Zabava-24.ru

Health of your feet

    • (Русский)
    • Home
    • Diagnostics
    • Gouty arthritis folk treatment

Gouty arthritis folk treatment

21 Jul 18

Home remedy for gouty arthritis

Gout is a metabolic disease; the amount of uric acid in the body increases, its salts disrupt the function of joints and kidneys. The pathology has long been known and well studied. The achievements of modern medicine and traditional folk recipes are available for the treatment of gouty arthritis.

No single cause can be identified for any metabolic disease. The combination of many unfavorable factors in lifestyle throws the body out of balance and forces you to consult a doctor. Gout factors:

  • Hereditary predisposition;
  • Excesses in nutrition: excess meat, rich broths, sausages, chocolate, strong tea, coffee, alcoholic beverages. Previously, gout was called “the disease of aristocrats” and was less common;
  • Taking medications - antihypertensives, diuretics, cytostatics;
  • Being male, overweight.
  • What happens with gout?

    1. Due to metabolic failure, the concentration of uric acid in the blood increases;
    2. Its salts in the form of microcrystals cover the hyaline cartilage of the joints;
    3. Urates irritate joint tissues - an acute inflammatory reaction begins (gouty arthritis);
    4. Long-term subacute inflammation involves surrounding tissues - changes in the bones (“punches” on an x-ray) and on the skin (tophi).

    How does gout manifest?

    The disease affects middle-aged men more often and more severely. In 90% of cases, the first manifestation is arthritis of one of the joints of the big toe. In the next exacerbation, gouty arthritis of the ankle joint or any other joint on the legs or arms develops. After hypothermia, a large holiday feast or physical activity, all signs of inflammation appear - redness, swelling, pain, the joint is hot to the touch. Severe pain forces the patient to consult a doctor.

    After examination by the doctor and examinations, the patient will hear the final diagnosis. Treatment of gout is divided into 2 sections:

    There is no need to hospitalize the patient. Exacerbation and chronic process can be treated at home. It takes a desire to get better and a lot of willpower; you have to give up something tasty.

    The basis of therapy is diet. Without it, treating gouty arthritis with medications makes no sense. For a long time you will have to forget about lamb and veal, sausages, rich meat broths, offal, some types of fish, and alcoholic beverages. Eat mushrooms, legumes, spinach, sorrel, rolled oats, radishes, cauliflower, tea and coffee less often. The list of permitted foods is wide enough to create a complete, satisfying menu for an adult man. It is important to drink enough fluids, including milk and alkaline mineral waters. Drink herbal or weak tea. Fruit drinks and rosehip decoction are welcome.

    During the period of exacerbation, the doctor will prescribe drugs that quickly relieve acute inflammatory syndrome - non-steroidal anti-inflammatory drugs, colchicine. Between gout attacks, you need to take medications that bind uric acid - allopurinol, febuxostat, probenecid. The exact name, dosage, timing of administration and date of control examination will be indicated by the doctor. If you do not neglect the doctor’s prescriptions, the attacks will become less frequent.

    Folk remedies against gout

    The experience of treatment with medicinal plants has accumulated over centuries; the disease has been affecting humans for more than a century. Folk remedies for gouty arthritis cannot be used without medical supervision and will not replace diet. They can only be part of complex therapy.

  • "Magic baths" Chamomile flowers (100g) are poured with hot water (10 liters) and table salt (20g) is added. Leave the mixture for 60 minutes, lower the sore leg there until the pain decreases.
  • “Cleansing joints with bay leaves.” Pour 5 grams of bay leaf into 300 ml of cold water, bring to a boil, and cook uncovered for 5 minutes or more. Remove the broth from the stove and wrap it in a towel, leave in this form for at least 3 hours. Drink the resulting drug within 24 hours. Use the recipe for a long time until complete recovery.
  • "Cold and Heat." Let's prepare 2 basins. In the first one we pour cold water (you can add ice cubes), in the second one we put the grains of a cereal plant and pour boiling water over them. The grains must soften, literally “breathe steam,” so that the joint can be immersed in an improvised grain bath. You need to put your foot in ice water for a few seconds, then in a bowl of warm grains. After warming up, wrap the foot in woolen material so that the heat is not lost quickly.
  • "Onion soup". 4 onions with skins are boiled in 2 liters of water until the onion is softened. You need to take 250 ml three times a day half an hour before meals for two weeks.
  • “The secret of mustard” is used as a treatment with folk remedies. Mix 1 teaspoon each of honey, mustard powder and baking soda to form a homogeneous paste. The mixture is applied to the steamed, sore joint (using the “Cold and Heat” or “Magic Baths” procedure). Wrap the top with plastic wrap and apply a tight bandage to make a compress. Leave it overnight. The course of treatment is 14 days in a row.
  • "Porous rice." 2 tablespoons of rice are washed with water, poured into a 500 ml jar, filled with cold water and left overnight. In the morning, the cereal is washed, brought to a boil, washed again and brought to a boil again. The manipulation is repeated 4-5 times. After the next wash, the rice should be eaten without adding salt or oil. After this, you should not take food or water for 4 hours. Before going to bed, take the “rice medicine” again. Thanks to repeated washing and boiling, starch is removed from the grains, and the structure of rice becomes cellular, reminiscent of a honeycomb. Porous rice, like a sponge, absorbs all waste and toxins, uric acid. Therefore, it is useful as a detoxifier, for example in preparation for a diet.
  • The recipes do not require complex technologies or foreign ingredients - everything for treatment at home is in the kitchen of every housewife.

    Gout can be cured or can reach a point where it flares up every few years. The body suffers even when the joints do not hurt - uric acid also affects the kidneys. The diet should be followed constantly. A rheumatologist will tell you in detail how to treat gouty arthritis; each case must be considered individually.

    Gouty arthritis (gout)

    Gouty arthritis is one of the main manifestations of gout, which is caused by a violation of the metabolism of purine bases.

    In addition to chronic arthritis, gout is characterized by kidney damage.

    The disease was most often recorded in men aged 40-50 years and in women over 60 years of age (after menopause), while women get sick 2-7 times less often than men.

    Main causes and forms of the disease ^

    Gout can develop:

  • primarily as a result of hereditary predisposition in combination with increased consumption of purines in food;
  • secondary – hyperuricemia resulting from a number of diseases or taking certain medications: neoplasms, hematological malignancies, heart failure, kidney disease, metabolic and hormonal pathologies, the use of diuretics, cytostatics, etc.
  • Photo: gout on the big toe

    The essence of the disease is a violation of the metabolism of uric acid.

