Gout is a chronic progressive systemic disease characterized by impaired metabolism of uric acid salts and their deposition in tissues. Translated from ancient Greek, the name of the disease is translated as “foot trap.”
Since ancient times, gout was considered a noble disease, because only the rich could afford to drink plenty of wine and eat meat.
Clinically, the pathology is manifested by gouty arthritis and nephropathy.
The disease most often develops in men over 50 years of age, and 20 times more often than in women. Why is this happening?
Simply, one of the reasons for the development of gouty arthritis is a genetic predisposition that occurs only in males. A gene defect occurs that encodes the synthesis of enzymes involved in the metabolism of uric acid and its excretion by the kidneys.
In addition to congenital characteristics, the development of gout is also facilitated by:
In women, acute gouty arthritis occurs after menopause due to a decrease in the level of sex hormones (estrogens).
Increased uric acid levels also cause a number of diseases:
Classifications of gouty arthritis according to ICD-10
Acute gouty arthritis usually occurs at night after a heavy dinner with wine or beer. A person, without thinking about anything bad, goes to bed, and at night suddenly wakes up from unbearable pain in the joints.
Most often the first metatarsophalangeal, knee or ankle joints are affected. The joint increases in size, the skin over it becomes bluish-purple and shiny, and the temperature locally rises. The patient cannot move his leg, the joint cannot perform its function. Some patients compare the pain that arises with the pain of a dislocated joint or ruptured ligament.
An acute attack is usually accompanied by general weakness, fever with chills, nausea, vomiting and lack of appetite.
The first attack in most cases lasts up to a week, then all symptoms of the lesion disappear: the leg shrinks to its previous size, the skin restores its normal color, and body temperature decreases. Patients return to a full life until a new attack. Each new attack occurs faster and faster.
New attacks can be provoked by:
The subacute form is accompanied by minor pain and tissue swelling
Signs of chronic gouty arthritis include the following:
Gouty status is a very dangerous complication of the pathology, characterized by an incessant attack of pain and tissue swelling caused by a massive release of uric acid into the blood.
Excess weight, consumption of meat products, strong coffee, a sedentary lifestyle, and smoking have led to an increase in the incidence of gouty arthritis. Gouty arthritis (gout) is an inflammation of the joints from accumulated uric acid salts (urates). Their accumulation occurs when uric acid is poorly excreted from the body due to improper purine metabolism. The concentration of uric acid is also influenced by the presence of male sex hormones, so women suffer from gout less often than men. Treatment of gouty arthritis is carried out by a rheumatologist.
Violation of purine metabolism in the human body leads to the accumulation of uric acid and its salts. The uric acid level for women is 6 mg% (0.36 mmol/l) and 7 mg% (0.42 mmol/l) for men is the norm. A higher level of urate in the blood is called hyperuricemia and is one of the factors in the development of gout. According to the Framingham study, gouty arthritis affects 90% of patients with uricemia above 9 mg% (0.54 mmol/l), 25% with uric acid levels in the blood of 8-8.9 mg% (0.48-0.53 mmol/l) and 17% – with an indicator of 7.0-7.9 mg% (0.42-0.47 mmol/l).
If excessively accumulated uric acid is retained in the body, its salts (urates) are deposited in the tissues of the renal pelvis, ureters, joints and other tissues. Over the course of 3-6 years, these deposits form nodules with a dense consistency and a rough-grained surface. They are called tophi. Gouty arthritis is an inflammatory process in the joints, formed as a result of the destruction of hyaline cartilage and periarticular tissues by crystals of uric acid salts. The hip and shoulder joints are very rarely affected by this disease.
Treatment of gouty arthritis of the ankle, elbow, wrist and finger joints is necessary for a larger number of patients. And most often (90%) gout affects the metatarsophalangeal joint of the big toe. Some patients mistakenly call its arthrosis gout. But these are different diseases.
Gout affects not only the musculoskeletal system, but also the urinary system. Urate stones are deposited in the ureters and renal pelvis, which leads to urolithiasis and the development of nephritis.
At the first stage of gouty arthritis, there are no external signs. The disease can be determined only by the presence of uric acid salts in the blood and the detection of uric acid crystals in the synovial fluid of the joint.
The second stage is called acute. Prolonged physical activity, consumption of alcohol and foods rich in purines, injuries, and infections can trigger an acute attack of gout. This can happen suddenly at night. Its characteristic symptoms:
Ineffective and untimely treatment leads to a chronic form of the disease. Gout attacks may not bother you for a long time. At this stage, the destruction of joints continues, urolithiasis worsens, and many tophi grow. They can be seen near the elbow joint, on the fingers and toes, on the knees and on the ears.
