Gout is a chronic disease, which is based on a metabolic disorder: an increase in the synthesis of uric acid and its salts (urates). When a certain concentration of uric acid in the blood is reached, the body ceases to cope with its excretion through the kidneys, and this leads to the fact that uric acid crystals begin to be deposited in organs and tissues.
As a rule, the small joints of the legs (foot joints) are affected, and less commonly the ankle and knee joints. Not so typical for gout, but damage to the joints of the hands, wrist joints, and elbow joints is still possible. An inflammatory reaction begins in the affected joints and gouty arthritis develops.
The reasons for the development of the disease are not fully understood. It is known for sure that there is a genetic predisposition to the occurrence of gout; the disease most often affects men after 40 years of age, and women suffer during menopause.
Nutrition plays an important role in the development of gout: abuse of alcohol, strong coffee and tea, the presence of a large amount of meat products in the diet, chocolate - such food addictions increase the likelihood of developing gout. That is why for a long time this disease was also called the disease of aristocrats.
During the course of the disease, it is customary to distinguish three periods. The first is latent. At this stage, you will not notice any external symptoms. There is only an increase in the level of uric acid in the patient’s blood (hyperuricemia), but this does not manifest itself externally, therefore at this phase the disease is most often not diagnosed.
The second period is acute relapse, or, in fact, the period during which the patient learns what acute gouty arthritis is. This is the stage in which the joints are affected. We have already talked about which joints are affected. It is worth adding to this that the most common localization of the process is the first metatarsophalangeal joint (this is the joint of the foot).
Gouty arthritis: symptoms are as follows. Most often the lesion is asymmetrical. The pain is severe and can chain the patient to the bed. The skin over the affected joint is tense, bluish or purple, and the joint is enlarged. Very often, at the onset of the disease, only one joint is affected. Monoarthrosis is an important differential diagnostic sign of gout.
Gouty arthritis is often accompanied by symptoms of general intoxication caused by high levels of inflammatory mediators in the blood - chills, fever, weakness and general malaise appear. The diagnosis is usually not difficult to make. It is enough to take a blood test for uric acid levels. Hyperuricemia will answer all questions.
The second period of the disease is characterized by attacks of gouty arthritis with long periods of remission - up to a year or even more. However, uric acid is present in the body all this time and does its dirty work. Therefore, over time, the process moves into the third stage - chronic gout. At this stage, gouty arthritis becomes chronic, and tophi are formed - deforming compactions in joints and tissues, the cause of which is the deposition of uric acid salts.
Features of the development and course of the disease will help us answer the question of how to treat gouty arthritis? We will highlight three types of therapeutic effects - stopping inflammation in the joint, reducing the content of uric acid in the blood and tissues, and diet.
The first stage is stopping inflammation. In other words, direct treatment of gouty arthritis. This process is quite simple and is carried out using standard anti-inflammatory drugs (non-steroidal anti-inflammatory drugs, topical glucocorticoids). However, there is a specific drug that is effective specifically for gout - colchicine. The mechanism of action of colchicine is quite complex, but its principle is to reduce the content of inflammatory factors in the affected tissue. The effect is that an attack of gouty arthritis goes away not in 10 days, but in just 2-3.
After we have removed the acute manifestations, we move on to the second stage.
Gouty arthritis: treatment of the cause of the disease. Since uric acid and its salts are to blame for everything, our task is to reduce its content in the blood. To do this, we have the right to use three groups of drugs: uricodepressive (allopurinol), uricosuric (probenecid, etc.) and uricolytic (uricozyme).
The first group is aimed at reducing the synthesis of uric acid, the second - at increasing the excretion of uric acid by the kidneys, the third - at increasing the breakdown of urates in the body. You can combine drugs, however, it must be taken into account that in case of kidney damage, uricosuric drugs are contraindicated.
The treatment is lengthy, and pills alone will not help the case. It is important to supplement therapy with auxiliary methods - ultraviolet irradiation of joints, massage, physical therapy and reflexology, but the most important thing is strict adherence to all recommendations regarding the diet!
It was not for nothing that at the beginning of the article we outlined a list of foods that potentiate the development of the disease. The diet for gouty arthritis is aimed at minimizing their presence on the patient’s table. Meat cannot be completely eliminated, but its amount can be reduced: it is enough to eat lean meat 2-3 times a week and only in boiled form. Strong coffee, cocoa, chocolate and alcohol should be completely removed from the menu.