    As a result, urate crystals are deposited in the periarticular tissues and the joint itself, which cause arthritis.

    There is also excessive formation of urate stones in the pelvis and ureters, and the development of interstitial nephritis.

    Photo: urate deposition in gout

    There are three possible mechanisms for increasing urate in the body:

  • increase in their synthesis (metabolic);
  • decreased excretion in urine (renal);
  • moderate increase in synthesis and decrease in excretion (mixed).
  • All of the mechanisms of metabolic disorders described above may be involved in the development of gouty arthritis.

    Joint damage due to gout occurs in the form of gouty arthritis with an acute course (in most cases monoarthritis) and the development of chronic polyarthritis.

    Along with joint damage, kidney damage occurs:

  • urolithiasis disease;
  • "gouty kidney";
  • diffuse glomerulonephritis;
  • interstitial nephritis.
  • Photo: urate kidney stones

    Big toe lesion, acute gouty arthritis

    Gouty arthritis in most cases manifests itself in the form of an acute attack in the midst of complete health.

    An attack can be triggered by:

  • hypothermia;
  • long walking;
  • injury;
  • infections;
  • abuse of fatty meat foods and alcohol.
  • The disease begins suddenly, often at night, and manifests itself:

  • sharp pain in the metatarsophalangeal joint of the 1st toe, which sharply intensifies when lowering the limb;
  • at the peak of pain - fever up to 38-39 degrees;
  • swelling and bluish-purple color of the joint.
  • The duration of the attack ranges from 3 to 10 days.

    When the inflammatory process subsides, the pain disappears, the joint restores its function and acquires a healthy appearance.

    Over time, the duration of periods between attacks decreases, and the duration of attacks increases.

    Other joints are involved in the inflammatory process, so after a few years from the onset of the disease, patients notice deformation (curvature) of the joints and limited mobility.

    Damage to the knee joint, ankle joint, hip joint, and foot joints occurs over a long period of time.

    Their deformation occurs, mobility is limited, subluxations and contractures appear, movements are accompanied by a rough crunching sound.

    A change in the appearance of the limb is observed due to bone growths and nodular deposits.

    Photo: view of the joint of the big toe with chronic gout

    Damage to the hands and fingers

    With the development of gouty arthritis in the upper extremities, differential diagnosis with other joint diseases: rheumatoid arthritis, osteoarthritis, gout, etc. becomes significantly more complicated.

    Photo: gouty arthritis of the fingers

    Patients lose their ability to work and their ability to care independently.

    Synovitis of the knee joint - what is it? Read here.

    Laboratory diagnostics

    During a blood test the following is noted:

  • increase in ESR;
  • neutrophilic leukocytosis;
  • increased levels of fibrinogen and alpha-2-globulin;
  • appearance of C-reactive protein.
  • These signs appear during an attack and disappear completely after the attack is stopped.

    The following diagnostic criteria are most typical for the gouty process:

  • hyperuricemia - an increase in the level of uric acid in the blood in men more than 0.42 mmol/l and more than 0.36 mmol/l in women;
  • the presence of tophi (gouty nodules);
  • the presence of urate crystals in the intra-articular fluid or periarticular tissues;
  • a history of acute arthritis and severe pain that began suddenly and disappeared on its own after 1-2 days.
  • An x-ray can reveal changes that have developed as a result of a severe course of the disease over a long period of time when it began at a young age.

    The most typical changes on an x-ray image:

  • rounded “stamped” defects of the end sections of bones (epiphyses) with a sclerotic border;
  • brush-shaped defects in the cortical layers of bones;
  • expansion of the shadow of the soft tissue components of the joint due to the deposition of urates in them.
  • Photo: gouty arthritis in the picture

    How to treat gouty arthritis (gout)? ^

    Therapy for gouty arthritis has the following goals:

  • normalization of purine metabolism in the body;
  • relief of acute arthritis;
  • restoration of the function of affected internal organs and treatment of chronic gouty polyarthritis.
  • You can normalize your metabolism with:

  • normalization of nutrition;
  • long-term use of drugs that reduce urate synthesis;
  • eliminating the causes of hyperuricemia.
  • People who are overweight need to lose weight, as there is a connection with excess weight, increased urate synthesis and decreased urate excretion by the kidneys.

    A number of patients with gouty arthritis have arterial hypertension.

    You should be aware that the use of thiazide diuretics (a group of drugs to lower blood pressure) increases the amount of uric acid in the body. The urate content also increases when taking acetylsalicylic acid (aspirin).

    Consequently, an attack of gouty arthritis can be provoked by these drugs.

    It is very important to follow a special diet:

  • Avoid alcohol completely. When taking it, hyperuricemia develops, since the end product of ethyl alcohol metabolism (lactic acid) slows down the excretion of uric acid salts by the kidneys.
  • Limit consumption of fish, meat, legumes.
  • Take at least 1.5 liters of liquid per day.
  • In most cases, normalizing nutrition is sufficient to reduce uricemia and prevent arthritis attacks.

    But some patients need to be prescribed medications that normalize metabolism and avoid arterial hypertension, kidney damage, and urolithiasis.

    Drug therapy

    To correctly prescribe drug treatment, it is necessary to know the mechanism of increased uricemia.

    When the synthesis of uric acid increases, anti-gout treatment involves the appointment of antagonists of purine production; if their excretion is impaired, uricosuric drugs are prescribed.

    Uricosuric drugs - anturan - increase the excretion of uric acid by suppressing its reabsorption in the tubules of the nephrons of the kidneys.

    During treatment with drugs of this group, it is necessary to increase daily water intake to 2-3 liters.

    Allopurinol is used to reduce purine synthesis.

    The drug is especially indicated for patients with uricemia more than 0.6 mmol/l; in the presence of tophi, renal failure, etc.

    The use of the above drugs is possible only after complete relief of the phenomenon of acute arthritis: against the background of subsiding inflammation, their use can provoke a serious exacerbation.

    A break in treatment leads to recurrence of the disease.

    Acute gouty arthritis is also treated with colchicine at a dose of 0.5 mg.

    The drug is applied every hour until the symptoms of arthritis decrease. The total daily dose of the drug should not exceed 8 mg.

    The positive effect occurs within 24 hours.

    Another group of drugs used to treat gouty arthritis are anti-inflammatory drugs.