During an attack, treatment of the symptoms of gouty arthritis comes down to the following: relieving pain, eliminating inflammation and lowering uric acid levels. The achieved result is consolidated by diet.
Colchicine relieves acute pain during an attack. It relieves pain within 48 hours. But due to toxicity and harmful effects on the liver and kidneys, it is used for a short course. If the patient vomits or feels sick, then colchicine can be administered intravenously. Diclofenac, voltaren, prednisolone, dimexide and other anti-inflammatory drugs will help relieve inflammation. Having eliminated the attack, the doctor prescribes drugs that break down, reduce the synthesis and accelerate the excretion of uric acid. For complex treatment, if necessary, physiotherapy, cryotherapy, therapeutic massage and other auxiliary procedures are prescribed.
Treatment of symptoms of gouty arthritis with folk remedies is used in combination with therapeutic methods. Traditional medicine offers many ways. Here are some of them:
Of course, before using any of the traditional medicine recipes, you need to consult your doctor.
Diet for gouty arthritis is first on the list of recommendations from rheumatologists. It will help achieve good results in the treatment of gout and avoid relapses of the disease. In medicine, it belongs to dietary table No. 6 and is distinguished by reducing the consumption of foods rich in purines. But it is recommended to consume vegetables and fruits in large quantities. As a result, purine metabolism is normalized and the formation of uric acid in the patient is reduced.
During an attack, food of animal origin and salt are completely excluded. They eat semi-liquid porridges (except oatmeal), vegetable purees and fruits. After a couple of days, you can add kefir, fruit, vegetable dishes and low-fat cottage cheese. The urine reaction becomes alkaline and the patient's condition improves.
Foods that should not be consumed if you have gout, even between remissions:
Products that are allowed to be consumed:
Beneficial berries:
Patients with gouty arthritis need to eat at least 4-5 times a day and drink up to 3 liters of water. Fasting and overeating only worsen metabolic disorders. But fasting days on vegetables and fruits once a week will only bring benefits.
Patients must follow all doctor’s recommendations, follow a diet, lead an active lifestyle, and constantly fight excess weight and overeating. This will help increase the interval between relapses or even eliminate them completely.
Gouty arthritis is characterized by inflammation in the joints, in which uric acid crystals begin to accumulate. In pathology, the metabolic processes of purines are disrupted. When urate accumulates in the joints, destruction of cartilage and tissue around the joints occurs. This disease is easy to treat. In men, the disease develops after 50 years, and in women after menopause (most often after 60 years). Women suffer from gouty arthritis seven times less than men, and the disease proceeds more calmly, not “aggressively.” This depends on the fact that the concentration of urates is greatly influenced by male sex hormones, while women do not have them.
A number of sequential pathological changes lead to the appearance of the disease:
The development of gout is primarily associated with metabolic problems in the human body. A misconception is the assumption that meat products or other foods aggravate gouty arthritis, although they are still predisposing factors.
If a person abuses alcohol, moves little, suffers from high weight, hypertension, has kidney disease, bad heredity, if he constantly and in large quantities consumes meat products, then he has a predisposition to gouty arthritis. Other causes of the disease can be hypothermia and complications after taking certain medications.
There is primary gout, which occurs if the patient has a genetic predisposition, and to this is added the consumption of purines in food. Secondary gout or hyperuricemia can be a complication in the presence of a number of diseases (tumors, hematological malignancies, heart failure, kidney disease, disruptions in the hormonal system) or the use of medications (diuretics, cytostatics, aspirin, riboxin). Secondary arthritis can also appear with heart defects, lead poisoning, and some types of leukemia.
Uric acid can increase due to an increase in the synthesis of urates - a metabolic mechanism; with the renal mechanism, the excretion of uric acid in the urine decreases, and a mixed mechanism combines an increase in synthesis and a decrease in the excretion of urates.
Often, gouty arthritis occurs in the small joints of the toes; very rarely it can affect the knees, ankle joint, as well as the wrist and elbow joints, and the limbs of the hands.
Also, a characteristic feature of the occurrence of gout, due to the fact that uric acid stones accumulate in the kidneys and ureters, kidney damage can occur, which is accompanied by the occurrence of urolithiasis and nephritis.