Dairy and plant products should be widely represented in the diet, and serious attention should also be paid to the water regime: a patient with gout should drink up to 2.5 liters of alkaline liquid per day (alkaline mineral waters, adding soda to drinking water).
If all recommendations are followed, it is possible to stop the process and prevent degradation of the articular apparatus.
Gouty arthritis is a disease characterized by the accumulation of sechoic acid salts in the sore throat, and also often affects the skin.
The exact reasons for this illness have not yet been clarified. It is clear that when the metabolism of sechoic acid, as well as purine compounds, is impaired, their concentration in the body increases greatly and leads to damage to tissues and organs. When sechoic acid is deposited in the carbonates, the stench begins to burn and settle over time.
We know for sure about the influx of the recession agent, which leads to the development of this illness. In addition, there are a number of factors that can be so-called trigger mechanisms, and themselves:
Gouty arthritis can occur against the background of other illnesses, in which case it may be of a secondary nature. For example, if a patient has a malignant swelling and is undergoing chemotherapy, then the depletion of cells in the body can lead to the development of illness.
Symptoms occur during the progression of illness and can be seen in three periods:
Gouty arthritis is characterized by an attack-like course. The frequency of zagostrenya in the first place depends on the way of life of the sick. Most often, attacks occur after physical stress, hypothermia, and also due to excessive consumption of meat and alcoholic drinks.
In case of acute illness, the symptoms immediately manifest themselves.
For the first time, the great toe on the nose suffers, because if you don’t immediately start bathing, you will suffer from illness and other problems.
At the hour of attack, pain appears, the skin over the area becomes hot, and blackness appears. Zagostrennya is accompanied by an increased temperature.
Step by step on the sourdoughs there is tofusi – the secretion of sechoic acid. Because of them, the storage cartilage collapses, which can lead to a repeated waste of productivity. With chronic illness, patients may develop problems with the thyroid system. In an advanced stage, multiple tofus are to blame, and skin discoloration is often visible above them. White paste may spontaneously appear behind them.
Comprehensive treatment of gouty arthritis is necessary. Therefore, not only drug therapy, but also other additional methods, for example, massage, physical exercise, diet, ultraviolet radiation, will be stagnated. Gouty arthritis needs to be treated by a qualified doctor, so that the development of the disease can be cured, the symptoms can be changed, or they can be eliminated.
Self-identified illnesses can only be caused by illness. With this illness, you cannot take aspirin and other similar drugs, because these drugs remove the build-up of sechoic acid in the body.
Gouty arthritis is treated mainly with medication. Anti-inflammatory drugs are prescribed for the kidney, then medications are prescribed by the doctor to reduce the level of sechoic acid, and then a continued diet is indicated. This cream can be used as ointments, various compresses, lotions, as well as physiotherapeutic procedures that help to change the symptoms of illness.
The savory bath is trivale, it cannot be overcooked, otherwise it may be congested. If the illness has not started and the patient completes all the doctor’s prescriptions, then the improvement seems to occur on its own within a month. The patient's condition is monitored by monthly tests for sechoic acid.
Gouty arthritis often occurs in people who suffer from obesity, so it is necessary to reduce their blood pressure. In the event of stress, the nerve will require calm, which cannot be forced. A compress that helps to relieve pain syndrome is applied to the forehead once a day for five minutes.
It is impossible to cure gouty arthritis without a full diet. This one is of great importance in curing someone’s illness. The patient should reduce the consumption of high-calorie hedgehogs, especially those rich in animal fats. It is also recommended to change the alcoholic beverages you drink and avoid drinking them as soon as possible.
The diet for gouty arthritis is reduced to the principle of the release of certain purines, and when combined with them, a sharp release of sechoic acid is produced. A sick person should not eat fatty meats, all kinds of cowbass, fatty and rich broths, offal, legumes, mushrooms, smoked meats, herring, and also delicious bacon. It is better to use cava, honey tea and cocoa products to mix, turn off salts and hot herbs, and also change the salt.
It is permissible to eat boiled low-fat yowl in small quantities twice a week.
Brown vegetarian soups with added cereals, porridge (oatmeal cream), fermented milk products. Almost all fruits and vegetables, cabbage, asparagus, radishes, raspberries and figs are allowed.
