Date of publication of the article: 08/11/2016

Date of updating the article: 05.12.2018

Gout is a metabolic disorder. The essence of this disease is a violation of the processes of formation, circulation and excretion of uric acid. The resulting excess uric acid is deposited as crystals on the surface of the joints, causing inflammation (arthritis). Most often, the joint of the big toe is primarily affected, but as the pathology progresses, any joints can be involved in the inflammatory process.

Uric acid crystals on the big toe

As part of this article, I will talk in detail about the symptoms and methods of treating the disease.

The main manifestations of the disease at the time of exacerbation are severe excruciating pain in the area of ​​the inflamed joint, its swelling and redness. Any movement increases pain, resulting in temporary loss of joint function. With a prolonged or aggressive course of gout, a pronounced inflammatory process occurs, which is accompanied by the destruction of articular cartilage, deformation, the appearance of gouty nodes (tophus) and limitation of joint mobility. In severe cases, internal organs are affected, primarily the kidneys. All this becomes the cause of temporary, but permanent disability.

In case of gout disease, treatment should be aimed not only at stopping arthritis, but also at restoring the normal metabolism of uric acid. If the doctor prescribes a complex conservative treatment immediately after the onset of the first manifestations of the disease, gout can be completely kept under control. Patients are obliged to adhere to dietary restrictions and recommendations regarding medication throughout their lives.

The diagnosis and treatment of this disease is carried out by a rheumatologist. Perhaps conservative treatment under the supervision of a therapist. A surgeon or orthopedist-traumatologist is involved in the treatment of gout with suppuration of gouty arthritis or, if necessary, removal of periarticular nodes (tophi).

Typical symptoms of the disease

Common signs

Gout is a chronic disease, that is, during its course there are two periods: exacerbation, when the symptoms of gout are pronounced, and remission - the extinction of manifestations.

You can suspect the presence of gout by the following symptoms:

Gouty arthritis (joint inflammation): pain, swelling, redness of the skin over the area of ​​the inflamed joint.

The appearance of nodular formations (tofuses) located subcutaneously in the area of ​​the joints.

Restriction of movement in the inflamed joint (for example, inability to walk and support on the foot).

General rise in temperature.

Signs of kidney damage (pain in the kidney area, blood in the urine, etc.).

Symptoms of Acute Gouty Arthritis

The obligatory first manifestation of gout is joint damage. The classic version of the onset of the disease is inflammation of the joint of the big toe (most often the lateral surface in the area of ​​the joint of the big toe with the metatarsal bone of the foot suffers). Less often, small joints on its back surface become inflamed.

Gout of the thumb joint

Patients are worried about:

• severe burning pain in the joint,
• rapidly progressive edema and redness of the skin over the inflamed area,
• increased pain with the slightest movement or stress on the affected joint.

Features of exacerbation of gouty arthritis of any localization:

• arises suddenly and instantly against the background of complete well-being;
• often provoked by the intake of alcoholic beverages, spicy and fried foods, overload or joint injury;
• pain always appears first, during the day, swelling and redness of the skin arises and maximizes;
• pain attack appears at night or in the morning;
• in one attack, one joint on one limb is predominantly affected, which distinguishes gouty inflammation from other types of arthritis;
• the body temperature rises: a slight increase (slightly more than 37.0 degrees), to a critical one (more than 39.0 degrees);
• within a few days (about a week) the attack goes away on its own.

Tophus - a sign of recurrent exacerbations of gout

If gout is not treated well enough, arthritis attacks often recur. The result is the formation of painless subcutaneous nodules in the area of ​​previously inflamed joints. Such nodules (they are called tophuses) have a yellowish-whitish tint and represent the deposition of uric acid in the periarticular tissues.

The favorite location of tofuses is fingers and toes, auricles, ankle and elbow joints.

Topuses on the finger

The chronic course of gouty arthritis is fraught with destruction of the cartilage that covers the surfaces of the articular ends of the bones. This threatens with deformation, complete destruction of the joint and its ankylosis (closure, fusion).

Signs of kidney damage

Since with gout, the blood is oversaturated with uric acid, the protective metabolic mechanisms are aimed at its enhanced excretion from the body. The main route is urinary excretion. Therefore, the kidneys with gout have a large functional load. A characteristic feature of uric acid is the rapid formation of crystals when passing through the kidneys, which causes the accelerated formation of urate stones.

Therefore, patients often complain of such symptoms of gout as lower back pain on one or both sides of the spine, accompanied by cuts in the lateral abdomen, urinary disorders. Large coral-type stones may form, which can cause severe inflammation (pyelonephritis), impaired renal function, or block the flow of urine.

Correct treatment

Complex therapy for gout should be step-by-step. It consists of three stages:

relief of an acute attack (gouty arthritis);

drug correction of excess uric acid;

diet and prevention of recurrent exacerbations.

1. Exacerbation therapy

Treatment of gout with an initial onset or repeated attack in the form of arthritis is carried out with the help of anti-inflammatory drugs.

Colchicine

This drug is best at relieving gouty inflammation in the joints. The speed of the onset of the effect depends on the route of administration of the drug: injections are the fastest, they are done within a few days. In the future, the patient takes pills.

Colchicine prevents recurrent attacks of gout and is taken for several weeks or months.

Non-steroidal anti-inflammatory drugs (NSAIDs)

These medications are most commonly used in the treatment of any form of gout because they are relatively effective and easily available from any pharmacy. NSAIDs act for a short time, stopping only the symptoms of inflammation. They do not affect the frequency of recurrence of gout, so doctors prescribe them only for the next attack of the disease.

The standard course of treatment is 1-2 weeks.

• indomethacin,
• ibuprofen,
• diclofenac,
• ketorolac,
• meloxicam.

Glucocorticoid hormones

The anti-inflammatory effects of glucocorticoids are very strong, but due to dangerous side reactions - for gout, doctors prescribe them relatively rarely.

Indications for glucocorticoid hormones: prolonged attack or simultaneous damage to several joints, involvement of large joints in the process.

Glucocorticoids are used in the form of injections (injections, droppers) or tablets.

The main principle of therapy with these agents is a gradual dose reduction. Glucocorticoid therapy should not be continued for more than 7 days, except in severe cases of the disease.

The drugs used:

• methylprednisolone;
• hydrocortisone;
• dexamethasone;
• triamcinolone.

Anti-inflammatory ointments

Applying an ointment or gel that contains an anti-inflammatory drug can relieve the symptoms of gouty arthritis. But local treatment of gout is only an additional component of complex therapy. It is unacceptable to place high hopes on it in terms of efficiency.

Anti-inflammatory drugs for local application to the area of ​​the inflamed joint:

• indomethacin ointment,
• gel "Indovazin",
• remisid,
• nimid gel,
• dolobene,
• diclak.

Unloading the joint

The joints affected by gout are left either at rest (that is, they exclude any movements and loads), or are fixed with a bandage, splint, orthosis. The main principle of this measure is to prevent mechanical irritation and progression of inflammation in the joint. A temporarily immobilized joint recovers much faster.

2. Basic therapy for gout and prevention of flare-ups

Since gout is a metabolic disease, anti-inflammatory treatment alone is not enough to maintain control over the disease.

The basic (main) treatment for gout is taking medications that eliminate excess uric acid in the body. What medications are these:

Means that block the synthesis (formation) of uric acid: allopurinol, thiopurinol, orotic acid. They are prescribed for all patients with gout.

Drugs that accelerate the excretion of metabolites and uric acid itself through the kidneys: drugs containing sulfinpyrazone (anturan, sulfazone, anturadin), probenecid, benziomarone (exurate, normurat, uriconorm). They are used with caution when combining gout with urolithiasis.

Medicines that dissolve uric acid: soluran, blemaren.

The drugs that are used for basic treatment are not suitable for the relief of acute attacks of arthritis. Likewise, anti-inflammatory drugs alone are not enough to cure gout. Therefore, both groups of drugs must be correctly combined, depending on the presence of exacerbations. Treatment with agents that cleanse the body from uric acid should be long-term (several months), and sometimes lifelong.

Physiotherapy

Physiotherapy procedures help to finally stop inflammation in the joints with gout. They are prescribed exclusively after drug reduction. In the acute period of the disease, any methods of physiotherapy are categorically contraindicated.

What techniques are used:

• applications of paraffin and ozokerite,
• healing mud,
• magnetotherapy,
• electrophoresis,
• phonophoresis of drugs.

Paraffin-ozokerite applications on the knees

3. Mandatory diet

In many cases, an exacerbation of gout provokes an unhealthy diet.

Patients need:

(if the table is not fully visible, scroll to the right)

Diet rules for gout

When is surgery needed?

Surgery for gout is rare. Brief description of possible surgical intervention and indications for them:

• Removal of tofuses - required when they are severely overgrown or inflamed.
• Opening of the joint cavity, drainage of purulent cavities. An autopsy is indicated in the presence of purulent complications of gout (phlegmon, bursitis, arthritis).
• Endoprosthetics of joints. Such an operation is performed in patients with severe gouty lesions of the large joints (hip, shoulder, knee).

Most cases of gout can be successfully treated with conservative methods.

It takes about a week to stop arthritis. Anti-relapse treatment is carried out in long courses for life: it can be either adherence to a diet, or a diet with taking basic drugs.

Owner and responsible for the site and content: Afinogenov Alexey.

Is a metabolic disease in which uric acid salts (known as urates) are deposited in the joints. Gout is also called "the disease of kings", it is an old disease that was known back in the days of Hippocrates. Now gout is considered a rare disease, it affects 3 people out of 1000. And most often it affects men over the age of 40, in women it most often manifests itself after menopause. Gout itself is one of the varieties caused by salt deposition.

All joints are affected by gout, from the joints of the fingers to the joints of the toes.

It was known back in the days of Hippocrates and is called the "disease of kings" due to the fact that the main source of its occurrence is immoderation in food and alcohol. Gout is often chronic.

Video: who is at risk of the disease of kings (gout)?

Causes of gout

Cause of gout is an elevated and sustained level of uric acid in the blood. During the course of the disease, urate crystals (a derivative of uric acid) are deposited in the joints, organs and other systems of the body. Sodium urate crystallizes and is deposited in small particles in the joints, which ultimately leads to partial or complete destruction of the joint. For the same reason, such situations are called microcrystalline.

A large amount of uric acid in the body can be for two reasons: the first reason is when healthy kidneys cannot cope with the excretion of unusually large amounts of uric acid, the second reason is when uric acid is excreted in normal quantities, but the kidneys are unable to excrete it.

Every year there are more and more patients with gout. Doctors explain this phenomenon by the fact that in recent years people are more likely to eat foods rich in purines (for example, meat, fatty fish) and a huge amount of alcoholic beverages. This is confirmed by the fact that during the wars the percentage of people with gout dropped sharply due to the fact that meat products, and even more so alcohol, were very difficult to get.