Beginning signs of gouty arthritis:
The articular cartilage is gradually destroyed, and cavities filled with uric acid crystals appear in the bones near the joint. The resulting nodular deposits - tophi and bone growths noticeably change the appearance of the foot, and if this pathology is left without treatment, it can provoke a complete loss of ability to work.
Women tolerate gouty arthritis much easier, attacks and inflammatory processes are much easier for them, and bone growths and tophi appear less frequently than in men. Therefore, in women it is difficult to distinguish gouty arthritis from arthrosis.
If the disease is just beginning, the doctor makes a diagnosis after detecting uric acid in the blood. Further, the diagnosis consists of identifying crystals in the fluid of the joints. This procedure is performed during acute attacks. Liquid for analysis is taken from any large joint; you can also take the contents of the tophi for examination.
If the disease has been progressing for too long, the patient is offered to undergo an x-ray. The images may show holes, bone end defects, and cartilage destruction.
Medicine still does not have specific treatments for gouty arthritis. Today, a specialist can only offer drugs to relieve the inflammatory process and maintenance therapy to prevent a relapse.
The course of treatment is carried out under the supervision of a doctor who prescribes a diet and medications to get rid of excess uric acid. In addition, proper nutrition, a complex of vitamins and proper rest are prescribed. Pay close attention to your health!
To achieve a quick therapeutic effect, patients with gouty arthritis are prescribed appropriate dietary nutrition. Thus, there are cases where only a strict diet for gouty lesions of the joints or kidneys gave a good therapeutic effect. This can be explained by the fact that dietary nutrition for gout limits the intake of exogenous purines, which has a beneficial effect on the level of these compounds in the blood serum and their content in tissues.
A strict diet for gouty arthritis does not mean strict fasting either during an attack of the disease or in the inter-attack period.
General characteristics of the diet for gout No. 6.
Diet for gout No. 6 suggests:
Culinary processing is common, but boiling meat, poultry and fish is mandatory.
The food temperature is normal.
Diet for gout: recommended and excluded foods and dishes
Excludes: meat, fish and mushroom broths, sorrel, spinach and legume soups.
Limit products made from butter dough.
Excludes: liver, kidneys, tongue, brains, meat of young animals and birds, sausages, smoked meats, salted fish, canned meat and fish, caviar.
Excludes: salted cheeses
Excludes: mushrooms, fresh legumes, spinach, sorrel, rhubarb, cauliflower, purslane; limit - salted and pickled;
Exclude: salty snacks, smoked meats, canned food, fish caviar;
Excludes: chocolate, figs, raspberries, cranberries.
Exclude: sauces based on meat, fish, mushroom broths, pepper, mustard, horseradish.
Exclude: cocoa, strong tea and coffee.
Excludes: beef, lamb, cooking fats.
Limit pork fat.
Causes of ankle arthritis here
Among the foods that are poor in purine bases are milk, chicken eggs, bread, caviar, Swiss cheese, hazelnuts and walnuts. It is allowed to eat carrots, buckwheat and pearl barley, and millet.
In the diet of patients, the amount of fat and table salt must be limited, which contributes to the accumulation of urates in tissues. They increase the amount of fluid, which helps the body more intensively remove uric acid compounds from the body.
It is imperative to reduce the total caloric content of food that the patient consumes, especially in cases where he has concomitant obesity.
Often patients do not include tomatoes in their diet, considering them harmful, although tomatoes can be consumed, just not in large quantities, since they actually contain a small amount of purines. It should be remembered that it is more advisable to exclude various sausages and smoked foods from your diet; you should also not use seasonings (this does not apply to bay leaves and vinegar).
It is useful to do fasting days for yourself from time to time and consume raw vegetables and fruits. You can, for example, hold rice-apple fasting days.
The diet for this disease includes a ban on alcohol, since it retains uric acid in the body. This is especially true for wine and beer. You should also exclude strong tea, cocoa or coffee, which can aggravate the pain syndrome.
For drinks, it is recommended to consume vegetable and fruit juices, as well as alkaline mineral water.
It is useful to eat foods containing vitamin B1 and ascorbic acid.
When providing therapeutic nutrition for gouty arthritis, use diet No. 6 according to M. Pevzner, which meets all the above conditions.
It is worth noting that some researchers believe that with correct pharmacological treatment, dietary therapy for this disease is not necessary. But as practice shows, dietary nutrition for gout significantly facilitates its course, which is why most doctors include diet in the general scheme of complex treatment of this disease.
Below is a sample menu for gouty arthritis:
One of the diseases of modern society is gout. And although it refers to metabolic diseases, its main manifestation is damage to the joints.