With licorice you can eat honey, jam, and also make various jelly. It is better to drink German tea with milk. Cory and peas, juices, fruit drinks, you can also add top and algae oil.
The diet for gout and arthritis is simple, there are a lot of things you can’t do, but there are plenty of permitted foods that are necessary for proper nutrition. If the illness does not go away and the diet is ruined, then it is necessary to immediately take medications to replace sechoic acid in the body. This does not mean that you can take liquids and fermentation products, until childbirth is the first and most important time before you get dressed.
Gouty arthritis or gout, or illnesses, which develop through impaired metabolism of speech, when the amount of sechoic acid, as well as salts, increases. When the concentration reaches small amounts, crystals of sechoic acid begin to form and are deposited in certain tissues and organs.
The ends of the feet (the balls of the feet) begin to suffer first, while the upper ends often become less severe. In the affected area, an inflammatory reaction begins, after which gouty arthritis develops.
The reasons behind the illness are definitely not known. For obvious reasons:
I will call this troubling hour of illness “the illness of the aristocrats.” Particularly strong men after 40 years of age, and women in the menopausal period.
This illness is characterized by three periods of progression:
The disease is not safe because it can be accompanied by symptoms of halal intoxication due to the increased inflammation instead of mediators. People feel chills, weakness, and illness. In this case, it is not very difficult to make a diagnosis. A blood test is required.
The other period is characterized by attacks of arthritis, with intervals of remission – and more. Since sechoic acid remains in the body all the time, it is likely to continue the development of infection. It was not possible for the disease to be properly treated until it reached the third stage - chronic. This period is characterized by the formation of tofum - a kind of thickening of tissues and joints, the reason for which is the addition of sechoic acid salt.
The healing of this illness lies in the development of the illness. There are three types of therapy:
The first stage is a complete celebration. It is necessary to seek additional help from anti-inflammatory drugs. For special episodes, use the specific drug colchicine, which is indicated for the diagnosis of gouty arthritis (gout). This drug will change the inflammation of the tissues. The onset of illness will subside within 2-3 days. After completing this stage, proceed to the next stages. My patients undergo treatment in a verified manner. Anyone can get rid of pain in 2 days without much effort.
According to the international classification of the illness, the disease is coded MKH 10 - M10-M10.9.
To help you understand what diseased tissue looks like, you can also look at photos of gouty arthritis on the Internet.
Brief description of the article: gouty arthritis Gouty arthritis or gout, and illnesses that develop through impaired speech metabolism when the volume of sechoic acid increases, and
Gout, a disease glorified by the classics of Russian literature, was not without reason considered a disease of the nobility. With this pathology, uric acid salts are deposited in a variety of tissues, including the joints of the legs. This process especially noticeably changes the joints of the big toes. The deposits cause inflammation in the joint (arthritis), and it loses its functions. The presence of an inflammatory process in the joint caused by salt deposits is gouty arthritis. The formation of deposits in gout is usually caused by metabolic disorders
Gout can be detected before unpleasant symptoms appear: it is enough to do a blood test, which will immediately reveal an increase in the amount of uric acid. However, most often people think about gout only after an acute attack of pain that occurs at night or in the morning. Pain is felt in the metatarsophalangeal joint of the big toe. The intensity of the pain is such that even a simple touch of the finger is unbearable. Then swelling of the joint and redness of the skin appear. The temperature may rise to 38-39 degrees, finger movements are painful. Sometimes the joint swells and becomes hyperemic so much that the doctor may mistakenly diagnose phlegmon or erysipelas. The first attack lasts about two to three days, then the symptoms may pass, supposedly leaving no consequences. But do not think that the disease has left you. She simply lay low until the next exacerbation, which can happen in a few weeks or months, and will be longer and much stronger than the first attack. Deposits accumulate, so the sooner you see a doctor, the better your chances of staying healthy.
Otherwise, the frequency of exacerbations will increase, and over time, damage to other joints may occur. Perennial gouty arthritis is characterized by the presence of tophi - accumulations of urate salts under the skin. Localization of deposits that look like whitish hard nodules is the ears and the space around the joint. Tophus can tear the skin, uric acid salts will come out, and the wound will close in a few days.