Purine is a complex organic compound, part of which is broken down in the body, and part is transformed into uric acid. A healthy body separates purine through renal filtration and excretes it from the body in urine.

In the case of gout, uric acid is produced much faster. Its elimination is difficult, which contributes to the accumulation in the body. Uric acid salts are converted into crystals and cause gout attacks. Individual food components, drinks can act as provocateurs of this process:

Foods with a high concentration of purine is a key risk factor. Some seafood, bacon, veal, beef are not recommended for patients with gout.

Beer- more often than others, it becomes the cause of the development of gout attacks. It is caused by brewer's yeast, which is very high in purine. It is important to remember that any alcohol increases the likelihood of developing a gouty crisis.

High fructose drinks, sugars, carbonated drinks, sweet fruit juices. They impede the excretion of uric acid by renal filtration and provoke the development of hyperuricemia.

Diseases that provoke the development of gout

Certain physical disorders can lead to the development of gout. Diseases of the internal organs affecting the function of the kidneys or causing pathological foci of inflammation cause the active production of uric acid. The most likely causes of gout are:

Chronic kidney disease;

Chronic heart disease;

Hemolytic anemia;

Decreased thyroid function - hypothyroidism;

Intercritical period. The disease does not give acute symptoms, the patient has no complaints of unpleasant, painful sensations. The joints maintain physiological mobility. Uric acid salts accumulate in the tissues during this time. A gouty attack can occur over a long time - months, years. The patient can control this process by following a diet and specific medications.

Chronic gouty arthritis. This condition is caused by the lack of special therapy in the early stages of gout, failure to observe monitoring of the uric acid content. The disease develops rather quickly. Other joints, bladder, kidneys, and other organs are involved in the pathological process. Gouty nodes - tophuses - increase in size, damage articular cartilage, ligaments, can lead to bone deformities, destruction of joints.

Timely treatment of gout, compliance with all the prescriptions of the attending physician makes it possible to reduce the intensity of attacks or eliminate them completely. Violation of therapeutic procedures, errors in the diet lead to an increase in gouty crises, a reduction in the time intervals between them, and intense pain.




The main and strongest complication of gout is the appearance, it is also possible the occurrence of urolithiasis, in which the resulting stones consist of urate or crystallized uric acid.

Gouty knots also called "tofus" are nothing more than conglomerates of sodium urate crystals, which have the ability to be deposited in all parts of the body. And in cases where such deposits get stuck in the joints or periarticular tissues, an immune reaction occurs, since these deposits are perceived by the body as a foreign body, due to which the accumulation of leukocytes occurs and severe inflammation begins, which is called gouty arthritis.

It is worth paying special attention to the fact that kidney stones arising from gout can become the main cause and, as a result, can lead to death.

Pain with gout

You can understand about the onset of gout by the sudden pain in the joint. They are accompanied by severe redness, swelling, and fever. "Burn" can not only the affected area, but also the area of ​​the body in the immediate vicinity. In this case, the body temperature can rise to 39-40 ° C. Symptoms usually develop within an hour. Most often, the big toe suffers from this. Conventional pain relievers like aspirin won't help.

The pain usually starts at night and becomes almost unbearable. In the daytime, some improvement is often observed, the pain recedes, but you should not think that everything has passed. Such acute symptoms can torment the patient for about a week.

Gout in men on the legs




Gout is a chronic condition. It is almost impossible to cure it completely. This ailment most often manifests itself on the legs. After the onset of the disease, the symptoms may recur again after six months or a year. The disease can go into a dormant state, but, without any doubt, it will make itself felt. With each attack, the time between them will decrease. Gout will come back to the person more and more often.

The damaged places on the legs are often destroyed more and more, the disease can also affect the neighboring joints. With a long-term illness, over time, on the affected areas, a kind of bumps may appear under the skin, which are called "gouty nodes" or "tophus".

This happens due to the fact that the body begins to perceive large salt deposits in the joints on the legs as a foreign body, the immune system begins to inevitably react - to accumulate leukocytes, after which severe inflammation begins. Sometimes tophuses burst and whitish dust is released from them - crystals of uric acid.

Gout often develops in old age. In men, it occurs much more often and at an earlier age. The male population is susceptible to this disease by the age of 40. It should be noted that women begin to suffer from gout closer to 55, mainly after menopause, when the amount of estrogen and female hormones in the body is sharply reduced. Children and young men are virtually immune to gout. There are rare exceptions in cases of hereditary disorders of uric acid metabolism.

The role of uric acid in the development of gout




This disease severely disrupts metabolism. Purines enter the human body with food, but they are also produced by him. Further, purines are broken down into uric acid, which is excreted by the kidneys. In people with gout, the content of this uric acid is significantly higher than the norm. Excess uric acid is deposited in tissues where there is no blood supply. It is there that the crystals are easiest to gain a foothold.

Most of all, joints, cartilage and tendons are susceptible to this. As a result of this disease, not only these places are affected, but also the kidneys. Most often, with gout, urolithiasis develops, with a lower percentage of the likelihood the patient may suffer from renal colic.

This can happen for two reasons: if too much uric acid is produced and the kidneys cannot cope with the volume of excretion, so it has to be deposited in the human body. And the second reason is that the amount of uric acid is normal, but the kidneys cannot excrete it.

However, an overestimate of uric acid in the body is not the only reason for the development of gout. Several other factors play a decisive role here: excessive nutrition, fatty foods, overweight, a sedentary lifestyle, and hereditary predisposition.

Diagnosing gout

The diagnosis is confirmed by a rheumatologist, based on the results of a comprehensive examination of the body. First of all, the doctor collects anamnesis data, examines the damaged joints. Laboratory diagnostics can differentiate gout from other diseases that have similar symptoms. For this, it is necessary to perform the following studies:

Blood test for creatinine and uric acid. For men, the rate of uric acid content is up to 0.42 mmol / l, for women - up to 0.36 mmol / l.

Analysis of synovial fluid obtained by puncture of a joint affected by gout. Urate crystals are found in the contents.

Hardware methods. X-ray, ultrasound, CT, MRI can exclude other diseases, fix the location, parameters of gouty tophi.

What to do in case of an acute gout attack?

Even if the recommendations are followed, an acute attack will not go away instantly. But this will significantly reduce the time during which the disease will torment a person. Above all, strict bed rest must be observed. Sore limbs are best kept in an elevated position, for example, by placing a pillow under them.

In case of unbearable pain, ice can be applied. After that, it is advisable to make a compress on the sore spot with Vishnevsky ointment or Dimexidum. It is better to limit your food intake, you can use liquid cereals and vegetable broths. It is worth drinking as many alkaline drinks as possible, for example, a decoction of oats, jelly, milk, mineral water or plain water, but with the addition of lemon juice (lemon juice dissolves uric acid deposits in rheumatism and gout). Very helpful. You need to drink at least 3 liters per day (in the absence of kidney disease).

Pain relievers won't help. You can take modern anti-inflammatory drugs without steroids. The most popular NSAIDs are diclofenac, ibuprofen. New generation drugs: Ksefokam, Movalis, Nimesulide, Celecoxib. If you took any prophylactic drugs prescribed by a doctor, then you should continue taking it.

Prevention of exacerbations of gout

Most often, gout appears in those places where the joint was injured. Therefore, treat such places with caution. You should not wear tight and uncomfortable shoes, as they can severely damage the big toe, which “loves” gout. Mainly for the prevention of gout attacks, diet and balanced nutrition are used.

The lifestyle will have to be completely revised, to make it healthy. You should reconsider your taste preferences. Recommended, which helps to reduce uric acid and urate in the body. Products containing purine bases - the main source of urates - are strictly limited, if not completely excluded. But poor in purines, and therefore permitted milk, cheese, eggs, vegetables, fruits and cereals will not leave you hungry. The patient's diet should contain whole grains, eggs, vegetables, fruits, and low fat dairy products.

In food, you should limit the intake of meat, fish, caviar, mushrooms, legumes. In addition, you need to limit the consumption of: smoked meats, marinade, anchovies, cauliflower, asparagus, sorrel, chocolate. Such a diet will normalize body weight and significantly reduce the stress on joints during an exacerbation of gout.

Detailed information on what you can and cannot eat, as well as other features

Alcohol and smoking inhibit the excretion of uric acid from the body. Consequently, its crystals are more deposited in the joints. For prevention, alcohol, especially beer, should be completely eliminated, as well as quit smoking. Drinking tea, coffee, cocoa is not recommended. In addition to the diet, it is worth doing a fasting day at least once a week with the use of a mono-product.

Small joints are primarily affected. Therefore, it is worth paying special attention to the development of their mobility. Attention should be focused on those areas where pain attacks occur. It is worth doing gymnastics for the joints every day. At first, this will be weird as the deposits make it harder for the joints to move. It is recommended to be outdoors and take walks more often.

Mineral water for gout

Mineral waters are excellent for removing unnecessary purines from the body. Give preference to alkaline and organic waters. These include, first of all, Narzan, Essentuki and Borjomi. Remember that any liquid should be consumed at least 2.5 liters per day.

A diagnosis of gout means that a person will have to significantly change their lifestyle and constantly take medications, because, unfortunately, it is impossible to achieve a complete cure for this disease. However, timely started treatment allows you to take control of gout, reduce painful attacks to a minimum and insure against serious complications.

The main principle of gout treatment is to control the level of uric acid in the body. For drug treatment, you should consult a rheumatologist. His prescriptions will be aimed at reducing the volume of uric acid and at its speedy elimination from the body. Only a qualified specialist can prescribe medications that, with possible concomitant diseases, will not cause the greatest harm to health.

Most often, doctors prescribe non-steroidal anti-inflammatory drugs for 1-2 weeks, such as metindol, diclofenac, butadion, indomethacin, naproxen. To quickly reduce the concentration of uric acid in the body, allopurinol, orotic acid, thiopurinol, hepatocatazal, and miluritis can be prescribed. For the relief of acute symptoms of gout, doctors recommend taking colchicine.

Drug therapy for gout is aimed at solving two main tasks:

Decrease in the level of uric acid in the patient's body;

Relief of acute inflammation and pain relief.

The earlier the patient is examined, revises his habits and starts treatment, the more likely it is to achieve a stable remission. Without adequate therapy, gout progresses rapidly, especially in patients of mature and old age, therefore, it is by no means possible to reason according to the principle of "grab and let go".

Drug therapy to lower uric acid levels

Since the root cause of gout is precisely the excess of uric acid, solving this problem in 90% of cases leads to the cessation of attacks of excruciating pain and allows you to count on a comfortable life in the future.