The process is very specific, characterized by a persistent and long-lasting course. It can cause severe destructive processes in the joints, which requires getting to know the true face of this enemy of humanity.
Gouty arthritis is one of the types of inflammatory joint damage, which is caused by the accumulation of uric acid crystals in the articular structures, its destructive effect on hyaline cartilage and periarticular tissues. The above definition of the disease clearly indicates all the key mechanisms of development and manifestation of this process.
If we explain everything in order, then the complex of pathological changes consists of a sequential chain:
Violation of uric acid metabolism in the direction of increasing its amount in the blood;
The settling of its crystals (urates) on the surface of the hyaline cartilage of the joints;
Irritation and damage to joint structures with the development of an inflammatory response, which is actually called arthritis;
The development of consequences of a destructive process;
Periarticular tumor-like growths.
Gout is also characterized by kidney damage, accompanied by the development of nephritis and urolithiasis, since urate stones are deposited in the renal pelvis and ureter.
In most cases, gouty arthritis affects small joints (toes), less often - ankle and knee joints, fingers, wrist joint and elbow.
Males in adulthood (25-50 years) are more susceptible to the disease. The manifestation of gouty arthritis can occur at an earlier period. The process is characterized by a long course with constant relapses. The small joints of the feet are predominantly affected, less commonly the ankle joint.
True gout is quite rare; older people often call gout a manifestation of arthrosis. Women get it 5 times less often than men. The risk group includes men 40-50 years old and women over 60 years old (postmenopausal age), since this disease has some connection with male sex hormones.
There are also forms of gouty arthritis when almost all large and small joints of the upper and lower extremities are affected. With a slowly progressive course, only small joints are gradually involved in inflammation. The disease rarely causes severe systemic reactions, although they can also occur. In addition to articular manifestations, gout is characterized by renal symptoms, which are the result of the formation of urate stones.
Medical practice knows cases of severe gout with severe intoxication and massive destructive processes simultaneously in several large joints. Fortunately, such cases rarely occur. But, nevertheless, long-term gouty arthritis sooner or later leads to dysfunction of the affected joint with possible disability of patients.
There are three periods in the development of the disease:
Latent, when there are no clinical symptoms and the onset of the disease can be diagnosed only by the increased level of uric acid in the blood (hyperuricemia);
Acute recurrent, when joint damage causes severe gouty attacks;
Chronic, in which long periods of remission are possible.
The frequency of attacks can vary from 1 time per week or month to 1-2 times per year.
The clinical picture of the disease is quite typical, which allows it to be diagnosed in time.
The first manifestations are acute and consist of:
Pain in the area of the big toe joint;
Redness of the skin over the inflamed joint;
Increased pain with movement;
Increased body temperature above normal levels;
The appearance of whitish subcutaneous growths (tophi) around the joints that are inflamed;
Consistent periodic pain in various small joints.
Some of these manifestations of the disease are worth dwelling on separately and detailing the main points. First of all, it is a manifestation of the process. The thumb is the first to be affected in 90% of cases. If, against this background, adequate therapeutic and diagnostic measures are not taken, the disease will certainly take a progressive course. Gradually, other small joints will begin to become inflamed and painful.
When gouty arthritis is highly active, the skin over the affected joint necessarily turns red, which is complemented by a general temperature reaction. Prolonged inflammation in gout leads to the formation of tophi (subcutaneous nodules) around the joints. They are represented by elements of joint tissue and uric acid.
The articular cartilage is gradually destroyed, and so-called “punches” are formed in the bones adjacent to the joint - cavities filled with monosodium urate crystals. Also, crystals of uric acid salts can be deposited in the tissues surrounding the joint and directly under the skin above the joint in the form of whitish dense nodules - tophi. Nodular deposits and bone growths lead to significant changes in the appearance of the leg. If left untreated, the result may be a complete loss of ability to work and the ability to self-care.
In women, the disease is much milder than in men. The attacks are not so strong and acute; tophi and punctures are formed extremely rarely. Therefore, in women it can be difficult to differentiate gouty arthritis from arthrosis.
The etiology of the disease is not fully understood. The main risk factors for its occurrence include:
Poor nutrition: excessive abuse of meat products, sausages, chocolate, strong coffee and tea, alcohol. (Gout used to be called “the disease of aristocrats”);
The presence of concomitant diseases, such as heart failure, hemoblastosis, kidney disease, hormonal abnormalities;
Use of certain medications: drugs for high blood pressure, diuretics, cytostatics, etc.