If left untreated, the kidneys are affected, resulting in pathologies such as uric acid nephropathy and urate nephrolithiasis. These disorders can lead to acute renal failure.
A rheumatologist in a hospital prescribes tests and treatment. It will take approximately 1-2 weeks to make a diagnosis, since there are many diseases that are extremely similar in individual symptoms to gout. Once diagnosed, treatment can be received on an outpatient basis.
With gouty arthritis, the doctor needs to solve three problems: 1) relieve inflammation and pain and 2) prescribe treatment to neutralize deposits and prevent the formation of new ones, and 3) recommend a diet and lifestyle that is compatible with the disease.
All information is provided for informational purposes only. Only a doctor can make the correct diagnosis and indicate appropriate treatment!
Gout is a disease caused by impaired purine metabolism and accumulation of sechoic acid in the body, which occurs with repeated attacks of acute arthritis. Gout has been around for a long time and was described by Hippocrates.
Crystals that cause gouty arthritis are cerate, sechoic acid salts, which accumulate in the cysts and irritants. An important symptom, in addition to arthritis, is tophi - white nodules on the ear, hands, feet.
All people suffer from gouty arthritis. At an early stage there is monoarthritis, then polyarthritis. Sometimes arthritis begins with the knee or metatarsophalangeal tendon, but arthritis of the first metatarsophalangeal tendon develops more often.
Diagnosis of gouty arthritis
Diagnosis of gouty arthritis is carried out based on the following signs: maximum inflammation of the joint (gout arthritis) on the first day, the presence of more than one attack of arthritis, monoarthritis, arthritis of the metatarsophalangeal joint of 1 finger, asymmetric arthritis.
Acute gouty arthritis develops through a tumor caused by an asymptomatic increase in the level of sechoic acid in the blood. The clinical picture of this kind of arthritis is rash-like growing pain, redness and swelling of the affected joint, insufficiency. In most cases, gouty arthritis in the first attack lasts for several days or even longer. Gouty arthritis occurs in attacks. Zagostrennya is often associated with the disruption of the child.
Arthritis of the metatarsophalangeal joint of the first toe may develop not only with gout, but the identification of provocative agents (alcohol consumption, lean meat and fatty hedgehogs) allows one to make a diagnosis of gouty arthritis itself.
Features of gouty arthritis
Arthritis with gout lasts a benign nature without treatment. Single attacks of arthritis, although painful, can easily be stopped with non-steroidal anti-inflammatory drugs or analgesics.
Patients with gouty arthritis, as a rule, do not want to be treated systematically. Obviously, this is due to the fact that most people suffer from arthritis. Alcoholization of patients also cannot have a positive effect on overcoming arthritis with gout.
According to the severity of inflammatory manifestations, septic and traumatic arthritis are similar to gout. In the remaining case, the presence of a provoking factor can often help in the differential diagnosis of arthritis.
One method that can help in the differential diagnosis of gouty arthritis is puncture of the affected cyst. Traumatic arthritis will be confirmed by the detection of hemarthrosis (houses of blood), the detection of monosodium urate crystals allows the diagnosis of gouty arthritis.
Additional evidence for the cause of gouty arthritis may be the fact of rapid relief of arthritis with non-steroidal anti-inflammatory drugs (and previously with colchicine), especially for arthritis.
Treatment for gouty arthritis
Treatment for gouty arthritis without diet or gluttony. Dzherelom sechoic acid is nitrogenous (purine). Therefore, the treatment of gouty arthritis can be preceded by strict cuts of meat and rib. For arthritis, dairy products, fruits, vegetables, cucumber juice.
At this time, non-steroidal anti-inflammatory drugs (diclofenac sodium, indomethacin in doses up to 200 mg per dose, Rapten Rapid) are used for the treatment of acute attacks of arthritis and gout. There is evidence that nimesulide (100 mg twice a day) is highly effective in treating gouty arthritis.
Glucocorticoids are the drugs of choice for polyarticular chronic gouty arthritis. In these cases, intravenous administration of metipred in doses of 250-500 mg can be recommended.
Prevention of acute attacks of gouty arthritis
Prevention of an acute attack of arthritis in gout can be achieved by using small doses of colchicine or non-steroidal anti-inflammatory drugs.
Characteristics and treatment methods for gouty arthritis
Gouty arthritis is a chronic illness, the causes of which have not yet been fully identified. According to the Fakhivts, it most often occurs in people with genetic diversity. As a rule, it affects men after 40 years of age and women during menopause.
