it worked as a pain reliever, since after it the pain subsided noticeably after 5-10 minutes. But suddenly I felt that my lower back became much easier. To be honest, I gave up on her a long time ago. I'd like to sort out my knees here. The operation is shining! But when, after a few days of using the cream, I was able to bend down and put on my boots without a half-meter “spoon”, I realized that Arthropant TREATS excellently!
After a week, I was able to take a half-hour walk without knee pain! Things were clearly getting better for me! And after a few days I considered myself a healthy person - there was no more pain! I could bend over freely, walk for long periods of time, and ride a bike (I really love riding it).
I was able to not only get on my bike again, but also go for two-hour walks
Six months have passed since my recovery. There is no pain! Although I stopped using Arthropant a long time ago. Now I: go fishing, work at the dacha and love playing with my grandson! My wife and I are planning to go south! Otherwise, young people were buzzing their ears about how beautiful it was there.
When you are healthy, playing with your grandson is no longer annoying, but on the contrary, it brings joy.
So, whoever has arthritis, osteochondrosis or arthrosis, in a word, who has joint and back pain, take my information into account: Arthropant - treats joints!
Utyugov Valery Pavlovich, Lipetsk.
Acute arthritis is an inflammatory process localized in the joints, which can have a different nature. In this case, pain, swelling and other symptoms are pronounced, and exudate accumulates in the joint cavity. One of the most dangerous is acute purulent arthritis, since it is associated with bacterial infection and can lead to the loss of a limb or fatal blood poisoning - sepsis.
According to the International Classification of Diseases, 10th revision, in the class of diseases of the musculoskeletal system and connective tissue, typical arthritis forms two groups of diagnoses depending on the etiology:
There is also a section for other joint lesions, which mainly includes all kinds of deformities, but most of them are chronic and not acute.
Factors that contribute to the development of arthritis include:
Depending on the cause of the disease, the clinical picture of arthritis can also vary significantly.
Arthritis of one etiology or another has its own characteristics, but some general symptoms are characteristic, namely:
Depending on the etiology of arthritis, signs of damage to other organs and systems may be observed. For example, with rheumatoid inflammation, internal organs, mucous membranes and skin may be involved (formation of specific subcutaneous nodules).
This type of arthritis is caused by damage from rheumatoid factor (a complex of IgG antibodies with IgM) and the inflammation it causes. The disease manifests itself:
Attention! General symptoms often include increased body temperature, weakness, fatigue, irritability, and weight loss.
In most cases, it manifests itself in the form of polyarthritis, less often - monoarthritis. Small joints are affected first. At the onset of the disease, a number of characteristic signs may not be present at all, namely: rheumatoid nodules, ulnar deviation of the fingers, rheumatoid factor, and bone erosions on x-ray.
Caused by the entry of an infectious agent into the joint cavity from the primary focus in the body or directly when the joint is damaged. As a rule, the onset is acute, with sharp pain in one or several joints at once (usually large ones). All signs of inflammation are present: pain, swelling, redness.
At the same time, body temperature rises, fever may be accompanied by chills and sweats. Lymph nodes near the affected joints may become enlarged.
Attention! Let me remind you that if you have any problem, you can seek advice from our specialists.
Inflammation of the joints, which develops as a consequence of an infection (genitourinary, respiratory, digestive systems) is called reactive arthritis. There is no direct penetration of infection into the joints; the mechanism of damage by immune complexes is the basis.
On a note! Reactive arthritis develops simultaneously or some time after an infectious disease.
All the typical signs of joint inflammation are present, but this arthritis has some special features:
A gout attack is caused by the deposition of uric acid crystals in the joints. The pain is of high intensity, reaching its peak at night and in the morning. The skin around the joints is swollen, red, and looks smooth and glossy. Most often one joint is affected, typical places: joints of the phalanges of the fingers/toes, elbows, forearms.
The disease is characterized by specific compactions of subcutaneous fatty tissue - tophi, located near the affected joints, as well as in the area of the ears.
It is somewhat more difficult for young children to diagnose arthritis than for adults, because they do not yet know how to correctly express their feelings and cannot always formulate complaints.