There are also primary and secondary gouty arthritis:
Primary gout develops as a result of a combination of genetic predisposition and high intake of purines from the foods listed above;
Secondary gout occurs due to the presence of these diseases and medications.
The accumulation of sodium urate microcrystals in the joint cavity can occur asymptomatically for a long time, until some factor provokes an acute attack: physical fatigue (long walking), injury, infection, stress, hypothermia, fasting or consumption of large amounts of “purine” foods in combination with alcohol.
The key point of diagnostic procedures is the detection of sodium urate crystals in the synovial fluid of the joints, both during an attack and during remission. Synovial fluid for analysis can be taken from any large joint, even one that has never been subject to inflammation, for example, from the knee. Also, the contents of the tophi or any other biological material can be taken for research.
Hyperuricemia (increased levels of uric acid in the blood) in combination with periodic inflammation of the joint of the big toe is not considered a confirmation of gout, it is only a marker of impaired purine metabolism. Many people with hyperuricemia do not have gout.
With a long course of the disease, it makes sense to conduct an x-ray examination. At the early stage of the disease there are no characteristic changes. Then, on x-rays, signs typical of gout appear: destruction of cartilage, defects in the end sections of bones, punctures.
When gout develops on the upper extremities, it is quite difficult to differentiate it from other joint diseases: rheumatoid arthritis, osteoarthritis, etc.
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Considering that gout is a consequence of poor nutrition, its complete cure cannot be achieved without strictly following the necessary dietary recommendations. That is why gouty arthritis in most cases has a progressive course. But I would like to focus the attention of patients specifically on the importance of such a therapeutic measure as diet therapy. According to medical nomenclature, it belongs to dietary table No. 6.
The most important principle is the exclusion of foods that are a source of purines. After all, when they break down, a powerful release of uric acid occurs, which does not have time to bind and be excreted from the body. Its approximate composition is given in the table.
Wheat and rye bread;
Vegetarian, dairy and cereal soups: cabbage soup, borscht, okroshka, milk noodles;
Any porridge, except oatmeal;
Boiled beef, chicken, turkey, rabbit meat - 2-3 times a week;
Low-fat boiled fish - 2-3 times a week;
Eggs – 1 pc. per day, prepared in any way;
Natural milk, cottage cheese, unleavened cheese, fermented milk products (kefir, curdled milk, sour cream);
Cereals and pasta prepared in any way;
Any fruits and berries, except those indicated in the above list;
Jam, honey, jelly;
Weak tea and coffee with milk;
Vegetable and fruit juices, lemon and cranberry juice, green, mint and linden tea, rosehip decoction;
Vegetable and butter;
Alkaline mineral water (you can sometimes add soda to drinking water);
Drinking wine is allowed outside of exacerbations.
Meat, fish, mushroom rich broths;
By-products (kidneys, liver, brains);
Sausages (especially liverwurst), ham;
Fatty fish (mackerel, sardines, mackerel, herring, cod;
Any canned food, smoked meats, salty and spicy foods;
Seafood (shrimp, anchovies);
Salty and spicy cheese, feta cheese;
Porcini mushrooms and champignons;
Pastries made from butter dough;
Rhubarb, radishes, cauliflower, asparagus, lentils;
Cocoa, chocolate, strong coffee and tea;
Alcohol (cognac, whiskey, beer);
As can be seen from the above data, much is prohibited, but there are also enough products for a normal healthy diet. The main thing to remember is to avoid excess. Even if it happened that a person could not resist and ate forbidden food, it is advisable to immediately take appropriate medications that remove or bind the metabolic products of uric acid.
Breakfast: cottage cheese with fruit jelly, coffee with milk;
Lunch: Tomato juice;
Lunch: vegetable rice soup, bread, compote;
Afternoon snack: apple, weak tea with marmalade;
Dinner: potato pancakes, green tea.
Breakfast: porridge with milk, rye bread, pineapple juice;
Lunch: pear, walnuts;
Lunch: Stewed rabbit, vegetable stew, compote;
Afternoon snack: Orange juice;
Dinner: sandwich with cheese, tea with milk.
Breakfast: Carrot cutlets with sour cream, fruit juice;
Lunch: Vegetarian borscht with sour cream, rosehip broth;
Afternoon snack: grapefruit, tea with jam;
Dinner: pumpkin casserole, green tea.