The following drugs are used to lower the level of uric acid in the body:

Allopurinol is a synthetic analogue of hypoxanthine. This substance inhibits the activity of the xanthine oxidase enzyme, which is responsible for the transformation of human hypoxanthine into xanthine, and then xanthine into uric acid. Thus, Allopurinol reduces the concentration of uric acid and its salts in all environments of the body, including blood, plasma, lymph and urine, and also promotes the gradual dissolution of already accumulated urate deposits in the kidneys, soft tissues and joints. However, this drug has a number of serious side effects and greatly increases the excretion of xanthine and hypoxanthine in the urine, therefore Allopurinol is contraindicated in patients with severe renal failure. Nevertheless, for the majority of patients with gout, it is he who remains the first-line drug to this day. Cost: 80-100 rubles per pack of 30-50 tablets;

Febuxostat (Uloric, Adenuric)- a selective (selective) inhibitor of xanthine oxidase, which, unlike Allopurinol, does not affect other purine and pyramidine enzymes of the human body, moreover, it is excreted not by the kidneys, but by the liver. Febuxostat is a relatively new drug for the treatment of gout, it is not produced in Russia, and in Western Europe and the USA it has undergone numerous clinical trials and has shown excellent results. Febuxostat completely dissolves the accumulations of uric acid crystals in the area of ​​the fingers and elbows within three months and effectively prevents their re-formation. Can be used by patients with concomitant renal pathologies. The drug is not cheap - on average, from 4500 to 7000 thousand rubles, depending on the country of origin;

Pegloticase (Pegloticase, Krystexxa)- an infusion solution of enzymes that quickly dissolve urate crystals (deposits of uric acid salts). It is used intravenously twice a month to stabilize the condition of patients with severe gout who are not helped by traditional drugs. Anaphylactic shock is possible during the procedure. This is a very expensive drug that is produced exclusively abroad and sold on order;

Probenecid (Santuril, Benemid)- a drug that prevents the reabsorption of uric acid in the renal tubules and enhances its excretion in the urine. Probenecid was originally used in complex antibiotic therapy to reduce the harm caused to the kidneys by antibiotics. But then it began to be prescribed for chronic gout and hyperuricemia (increased content of uric acid in the blood). It is important to understand that Probenecid enhances the excretion of uric acid, and does not suppress its synthesis. Therefore, the treatment of gout with this drug is advisable only at the stage of remission. If Probenecid is prescribed to a patient with an acute inflammatory process, this will lead to the active dissolution of already accumulated urates, an increase in the level of uric acid in the plasma, and, as a consequence, to attacks of excruciating pain. To avoid this risk, the first months of treatment for gout with Probenecid are accompanied by additional hormonal and anti-inflammatory therapy. The drug costs from 3,500 to 7,500 rubles.

Treating gout with decongestants and pain relievers

Symptomatic treatment of gout consists in relieving seizures, relieving swelling and pain, and is performed with the following drugs:

Colchicine (Colchicum, Kolkhimin)- alkaloid, isolated from poisonous plants of the melantium family. The most common source of colchicine is colchicum. Colchicine inhibits the formation of leukotriene, stops cell division of granulocytes, prevents the movement of leukocytes to the site of inflammation and prevents urates (uric acid salts) from crystallizing in tissues. This drug acts as an emergency aid, and is recommended for admission in the first twelve hours after the onset of an acute gout attack. It is necessary to drink two tablets of Colchicine at once, after an hour - another one, and then one tablet three times a day for a week. The drug very often causes undesirable reactions from the gastrointestinal tract - nausea, vomiting, loose stools. The average price of Colchicine in pharmacies is from 1000 to 2000 rubles;

Glucocorticoids (Cortisone, Hydrocortisone, Prednisone, Prednisolone)- synthetic analogs of human corticosteroids, that is, hormones produced by the adrenal cortex. Drugs in this group break the chain of the body's natural reactions to the interference of allergens, chemicals, bacteria, viruses and other foreign elements. Glucocorticoids quickly stop inflammation, but suppress the immune system, so hormonal treatment for gout is advisable only when the expected benefit outweighs the potential risk. The cost of synthetic steroid hormones varies from 30 rubles (the oldest drug is Prednisolone) to 1,500 rubles (Cortisone);

NSAIDs (Aspirin, Analgin, Diclofenac, Ibuprofen)- nonsteroidal anti-inflammatory drugs are named so in order to emphasize their difference from hormones. However, the effect of drugs in this group is somewhat similar to the effect of glucocorticoids. NSAIDs are non-selective inhibitors of cyclooxygenase, an enzyme responsible for the synthesis of thromboxane and prostaglandins. Thus, these drugs also suppress inflammation, but unlike synthetic corticosteroids, they do it more slowly and are not immunosuppressive. For the symptomatic treatment of gout, Diclofenac and Ibuprofen are most often used, the average cost is 10-30 rubles, the price of a popular generic (drug with the same active substance) Nurofen can reach 150 rubles.

How to prevent gout attacks?

To keep your risk of new gout attacks to a minimum, follow a few simple rules:

If possible, do not subject the sore joint to any stress, periodically fix it in an elevated position and apply ice for 15-30 minutes 2-3 times a day until the pain subsides;

Do not overuse aspirin, which can cause spikes in blood uric acid levels and worsen gout symptoms;

Measure the level of uric acid regularly - it should not exceed 60 mg / l;

Devote at least half an hour every day to physical education: walk, ride a bike, jog, dance, swim. Be sure to exercise in the morning. Regardless of age and weight, patients with gout should give themselves a feasible physical activity every day - sports are more effective for gout than any drugs;

Drink at least two liters of clean water a day. In order for the kidneys to excrete uric acid from the body, they first of all need clean water. Without enough water, even healthy kidneys will not be able to cleanse the body;

Take a blood test to determine the level of essential minerals and vitamins, and, if necessary, supplement the diet with a good vitamin-mineral complex. It is especially important for patients with gout to provide themselves with vitamin C;

Do not drink carbonated drinks with sodium benzoate and powdered juices with fructose, completely give up alcohol;

Reconsider your diet in favor of vegetables, fruits and cereals, eat no more than 120 grams of animal protein per day, avoid offal and fatty sausages.

Gout is a painful inflammatory condition of acute arthritis characterized by the deposition of uric acid crystals in the joints and soft tissues. The painful sensations often start at night and can last for up to a week.

If gout is diagnosed correctly, then the treatment of the disease is relatively easy for both doctors and patients. The main recommendations for reducing the symptoms of chronic gout are adherence to treatment and lifestyle. However, the asymptomatic course of the disease between painful sensations contributes to the fact that not all patients seek help in a timely manner.
People with gout are at increased risk of having metabolic syndrome. Metabolic syndrome is a collection of symptoms such as abdominal obesity, high blood pressure, and low cholesterol levels. This syndrome increases the risk for a person to get heart disease and stroke. Thus, lifestyle changes are an important aspect of preventing gout and improving overall health.

Brief Anatomy

The disease of gout appears in the human body as a result of the following phenomena:

- Purine metabolism... The process leading to hyperuricemia and gout begins with the exchange of purines, nitrogen-containing compounds that are important in energy production. Purines can be classified into two types:
1. Endogenous purines, which are produced in human cells.
2. Exogenous purines - obtained from foods.
The breakdown of purines leads to the formation of uric acid in the body. Most mammals have an enzyme called uricase, which breaks down uric acid so it can be easily removed from the body. Humans do not have the enzyme uricase, which makes uric acid not so easy to excrete, which leads to its accumulation in the tissues of the body.

- Uric acid and hyperuricemia. Purines in the liver produce uric acid. Uric acid enters the bloodstream, most of it eventually travels through the kidneys and is excreted in the urine. The rest of the uric acid travels through the intestines, where bacteria help break it down.
Usually, these processes allow maintaining a healthy level of uric acid in the blood plasma (liquid part of the blood), the indicator in a healthy person is below 6.8 mg / dL. But under certain circumstances, the body produces too much uric acid or excretes too little. In this case, an increase in the concentration of uric acid in the blood occurs. This condition is called hyperuricemia.
When the concentration of uric acid in the blood reaches levels above 7 mg / dL, needle-like salt crystals called monosodium urate (MSU) begin to form. The higher the level of uric acid in the blood, the higher the risk for crystal formation. The process of crystal growth in the joints causes inflammation and pain, common symptoms of gout.

Causes of the development of gout

Gout is classified as primary or secondary, depending on the underlying causes of high levels of uric acid in the blood (hyperuricemia).
More than 99% of cases of primary gout are called idiopathic, which means that the cause of hyperuricemia cannot be determined. Primary gout is most likely the result of a combination of genetic, hormonal, and dietary factors. Secondary gout is caused by drug therapy or other factors that have caused metabolic disorders in the body.

Risk factors for development gout

The following factors increase the risk of gout:

- Age... Gout usually occurs in middle-aged men, peaking at the age of 40. For this age group, obesity, high blood pressure, low cholesterol, and alcohol abuse are most commonly associated with the onset of the disease.
Gout can also develop in older people, and it occurs equally in men and women. Within this group, gout is most commonly associated with kidney problems and diuretic use. It is less commonly associated with alcohol consumption.
With rare hereditary genetic disorders that cause hyperuricemia, gout occurs in children.

- Floor. Men. Men have a significantly higher risk of developing gout. In them, uric acid levels rise significantly during puberty. About 5 to 8% of Americans have uric acid levels above 7 mg / dL (indicating a diagnosis of hyperuricemia). As a rule, men experience their first attack between the ages of 30 and 50.
Women. Before menopause, women have a significantly lower chance of developing gout than men, possibly due to the action of estrogen. It is a female hormone that helps to facilitate the excretion of uric acid by the kidneys. (Only 15% of women develop gout before menopause.) After menopause, women are at increased risk of gout. At the age of 60, the incidence is equal in both men and women, and after 80, gout is even more common in women.

- Family genetic inheritance. Genetic gout is present in about 20% of patients who have family members with the condition. Often these people have a defective protein (enzyme) that interferes with the breakdown of purines.

- Obesity. Researchers report that there is a clear relationship between body weight and uric acid levels. In one Japanese study, overweight people were three times more likely to have hyperuricemia than healthy people. Children who are obese have a higher risk of developing gout in adulthood.

- Medicines. Thiazide diuretics are "diuretics" used to control hypertension. The drugs are closely related to the development of gout. A large percentage of patients who develop gout at an older age report using diuretics.

In general, many medications can raise uric acid levels and increase the risk of gout. These include:

Aspirin - Low doses of aspirin reduce the excretion of uric acid and increase the likelihood of hyperuricemia. This can be a problem for older people who take aspirin (81 mg) for heart disease.
- Nicotinic acid - used to treat cholesterol problems.
- Pyrazinamide - essential for the treatment of tuberculosis.