    The most effective in this case are indomethacin, nimesulide, voltaren, which must be taken in maximum doses.

    For unbearable pain, glucocorticosteroids are used: intra-articular administration of metipred, depomedrol, kenalog, diprospan is used.

    Gymnastics and sanatorium treatment

    Restoring joint function in chronic gouty arthritis is achieved through physical therapy and balneotherapy.

    In sanatoriums, patients are prescribed sulfide and radioactive baths and mud applications on sore joints.

    To prevent exacerbations, anti-inflammatory drugs should be taken in the first week of spa treatment.

    Physiotherapy and hardware treatment

    Physiotherapy can be used in the acute period and after the inflammation has subsided.

    CUV rays and SUV rays on a sore joint and acupuncture have a good analgesic effect.

    In addition, high-frequency therapy is used on the area of ​​the affected joint and on the area of ​​the adrenal glands (to stimulate the synthesis of anti-inflammatory hormones), phototherapy, and laser treatment.

    Treatment at home with folk remedies

    Fans of alternative medicine:

  • apply onion decoction topically;
  • apply finely chopped pieces of lard or a paste of flax seeds and activated carbon;
  • make a compress from fish;
  • use iodine rubbing and iodine baths;
  • use a decoction of string and sage baths.
  • Video: treatment of gout with folk remedies

    Prognosis for the patient ^

    The prognosis is relatively favorable if all treatment conditions are met.

    Loss of joint function is possible only in rare cases.

    The prognosis becomes unfavorable with the development of renal complications.

    Looking for information about whether infectious arthritis occurs in children? Read about it here.

    How to treat heel spurs? Find out here.

    Preventive measures mainly include normalization of diet and avoidance of alcoholic beverages.

    These conditions especially apply to people with a family history

    Frequently asked questions^

    What can contribute to an exacerbation?

    An exacerbation can be triggered by poor eating habits (consumption of alcohol, meat, spicy foods, strong coffee or tea), joint injury, or prolonged stress on the legs.

    Gout is treated by several specialists: a therapist, a rheumatologist, a physiotherapist, a rehabilitation specialist, and a reflexologist.

    Is there any disability for this disease?

    In case of persistent impairment of joint function, a disability group is indicated.

    Video: symptoms and treatment of gout

    Did you like the article? Subscribe to site updates via RSS, or follow updates on VKontakte, Odnoklassniki, Facebook, Google Plus, My World or Twitter.

    Tell your friends! Share this article with your friends on your favorite social network using the buttons in the panel on the left. Thank you!

    Gouty arthritis folk treatment

    Gouty arthritis is a clinical manifestation of gout - deposits of uric acid salts in joints, bones, tendons, cartilage and other components of the human body. The disease occurs due to improper metabolism and is accompanied by attacks of acute, often night, pain. Symptoms are sudden acute pain, swelling of the affected joint, local redness of the skin, chills and a sharp increase in body temperature.

    As a rule, by the morning the pain stops, the temperature drops, and at night all unpleasant manifestations are noted again. After a few days, the attack passes, only to be repeated at irregular intervals - from two to three days to several years.

    Unfortunately, the question of how to treat gouty arthritis is asked by most patients at a time when changes occur in the body that require immediate appropriate therapy.

    In the treatment of gout there are:

  • therapy for an acute attack of gouty arthritis, which must be effective and efficient;
  • measures taken during the interictal period, ensuring gradual normalization of the level of uric acid in the body.
  • At any stage of the disease, the prescription of dietary (therapeutic) nutrition becomes an obligatory component of treatment. The diet for gout involves a reduced intake of animal lipids and proteins into the body with a normal or slightly increased amount of carbohydrates.

    The patient must receive a sufficient amount of fluid, alkaline mineral waters, tea, fruit drinks - maintaining the water-drinking regime at a normal level ensures the removal of metabolic products of purine bases from the body, and not their deposition in tissues, especially in the kidney tubules.

    Any offal, fatty lamb, legumes, wine, tea, coffee, spinach, sorrel, and any greens that increase the amount of purine bases in the blood serum are excluded from the diet of patients.

    Questions about drug treatment for gout at any stage should be discussed with your doctor.

    With this disease, some non-steroidal anti-inflammatory drugs are also undesirable - some of the drugs in this clinical group, for example, aspirin and any drugs that contain acetylsalicylic acid, can themselves cause an exacerbation of gout.

    However, to relieve a painful attack, non-narcotic and narcotic analgesics can be prescribed, and steroid hormones can be prescribed in short courses to suppress inflammation, but their dose must be selected by a doctor. If a patient is diagnosed with gouty arthritis, treatment with folk remedies helps slow down the progression of changes in tissues.

    For the treatment of gout using folk methods, both extracts from plants that directly affect the metabolism of purine bases (colchicine) and herbs that have anti-inflammatory, anti-edematous and antipyretic effects can be used - decoctions and infusions, which include aspen, alder, cornflower, mother and -stepmother.

    Physiotherapy for shoulder arthritis link here

    One effective treatment for active gout flares is colchicine. This medication may be effective if prescribed at the onset of gout attacks. However, the drug can cause a number of side effects: nausea, vomiting, diarrhea and other similar symptoms. Side effects are less common when the drug is administered intravenously. However, since the drug has a very high activity, it can have a strong irritant effect on the skin and veins. To minimize the effects of the drug, intravenous injection of the solution is carried out at a minimum rate of drug administration. The drug is always administered under the supervision of a doctor. The administration of the drug may take several minutes, and this is considered normal.

    If colchicine does not significantly improve the patient's well-being and causes severe side effects for gout, the doctor may prescribe treatment with nonsteroidal painkillers (NSAIDs). This group of drugs includes aspirin, as a medicine that reduces inflammation and relieves pain. Indomethacin (Indocin) and naproxen (Naprosyn), which are given intravenously for the most severe attacks of gout.

    In medical practice today there are no statistics on which drugs are most effective for gout. High doses of short-acting NSAIDs provide the fastest results in relieving pain symptoms. However, these medications may cause side effects such as upset stomach, skin rash, or diarrhea. If the drugs are prescribed in the short term, they are often well tolerated by most patients.

    But some people cannot use NSAIDs due to chronic conditions such as stomach disease or various kidney problems. For these patients, doctors prescribe injections of corticosteroids such as prednisone and triamcinolone. Injections are given into the muscle and are considered a very effective treatment for gout. If, during an exacerbation of the disease, 1-2 joints become inflamed in a patient, the doctor may prescribe the use of corticosteroids directly to the affected joints.