In general, a sick child is more capricious and whiny, refuses outdoor games (due to stiffness and pain in the joint), and lameness may appear. Even if there are no obvious complaints of pain, all of the above should alert adults and prompt them to see a doctor.
To confirm the disease, an examination by a doctor is required, as well as additional instrumental (X-ray examination) and laboratory (clinical and biochemical blood tests, general urine analysis, etc.) examinations.
For the diagnosis of rheumatoid arthritis, the detection of rheumatoid factor in the blood or intra-articular fluid is important. But its absence does not help to exclude the disease (since a seronegative variant of the pathology is possible).
In infectious arthritis, finding the source of infection is of great importance. Laboratory indicators: leukocytosis with a pronounced shift of the leukocyte formula to the left, increased C-reactive protein and accelerated ESR.
To diagnose reactive arthritis, a history of an infectious disease is detected, as well as characteristic damage to other organs typical of a particular infection (conjunctivitis, urethritis, erosions on the mucous membranes).
With gout, the level of uric acid in the blood increases, in addition, changes characteristic of gouty arthritis appear on x-rays - the so-called holes (voids in the bone tissue).
Therapy for arthritis of any type should be comprehensive and aimed at the cause of the disease. In treatment, not only medications are used, which only a doctor can choose correctly, but also some methods of physiotherapy, dietary nutrition, and folk remedies.
All patients without exception are prescribed basic therapy (cytostatics/immunosuppressants). A specific drug (Methotrexate, Sulfasalazine, gold salts) is selected depending on the duration of the disease, its prognosis factors (rheumatoid nodules, vasculitis, the presence or absence of rheumatoid factor, increased blood C-reactive protein and ESR).
Biological drugs can be used (if the basic therapy drugs are insufficiently effective): Infliximab, Adalimumab.
Glucocorticosteroids in low or medium doses are used to quickly relieve exacerbations, often becoming part of a combined treatment regimen (Dexamethasone, Prednisolone, Flosterone).
Attention! Hormonal and basic drugs are prohibited from being used without a doctor’s prescription. Side effects from an overdose or the wrong choice of drug can be irreversible and even cost you your life!
NSAIDs are prescribed as symptomatic therapy; they provide analgesic and anti-inflammatory effects (Meloxicam, Nimesulide, Diclofenac).
Treatment is based on antibacterial therapy aimed at eliminating the infectious agent that caused the disease from the body. For pain relief and relief of inflammation symptoms, NSAIDs and glucocorticosteroids are prescribed.
Treatment is aimed, first of all, at eliminating the infectious pathogen from the body, so first-line drugs are antibiotics. Therapy is supplemented with NSAIDs and glucocorticosteroids. Basic drugs (cytostatics) are used only in severe, rapidly progressive cases.
A specific drug for the treatment of gout is Colchicine, it is needed to reduce the intensity of the formation of urate salts, and it also helps to subside the inflammatory reaction.
In addition to Colchicine, nonsteroidal anti-inflammatory drugs and glucocorticosteroids are prescribed. For all types of arthritis, local treatment using ointments, as well as electrophoresis with medications, is indicated.
Timely diagnosis and treatment of diseases that can trigger the development of arthritis is the basis for preventing inflammation in the joints. Once arthritis is diagnosed, maintaining its remission serves as secondary prevention.
In addition, to prevent arthritis, it is important to:
With timely diagnosis and a responsible approach to treatment, arthritis responds well to therapy. Inflammatory changes gradually regress and the joints return to normal. The exception is rheumatoid arthritis - it is difficult to cure completely, but competent therapy can quickly overcome exacerbations and slow down the destruction of joints, as well as avoid the development of severe complications.
Lack of treatment can lead to irreversible damage to the joints, as a result of which they can become deformed or even completely lose mobility.
Arthritis of almost any etiology causes changes not only in the joints, but also affects other organs. For example, with rheumatoid arthritis, the kidneys often suffer; with inflammation of the joints of an infectious nature, the risk of generalization of the infection and the formation of new lesions throughout the body increases.
Elena Bobkova talks about playing sports during exacerbations of arthritis and arthrosis.