Breakfast: boiled egg, cheese sandwich, tea with lemon;
Lunch: a glass of cherry juice;
Lunch: Trout baked with potatoes, vegetable salad with butter, fruit drink;
Afternoon snack: Kefir, marshmallow;
Dinner: Muesli with nuts, fruit juice.
Breakfast: buckwheat porridge cooked in milk, green tea;
Lunch: baked apples with honey and nuts;
Lunch: vegetable salad, boiled rice, bread, orange juice;
Afternoon snack: tomato juice;
Dinner: stewed potatoes, fresh vegetable salad, a glass of skim milk.
Breakfast: scrambled eggs, a piece of rye bread, jelly;
Lunch: peach juice, almonds;
Lunch: cabbage soup in lean meat broth, rose hip decoction;
Dinner: cereal soup, cheese sticks, tea with milk.
Breakfast: corn porridge with milk, coffee with milk;
Lunch: kefir, marshmallow;
Lunch: vinaigrette, bread, fruit drink;
Dinner: boiled tuna with fresh or stewed vegetables.
After a year of treatment, if you feel well and there are no relapses, strict dietary restrictions can be lifted. In this case, you can choose: either continue to adhere to the diet and reduce the dosage of medications taken or stop them altogether, or continue taking medications and allow some relaxations in the diet.
For many decades, official medicine has not come up with anything new in the treatment of gout and gouty arthritis. The entire treatment process also consists of two stages: relief of inflammation and supportive anti-relapse therapy.
When an exacerbation or primary occurrence of gouty arthritis occurs, it is necessary:
Administration of non-steroidal anti-inflammatory drugs. The most effective for gout are indomethacin, ibuprofen (imet, nurofen), movalis, and rheumoxicam. It is good to use their step-by-step administration with the gradual use of injectable forms and replacement with tablet forms;
The use of the drug colchicine is a specific anti-inflammatory drug for gout;
Local use of ointments based on NSAIDs: indomethacin, deep relief, dolobene, remisid;
Lotions and compresses based on a semi-alcohol solution or dimexide in a 25% concentration;
Physiotherapeutic procedures: paraffin and other thermal procedures, laser therapy, magnetic therapy, exercise therapy, massage, gymnastics.
Treatment of the disease itself includes the following components:
Diet (normalization of purine metabolism);
The use of medications that reduce urate synthesis;
Eliminating the causes of hyperuricemia.
To eradicate the problem completely, you need to act on its basis - excess uric acid. For this purpose the following are assigned:
Allopurinol. Refers to drugs that reduce the production of uric acid in the body. Its analogue is Zylorik;
Probenecid. Promotes the elimination of excess uric acid crystals in the urine, which reduces the symptoms of gout. Drugs in this group include sulfinpyrazone, etebenecid, anturan;
Uricozyme. It has a direct destructive effect on existing urate crystals in the body.
Allopurinol (Allupol, Purinol, Remid, Milurit), belonging to the drugs of the first group, is most preferable. Indications for its use are high hyperuricemia (over 0.6 mmol/l), frequent acute attacks of arthritis, the presence of tophi, and renal failure. The initial dose is 300 mg/day. In case of ineffectiveness, it is increased to 400–600 mg/day, and when significant results are achieved, it is gradually reduced. The maintenance dose is 100–300 mg/day depending on the level of hyperuricemia.
Allopurinol helps to weaken attacks and soften tophi, normalize uric acid levels. In the first week of taking it, a slight exacerbation of symptoms is possible, so at this stage of therapy it is combined with anti-inflammatory drugs, low doses of colchicine or NSAIDs. If an attack of gout occurs for the first time, and Allopurinol has never been taken before, you should absolutely not start taking it to reduce pain. If an attack occurs while taking Allopurinol, you need to continue taking it at the same dosage. Allergic reactions (skin rash) are possible during treatment.
Drugs of the second group are of less importance in the treatment of gouty arthritis. They are not used for high levels of uric acid in the blood, for nephropathy and renal failure. Sulfinpyrazone is taken 200–400 mg/day in 2 divided doses with a large amount of alkaline liquid. An additional contraindication is gastric ulcer.
Probenecid (a derivative of benzoic acid) is prescribed at 1.5–2.0 g/day. Benzoic acid is found in cranberries, as well as lingonberries and their leaves. Therefore, cranberry and lingonberry decoctions and fruit drinks are very useful for patients with gout.
Drugs from different groups can be combined with each other, however, as mentioned above, in case of serious kidney pathology, uricosuric drugs are contraindicated. They can also be used only after the attack of acute arthritis has completely stopped, otherwise they can provoke another exacerbation. During treatment with drugs of this group, daily water consumption should be at least 2.5-3 liters.