    In particularly difficult cases of the disease, the doctor may prescribe Anakinra (Kineret) injections. Although the drug is not approved for use in rheumatoid arthritis, it is actively prescribed by doctors to treat gout and can quickly relieve symptoms of the disease in some patients.

    So let's figure out how to remove excess uric acid

    Patients who have frequent gout attacks due to abnormally high levels of uric acid in their blood need injections to lower their blood acid levels. These drugs do not eliminate pain, so they should be prescribed after the acute course of the disease.

    The drug most often prescribed to patients with gout is allopurinol (Lopurin, Zyloprim). It blocks the production of uric acid. Recently, an analogue of the drug appeared on the shelves of pharmacies - Febuxostat (Uloric). No less effective is the drug Probenecid (Benemid), which helps the kidneys remove uric acid.

    Pegloticase Krystexxa, which is administered to patients by injection, is considered an effective drug. It changes the composition of uric acid and neutralizes its harmful effects. The drug is specially designed for patients who do not respond to other types of treatment or cannot tolerate their side effects. Today, a huge number of new drugs designed to reduce the level of uric acid in the blood and to treat gout inflammation are under development.

    If the patient is taking medications that reduce the concentration of uric acid in the blood, the doctor should regularly increase their doses and closely monitor the patient's well-being. As soon as the level of uric acid drops below 6 mg per 1 kg of body weight (to normal values), the dissolution of crystalline deposits on the joints begins, and the well-being of patients significantly improves. For many patients, the fight against the disease is drawn out over the long term and is aimed at preventing gout attacks.

    Drugs that work well for one person are often ineffective for another. Therefore, this leads to a decision about when to start treatment and which drugs are most suitable in each individual case. They are different for all patients and can only be prescribed by a doctor. Treatment choices depend on kidney function, existing health problems, personal preferences, and other factors.

    What you eat can increase your uric acid levels. Therefore, patients with gout should limit themselves to foods high in fructose and soda. In addition, exclude alcohol from your diet, especially beer. Limit the consumption of foods that are rich in purine and which, when they enter the blood, break down into uric acid and other not entirely useful components. High purine content is present in meat and some types of seafood. There is a lot of purine in some vegetables. Low-fat dairy products can help lower uric acid levels.

    In almost all cases, gout can be successfully treated and flare-ups gradually cease. Treatment can also reduce the number and size of gouty tophi, which are areas of abnormal thickening of the subcutaneous tissue.

    Folk remedies

  • Regular consumption of carrots can fight the disease. The daily norm is 100 g of grated carrots and one dessert spoon of vegetable oil.
  • Drink 50 ml of garlic and lemon tincture 3 times a day. To do this, you will need to chop 4 citrus fruits and 3 heads of garlic with a blender or meat grinder. Pour the resulting mixture into seven glasses of boiling water and let it brew for a day.
  • Hot pepper can improve immunity to fight the disease. Need 10 pcs. pour 350 ml of water and boil for about 10 minutes. Infusion time: 5 hours. After which the infusion is filtered and honey is added in a 1:1 ratio.
  • A decoction will help: you need to take 20 g of pansies (dry), pour one glass of strong boiling water and let it simmer. After 15 minutes, the broth will infuse. It is filtered and diluted with drinking water.
  • All infusions and decoctions are drunk according to Art. l. 2-3 times during the day.

    It is quite possible to cure gouty arthritis, but you cannot do it with pills alone. An integrated approach to the problem is very important: in addition to drug treatment, perform ultraviolet irradiation of the joints, physical therapy or massage. The most important requirement is compliance with the diet.

    By eliminating unhealthy foods, as well as alcohol, you should enrich your diet with dairy and plant products. It is very important to remember about the water regime. The recommended amount is 2.5 liters of alkaline mineral water.

    By following simple recommendations, you can easily stop the inflammatory process and stop the degradation of the damaged joint.

    Gouty arthritis

    Gouty arthritis is one of the types of arthritic lesions of the joints of the human musculoskeletal system, the development of which is mainly provoked by impaired metabolism of purine substances in the body. Statistics show that about 2% of the entire world population suffers from a similar disease.

    Although gout was once considered the “disease of kings,” today the disease is widespread. The development of the disease has a long-term chronic nature with intervals of remission.

    Arthritis of gouty origin is often diagnosed in males over 25 years of age. Women are 5 times less likely to encounter this disease and get sick between the ages of 45 and 60 years, after menopause.

    As a rule, gouty arthritis is localized in the area of ​​the following joints:

  • First metatarsophalangeal joint of the foot (other phalangeal joints);
  • Joints of the fingers;
  • Ankle joint;
  • Knee;
  • Radiocarpal;
  • Elbow.
  • Pathogenesis is explained by these processes:

  • Disruption of metabolic processes leads to an increase in the content of uric acid in the blood;
  • Crystallized components of uric acid (urate) accumulate on the surface of the cartilage shell of the joint;
  • The body reacts to such a process with an inflammatory reaction (arthritis);
  • The damage affects other articular fragments: erosion of cartilage and bones occurs, the affected areas of which are filled with urates;
  • Inflammation spreads to the periarticular soft tissues;
  • Tophi accumulations of urates form in the form of gouty nodes in the area of ​​the affected joint under the skin.
  • Gouty arthritis significantly reduces the patient’s standard of living, and in some cases leads to loss of performance and disability.

    In the International Classification of Diseases, the ICD 10 code for gouty arthritis is numbered M10.

    Depending on the course of the disease, the following periods are distinguished:

  • Latent period (there are no symptoms, the disease can be identified by conducting a blood test to determine hyperuricemia - increased urate levels);
  • Acute gouty arthritis (the period is characterized by the onset of acute attacks of arthritic pain, an attack can occur once a week, month or year);
  • Chronic period (an acute attack is followed by a long period of remission).
  • Depending on the nature of the development of the disease, the following types of disease are distinguished:

  • Primary gouty arthritis (develops due to heredity and poor nutrition);
  • Secondary (gouty arthritis is provoked by concomitant diseases and medications).
  • The following factors provoke the development of gouty arthritis:

  • Genetic predisposition;
  • Excessive diet (abuse of foods rich in purine substances, such as meat, sausages, alcohol, chocolate, legumes);
  • Disturbed metabolic processes;
  • Concomitant diseases (for example, diseases of the cardiovascular system, renal failure, hormonal imbalance);
  • Long-term use of certain medications (hypertension medications, diuretics, cytostatics, aspirin, ethambutol).
  • The disease can occur in a latent form, in which the symptoms of acute arthritis do not appear until certain factors provoke an attack of gouty pain.