Any arthritis that occurs in an acute form requires particularly rapid diagnosis and treatment. For any inflammation of the joints, it is necessary to conduct additional examinations to help determine the cause of the disease. And when the etiology is established, one thing remains - strictly follow the recommendations of the attending physician, who will help defeat the disease.
ICD-10 category: M10.0
Gout is a systemic disease associated with a disorder of purine metabolism, characterized by an increase in uric acid in the blood (hyperuricemia), deposition of urates in articular and/or periarticular tissues and inflammation developing in connection with this. Detection of hyperuricemia is not sufficient to establish a diagnosis, since only 10% of individuals with hyperuricemia have gout. Chronic gout is characterized by the formation of tophi.
— Hyperuricemia is detected in 4-12% of the population, gout affects 0.1% of the population.
— The frequency of gouty arthritis in different populations varies and ranges from 5 to 50 per 1000 men and 1-9 per 1000 women, and the number of new cases per year is, respectively, 1-3 per 1000 in men and 0.2 per 1000 in women.
- The risk of gout increases as uric acid levels increase: 5-year cumulative incidence - with normal uric acid levels - 5/1000 -0.42-0.47 mmol/l - 20/1000 -0.48-0.53 mmol /l - 41/1000 -0.54-0.59 mmol/l - 198/1000 ->0.6 mmol/l - 305/1000.
— The ratio of men to women is 2-7:1. Peak incidence: 40-50 years in men, 60 years and older in women. Before menopause, women rarely become ill, possibly due to the effect of estrogen on uric acid excretion.
- An acute attack of gout in adolescents and young adults is rare and is usually mediated by a primary or secondary defect in uric acid synthesis.
Persistent hyperuricemia (increased serum uric acid levels) is an obligate risk factor for the development of gout. Previously, hyperuricemia was defined as a uric acid level greater than 420 μmol/L, based on the serum urate supersaturation point at which monosodium urate crystals begin to form. The European League Against Rheumatism recommends that uric acid levels above 360 µmol/L (6 mg/dL) be considered hyperuricemia, based on studies demonstrating a 4-fold increase in the risk of developing gout in men and 17-fold in women when serum uric acid levels exceed this level. acids.
Causes of hyperuricemia: obesity, arterial hypertension, taking medications, genetic defects leading to overproduction of urates, other concomitant diseases, alcohol intake.
There are 3 stages in the development of gout:
- acute gouty arthritis;
- interictal (“interval”) gout;
- chronic tophi gout.
Acute gouty arthritis
- Sudden onset, rapid increase in intense pain, usually in one joint, hyperemia of the skin over the joint, swelling and dysfunction of the affected joint.
— Most often develops at night or in the early morning hours, the duration of the attack without treatment varies from 1 to 10 days.
— Acute gouty arthritis can be triggered by injury, alcohol intake, dietary errors, surgical procedures, exacerbation of concomitant diseases, local inflammation (for example, with osteoarthritis).
— In more than half of patients, the first gouty attack is manifested by damage to the first metatarsophalangeal joint of the foot (this localization of gouty arthritis is typical for 90% of patients).
— General manifestations: fever and leukocytosis.
— A characteristic feature of acute gouty arthritis is complete spontaneous recovery and absence of symptoms between attacks before the development of chronic gouty arthritis. Without treatment, there is an increase in attacks, a more protracted course, and the involvement of new joints in the process.
— Features of gouty arthritis depending on gender and age:
a) In men, the joints of the foot are predominantly affected, especially the big toe (arthritis of the big toe in 50% of cases is the first manifestation of gout; in general, it develops in more than 80% of patients).
b) Women at the onset of the disease more often develop oligo- and polyarthritis (apparently, this is due to age-related characteristics, since in women gout develops at an older age), the joints of the hands are more often affected.
c) In elderly people, a polyarticular variant of the onset of gouty arthritis is more often observed: damage to the joints of the upper extremities (including small joints of the hands), rapid development of tophi. The development of arthritis is often associated with the use of diuretics.
Interictal gout and recurrent gouty arthritis
— In the absence of treatment, a recurrent attack usually develops within 1 year in 62%, 2 years in 78% of patients.