- Alcohol. Drinking too much alcohol can increase your risk of gout. Beer is most closely associated with the development of gout. Moderate wine consumption does not increase your risk of developing gout.

Alcohol increases uric acid levels in the following three ways:

Provides an additional food source of purines (compounds from which uric acid is formed);
- Enhances the body's production of uric acid;
- Influences the ability of the kidneys to excrete uric acid from the body.

- Organ transplants. Kidney transplantation poses a high risk of kidney failure, which can lead to gout. In addition, other transplants such as heart and liver transplants increase the risk of gout. Not only does the procedure itself pose a risk of developing gout, but also drugs (cyclosporine) used to prevent rejection of the transplanted organ.

- Other diseases. Treatment of some other diseases can lead to a significant increase in uric acid in the blood and, therefore, a gout attack. Such diseases include:

Leukemia;
- lymphoma;
- psoriasis.

Gout symptoms

The obvious symptoms of gout depend on the stage of the disease. Gout is often divided into four stages:

- Asymptomatic hyperuricemia. Asymptomatic hyperuricemia is considered the first stage of gout, which occurs without any symptoms. The level of urate in the body gradually increases. This stage can last for 30 years or more.
It is worth knowing that hyperuricemia does not always lead to gout. In fact, only 20% of hyperuricemia cases result in full-blown gout.

Acute gouty arthritis. Acute gouty arthritis occurs when the first symptoms of gout appear. Sometimes the first signs of gout are limited to brief bouts of pain in the affected joint.

Symptoms of acute gouty arthritis include:

Severe pain in and around the joint;
- physical activity or even the weight of the sheet may be unbearable;
- pains occur late at night or early in the morning;
- edema that can extend beyond the joint;
- local temperature rise;
- red, shiny skin on the damaged area;
- chills and a slight increase in temperature, loss of appetite and a feeling of malaise;
- Most often, symptoms begin in one joint.

Monoarticular gout. Gout that occurs in one joint is called monoarticular gout. About 60% of all first attacks of gout in adults and middle-aged people occur in the big toe. Symptoms can occur in other places as well, such as the ankle or knee.

Polyarticular gout. If pain is felt in more than one joint, the condition is called polyarticular gout. Only in 10 - 20% of cases, with the first symptoms of gout, several joints suffer at once. Older people are more likely to have polyarticular gout. The joints of the foot, ankles, knees, wrists, elbow and hand are most commonly affected. The pain is mainly felt on one side of the body, and this is usually, although not always, the lower leg and feet. People with polyarticular gout tend to have a slower onset of pain and a longer delay between discomfort. They are also more likely to experience low-grade fever, loss of appetite, and general ill health.

Seizures should usually be treated within 24 to 48 hours after the first symptoms appear. However, some pain sensations last only a couple of hours, while others persist for several weeks. Although symptoms may subside, crystals are still present in the body and pain may soon reappear.

- Intercritical gout. The term intercritical gout is used to describe the periods between seizures. The first sensation of pain is usually accompanied by complete remission of symptoms, but if left untreated, gout will almost always return. More than two thirds of patients will have at least one seizure within 2 years of the first discomfort.

Chronic gout.After several years, the onset of persistent gout symptoms may develop a condition called chronic gout. This long-term condition is often referred to as tophus, which are hard deposits of crystals that form in joints, cartilage, bones, and other parts of the body. In some cases, tophuses break through the skin and appear as white or yellowish-white, chalky nodules.

Topuses usually form in the following locations:

In curved projections along the edge of the outer ear;
- forearm;
- elbow or knee;
- arms or legs - in elderly patients, especially women, gout is often observed in the small joints of the fingers;
- around the heart and spine (rarely appears).

Topuses are generally painless. However, they can cause pain and stiffness in the affected joint. In rare cases, they can even undermine cartilage or bone, ultimately leading to joint destruction. Large tophuses under the skin of the hands and feet can lead to extreme bone deformities.

The main symptoms of chronic gout include:

Tophus for gout on the hands. Without treatment, tophus can develop about 10 years after the initial onset of gout, although their appearance can range from 3 to 42 years. Tophus, most likely, almost immediately at the very onset of the disease, will appear in the elderly. In old age, women are at a higher risk of developing tophus than men. Some people, such as those who receive cyclosporine after organ transplants, also have a high risk of developing tophus.

The development of chronic pain. If gout is left untreated, its intercritical periods tend to become shorter and shorter, and the pain itself can last longer. In the long term (about 10 to 20 years), gout becomes a chronic disease characterized by persistent joint pain or acute inflammation. Ultimately, gout can even affect joints that were not affected by symptoms when the disorder first appeared. In rare cases, the shoulders, hips, or spine may be affected.

Diagnosing gout

Research has shown that family doctors can diagnose gout reasonably well using simple diagnostic information based on the patient's specific symptoms, history and lifestyle. However, there are a number of methods and ways to diagnose gout, these include:

Examination of synovial fluid is the most accurate method for diagnosing gout. Synovial fluid is a lubricant that fills the synovial membranes (the membranes around the joints that create a protective sac). This test can detect gout even between periods of pain.

The procedure is called a joint puncture. The health care provider uses a needle attached to a syringe to draw fluid from the affected joint. Local anesthesia is not used because it can reduce the effectiveness of the procedure. After the test, there may be some discomfort in the area where the needle was inserted, but this usually goes away quickly.
A liquid sample is sent to a laboratory for analysis. Testing can reveal the presence of monosodium urate crystals (MSU), which almost always confirm the diagnosis of gout.

- Urine tests. This test is sometimes useful for determining the amount of uric acid in a patient's urine, especially if the patient is young and has pronounced symptoms of hyperuricemia, which may be associated with metabolic disorders. If the level of uric acid in the urine exceeds a certain value, further tests should be performed to check for an enzyme defect or other identifiable cause of gout. A significant amount of uric acid in the urine also means that the patient is more likely to develop uric acid stones in the kidney.

Urine is collected between attacks after the patient has been placed on a purine diet. The patient is also asked to temporarily stop drinking alcohol and any medication, as this may negatively affect the validity of the test.

- A blood test to determine the level of uric acid. A blood test is usually done to measure uric acid levels and check for hyperuricemia. Low blood uric acid levels make the diagnosis of gout much less likely, and very high levels increase the chance of gout developing, especially if the patient has symptoms of the condition. However, blood uric acid levels during a gout attack may be within or below normal, and the presence of hyperuricemia does not necessarily indicate gout. 82% of patients with high uric acid levels and acute onset of joint pain are diagnosed with gout.

X-ray. For the most part, X-rays do not reveal any problems during the early stages of gout. Their usefulness lies in assessing the progress of a disorder in the chronic phase and in identifying other conditions with symptoms similar to gout. The tophuses can be seen on the x-ray before they become apparent on the physical.

CT and MRI. Advanced imaging techniques are used to identify tophi and include computed tomography (CT), magnetic resonance imaging (MRI), and Doppler ultrasound.

Exclusion of other diseases

There are two conditions that are similar in symptoms to gout - pseudogout and septic arthritis. Pseudogout is often confused with gout, and chronic gout can mimic rheumatoid arthritis.

Pseudogout. Pseudogout (also known as calcium gout) is a common inflammatory arthritis among the elderly. While the symptoms of pseudogout resemble gout in some respects, there are differences:

For the first time, pain usually affects the knee. Other joints such as the shoulders, wrists, and ankles are also often affected. Pseudogout can affect any joint, although the small joints in the fingers or toes are usually not affected. Compared to gout, pseudogout symptoms appear much more slowly. Pseudogout occurs most often in the fall, and gout attacks are most common in the spring.

The highest risk of developing pseudogout is observed in elderly patients after acute illness, injury, or surgery. Acute illnesses include hypothyroidism, diabetes mellitus, gout, and osteoarthritis. Liver transplantation can also increase your risk of developing this disease.

There is no separate treatment for pseudogout. It is a progressive disease that can eventually destroy the joints. Treatments for pseudogout are similar to common gout and are aimed at relieving pain as well as reducing inflammation and the frequency of attacks.

Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving inflammation and pain from pseudogout. For acute attacks, colchicine may be used. Magnesium carbonate can help dissolve the crystals, but tough deposits may remain.

Rheumatoid arthritis. Rheumatoid arthritis can affect the joints of the fingers and cause severe inflammation and pain, which is also present in people with gout. In older people, it is very difficult to distinguish chronic gout from rheumatoid arthritis. A proper diagnosis can only be made on the basis of a detailed anamnesis, laboratory tests and the identification of MSU crystals.

Arthrosis. Gout is often confused with osteoarthritis in the elderly, especially when it affects the finger joints in women. However, gout should only be suspected if the joints of the fingers are significantly enlarged.

Infections . Various infections affecting the joints can have symptoms that resemble gout. In this case, it is very important to establish the correct diagnosis in order to prescribe the appropriate treatment. For example, some cases of gout have been confused with infection after joint replacement. Gout is often confused with other non-surgical infections such as sepsis, which is a widespread and potentially life-threatening bacterial infection that can cause joint inflammation, chills, and even fever. The severity of the fever and high white blood cell counts in the synovial fluid help diagnose septic infections.

Charcot's foot. People with diabetes who also have problems with the nerve endings in their legs (diabetic peripheral neuropathy) may develop Charcot's feet or Charcot's joint disease (neuropathic arthropathy). Early symptoms may mimic gout, and the legs are swollen and reddened. Diagnosing and treating this condition is very important as the legs can become deformed. Bones can crack and joints move, the shape of the leg changes, it becomes unstable.

Bunion of the big toe. Bunion is a deformity of the feet, usually affecting the first of the five long bones (metatarsals). This is often confused with gout. Bursitis of the big toe begins to form when the big toe moves away from the rest of the toes, as a result of which the head of the first one rubs against the shoes, the main tissues become inflamed, and painful attacks occur.

	Specific subtypes
Infectious arthritis	Lyme disease, bacterial arthritis, tuberculous and fungal arthritis, viral arthritis, osteomyelitis
Post-infectious or reactive arthritis	Reiter's syndrome (a disease characterized by arthritis and inflammation in the eye and urinary tract), rheumatism, inflammatory bowel disease
Rheumatism autoimmune diseases	Rheumatoid arthritis, systemic vasculitis, systemic lupus erythematosus, scleroderma, Still's disease (juvenile rheumatoid arthritis)
Other diseases	Chronic fatigue syndrome, hepatitis C, familial Mediterranean fever, cancer, AIDS, leukemia, dermatomyositis, Whipple Behcet's disease, Kawasaki's disease, erythema nodosum, pyoderma gangrenosum, psoriatic arthritis

Treating gout

Acute gout attacks and long-term treatment require different approaches. Treatment usually consists of medication. There are also special treatments for reducing symptoms associated with gout, including uric acid nephropathy and kidney stones.