    The following factors can trigger an attack of arthritis:

  • Physical fatigue;
  • Injury received;
  • Infectious lesion of the body;
  • Stress;
  • Hypothermia;
  • Overeating (especially before bedtime or large consumption of prohibited foods for gout);
  • Prolonged fasting.
  • An attack of gouty arthritis has typical symptoms, which makes it easy and timely to diagnose.

    Gouty arthritis symptoms:

  • The attack develops acutely and rapidly (most often at night, awakening the patient);
  • High intensity pain is usually felt in the area of ​​the first metatarsophalangeal joint;
  • A local and general increase in temperature can be observed;
  • The skin in the affected area turns red and becomes hypersensitive to touch;
  • Swelling of the joint occurs;
  • The attack lasts from 1-2 to 7 days, then a state of remission occurs.
  • The first attack of gouty arthritis can last several days, then the duration of each subsequent attack only increases, and the duration of periods of remission becomes shorter.

    A qualified rheumatologist will help you establish a diagnosis of gouty arthritis, symptoms and treatment.

    Diagnosis of gouty arthritis involves the following studies:

  • Blood chemistry:
  • Determination of leukocyte level (increased);
  • ESR (erythrocyte sedimentation rate increased);
  • Uric acid level (urate content is increased: in men - above 460 μM/l, in women - above 330 μM/l);
    1. Complete blood count (examination of urate levels in urine);
    2. Rheumatoid tests (high levels of C-reactive protein, presence of rheumatoid factor);
    3. Puncture with examination of the synovial fluid of the joint;
    4. Ultrasound of the kidneys;
    5. Radiography.
    6. Provides treatment for gouty arthritis with complex therapy.

      Treatment is based on the following methods:

    7. Drug treatment;
    8. Treatment with folk remedies;
    9. Diet food;
    10. Physiotherapy;
    11. Exercise therapy and massage.
    12. Drug therapy

      The use of medications helps achieve the following goals:

    13. Relieving an acute attack of arthritis and eliminating the symptoms of the inflammatory process;
    14. Reducing the level of uric acid in the blood;
    15. Eliminating the causes of hyperuricemia by normalizing metabolic processes;
    16. Restoring the natural functions of the joint.
    17. Since the cause of the development of gouty arthritis is an increase in the concentration of urate in the blood, the basis of treatment is medications that remove uric acid from the body (uricosuric drugs) and drugs that suppress excessive production of urate (uricodepressants).

      The following drugs are used to treat hyperuricemia:

      • Allopurinol or a similar drug Zilorik (has a uricodepressive effect);
      • Probenecid, sulfinpyrazone, etebenecid, anturan (has a uricosuric effect);
      • Uricozyme (the drug actively affects crystallized accumulations of urates, destroys them and removes them from the body through urine).
      • Allopurinol is one of the most effective drugs used to treat hyperuricemia. This medication is contraindicated during an acute attack of gouty arthritis.

        Indications for prescribing allopurinol are the following factors:

      • High concentration of urates in the blood;
      • Regular attacks of acute gouty arthritis;
      • Formation of tophi nodes under the skin;
      • Development of renal failure.
      • The use of medication is strictly discussed with the treating specialist. The initial daily dosage is 300 mg of the drug per day, then, if the course of therapy does not have a positive result, the dose is increased to 400-600 mg per day.

        Treatment of an acute attack

        The following medications are used to relieve an acute attack of gouty arthritis:

      • Nonsteroidal anti-inflammatory drugs (NSAIDs relieve pain and inflammation):
      • Indomethacin;
      • Ibuprofen;
      • Movalis;
      • Revmoxicam.
      • The drug colchicine (a specific drug used for gouty type of arthritis);
      • Local agents for external use:
        • Indomethacin ointment;
        • Dolobene;
        • Remisid.
        • Lotions and compresses using alcohol or 25% dimexide.
        • Treatment of gouty arthritis with folk remedies:

        • Infusion of chamomile flowers (pour 100 g of the plant into 10 liters of water and add 20 g of salt, infuse, use as a bath for damaged limbs);
        • Tincture of fir cones (pour 300 g of boiling water over a young cone with seeds, leave overnight, take 3 times a day half an hour before meals);
        • A decoction of red madder roots (pour 1 tsp of the plant into 200 g of boiled water, leave or boil in a water bath for about 10 minutes, take 100 g 2 times a day);
        • Salt compress (add water to 0.5 kg of salt, mix until a thick paste forms, put on fire so that the water evaporates, then add 200 g of medical Vaseline or chicken fat, apply as a compress, applying to the sore area, fixing with a warm bandage) ;
        • Valerian solution (3 packs of pharmaceutical valerian tablets, pour 200 g of triple cologne, leave overnight, then use as a compress, apply the solution to the sore spot, cover with plastic, wrap in a warm scarf).
        • From the following video you can learn more information about the treatment of gouty arthritis:

          Treating gouty arthritis at home

          The joint swells and the skin becomes bright red or purple in appearance and hot to the touch. Touching the sore spot and trying to move is very painful. In the initial stages of arthritis, the attack lasts for several days and then disappears, as if it never happened. Remission may occur within a few weeks, months or days. As time passes, the intervals between attacks decrease and if adequate treatment is not available, the disease will enter the chronic stage.

          Proper nutrition is the path to recovery

          Just a hundred years ago, gouty arthritis was considered a purely male disease. It was also called the disease of aristocrats, because it most often affected rich people. In addition, male sex hormones have a strong influence on uric acid levels. It began to affect women only recently, apparently due to the fact that they began to eat better and eat more meat and sausages. And also due to taking certain medications. It has been noted that drugs to lower blood pressure cause increased concentrations of uric acid in the body.

          To overcome gouty arthritis, treatment with folk remedies must be combined with dietary nutrition. This is considered the main point that guarantees a complete cure. Moreover, it is necessary to maintain the diet for a long time, for a year or even more.