- Characterized by a reduction in the duration of the asymptomatic period, attacks become more severe, affect new joints, and sometimes have a polyarticular migratory nature.
- Inflammation of periarticular tissues (ligaments, joint capsules), formation of single tophi in tissues, usually painless.
Chronic tophi gout
— Development of tophi (often multiple), chronic arthritis, kidney damage, urolithiasis.
a) subcutaneously or intradermally in the area of the fingers and toes, knee joints, elbows, ears, although tophi can form in almost any part of the body and in internal organs. In postmenopausal women, tophi are often located in the area of Heberden’s nodes.
b) Sometimes there is ulceration of the skin over the tophi with spontaneous release of the contents in the form of a pasty white mass.
— Early appearance of tophi is observed:
a) in some forms of juvenile gout;
- in elderly women taking diuretics;
- for myeloproliferative diseases;
- in some kidney diseases leading to severe hyperuricemia.
a) Determination of the serum level of uric acid - hyperuricemia is determined in the vast majority of patients. During an acute gouty attack, it has limited diagnostic value, since almost half of the patients have a normal level during this period.
b) Study of synovial fluid
— During an acute attack of gouty arthritis, the number of leukocytes (mainly neutrophils) increases to 10-20×10 9 /l.
— A more informative method for confirming the diagnosis is polarization microscopy of synovial fluid and other tissues (for example, tophi), which makes it possible to detect urate crystals (size 3-30 microns, characteristic needle-shaped shape, negative birefringence). However, the sensitivity and specificity of this test are low (high rates of false-positive and false-negative results) due to insufficient standardization of the method.
c) Biochemical study before prescribing antihyperuricemic therapy: general blood count, creatinine and glucose, liver tests.
d) Instrumental research:
X-ray of affected joints:
— the “punch” symptom is a typical, but late radiological phenomenon (X-ray negative intraosseous tophi);
- at the onset of the disease, nonspecific signs may appear;
- narrowing of the joint space, destruction of the articular surface.
To make a diagnosis, classification criteria developed by Wallace are used:
A. The presence of characteristic uric acid crystals in the joint fluid.
B. The presence of tophi, the content of uric acid crystals in which is confirmed chemically or by polarization microscopy.
B. Presence of 6 of the 12 signs listed below:
1. History of more than one attack of acute arthritis.
2. Joint inflammation reaches its maximum on the 1st day of illness.
4. Hyperemia of the skin over the affected joint.
5. Swelling and pain in the first metatarsophalangeal joint.
6. Unilateral lesion of the first metatarsophalangeal joint.
7. Unilateral damage to the joints of the foot.
8. Suspicion of tophi.
10. Asymmetric swelling of the joints.
11. Subcortical cysts without erosion (radiography).
12. Negative results from synovial fluid culture.
Six or more clinical criteria were present in 88% of patients with gout, <3% of patients with septic arthritis, and 11% of patients with pyrophosphate arthropathy.
Differential diagnosis of gouty arthritis should include:
- exacerbation of osteoarthritis (these diseases are often combined);
— Quick and safe relief of acute gouty arthritis.
— Prevention of relapses of arthritis and the development of complications associated with hyperuricemia.
— Prevention and treatment of concomitant diseases and complications of drug therapy.
a) Patient education:
- elimination of risk factors for exacerbation of arthritis: weight loss, avoidance of alcohol intake;
— detailed information about the nature of clinical manifestations in acute gouty arthritis and the consequences of uncontrolled hyperuricemia;
— the need for rapid relief of acute gouty arthritis (always have an effective NSAID with you);
- information about the side effects of drug therapy.
A low-calorie and low-carbohydrate diet with the inclusion of polyunsaturated fatty acids leads to a decrease in uric acid levels.
Treatment strategies for acute gouty arthritis and complications associated with hyperuricemia are different.
Treatment of acute gouty arthritis
— To relieve an acute attack of gout, NSAIDs, colchicine and GC are used (locally and systemically).