Many patients do not need medication. In between gout attacks, patients are advised to avoid foods high in purines and maintain a healthy weight. Patients should also avoid excessive alcohol consumption and reduce the occurrence of stress.

Medications for acute gout attacks are aimed at relieving pain and reducing inflammation. They should be assigned as early as possible.

Medicines used to treat gout

- Non-steroidal anti-inflammatory drugs (NSAIDs). Potent forms of non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed for acute attacks in young, healthy patients without major health problems such as kidney, liver, and heart problems.
Many NSAIDs are available. The following NSAID drugs are available without a prescription:

Low dose ibuprofen (Motrin IB, Advil, Nuprin);
- naproxen (Aleve);
- ketoprofen (Actron, Orudis KT);
- ibuprofen (Motrin);
- naproxen (Naprosyn, Anaprox);
- Flurbiprofen (Ansaid);
- diclofenac (Voltaren);
- Tolmetin (Tolectin);
- ketoprofen (Orudis, Oruvail);
- dexibuprofen (Seractil).

Indomethacin (Indocin) is usually one of the main drugs, which is preferred by patients without a special doctor's prescription. Usually 2 to 7 days of high doses of indomethacin is sufficient to treat a gout attack. The first dose of indomethacin usually begins to act against pain and inflammation within 24 hours.
Ibuprofen, naproxen, sulindac, or other NSAIDs are good alternatives, especially for elderly patients who may experience side effects when taking indomethacin.

- Corticosteroids. Corticosteroids can be used by patients who cannot tolerate NSAIDs and can be especially helpful in the elderly. Injection into the affected joints provides effective relief for many patients, but it is not beneficial for patients who have multiple affected joints. For patients who cannot take NSAIDs or colchicine and who have gout in more than one joint, steroids are prescribed. Also, in case of intolerance or contraindications to NSAIDs, glucocorticoids or corticotropin may be prescribed. Corticosteroids include triamcinolone and prednisolone.

- Colchicine. Colchicine has been used against gout attacks for centuries, although it is relatively recently approved by the FDA (Colcyrs). It is a highly effective remedy for relieving gout attacks. However, taking this drug can lead to unpleasant and sometimes serious side effects. Side effects include upset stomach, vomiting, and diarrhea. In this case, it is necessary to reduce the dosage of the drug and gradually increase its intake to the maximum total dose by the time of the gout attack (or reduce the dose at least until the upset stomach has passed).
Colchicine should not be used by elderly patients, as well as those with impaired kidney, liver or bone marrow. It can also interfere with fertility and should not be used during pregnancy. Some patients require careful diagnosis before taking colchicine.
The antibiotic erythromycin or H2 blockers such as famotidine (Pepcid AC), cimetidine (Tagamet), or ranitidine (Zantac) may reduce gastrointestinal side effects from colchicine.
However, it is worth remembering that colchicine overdose can be dangerous, there have even been deaths. The drug can also suppress the production of blood cells, which can lead to nerve and muscle injury in some people. Careful monitoring of the drug for toxicity is of great importance.

- Uricolytic drugs. These drugs protect the kidneys from the reabsorption of uric acid, and therefore increase its excretion in urine. They can be used when the kidneys do not excrete enough uric acid, a problem present in about 80% of cases of gout. To diagnose this problem, the doctor must conduct a urine test according to Zimnitsky. Uricolytic drugs are not used in patients with reduced kidney function or chronic gout.

Patients who can significantly benefit from taking uricolytic drugs:

Age up to 60 years old;
- normal diet;
- healthy kidney function;
- there is no risk of kidney stones.

Probenecid (Benemid, Probalan) and sulfinpyrazone (Anturane) are standard uricolytic drugs. Probenecid is taken two to three times a day, and sulfinpyrazone is taken twice a day and increased to three to four. Initial doses should be low and gradually increased. Probenecid in combination with colchicine is more effective than probenecid alone.

Possible side effects from probenecid and sulfinpyrazone include skin rashes, gastrointestinal problems, anemia, and kidney stones. To reduce acidity and the risk of kidney stones, patients should drink plenty of fluids (ideally water, not caffeinated drinks).

Taking NSAID drugs, in particular, aspirin and salicylate, reduces the effect and effectiveness of uricosuric drugs. They can interact with many other drugs, the patient must be sure to tell the health care provider a list of all the drugs he is taking.

Probenecid in combination with allopurinol (another type of medication that lowers uric acid levels) is available and may be helpful in some cases.

- Allopurinol (Lopurin, Zyloprim). This drug is most commonly used in the long-term treatment of gout for elderly patients and those who have been found to have an overproduction of uric acid. Allopurinol is taken orally once a day in doses of 100 to 600 mg, depending on the patient's response to treatment. When used for the first time, allopurinol may cause further gout attacks. Therefore, in the first months (or more) of therapy, the patient also takes NSAIDs or colchicine to reduce this possibility.

Allopurinol has a positive effect on cholesterol levels, so its use may be effective in patients with coronary artery disease.

- Febuxostat. Febuxostat is the first oral drug as a new treatment for chronic gout. Approved by the FDA in 2009, it is especially beneficial for patients who are allergic to allopurinol. It is structurally different from allopurinol. Febuxostat is much more expensive than allopurinol.

- Krystexxa (pegloticase). In September 2010, the FDA approved Krystexxa (pegloticase) IV injections for the treatment of gout. These Injections are given every two or four weeks and are reserved for patients with severe chronic gout. Krystexxa is an enzyme that converts uric acid into another molecule, which is eliminated in the urine. According to studies, 25% of patients experience an allergic reaction, both mild and severe. Side effects may include rash or hives, difficulty breathing, nausea and vomiting, constipation, chest pain, redness and itching, shortness of breath, swelling of the lips or tongue, changes in blood pressure, or anaphylactic shock. The injection has not been tested in patients with heart failure.

- Other medicines. People with gout are at a higher risk for high blood pressure. Some of the drugs used to treat high blood pressure, such as thiazide diuretics, can increase the risk for gout attacks. Newer drugs such as losartan (an angiotensin II receptor antagonist) and amlodipine (a calcium channel blocker) may have beneficial effects on both high blood pressure and gout symptoms.

Surgical treatment for gout

Large tophuses that are infected or interfere with joint movement must be surgically removed. In the presence of infections in the body, the procedure is associated with a high risk of complications. In one study, experts suggested that certain preventive measures, such as the use of allopurinol, could reduce the need for surgery. Sometimes it is necessary to replace the joints.

Resting and protecting the affected joint with a splint can also aid recovery. The use of ice and heat has been found as a means to relieve the symptoms of gout.

Preventing pain with gout

After an acute attack, some patients remain at risk for other pain, which may occur during the intercritical period of several weeks. These patients include people with kidney and heart failure who are taking diuretics. During this period, small doses of colchicine or NSAIDs may be used to prevent pain recurrence. They should be taken in low doses for 1 to 2 months after pain, or for longer periods in patients who have experienced frequent attacks.

Medicines to lower uric acid levels. Patients may be prescribed medications to help lower the level of uric acid in the blood and thereby prevent gout attacks and other complications. The decision about whether to use these medications and at what point is not entirely clear. Some doctors do not prescribe them if the hyperuricemia is mild or until the patient has had two attacks of gout. Others prescribe them immediately after the onset of pain.

Treatment for hyperuricemia that does not cause any symptoms is not recommended. Asymptomatic hyperuricemia often does not lead to gout or other health problems. In addition, such drugs are expensive and carry certain risks. However, in some circumstances, treatment may be warranted, for example, in patients with very high uric acid levels, certain medications may prevent kidney problems.

Before starting treatment, some doctors recommend that patients with frequent gout attacks undergo a urine test according to Zimnitsky. Also, before starting one of these medicines, all previous acute attacks should be completely controlled and the joints should not be inflamed. Some doctors choose to wait and start treatment about a month after the pain starts.

Lifestyle changes with gout

Any activity associated with high expenditure of energy in the body increases the metabolism of purines, which contributes to the formation of uric acid. Avoiding stress and maintaining health are important to prevent gout from occurring.

Diet recommendations. Dietary treatment does not play a large role in preventing disease. However, people who have had a gout attack may notice some effect after reducing their intake of purine-rich foods.
While meat and certain types of seafood and shellfish do contribute to high blood purine levels, research suggests that not all purine-rich foods are associated with gout.

Dairy products, especially those that are low in fat (such as low-fat yogurt and skim milk), can help protect against gout. The researchers also found that taking 500 mg of vitamin C daily significantly reduced uric acid levels. Scientists are studying whether vitamin C can be used to prevent or treat gout.

Foods to limit or avoid:

Animal organs (liver, kidneys);
- red meat (beef, pork and lamb);
- meat extracts (soup, broth and gravies);
- seafood (anchovies, sardines, herring, fish roe, canned tuna, shrimp, lobster, scallops and mussels);
- yeast (beer and baked goods);

Maintaining a healthy weight. Prepared weight loss programs can be a very effective way to lower uric acid levels in overweight patients.

Liquids and alcohol . Drinking plenty of water and other soft drinks helps remove uric acid from the body.

Large amounts of alcohol should be avoided, which promotes the metabolism of purines and uric acid. Alcohol can also reduce the excretion of uric acid. Avoid heavy drinking, especially beer or hard liquor.
Fructose, including soda and fruit juices, may increase the risk of gout in both men and women.

Medicines. Treating other conditions with medications can increase uric acid levels. For example, some diuretics and a daily dose of aspirin can affect uric acid levels.

Joint damage. People with gout should try to avoid activities that can injure joints, such as wearing tight shoes.

Preventing seizures while traveling. Traveling significantly increases your risk of gout attacks. Patients should discuss preventive measures with their healthcare provider before traveling. A doctor may prescribe prednisone, which should be taken immediately at the first sign of a gout attack. In most cases, this stops the pain syndrome.

Complications of gout

Proper treatment of gout rarely poses a long-term health threat, although it does cause short-term pain and even disability. With gout in the body, the following complications can be observed:

- Pain and disability. If left untreated, gout can develop and become chronic. Persistent gout can destroy cartilage and bone, causing permanent joint deformities and loss of movement. A study published in 2006 shows that two-thirds of people with gout experience very intense pain when they develop bumps. An estimated 75% of patients interviewed said sudden flare-ups led to difficulty walking.

Topuses. If gout is left untreated, tofuses can grow to the size of golf balls, which, like rheumatoid arthritis, leads to the destruction of bones and cartilage in joints. If tofuses form in the spine, they can cause serious injury. In extreme cases, the development of tophus leads to complete disability.