        • Apples and their juice are good for reducing uric acid levels . This is also facilitated by carrots, from which puree is prepared with a small addition of sunflower oil. It must be eaten 100 grams daily. Watermelon and currant fruits have a similar effect.
        • A composition of lemon and garlic has been successfully used as an effective folk remedy for gouty arthritis For preparation, take several lemons and large heads of garlic. The seeds are removed from the lemons, and the pulp and peel are ground together with the garlic. Pour the mixture with 1.5 liters of boiling water and leave for 24 hours. Then strain the infusion and take 50 ml three times a day.
        • Another folk remedy is hot peppers. You need to take 10 medium-sized pods, add 300 ml of water and boil for 10 minutes over low heat. Leave for at least 6 hours, then strain and add the same amount of honey. Take one teaspoon in the morning and evening.
        • You can supplement the treatment with a decoction of onions . For one liter of water, take three onions, which must be simmered over low heat until they are softened. Then strain the broth and take a glass three times a day for two weeks.
        • Treatment of gouty arthritis with herbs

        • An effective folk remedy in the fight against gouty arthritis is celandine . It is used as an infusion, rubbing and for bathing. For the infusion, take a spoonful of chopped herbs and pour a glass of boiling water. Infuse for an hour, then strain. For treatment, you need to take 2 tablespoons three times a day. Fresh herbs can be used to rub the affected joints. For a bath, you need to take 100 grams of herb per 10 liters of water, boil for 30 minutes and add to the bath water.
        • To relieve acute pain, you can use a bath with chamomile and regular table salt. Brew 100 grams of chamomile in 10 liters, leave, dissolve 200 grams of salt, add to bath water.
        • sage infusion can be considered a good remedy for the treatment of gouty arthritis . For 6 liters of water you need two pharmaceutical packages of herbs. Brew, cool part and steam the legs, and keep the other hot constantly and periodically add small quantities.
        • For rubbing, you can prepare an infusion of black henbane : leave 1 part of fresh leaves and 10 parts of vodka for two weeks.
        • For oral administration, traditional medicine recommends a decoction of field steelhead . It is prepared in a water bath; 30 grams of dry herb are needed per liter of water. Boil for half an hour, cool, bring to the original volume. Take 50 ml before meals, the course of treatment is 4 weeks. You can remove salts from the body using regular unsalted pork lard . For periodic pain, apply pieces of lard to the sore joints. If the pain is constant, apply thin pieces to the sore spots and secure with a bandage. Leave the compress overnight. This treatment gives quick and effective results.
        • It is also quite unusual to treat gouty arthritis using fillets of any fish. You will need two kg, which are divided into 10 equal parts and frozen. Every evening before going to bed, make a compress at night, after defrosting the fillet. It is good to insulate and leave overnight. As a rule, after a 10-day course of treatment, the pain goes away.

          Gouty arthritis - causes, symptoms and principles of complex treatment

          One type of chronic joint disease is gouty arthritis. The pathology is caused by the accumulation of large quantities of uric acid, more specifically, crystals of this acid are localized in the articular structures, having a detrimental effect on the periarticular tissues and hyaline cartilage.

          Causes of gouty arthritis

          Most often, the disease in question is diagnosed in males aged 40-50 years, but in women, gouty arthritis is rare and only after 60 years. The pathology often occurs in men 25-50 years old - this age “dispersion” is associated with a direct connection between gouty arthritis and male hormones, which can either be actively produced or be in normal quantities. That is why doctors include women during menopause at risk for gouty arthritis. Please note: it is extremely rare that gouty arthritis is diagnosed in childhood - in this case, we will be talking about a genetic predisposition. Modern medicine cannot name specific reasons for the development of the disease in question - the etiology of gouty arthritis is not fully understood. But the factors that can provoke gouty arthritis are known for certain. These include :

        • genetic predisposition;
        • violation of the diet - we are talking about excessive consumption of meat, sausages, coffee, chocolate. Previously, gouty arthritis was generally called a disease of aristocrats based on the list of foods that should be consumed in limited quantities;
        • a long period of taking certain medications for medical reasons or on their own - for example, diuretics, drugs against high blood pressure, cytostatics and others can provoke the development of the disease in question.

        Gouty arthritis can also occur as a secondary disease - it is often diagnosed against the background of kidney disease, heart failure, and hormonal imbalances. Please note: the deposition of uric acid crystals can be completely asymptomatic for a long time, but even with a small “push”, gouty arthritis will manifest itself very intensely. Such a “push” can be an infectious disease, stress, severe physical fatigue, forced starvation, and more.

        Symptoms of gouty arthritis

        The disease in question goes through three periods in its course, each of which has its own distinctive features.

        Gouty arthritis is completely asymptomatic, nothing bothers the patient, and no manifestations of any pathology are observed at all. During this period, the disease in question can only be identified through a laboratory blood test - it reveals a high content of uric acid.

        This may be the primary manifestation of a gouty nature, or another relapse of a chronic form of pathology.

        Gouty arthritis has already been diagnosed, is actively progressing, but is characterized by long-term remissions with the subsidence of all the characteristic symptoms for the disease in question. In general, the clinical picture of gouty arthritis is pronounced, so doctors have no problems with diagnosis. The main symptoms include :

      • acute pain in the joint of the big toe of the lower limb;
      • swelling of the affected joint and hyperemia of the skin in this place;
      • when moving the affected joint, the pain intensifies significantly;
      • body temperature rises in the absence of signs of colds or any chronic inflammatory/infectious diseases;
      • Tophi begin to appear around the joints - these are subcutaneous growths of a whitish color;
      • periodically appearing pain in other, small and large, joints.
      • It is worth clarifying that gouty arthritis differs in the manifestation of the process - first of all, the joint of the big toe on the left or right foot is affected, which is observed in 90% of cases. And if no therapeutic measures are taken during this period, then the progression of the pathological process in question is guaranteed. If the inflammatory process has been going on for a long time without proper treatment, then “punches” form in the bones that are directly adjacent to the affected joint. These are cavities that are filled with monosodium urate crystals. The next step in the progression of gouty arthritis is tophi (subcutaneous growths), which severely deform the leg and can lead to disability of the patient. Please note: in women, gouty arthritis is much easier; characteristic cavities with accumulation of sodium monourate crystals and whitish subcutaneous growths are formed extremely rarely. By the way, it is these factors that provoke erroneous diagnosis - doctors can confuse gouty arthritis and arthrosis. Acute attacks of the gouty process, which are always accompanied by severe pain in the affected joints, occur quite often - from 1 time per week to 1-2 times per month or year.