There are three stages in the development of gouty arthritis:
Gout is caused by the accumulation of sechoic acid salts in sour milk
When ill, there are no objective symptoms of gouty arthritis.
The only diagnostic sign is an increase in the level of sechoic acid in the blood (hyperuricemia).
Due to the fact that the patient does not have daily scars, it is rarely possible to detect a pathological process at this stage of illness.
As a rule, the beginning of the pathological process is accompanied by inflammation of one joint (mono-arthrosis). This is the most important diagnostic sign of gouty arthritis.
This is characterized by severe pain in the neck, almost like turning the patient to bed. The burned plot swells greatly, and the skin in this area becomes crimson-red or bluish.
The pathological process is accompanied by underlying symptoms of intoxication (unfatigue, weakness, chills and fever). The blood shows hyperuricemia.
At this stage of illness, periods of congestion alternate with painful periods of remission (or more).
In the axillary tissue, on the outer surfaces of the ends, on the outer shells, and especially on the sore spots themselves, thickenings (tofusi) begin to form. As a rule, such a condition is typical for gout, which lasts more than 5 – 6 days and is accompanied by a high level of sechoic acid in the blood.
Tofusi are painless knots of a yellowish color. Sometimes during attacks they can instead be seen named through norms.
The primary symptom of chronic gouty arthritis is tightness in the joints, which is indicated in the body at rest. Further, permanent deformation is formed and the stiffness of the corner increases. This form of pathology is characterized by insignificant manifestations of local pain.
The joints of the feet most often suffer from this illness
For which standard anti-inflammatory drugs of a non-steroidal nature and/or glucocorticoids are used.
At the same time, there is a drug that is effective in treating gout. It's called colchicine. This results in a decrease in intensity directly in the activity.
Note: The therapeutic effect after stagnation of colchicine occurs after 2 – 3 days, which means that the discomfort of the attack is significantly reduced.
Since this pathology develops as a result of advanced vibrolysis of sechoic acid and its salts, in order to respond to nutrition to treat gouty arthritis, first of all, it is necessary to reduce it to a minimum Is in the blood.
At another stage of treatment, the patient is prescribed uricodepressants (alopurinol), uricolytics (uricozyme) and uricosuric drugs (probenecid). Alopurinol reduces the production of sechoic acid, probenecid enhances the elimination of nitric acid, and uricozyme helps break down urate. As a rule, during the treatment process the drugs are combined.
Get ready! In case of pathology, low probenecid and other drugs in this group are contraindicated.
At the same time, the treatment of gouty arthritis in the budinka transfers the stagnation of traditional methods of treatment.
Get ready! Traditional medicine and physiotherapeutic procedures are an individual technique that must be carried out under the full supervision of a doctor.
Recommendations for food
The key to successful treatment of gouty arthritis is to carefully follow all the doctor’s recommendations regarding food intake.
The most popular vegetables for gout are cucumbers, zucchini, cabbage, dini, tomatoes, watermelon and white cabbage. For fruits, it is necessary to give preference to oranges, apples, apricots, pears and plums. For berries, cherries, grapes, chornitsa and sunitsa.
Recommendation: patients suffering from gouty arthritis are recommended to have a fruit-and-vegetable day every week.
It is not possible to overdo it at any time! It is important to understand that without following all the recommendations, it is possible to initiate the ignition process and increase the swelling of the joint.
Brief description of the article: gouty arthritis Gouty arthritis is a chronic progressive pathology associated with impaired purine metabolism, increased synthesis of sechoic acid and deposits of urates (salts) in the muscles and internal organs sechoic acid). gouty arthritis treatment symptoms diet as treatment gout, arthritis
Gout is a metabolic disease caused by impaired purine metabolism and accumulation of sechoic acid in the body, which results from tissue urates .
Gout most often develops in the fifth decade of life. The prevalence of the disease is 0.1%. Men get sick 20 times more often than women.
They separate primary and secondary gout. Pervice - Samostyina Zakhvoryvannya, secondary gout - manifested auspicat (miLoleicosis, psoriaz, Khronsky Nirkov lack of lack, hemoglobinopathy), namephaznaya Likarskin (riboxin, cytostanics, saluretics tu іn.).