Treatment is long-term (from several months to several years), breaks in treatment usually lead to relapses. If all medical recommendations are followed, the patient’s condition returns to normal within the first month. It is recommended to monitor uric acid levels monthly and adjust drug dosages depending on test results. Basic therapy can be supplemented with physiotherapy, massage, exercise therapy.
If you are overweight, it is recommended to lose weight, since there is a connection between excess weight, increased urate synthesis and reduced excretion by the kidneys. You should also avoid taking thiazide diuretics to lower blood pressure and aspirin. These drugs increase the level of uric acid in the body and can trigger an attack.
During exacerbations, the load on the affected joint should be reduced as much as possible. Additionally, you can apply ice compresses several times a day for 5-7 minutes.
Only an integrated approach to treatment, including anti-inflammatory therapy, local effects, diet and medications that affect the metabolism of uric acid, can help in the fight against gouty arthritis.
Author of the article: Dmitry Sergeevich Volkov, candidate of medical sciences, surgeon
Gout is a disease caused by a violation of purine metabolism, which leads to an increase in uric acid in the body with the progressive deposition of its salts in various tissues and organs. The disease develops predominantly in men and is characterized by an increase in uric acid in the blood (above 0.254-0.325 mmol/l), deposition of crystalline urates in connective tissue (synovial membranes, tendons, cartilage, articular parts of bones), interstitial tissue of the kidneys, blood vessels, scleral area eye.
With gout, one of the symmetrical joints is usually affected, most often the metatarsophalangeal joint of the big toe, less often the joints of the arch of the foot, ankle, knee, rarely the joints of the hand, wrist, and elbow. Gouty arthritis usually occurs acutely, often at night, and is accompanied by severe pain. There is rapid (within 1-3 hours) swelling of the joint, its hyperemia (the joint is blue-purple or dark red) and hyperthermia. The general body temperature may increase, which is accompanied by an increase in ESR and leukocytosis. The attack lasts 3-10 days, then completely disappears with the restoration of normal joint function. Acute gout attacks initially occur 1-2 times a year.
In accordance with the generally accepted classification, metabolic and renal forms of gout are distinguished. In the metabolic form, an increase in the synthesis of uric acid predominates, while in the renal form, a decrease in its excretion predominates.
Physical factors are used to treat patients with gout both during the non-attack period and during an acute and subacute gout attack. During the non-attack period, an important role is played by ballroom therapy, which is carried out both in resort and non-resort settings. Of the balneotherapeutic factors, radon and sulfide waters are of greatest importance for gout; sodium chloride, nitrogen-thermal and other waters are less effective.
Balneotherapy is indicated for patients with gout without a pronounced attack of gouty arthritis with concomitant urolithiasis without damage to the kidneys by the gouty process. The prescription of balneotherapy is not indicated for patients with acute as well as chronic gout, in the presence of a “gouty” kidney, severe gouty vascular damage, with concomitant changes in the cardiovascular system (coronary artery disease, hypertension stage IIIB-III, heart rhythm disturbances).
Mud therapy is used for patients with chronic gouty arthritis in order to have a resolving effect on urate deposits in articular and periarticular tissues. Mud applications are applied directly to the affected area, temperature 38-44? C, duration 10-15 minutes. The course includes 8-10 procedures, performed every other day.
Mud therapy is indicated for patients with chronic gouty arthritis, as well as those with urate deposition in periarticular tissues without inflammatory phenomena. Mud therapy is not used for exacerbation of the gouty process, for gouty damage to the kidneys, blood vessels, as well as concomitant ischemic heart disease, atherosclerotic coronary artery sclerosis, cardiac arrhythmias, thyrotoxicosis.
When carrying out balneo- and mud therapy, sometimes an exacerbation of gouty arthritis occurs, which requires the abolition of these treatment methods, the prescription of drug therapy, UV irradiation, etc. UHF.
Ultrasound therapy is indicated for patients with gouty arthritis without signs of exacerbation. Hydrocortisone phonophoresis is used for patients with gouty arthritis in the presence of residual symptoms of exacerbation or frequent gouty attacks. Ultrasound and hydrocortisone phonophoresis are not used in patients with an acute attack of gouty arthritis, gouty damage to the vascular system, as well as concomitant coronary artery disease, circulatory failure, and transient cerebrovascular accidents.