        Diagnostic measures

        To diagnose gouty arthritis, doctors prescribe the patient a full examination of the entire body. But first of all, joint fluid is taken from the affected joint - sodium urate crystals will be detected in it. In some cases, synovial fluid for laboratory testing is taken even from a healthy joint or from a tophi - this is allowed as part of the diagnosis, the results will be accurate. At the same time, blood is taken for laboratory testing - an increased amount of uric acid will be detected in it. But even in combination with the presence of sodium urate crystals in the synovial (joint) fluid, this research result does not give the right to immediately diagnose gouty arthritis. For many people, such examination results will only indicate a violation of purine metabolism. If the disease in question has been going on for a long period of time, then it makes sense to order an X-ray examination - characteristic changes in the joints will be noticeable. These include, for example, destruction of cartilage, “punches,” and defects in the end sections of bones.

        Treatment of gouty arthritis

        The disease in question can only be treated with complex therapy - it is impossible to take medications and refuse nutritional correction; traditional medicine also has a good effect. There is only one thing that is certain – visiting a doctor at the first symptoms of gouty arthritis increases the chances of complete relief from the pathology significantly.

        Drug treatment

        At times of exacerbation of chronic gouty arthritis, it is advisable to undergo drug therapy. And doctors make the following prescriptions :

      • Non-steroidal anti-inflammatory drugs - ibuprofen (as substitutes can be imet or nurofen), indomethacin, rheumoxicam, movalis. The listed medications are considered the most effective during acute attacks of gouty arthritis. Moreover, doctors first prescribe them in the form of injections (this way the effect is faster and more complete), and then gradually transfer the patient to using the same drugs, but in tablet form.
      • A specific anti-inflammatory drug used specifically for gout is colchicine.
      • Ointments based on non-steroidal anti-inflammatory drugs - remisid, deep relief, indomethacin. These ointments are intended for application to the skin over the joint affected by the inflammatory process.
      • Compresses/lotions made on the basis of dimexide (25% solution) or a regular semi-alcohol solution (alcohol is diluted with water in a 1:1 ratio).
      • Physiotherapeutic procedures. They are prescribed against the background of the subsidence of an acute attack of gouty arthritis - magnetic therapy, laser therapy, paraffin baths and more.
      • But even if the disease in question occurs in a latent form, or the chronic process is in remission, then taking medications should under no circumstances be stopped! Doctors simply make other prescriptions, adjust the treatment regimen - for example, prescribe medications that reduce the synthesis of urates. To get rid of any pathological process, it is necessary to eliminate the cause - the same applies to gouty arthritis. This means that it is necessary to get rid of excess uric acid in the body. To do this, make the following appointments :

      • uricozyme - it acts directly on already formed urate crystals, destroying their structure;
      • allopurinol - actively reduces the amount of uric acid secreted by the body. Doctors can also prescribe an analogue of this drug – Zylorik;
      • probenecid – removes excess uric acid crystals.
      • Allopurinol is of greatest importance in the treatment of gouty arthritis - it is prescribed in the case of high levels of uric acid in the blood, with developing renal failure, in the case of already formed tophi. You need to know that after taking this drug in the first 5-7 days, all the characteristic symptoms of gouty arthritis can become greatly aggravated, and that is why it is advisable to take allopurinol simultaneously with anti-inflammatory non-steroidal drugs. Please note: allopurinol is never used as a pain reliever if it is the first time an attack of gouty arthritis has occurred. During treatment with this drug, an allergic reaction such as a skin rash may occur. Probenecid and uricozyme are never prescribed for progressive renal failure, too high levels of uric acid in the blood. A contraindication to the use of these groups of drugs is previously diagnosed peptic ulcer of the stomach and/or duodenum. Please note: during treatment with all of the above medications, you must drink a large amount of water - at least 2.5 liters per day. Patients should understand that treatment for gouty arthritis will be long-term; they will definitely need to follow a diet and undergo monthly tests to monitor the level of uric acid in the body. If the dynamics of the disease in question are positive, then patients can supplement the main therapy with physical therapy, massages and physiotherapy.

        Diet for gouty arthritis

        If the patient ignores the nutritionist’s prescriptions, violates the diet and continues to consume large quantities of meat products, coffee, chocolate and other harmful products, then even with specialized treatment there will be no results. There are clear restrictions and permissions regarding the products :

      • Eliminated completely from the diet for at least 12 months:
      • lamb and veal meat;
      • offal - liver, lungs, heart and others;
      • aspic;
      • herring, mackerel and sardines in any form - smoked, pickled, salted, fried;
      • soups and broths with meat.
      • It is necessary to limit consumption:
      • poultry meat, ham, liver sausage;
      • cod, sprat, pike perch, sprat;
      • peas, beans, lentils, beans;
      • cauliflower, radish, spinach, sorrel;
      • coffee, beer and cocoa.
      • Feel free to include it in your daily menu:
      • any dairy products, including hard/soft cheese;
      • chicken and quail, goose and duck eggs;
      • nuts of absolutely all types;
      • jelly and gelatin;
      • vegetable soups (except those prohibited for consumption);
      • porridge of all varieties/types, except oatmeal;
      • vegetable and butter.
      • Fish and meat with diagnosed gouty arthritis should be eaten only boiled and no more than 3 times a week. It is necessary to limit the consumption of salt, including in the form of marinades and brines for preserving vegetables. During the treatment of the inflammatory joint disease in question, it is very useful to use rosehip decoction, cranberry juice, linden tea, berry compotes - just do not forget to make sure that there are no diseases of the cardiovascular system. In general, for gouty arthritis you need to eat according to diet No. 6, but only with some clarifications. Below is a sample patient menu :

      • Breakfast - cottage cheese with fresh or canned fruit jelly, coffee with plenty of milk.
      • Second breakfast – a glass of apple juice.
      • Lunch – rice soup with vegetable broth, rye bread, a glass of dried fruit compote.
      • Afternoon snack – black tea (slightly brewed), marmalade, apple.
      • Dinner – a glass of green tea, potato pancakes.
      • Breakfast - any porridge with milk (except oatmeal!), rye bread, a glass of pineapple juice.
      • Second breakfast – walnuts, pear of any kind.
      • Lunch – vegetable stew, stewed rabbit meat, a glass of compote.
      • Afternoon snack – a glass of orange juice.
      • Dinner – a glass of black tea with milk, a sandwich with hard cheese.
      • Breakfast - fresh carrot cutlets, sour cream, a glass of black tea.
      • Second breakfast – one or two bananas.
      • Lunch – borscht in vegetable broth with sour cream, a glass of rosehip broth.
      • Dinner – pumpkin casserole, herbal tea.
      • Breakfast - sandwiches made from wheat bread with any type of cheese, black tea.
      • Second breakfast – a glass of cherry juice.
      • Lunch – potatoes baked in the oven with trout, vegetable salad with vegetable oil, a glass of cranberry juice.
      • Dinner – muesli with any kind of nuts, a glass of green tea.
      • Only an approximate menu is given - from it it is clear that the nutrition of a patient diagnosed with gouty arthritis, despite the restrictions and exceptions, is quite varied and cannot be called inferior. Although for many patients even such a menu is very meager, you cannot break the diet - this will lead to an exacerbation of the disease in question. Please note: the specified diet must be strictly followed by patients for 12 months. This is followed by a thorough examination of the patient’s body, and if the dynamics of gouty arthritis are positive, some dietary allowances may be allowed.