- Stones in the kidneys. Kidney stones are observed in 10 - 40% of patients with gout, they can form at any time after the development of hyperuricemia. Although stones are usually made of uric acid, they can also be mixed with other materials.

- Nephrolithiasis. Approximately 25% of patients with chronic hyperuricemia develop progressive kidney disease, which sometimes results in renal failure. It should be noted, however, that many experts believe that chronic hyperuricemia is unlikely to be the cause of kidney disease. In most cases, kidney disease is caused by high concentrations of uric acid.

- Heart diseases. Gout is common in people with high blood pressure, coronary artery disease, and heart failure. Hyperuricemia actually carries a very high risk of dying from heart disease. Research has also found a link between gout and metabolic syndrome - a combination of problems such as abdominal obesity, high blood pressure, high triglycerides, and low cholesterol levels. This syndrome increases a person's susceptibility to cardiovascular disease and diabetes.

Some studies suggest that hyperuricemia may be associated with heart disease, but there is insufficient data to support this association.

- Other diseases associated with gout. With long-term gout, the following diseases can also develop:

Cataract
- Dry eye syndrome
- Complications in the lungs (in rare cases, uric acid crystals are found in the lungs).

Gout is a metabolic disorder in which uric acid salts are deposited in the body. Most often occurs in men after 40 years and in women after menopause. It develops on the joints of the knees, toes and hands, hands, feet and elbows. It is almost impossible to completely cure gout, but the patient is able to alleviate his condition and prevent an exacerbation.

The main reason is persistently high uric acid levels. Urate crystals are deposited in tissues, joints and organs. Over several years, a significant amount of them accumulates, and ultimately the disease destroys the joint.

Delayed excretion of uric acid occurs due to poor kidney function, which is due to the consumption of foods rich in purines. Large amounts of alcohol can also make it worse. Symptoms are aggravated by a sedentary lifestyle and constant stress.

The main reasons are:

1. Overeating and eating a lot of meat products.

2. Significant excess in the diet of the permissible norms of hot spices, vinegar, salt and sugar.

3. The cause of gout can be bad habits, in particular, the use of alcoholic beverages in excessive doses.

4. Nervous fatigue, constant stress.

6. The disease is often inherited from the next of kin.

7. Overheating or hypothermia of the diseased joint.

8. Sedentary lifestyle, lack of sports.

9. If kidney pathology is not treated, then this may be the culprit for the accumulation of salts in the future.

Distinguish between primary and secondary gout. The first reason is that the kidneys are unable to excrete uric acid crystals in time. In the second case, the functions of the main filter of the body are disrupted, and severe intoxication occurs.

Disease manifestations

At the initial stage, there are no symptoms, signs appear only at the stage of exacerbation. Usually the attack overtakes the patient after overeating or drinking alcoholic beverages. The manifestations of the acute form are:

1. Acute painful sensations in the early morning and at night, which cannot be eliminated with conventional analgesics.

2. Inflammation and swelling of the joint. The most common gout is on the feet, in which the big toe is affected.

3. Increase in temperature and blood pressure.

4. The symptom is also redness of the skin around the diseased joint, fever in this area.

5. Signs of an impending attack are nausea, heartburn, decreased appetite and changes in taste.

6. Limited mobility.

7. Shortness of breath is another symptom of this disease.

Symptoms of an attack may last 2-7 days. With a repeated exacerbation, inflammation covers the adjacent joints. An active process of their destruction begins.

If the disease is not treated, then it gradually becomes chronic. It may take more than one year from the first attack to this stage. At this stage, the symptoms become obvious - kidney function is disrupted, urolithiasis and gouty nephritis develop.

It is easy to identify an ailment before the first signs of gout appear through an analysis that will show a high level of uric acid. Extrinsic symptoms are growths on the limbs. When they burst, whitish crystals are found inside - this is uric acid.

Diagnostic methods

What is this disease and how to treat it, the rheumatologist knows, you need to contact him for advice. The following diagnostic methods will help to identify the disease:

1. A general blood test will show an increased level of ESR. Biochemical research will be more informative. Indicators worsen only with exacerbation of the disease.

2. An x-ray is used, which will show degenerative changes in the joints in the chronic form. In the pictures, you can see the accumulation of masses in the form of whitened areas 2-3 cm in size.

3. To determine the presence of crystals of uric acid, a puncture with taking a liquid helps.

4. Ultrasound of the kidneys, which detects urate calculi.

At home, it is easy to diagnose gout by visual inspection of the affected areas.

Drug therapy

Modern medications relieve symptoms. Drug treatment solves two main tasks:

• Helps keep uric acid levels under control.
• Allows you to cure inflammation and eliminate joint pain.

Medicines also improve kidney function and remove urate crystals from the body faster.

To lower the level of uric acid, the following drugs are used:

1. Allopurinol gradually dissolves and removes urate deposits accumulated in the kidneys, joints and soft tissues. It is often prescribed for patients with severe renal impairment.

2. Febuxostat is indicated in the treatment of salt deposits as it dissolves uric acid crystals in the joints of the fingers and elbows. It also prevents them from reappearing. The drug is excreted by the liver and is absolutely safe for people with kidney disease.

3. Pegloticase is an enzyme solution that is used for intravenous injection twice a month. The medicine quickly removes uric acid salts, relieves symptoms and stabilizes the condition of patients with severe form.

4. Probenecid - prevents uric acid from being absorbed in the kidney tubules. Taking the drug is indicated for patients with a chronic form. For those who are being treated, trying to relieve exacerbation, it is not recommended to use it, since too active excretion of salts can cause severe pain. Reduce the risk of its occurrence by taking anti-inflammatory and hormonal drugs at the same time.

Treating gout by treating symptoms such as swelling and pain can help prevent new attacks. For this purpose, drugs are used:

• Colchicine prevents the crystallization of uric acid salts in the tissues of the body. Therapy should be carried out within the first 12 hours after the onset of a painful attack. Gastrointestinal upset is a side effect.
• Glucocorticoids relieve symptoms by eliminating inflammation, but reduce the body's defenses.
• Non-steroidal medications treat joint inflammation.

Medicines will allow you to establish purine metabolism and, if not cured, then stop the development of the disease.

The most serious complication is arthritis. Its main symptoms are accumulations of crystals, nodes in different parts of the body, joints and tissues. The body perceives them as a foreign body and seeks to get rid of them. The level of leukocytes in the blood rises significantly. This provokes the onset of severe inflammation, which flows into gouty arthritis. Urate deposition leads to the development of urolithiasis and renal failure.

Features of the diet for salt deposition

Should be based on certain rules. When treating, it is better to exclude from the diet:

1. table salt;

2. smoked meats, sausages;

3. legumes;

4. fatty meat products, offal, lard;

7. hot spices and seasonings;

8. strong alcoholic drinks;

9. chocolate;

10. cocoa, strong coffee and tea;

11. salty cheeses;

12. meat broths.

The diet for gout includes the following foods in small amounts:

• butter and skim milk, which can be added to porridge;
• boiled poultry;
• tomatoes;
• cauliflower;
• greens;
• radishes and turnips;
• plums;
• fish, in particular salmon or trout.

The diet should consist of vegetarian vegetable soups with the addition of cereals, low-fat fish, crustaceans, rabbit meat, pasta, dairy, dairy products and cheeses. Dishes can be flavored with green dill, white and black bread is allowed. Products with animal fats in the composition are replaced with vegetable ones. The limit on eggs is not more than a piece per day. The diet menu includes any vegetables except prohibited ones. Almost all fruits are allowed for dessert. Berries are consumed by everyone except raspberries. Dried fruits are extremely useful, the only exception is raisins. Nuts, seeds and honey are allowed, marshmallows, jam and marmalade are recommended from sweets.

From drinks for daily use in the treatment of salt deposition, preference should be given to juices, berry fruit drinks, kvass, compotes and green tea, to which lemon or milk is also added, cucumber juice is useful.

Gout is not completely cured, but alkaline mineral water helps to remove purines from the body. Drink at least 2.5 liters of fluid per day.

During the treatment of joints, it is recommended to carry out unloading on a certain type of vegetables or fruits. Green apples or boiled potatoes are good choices for a one-day diet. Salads are prepared from vegetables and consumed all day. An excellent alternative is kefir or cottage cheese. Fasting days activate metabolic processes.

Popular daily diet menus include rice and apples. For one day, boil 75 g of cereal and eat it in small portions. Between meals of rice, apples are eaten in an amount of 250 g per day. They are also used for making compotes without added sugar. With gout, fasting, including medical fasting, is strictly prohibited. Therefore, even during unloading, it is necessary to consume any light foods. This is explained by the fact that fasting provokes a jump in the level of uric acid in the blood, which causes another attack of joint disease.

Preventive measures

It was found that the disease most often affects those joints that were previously injured. If the risk zone is on the foot, then as a preventive measure it is recommended to wear only comfortable shoes, avoiding tight ones. It is necessary to exclude shoes with a narrow toe, which can pinch the thumb, where the symptoms of salt deposition are most often manifested.

But the main method of preventing salt deposition in the body is proper nutrition. The optimal exercise regimen is equally important. As a prophylaxis for gout, a rheumatologist prescribes diet No. 6 to the patient, which will help lower the level of uric acid. It is recommended to increase the content of vegetables, cereals, fruits and low-fat dairy products in the diet, in which there are almost no dangerous purines.

Losing weight is an excellent prevention of salt deposition. By limiting fatty foods in your diet, it will not be difficult to achieve significant weight loss. This will have a positive effect on the condition of the joints by reducing the load and prevent exacerbation.

The use of alcoholic beverages and smoking delay the excretion of uric acid from the body and contribute to the deposition of urate crystals, therefore it is recommended to abandon them completely, at least for the duration of the treatment of gout and subsequent rehabilitation. Beer is considered the most harmful for patients with salt deposits.

Since small joints are in the risk zone first of all, it is necessary to pay attention to their development. Exercises to increase the mobility of painful areas are considered effective prevention. Shown daily gymnastics, the patient should often go outside, making regular walks.

Prevention of seizures

The following recommendations significantly reduce the risk of recurrence of gout and reduce the level of uric acid:

1. Try to load the diseased joint less often. It is helpful to keep it in an elevated position from time to time. An ice compress, which is applied to the sore joint for 15-30 minutes, will cure inflammation. The procedure is carried out several times a day until the pain sensations disappear.

2. A person who is being treated for gout needs to limit, and if possible completely refuse to take medications that increase the level of uric acid in the blood. These medicines include aspirin.

3. Along with drug treatment, the patient is shown regular gentle physical activity for half an hour a day. This can be jogging, cycling, walking in the fresh air, dancing, or swimming. It is good to do exercises in the morning. Sport is necessary for a patient with gout at any age, as he is able to normalize the condition better than chemical drugs.