In an acute attack of gouty arthritis, the administration of physical factors that have an anti-inflammatory and analgesic effect is indicated. UV irradiation (integral spectrum, long and short rays) is prescribed directly to the inflamed joint. The impact on the metatarsophalangeal joint of the foot and ankle joint begins with 8-10 biodoses, on the knee, elbow and wrist joints - with 5-6 biodoses. As the erythema subsides (after 1-2 days), the dose is gradually increased by 1-2 biodoses. The course includes 4-6 irradiations.
Brucellosis arthritis (polyarthritis) develops in patients infected with Brucella through contact with relevant animals or who have taken products obtained from these animals. Brucellosis affects various organs and systems: organs of immunogenesis, nervous system, musculoskeletal system, etc. A characteristic syndrome of brucellosis is damage to peripheral joints, periarticular tissues, and the sacroiliac joint of the spine.
Brucellosis arthritis manifests itself as arthralgia, acute or subacute arthritis, mainly of infectious-allergic origin with the accumulation of serous-fibrous fluid in the joint cavity. Sometimes subacute or chronic destructive arthritis occurs, which leads to joint deformation and disruption of its function.
Treatment for brucellosis arthritis is aimed at suppressing the causative agent of the disease, relieving inflammation and pain, and preventing dysfunction of the locomotor system. Among the medications used are antibiotics (chloramphenicol, streptomycin, etc.), vaccine therapy, non-steroidal anti-inflammatory drugs (acetylsalicylic acid, etc.). Physical methods of treatment are used in the complex treatment of brucellosis arthritis only when it passes into the subacute and chronic stages.
Hydrocortisone phonophoresis has a hyposensitizing, anti-inflammatory and absorbable effect in brucellosis arthritis. In each procedure, effects are applied to two affected joints and their corresponding paravertebral reflexogenic zones. An ointment containing a suspension of hydrocortisone (5g), lanolin and petroleum jelly (25g each) is used as a contact medium. They use a labile method of exposure, a pulse mode (pulse duration 4 ms). The intensity when voicing the joint is 0.4-0.6-0.8 W/cm2, paravertebral zones - 0.2-0.4 W/cm2. The duration of exposure to one joint is 5-6 minutes, for each paravertebral field - 3-4 minutes. The total duration of the procedure should not exceed 20 minutes. The course of treatment includes 10-12 procedures performed daily or every other day.
Inductothermy and DMV therapy have an anti-inflammatory and resolving effect in brucellous arthritis. The impact of these factors is localized on the affected joints, bursitis, fibrositis. Inductothermy is carried out using an inductor cable in the form of a cylindrical spiral (2.5 turns) when affecting joints or a flat spiral when affecting fibrositis and bursitis. The exposure dose should be low-thermal and thermal (“2” - “5” power switching positions). Duration is 10-15 minutes. per joint no more than 25-30 minutes. for one procedure. The course includes 10-12 procedures, performed daily or every other day.
In case of exacerbation of chronic brucellosis arthritis, UV irradiation is recommended, which has an anti-inflammatory and analgesic effect. Irradiation is carried out on the area of the affected joints, but no more than two joints in one procedure. For the shoulder and hip joints, the dose of exposure begins with 3 (anterior surface) or 4 (posterior surface) biodose; on the knee, ankle and elbow joints start with 5-6 biodoses. Gradually, as the erythema subsides (after 1-2 days), the effects are increased by 1 biodose. 4-6 procedures are prescribed per course.
An effective resort treatment for chronic brucellosis arthritis is mud therapy. Mud applications have a pronounced absorbable effect on proliferative processes, bursitis, fibrositis. They have an anti-inflammatory effect on chronic, long-term inflammation in the joints, improve blood circulation and trophic processes in the affected articular and periarticular tissues. All this helps to reduce and eliminate pain and improve locomotor function of the joints.
Balneotherapy is indicated for patients with chronic brucellosis arthritis, as well as with brucellosis lesions of the peripheral nervous system (radiculitis). Balneotherapy is not prescribed to patients with the subacute stage of brucellosis arthritis or chronic arthritis during its exacerbation, severe brucellosis damage to internal organs, as well as concomitant ischemic heart disease, circulatory failure, stage IIIB-III hypertension, etc.
When creating a physiotherapeutic complex, the stage and form of the disease, as well as concomitant diseases, are taken into account. For patients with chronic brucellosis (with joint damage in the form of arthritis and the peripheral nervous system), a complex is recommended, including hydrocortisone phonophoresis at the 1st stage, mud applications or balneotherapy, therapeutic exercises and massage at the 2nd stage.