In primary gout, genetically determined defects in enzymes involved in the metabolism of purines are often detected: decreased activity of hypoxanthine-guanine phoribosyltransferase and increased activity; 5-phosphorylbosyl-l-synthetase, which leads to increased synthesis of sechoic acid. The synthesis of enzymes is controlled by genes linked to the 3rd X chromosome, which is why the defect is rare in humans. 3, a genetic defect is associated with the hypofunction of enzyme systems that regulate the excretion of sechoic acid.
The development of gout is also caused by supernatural food, monotonous meat, drinking alcoholic beverages (especially beer, dry grape wines), as well as a low-grade way of life. The most common cause of secondary gout is nitric acid deficiency, blood disease (leukemia), which is accompanied by cell breakdown and hyperuricemia.
The development of the disease is based on a disruption in the metabolism of sechoic acid. There are three phases of pathogenesis:
1) hyperuricemia i accumulation of urates in the body;
2) insertion of urates in textiles;
3) gouty inflammation.
In healthy people, the clearance of sechoic acid is 6-7 ml/min, and the uraturia is 1.8-3.6 mmol (300-600 mg).
Hyperuricemia and decreased excretion of urates from tissue leading to the release of urates in tissues.
Acute gout inflammation develops as a result of the deposition of urate microcrystals in the throat, which activate the Hageman factor, complement components, kinins, which lead to increased vascular permeability, neutrophic influx Lv. Phagocytosis of crystals is accompanied by the release of lysosomal enzymes and cytokines, as a result of which inflammation develops. Urate crystals are also deposited in the interstitium of the lower tubules, leading to the development of gouty nephropathy, another important clinical sign of gout.
Clinical manifestation. A typical ghost attack (classic) is avoided in 50–80% of attacks.
The attack occurs most often in the middle of good health, begins raptically, often at night, a very sharp pain appears in the plephalangeal angle (big toes), the angle of the foot swells slightly, the skin over it turns red, then becomes є bluish-purple, hot body temperature Moves to 38 - 39 °C, the function of the suglob is destroyed.
As the attack progresses, the amount of blood sugar, sialic acids, fibrin, seromucoid, which is C-reactive protein, increases.
For the first attack of gout in men, the characteristic monoarthritis is more important than the severity of the balls of the feet (the balls of the great toe, plephalangeal, forefoot, etc.) In women, one can often beware of oligo- or polyarthritis, and more often under the hour why should the wrists retract? (in 1/3 of patients ).
In 3 hours, patients develop chronic gouty polyarthritis, which most often affects the joints of the legs, deformation of the joints, crimping of the ribs, then deformation of the joints behind the arch of the joints, cysts kovih ruinuvan. Against the background of this illness, acute attacks of gout continue to occur, and the most severe variety is gouty status - a permanent aggravation of arthritis.
Tofus (gouty nodules) - a specific sign of gout - these nodules, which are the result of urination, are most often localized on the ears, elbows, bursae of the elbow joints, etc. (Fig. 30, 31, 32).
Nirkovakamyan disease occurs in 40% of patients, gouty nephropathy - gouty interstitial nephritis, and then CNN - in 30% of patients.
Laboratory and instrumental data . At the hour of attack - neutrophilic leukocytosis, increased SCE, instead of seromucoid, fibrin, sialic acids, gammaglobulins, sechoic acid.
X-ray of the corners - against the background of osteoporosis, changes in the corners and epiphysis are revealed in the appearance of round “stamped” cavities of lightening up to 2-3 cm in diameter.
In the synovial region, crystals of sodium urate are microscopically detected. Puncture and biopsy of tophi reveal crystals of sechoic acid.
Rice. 30. Tofusi on the ear canal. Rice. 31. Great tofusi in the hand-shade.
Rice. 32. Chronic tophi arthritis in a patient with gout.
1. Sechoic acid in the blood is more than 0.42 mmol/l (7 mg%) in men and 0.36 mmol/l (6 mg%) in women.
2. Detection of tophi.
3. Detection of crystals of secundant sodium in the synovial tissue or the presence of secundant salts in tissues (chemical or microscopic examination).
4. Clear anamnestic information about the severity of the joints (swelling with 3 attacks of pain).
The diagnosis depends on whether two criteria are positive.
Date added: 2015-11-25 | Views: 210 | Copyright infringement