4. The course of joint treatment should be constantly monitored by measuring the level of uric acid. If it exceeds 60 mg / l, then urgent measures are taken to reduce it.

5. For the purpose of prevention, to improve kidney function and stimulate the excretion of uric acid from the body, about 2 liters of water are consumed per day. No need to try to replace it with tea or coffee. Only clean water is able to eliminate the symptoms, clearing the joints from the deposition of urate crystals.

7. You need to carefully monitor the diet, follow the diet, limiting the intake of foods with animal proteins to 120 grams per day.

8. It is worth limiting the use of carbonated drinks containing sodium benzoate, as well as juices from bags saturated with fructose.

If symptoms are found, you should quickly seek professional help, get diagnosed and start treatment. This will allow you to achieve a stable remission sooner. Without the right therapy, the disease progresses rapidly, in particular in elderly patients.

Gout is a joint disease, the etiology of which is metabolic disorders, an imbalance in the metabolism of purine compounds and the accumulation of uric acid in the body.
The first scientific description of the symptoms of chronic gout dates back to 1865. Thomas Sindegam, who suffered from the disease for 30 years, wrote A Treatise on Gout, which included descriptions of what gout is, the clinical signs of the chronic stage of the disease and acute attacks of gout.

Gout at various ages

Photo: Africa Studio / Shutterstock.com

Mostly adults are ill with gout. According to statistics, 0.1% of the world's adult population on average suffers from gout, and in developed countries (Western European region, USA) the number of people suffering from gout is approaching 2%. At the same time, experts assume that the actual picture of the morbidity differs from the research data, since a full study of statistics is complicated by the late diagnosis of patients.
Medical researchers also point out that gout, which until the 20th century was considered a predominantly male disease with rare exceptions, now affects both sexes, although the ratio of male to female patients is still far from uniform: in 20 cases of this diagnosis in males, one disease is detected in women. The reason for the increase in the frequency of diagnosing female gout is believed to be an improvement in the quality of life of the population, an abundance of food rich in purines, and an increase in alcohol consumption by the general population.
There was also a tendency to "rejuvenate" the diagnosis of gout: if earlier the disease manifested itself as an acute gouty attack in men 35-45 years old, now the lower limit is 30 years.

Gout in men

The incidence of gout in the male population compared with the female is explained by two factors: the hereditary nature of some of the diseases, the predisposition to which is transmitted through the X chromosome, which means that there are no variants in men who have only one chromosome of this type; and the development of gout due to unhealthy diet and alcohol consumption, which is more common in men.
A feature of male gout is considered to be late diagnosis due to the tendency of this part of the population to seek medical help at the stage of a developed disease with acute gouty attacks or at the stage of external manifestations of gout in the form of joint deformation and the formation of tofuses.

Features of gout in women

In women, the process, accompanied by an increase in the level of uric acid and the deposition of urates, salt crystals, in soft tissues, is characteristic of the menopause period. During this period, the risks of gout increase significantly, especially in the presence of a hereditary predisposition, therefore, most often, female gout is diagnosed at the age of 50-55 years.
However, the genetic inheritance of gout for women only suggests the likelihood of developing the disease, in contrast to males. The gene responsible for the production of enzymes necessary for the metabolism of purine compounds is located on the X chromosome, and women have two such chromosomes. Therefore, if a gene is damaged on one chromosome, its dysfunction is compensated by the intensive work of the preserved gene on the other.
In the presence of two damaged genes in the genome, the likelihood of developing gout in women is the same as in men (almost one hundred percent), and the age of onset of the disease is also significantly reduced.

Gout: Signs and Treatment in Children 10 Years of Age

An increase in the level of uric acid in the body, or hyperuricemia in childhood, is a secondary dysfunction against the background of a primary disease or condition and is not due to a hereditary predisposition.
The causes of gout in children of 10 years old include active cell death, which provokes an increased production of purines and is noted with dehydration, starvation, renal failure and other pathologies of kidney function, the presence of malignant tumors, etc.
Also, in the etiology of the development of gout in childhood, there may be a complete or partial absence of hypoxanthine guanine phosphoribosyl transferase, as well as increased activity of phosphoribosyl pyrophosphate synthetase.

Causes of the development of gout

A steady increase in the concentration of uric acid in the blood, leading to the formation of salt crystals and their deposition in the soft tissues of the body, is the only reason for the development of gout. The initial stage of hyperuricemia, the accumulation of uric acid, does not lead to the formation and deposition of crystals, however, it signals metabolic disorders, the first manifestations of the disease.
Several factors can contribute to the increase in uric acid concentration. The main ones are hereditary predisposition, excessive intake of purine compounds into the body with food and liquid, an increase in purine catabolism, as well as age-related or dysfunctional slowing down of the process of excretion of uric acid from the body during urination.

The relationship between the development of gout and an increase in the concentration of uric acid

In the process of processing purine bases that enter the body with food or are formed as a result of the breakdown of its own cells, uric acid is produced. This compound is filtered out by the renal glomeruli and is normally excreted from the body along with urine. If at any stage violations occur (an increase in the production of uric acid, lack of concentration, output), conditions are formed for the development of hyperuricemia. It should be remembered that the diagnosis of hyperuricemia is not the same as the presence of gout, since an increased concentration of uric acid may be a sign of other diseases. But hyperuricemia itself can provoke the development of gouty processes.
With gout, uric acid, which chemically reacts with calcium, sodium, potassium and other elements, is converted into crystalline compounds or urates. Urates accumulate in tissues of mainly two types of localization: organs of the urinary system (urate stones in the kidneys, in the bladder) and soft tissues of the joints, periarticular tissues - urates enter and settle there due to the peculiarities of blood flow in these parts of the body.

The rate of synthesis of purine nucleotides as a factor in the development of gout

The breakdown of purine bases, leading to the formation of uric acid, has a normally stable rate, determined by the amount of enzymes. With an increased amount of purines in the body due to their increased intake with food, significant disintegration of their own cells or other pathological processes and interventions, the rate of synthesis increases, forming an excess of uric acid in the blood, which creates conditions for the development of gout.
This process can be temporary, easily reversible, or be prolonged due to chronic diseases, constant disturbance of a balanced diet. Enhanced synthesis of nucleic acid bases is also provoked by long courses of taking cytostatic drugs, radio and chemotherapy, hemolysis, and some types of surgical interventions.

The rate of excretion of uric acid from the body

Gout as a secondary disease develops against the background of impaired renal function. After processing and filtration by the renal glomeruli, uric acid normally leaves the body along with urine. In chronic kidney disease, the process of removing the decay products of purine bases can be disrupted, which leads to an increase in the concentration of uric acid in the blood.
The main factors preventing the excretion of uric acid are partial blockage of the duct lumen due to inflammatory processes or proliferation of connective tissue.

Excessive intake of purines

Photo: Anna Grishenko / Shutterstock.com

Although in itself, excessive consumption of foods rich in purines is not the cause of the development of gout, it creates optimal conditions in the presence of impaired functions of their processing or removal of their decay products. And a specific diet is both part of therapy for gout, and a method of preventing the onset or exacerbations of this disease, especially in the presence of a hereditary predisposition or other provocative conditions for the development of gouty inflammation.

Genetic predisposition as a cause of gout

A group of enzymes, proteins that ensure the processing of purines, is determined by the presence of certain genes in the human genome. With fermentopathy, the body is not able to produce enzymes in sufficient quantities to support the synthesis process, the processing of various compounds. With a lack of specific proteins that regulate the processing of purines and the excretion of uric acid, the concentration of toxic compounds in the blood plasma increases, which causes the development of gout. This pathology is hereditary and is transmitted from parents to children.
Often, enzyme deficiency, which is a provocative factor in gout, is included in the general genetic metabolic syndrome, which also causes a tendency to overweight, diabetes mellitus, hypertension, and hyperlipedimia.

Gout symptoms, stages of development and forms of the disease

As a rule, this disease is characterized by a clear clinical picture, pronounced symptoms and a sequence of changes in the stages of development of the disease. However, in some cases, symptomatic manifestations may be insufficiently expressed or hidden behind manifestations of other diseases.
Only a specialist can establish the correct diagnosis, and the first characteristic signs of gout should become an appeal to him. In the absence of therapy, restriction of diet, untimely diagnosis, pain attacks become more frequent, inflammation, deformation of the joints increase, conditions for urolithiasis, systemic damage to the body, significant health problems, and disability of the patient develop.

Stages of gout

The stages of gout are distinguished by the following indicators:

• clinical picture of the disease with manifestations characteristic of individual stages;
• the level of concentration of uric acid in the blood;
• the presence of solid urates, crystalline formations.

Based on these signs, one of three stages of gout is determined:

• the initial premorbid stage is characterized by hyperuricemia, which is determined by a blood test by a biochemical study. There are no signs of damage to the articular tissues and the urinary system, however, a general picture of nonspecific symptoms can be observed: a tendency to overweight, disturbances in the digestive system (frequent constipation, difficulty defecating), itching, etc.;
• intermeting or interval stage, the beginning of the formation of salt crystals in the periarticular tissues, occasionally in the tissues of the kidneys. This stage is characterized by the onset of a pain symptom, acute inflammation of the joints, and gouty attacks. Acute pain, attacks last from 3 to 7 days, ending in self-remission. The duration and frequency of occurrence depends on several factors. A violation of the diet, the use of alcoholic beverages, dehydration, starvation, hypothermia, acute infectious diseases, surgical interventions and so on can provoke an attack of gout;
• the chronic stage of gout is accompanied by a change in seizures and periods of remission. It differs from the interval formation of tofuses, compounds of small salt crystals. Depending on the neglect of the disease, tophus can be quite significant in size, causing severe pain. This stage is also accompanied by reddening of the skin in the area of ​​the affected joint, limitation of its mobility, hyperthermia and inflammation in local tissues. At the stage of chronic gout, urolithiasis often also develops.

Localization and features of pain in gout

Photo: Monkey Business Images / Shutterstock.com

Intermittent and chronic stages are accompanied by acute pain attacks. Most often, pain begins in the evening and at night, while localization can spread from the affected joint to the entire limb. Solid urates, crystals that accumulate in soft tissues, injure joints, cartilaginous joints, causing acute pain, to which soreness from the inflammatory process in the periarticular bag is added.
Pain medications are usually ineffective for an attack. The pain increases even with slight pressure on the joint area.
Most often, the joints of the base of the big toes, the first metatarsophalangeal joint, are affected, which is associated with the peculiarities of the blood supply to this area. Such localization of urates is observed in more than 50% of patients with gout. The joints of the phalanges of the fingers, wrist, elbow, ankle, knee, hip and others can also be affected.