        Treatment of gouty arthritis with folk remedies

        Important: in no case should remedies from the category of traditional medicine be considered a panacea - the inflammatory joint disease in question should be treated by medical professionals. But even official medicine recognizes and “gives the go-ahead” for the use of folk remedies during therapy. Naturally, patients must obtain permission for such treatment from their doctor, and exclude possible hypersensitivity and/or individual intolerance to any medicinal plants or products.

        The juice of this vegetable is considered the most effective for removing salts from joints, but only if you use only freshly prepared product. Preparing black radish juice is quite easy - the vegetable is peeled, grated and squeezed through cheesecloth, but you can use a blender for chopping and a juicer. Scheme for taking black radish juice for gouty arthritis: on the first day, take 1 teaspoon of juice 60 minutes after a meal, once a day. Then we increase the dosage daily and bring it first to a tablespoon, and then to ? glasses at a time. This regimen of taking black radish juice allows you to determine the absence/presence of side effects and not harm your own body. Please note: if, while drinking black radish juice, pain is noted in the epigastric region, liver (on the right), then taking the drug should either be stopped altogether or the daily dose should be significantly reduced. For the entire period of treatment with the folk remedy in question, sour and spicy foods are completely excluded from the diet. The duration of the course is individual, but it is necessary to consume at least 3 liters of black radish juice in total.

        A decoction of the flowers of this healing decoction will help with an acute attack of pain in a joint affected by gouty arthritis, but it must be prepared in an unusual way. Moreover, adherence to technology is a must :

      • First, a saline solution is prepared - 20 g of ordinary table salt per 10 liters of hot water;
      • then dip 100 g of chamomile flowers into it and simmer over low heat for 10 minutes.
      • After the finished broth is cooled to a temperature that the skin can withstand, a bath is applied to the sore joint.

        A decoction is prepared from unopened fir cones with seeds - one cone is poured with 500 ml of boiling water and infused for 6-8 hours. Take the decoction 3 times a day, half an hour before meals. This decoction effectively cleanses the joints and the body in general of excess uric acid. The duration of taking this decoction is determined individually - traditional healers recommend not interrupting treatment until complete recovery.

        Such a common product in cooking turns out to be an excellent way to cleanse joints of monosodium urate crystals. The medicine is prepared as follows :

      • take no more than 5 grams of bay leaf and fill them with 1.5 glasses of water;
      • cook the product over low heat, at a low simmer for 10 minutes;
      • remove the broth from the stove, wrap the dishes in a towel or scarf and leave for 3 hours.
      • The resulting decoction should be drunk in small portions throughout the day.

        Some people are surprised by unusual folk remedies, others actively use them – this is a purely individual matter. According to official medicine, there is nothing harmful in the following remedies, but it is still necessary to consult with your doctor. Fresh lard Many people use lard to treat gouty arthritis - cut a small piece from it and rub it into the area of ​​the affected joint until the piece is reduced by 2-3 times. If attacks of pain in a joint are too frequent, then you should simply tie a piece of lard to the sore joint and leave it there overnight. As a rule, after such a procedure in the morning there is significant relief - the pain almost disappears. Traditional healers recommend eating millet porridge cooked in water when treating the disease in question with lard - it helps remove salts from the joints. Butter Take butter (unsalted and it is advisable to find a homemade product) and alcohol in equal proportions. The oil is heated in a water bath or low heat until foam begins to appear on its surface. At this moment, remove the oil from the heat, pour the prepared alcohol on top and set it on fire. Only after the fire in the bowl with oil burns out will the ointment be considered ready. It should be used in moments of acute pain in the affected joint - it is simply rubbed into the skin until the pain subsides. The butter-based ointment is stored in a warm place for no more than 5 days. Mustard Mix 1 teaspoon of honey, mustard (ready-made, not powder) and baking soda in a bowl. Next, we steam the limb on which the diseased joint is located and apply the resulting product to the steamed skin. We put plastic wrap on top, then wrap the area with something warm (scarf, handkerchief) - such a compress should remain on the affected joint all night. The course of treatment with such compresses is 10-15 days. Fish You will need 2 kilograms of fish trimmings - this amount must be divided equally into 10 bags and put everything in the freezer, having first cleared the backbone and all the bones from the product. Then every evening take out one bag, defrost it and put it on the sore leg directly with the fish, and on top - a warm sock. Such a strange compress should be done for 6-8 hours, and in the morning everything is removed and thrown away, the leg is washed thoroughly. It is believed that after 10 days of such daily fish compresses, the pain in the joint affected by gouty arthritis disappears for a long time. Gouty arthritis is a rather complex disease that is difficult to treat. But with all this, doctors assure that if you carefully follow all the recommendations and prescriptions of specialists, the disease in question is either completely cured or goes into long-term remission. Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.

        7,472 total views, 4 views today

        Categories : Diagnostics

    Why does the big toe nail darken?

    Goosebumps treatment

    Recent Entries

    • Feet with white spots itching
    • Tablets for varicose veins
    • Varicose veins first manifestations
    • Leg joint enlargement
    • Itchy veins on the legs

    Categories

    • Lower extremity pain
    • Diagnostics
    • Legs
    • Prevention
    • Adviсe
    • Treatment options
    February 2019
    Mon W Wed Thu Fri Sat Sun
    « Oct    
     123
    45678910
    11121314151617
    18192021222324
    25262728  

    Archives

    • October 2018
    • September 2018
    • August 2018
    • July 2018
    • June 2018
    • May 2018
    • April 2018
    • March 2018
    Zabava-24.ru 2018 All rights reserved