- Treatment should begin as early as possible, preferably within 24 hours of the onset of arthritis.
a) Non-steroidal anti-inflammatory drugs
In the absence of contraindications, the drug of choice is NSAIDs in full therapeutic doses: indomethacin (25-50 mg 4 times a day), naproxen (500 mg 2 times a day), diclofenac (25-50 mg 4 times a day), nimesulide (100 mg 2 times a day).
— Differences in effectiveness between NSAIDs have not been established.
- NSAIDs are more effective than colchicine in patients with long-term acute arthritis.
— In patients with cardiovascular risk factors, it is not recommended to use specific COX (cyclooxygenase)-2 inhibitors due to an increased risk of vascular complications.
— Colchicine is rarely used due to the high incidence of side effects (diarrhea, nausea).
— Colchicine should not be prescribed to patients with severe damage to the kidneys, gastrointestinal tract, or cardiovascular system, as the risk of severe side effects increases.
— Potential indications: ineffectiveness of NSAIDs or the presence of contraindications (for example, treatment with warfarin) for their use.
1. 0.5-0.6 mg po every hour until relief of arthritis or the appearance of side effects or until the maximum allowable dose is reached (6 mg) or on the 1st day 3 mg (1 mg 3 times after meals) , on the 2nd day 2 mg (1 mg in the morning and evening), and then 1 mg/day.
2. In some cases (especially with exacerbation of gout in the postoperative period), colchicine is used intravenously (no more than 3 mg in 10-20 ml of saline is administered over 10-20 minutes). IV administration of colchicine can lead to severe toxic reactions (myelosuppression, renal failure, intravascular hypercoagulation, hepatonecrosis, hypocalcemia, convulsions, heart failure).
3. To prevent exacerbations of arthritis at the beginning of antihyperuricemic therapy - 0.5-1.5 mg/day (elderly people and those with renal failure should be prescribed the minimum effective dose of colchicine).
— Combination therapy with colchicine and NSAIDs has no advantages over monotherapy.
— Used when there are contraindications for the use of NSAIDs and colchicine.
- If 1 or 2 joints are affected (with the exception of septic arthritis) - intra-articular administration of triamcinolone (40 mg in large joints, 5-20 mg in small joints), or methylprednisolone aceponate (40-80 mg in large joints, 20-40 mg in small joints) joints), or betamethasone (1.5-6 mg).
— In case of multiple joint damage, systemic administration of GCS:
1. prednisolone 40-60 mg po on the first day, followed by a dose reduction of 5 mg on each subsequent day - triamcinolone 60 mg intramuscularly or methylprednisolone 50-150 mg intravenously, if necessary, repeat the administration after 24 hours.
Antihyperuricemia therapy effectively prevents the recurrence of gouty arthritis and the development of complications associated with uncontrolled hyperuricemia.
The effectiveness of antihyperuricemic therapy is determined by normalization of the level of uric acid in the blood serum, a decrease in the frequency of gout attacks, resorption of tophi, and the absence of progression of urolithiasis.
— To prevent acute attacks of arthritis and severe adverse reactions, allopurinol therapy is started with a small dose (50 mg/day) and gradually increased until normouricemia is achieved (under monitoring uric acid levels every 2 weeks). With the correct dose of allopurinol, the decrease in uric acid levels should be no more than 10% of the initial level within a month.
— The effective dose of allopurinol varies widely (from 100 mg/day to 900 mg/day or more).
— Allopurinol at a dose of more than 300 mg/day is prescribed in several doses.
- When selecting the dose of allopurinol, the creatinine clearance should be taken into account (if the clearance decreases to less than 30 ml/min, the dose of allopurinol must be reduced).
- When allopurinol is discontinued, uric acid levels return to baseline within 3-4 days.
— Treatment with allopurinol is associated with the development of side effects (sometimes severe -5%) and should be carried out under strict supervision.
b) Uricosuric drugs
The angiotensin II receptor antagonist, losartan, has a certain uricosuric effect. Its use is especially advisable in patients with hyperuricemia induced by taking thiazide diuretics.
Hypouricemic therapy (allopurinol) is used only in patients receiving chemotherapy for malignant neoplasms.
In general, the prognosis for gouty arthritis is favorable, but urolithiasis develops in 20-50% of cases. The cause of death in 18-25% of gout patients is kidney failure.