Forms of gout

From 60 to 80% of patients with gout suffer from classic acute attacks with severe clinical symptoms. Against the background of remission of a chronic disease, severe pain begins, after the attack expires, a period of remission begins again.
The duration of the attacks depends on the general condition of the patient, the types of therapy and the stage of the disease. In addition to acute painful sensations in the area of ​​the affected joint, there may be a general deterioration in well-being, weakness, headache, low-grade hyperthermia, swelling, redness, and then cyanosis of the skin around the joint / joints.
The following forms of gout are also distinguished:

• the subacute form is characterized by less pronounced symptoms affecting the area of ​​only one joint, without severe pain, swelling, nonspecific manifestations of the disease;
• The pseudophlegmonous form differs from the typical clinical picture of a gout attack: there is an acute inflammation of the periarticular tissues, high body temperature (39 ° C and above), a significant deterioration in well-being, chills, general symptoms of intoxication of the body;
• with a rheumatoid-like form of gout, the clinical picture is similar to the symptoms of rheumatological diseases, for example, chronic arthritis. As a rule, with this form, symptoms appear most often in the area of ​​the joints of the fingers and wrists. Gout of this form is characterized by the duration of exacerbation attacks lasting from several weeks to months;
• a separate form of gout is accompanied by symptoms similar to the manifestations of infectious-allergic polyarthritis. In 5% of patients, there is a clinical picture of migratory polyarthritis, with differentiation of the diagnosis defined as specific gout;
• with oligosymptomatic gout, there is an erased clinical picture of the manifestations of the disease with mild symptoms during the period of exacerbations, moderate pain, slight swelling, reddening of the skin of the tissues of the affected joint.

The above forms are typical for the initial stages of gout development,

Articular manifestations of gout

Gouty arthritis or gout of the joints in the more common name manifests itself in various external symptoms. In an acute attack of the disease, there is hyperemia, redness of the skin area around the inflamed joint, which intensifies as pain increases due to the peculiarities of the blood circulation of the inflamed joint.
Other symptoms of gouty arthritis are also distinguished:

• bursitis, tendonitis, tendovaginitis of secondary etiology due to the inflammatory process in the soft tissues around the joint;
• limited mobility of the affected joint, mainly manifested during the period of acute attacks, although during the period of remission, some patients note this symptom;
• local hyperthermia of the inflamed area, an increase in local temperature by 1-2 ° C.

A specific articular manifestation of gout in the later stages of the development of the disease is the formation of tofuses, subcutaneous and intradermal formations consisting of solid crystalline uric acid compounds. The average time for tophus formation is 3 to 5 years after the onset of gout progression, but in some cases, there is an accelerated formation of hard inclusions.
The development of the disease leads to an increase in tofus in size, up to several centimeters in diameter. Circulatory disorders caused by crystalline neoplasms can provoke the appearance of fistulas with the release of a thick white mass or powder from the hole.
The most common localization of tophuses is considered to be the ankle, elbow, knee, phalangeal and metatarsophalangeal joints, as well as the auricles and eyebrows. With gout of the fingers and other joints that are not the most common sites of lesion, the formation of tofuses can progress faster and the onset of the process starts earlier than the average period of salt crystal deposition.

Diagnostic methods for gout

Since the main symptom noted by patients suffering from gout is the occurrence of painful sensations in the joints of various localization, this fact can significantly complicate diagnostic measures due to the need to differentiate gout from a variety of rheumatological diseases, the consequences of injuries and other articular pathologies.
For an accurate diagnosis of the disease, the specialist relies on the data of the collected anamnesis, as well as on the paraclinical studies and analyzes carried out in this case (biochemical, general analysis of blood and urine). The timing and accuracy of the diagnosis also depend on the severity of the symptoms, the degree of development of the disease, the general well-being, the patient's health, the presence of concomitant dysfunctions and deviations. Only urine analysis by any method is ineffective, since its indicators largely correlate with the presence or absence of diseases of the urinary system.
With the help of additional studies to diagnose gout, the following manifestations are checked:

• hyperuricemia, a steadily increased concentration of uric acid in the venous blood, determined by the method of biochemical research;
• the presence in the body and the stage of the urate accumulation process;
• deposition of these crystals in the periarticular tissues;
• the presence of periods of acute inflammatory processes, the degree of joint mobility.

With the progression of the disease, kidney dysfunctions, the occurrence of urolithiasis are noted with a high frequency, therefore, when diagnosing gout, it is necessary to regularly check the condition and functioning of this organ.

Instrumental methods for diagnosing the disease

The etiology of painful manifestations in the articular and periarticular tissues is subject to examination using diagnostic equipment. Affected joints are examined using ultrasound research methods, computed tomography, radiography, and scintigraphic examination using intravenously administered technetium pyrophosphate. The latter method is effective both in the late and early stages of the development of the disease.
At the initial stage of gout, other, most common instrumental examination techniques are not entirely informative, since with gout in the primary stage of the onset of the disease, destructive signs of damage to the articular and periarticular tissues are still insignificant and cannot be detected by most hardware diagnostic techniques. However, their use makes it possible to differentiate with high accuracy the development of gouty arthritis from other types of rheumatic diseases.

Methods for the treatment and prevention of gout

Photo: gpointstudio / Shutterstock.com

The process of disintegration of purine bases supplied or produced by the body is quite complex and has several stages. Violations of each of the stages lead to the accumulation of uric acid, depending on the type of violation, there is a rapid or gradual development of gout. Severe symptomatology manifests itself only with an acute attack of the disease, therefore, until the moment of its onset, the patient may not be aware of dysfunctions, disorders and the onset of the disease.
The etiology of gout determines the principles of therapy. Gout of secondary etiology caused by the presence of other diseases and abnormalities should be treated only if the original source of the disorder is eliminated. With hereditary gout with enzymopathy, lack of enzymes for processing purine bases, drug therapy is aimed at symptomatic treatment.

Medicines used for gout

The specialist makes the choice of medications for gout based on data on the form, stage and cause of the disease. Independent attempts to treat gout can lead to a significant deterioration in well-being, rapid progress of the disease, and other health problems.
The drug groups of first choice for gout are anti-gout and anti-inflammatory drugs.
Anti-gout drugs (uricodepressive and uricosuric) are aimed at accelerating specific metabolism, the processing of purines, as well as the production and removal of degradation products of purine bases. In some cases, as prescribed by a specialist, medications of mixed action are also used, for example, colchicine injections at the onset of an acute gouty attack.
Both in acute periods and during remission, it is advisable to use anti-inflammatory drugs, systemically or locally in the form of compresses and applications. Among the most commonly used anti-inflammatory drugs for gout, there is a group of non-steroidal drugs (Indametacin, Butadion and others) and glucocorticosteroids (mainly Prednisolone). The use of these drugs allows you to reduce inflammatory manifestations, soreness, tissue swelling at the site of the lesion.
Depending on the form and stage of gout, physiotherapeutic agents can be prescribed: UV irradiation, electrophoresis, heating with paraffin, ozokerite, and so on.

Nutrition for gout

Dietary principles of nutrition for gout are effective in the case of the primary etiology of the disease so that they also serve as a method for diagnosing gout. A biochemical blood test, which allows you to determine the concentration of uric acid, is carried out at the beginning when the patient turns to a specialist and after a week strictly adhering to the rules of nutrition. With gout of primary etiology, the level of uric acid in such cases decreases, which makes it possible to more accurately diagnose the cause of the disease and develop tactics for effective treatment of gout.

Diet number 6 for gout

A dietary food according to Pivsner with minor variations depending on individual characteristics is prescribed for everyone suffering from gout. Adhering to this diet can effectively affect the metabolism of purines and reduce the level of uric acid, thereby preventing the formation of salt deposits in the periarticular and other tissues. With a properly composed diet, patients with gout of primary etiology have long periods of remission up to clinical recovery in the early stages of the development of the disease. Frequent exacerbations of primary gout, as a rule, are a sign of a violation of the diet, the use of foods from the non-recommended list, non-compliance with the rules of the drinking regime, calorie content, the inclusion of alcoholic beverages.
The presence of frequent exacerbations when following diet No. 6 and the doctor's recommendations indicates the addition of other factors that provoke gout attacks, or an incorrect diagnosis of the cause of gouty changes.
The basic rules of diet number 6 include:

• splitting the general diet of the day into 4-6 meals;
• meat, fish, poultry must be boiled before further processing or serving in order to release the maximum amount of purines. Broth for patients with gout, especially its strong variations, should not be eaten;
• the average portion of a meat or fish dish is no more than 150 g with a frequency of consumption 2-3 times a week;
• weekly fasting days should be organized for fermented milk products, fresh fruits and vegetables;
• it is necessary to observe the drinking regime, daily drinking at least 2.5 liters of liquid, optimally pure water.

With exacerbations of gout, they switch to diet No. 6e, which excludes all products of animal origin, with the exception of the fermented milk group. The diet includes vegetable soups, cereals, compotes, fruit drinks, jelly, juices. This diet must be adhered to until remission occurs.

Food choices for gout

To facilitate food choices for gout sufferers, the specialist will recommend referring to a list that divides staple foods into high, medium, and low purine base groups.
The first group with a high purine content, categorically not recommended at any period of the disease, includes beef liver, legumes of all kinds, sardines, mackerel, shrimp.
The second group with an average level of purines includes all types of meat, poultry, fish, crustaceans (with the exception of shrimp). When choosing meat, it is recommended to give preference to adult animals, since the concentration of purine bases in the meat of young animals is much higher.
The group of foods suitable for consumption for gout at any time due to the low content of purine nucleotides includes milk and dairy products, cereals, vegetables, fruits, eggs, nuts, honey, and caviar.

Prevention of gout

Prevention of gout is especially relevant for people who have a hereditary or individual predisposition to the onset and development of this disease. Primary gout occurs against the background of an increase in the concentration of purine bases, therefore, compliance with restrictions on the use of certain products serves not only as a basis for preventing frequent exacerbations, but is also recommended for people prone to gout who do not have signs of the disease.
A healthy lifestyle and regular preventive visits to specialists are also included in the prevention and control of gout. Risk factors for the development of gout include regular fasting, including for recreational purposes, rapid weight loss, leading to an increase in the breakdown of one's own tissues, taking certain groups of drugs (cytostatics, diuretics both in tablet form and in the form of teas, medicinal herbal preparations etc.), abuse of alcohol, foods and liquids with a diuretic effect that causes dehydration, non-compliance with the drinking regime, trauma, stress, acute infectious diseases, etc.
With an existing diagnosis of gout, all preventive measures will help reduce the frequency of exacerbations, slow down or stop the development of the disease, and restore health.