Gout

Gout is an exchange disease, accompanied by the accumulation of uric acid salts in the tissues. Gout occurs with inflammation in the joints - repeated attacks of arthritis, synovitis. Symptoms of gout are usually characteristic. Gout more often affects men.

What is the cause of gout?

Gout is caused by a violation of the exchange of purines( natural substances coming in large quantities with food) and subsequent accumulation in the body of salts of uric acid. Accumulation of salts of uric acid( urate) is due to their increased production in the body and reduced excretion in the urine.

Genetic predisposition plays an important role in the development of gout. Primary gout is caused by hereditary defects of enzymes that participate in the exchange of purines. The activity of these enzymes is associated with certain genes located on the sex chromosomes, and this genetic defect is possible only in men. The inadequate function of the enzyme systems of the kidneys responsible for excretion of

uric acid is also a hereditary disease.

Gout may also cause prolonged and excessive consumption of protein foods( red meat, liver, caviar, beans, etc.), especially in combination with alcoholic beverages.
Secondary gout( gout that developed not independently, but against the background of another disease) can cause a number of kidney diseases;Some blood diseases;Psoriasis, etc.

What are the types of gout?

Gout is classified according to the clinical picture of the onset of the disease.

  • A typical( classical) variant of gout is an acute attack of painful swelling of the joint of the larger toe. The attack happens usually after overeating and drinking alcohol. Symptoms of gout of this form are observed in almost 80% of patients with gout.
  • Subacute gout is a classic gout variant also in the area of ​​the thumb, but with mild inflammation and minor pain.
  • "Migrating" variant of gout - gouty inflammation of different joints is observed, and a typical for gout joint - the larger toe is not involved.
  • Rheumatoid-like gout is a lesion of the small joints of the hands, manifestations resemble rheumatoid arthritis.
  • Pseudophlegmonous form of gout - the affected joint( not necessarily typical) is acutely inflamed: the skin in this area is hot, very painful, bright red and edematous. Symptoms of gout of this form resemble diffuse purulent inflammation of soft tissues( phlegmon).
  • Malosymptomnaya gout is accompanied by mild pain, occasionally there is a slight reddening of the skin in the area of ​​the affected joint.
  • Gout by type of infectious-allergic polyarthritis proceeds as migrating polyarthritis with rapid reverse development of inflammation.

How is gout manifested?

Gout begins suddenly, with an acute attack. Symptoms of gout are severe pain in the joint of the big toe, occurring usually at night or early in the morning. The pain is extremely strong, even the touch of the sheet becomes so unbearable( the so-called "sheet" symptom).Then, within a few hours, edema develops in the joint region, the skin over it blushes, becomes hot. The motor capacity of the affected joint is severely limited. The symptoms of gout themselves and finally go away in 3-10 days. The person feels perfectly healthy.

Symptoms of gout are not immediately determined: after the first attack it can take from six months to several years. Then attacks become more frequent, and their duration increases, new joints can be involved. To late stages of the gout current may form tofusi( gouty nodes).Tofusi is a characteristic sign of gout - similar to dense tumors and represent a cluster of urates. Tofusy yellowish color, rarely their contents during seizures can liquefy and be excreted through fistulas. Tofus are formed on average after 5 years of gout. Tofus are usually located on the auricles, elbows, feet, hips, shins, fingers, etc.

Gout attack can be triggered by the following factors:

  • alcohol( hinders the excretion of uric acid by the kidneys);
  • overeating;
  • excessive intake of vitamin preparations, especially vitamin A and nicotinic acid;
  • physical and emotional overvoltage;
  • subcooling or overheating;
  • infection and trauma;
  • intake of diuretics and some other drugs.

How to diagnose gout?

With the help of a biochemical blood test, the increased content of uric acid in the blood is the earliest symptom of the disease. The general analysis of the blood is indicative only during an attack: - The indicators of ESR are increased;Neutrophilic leukocytosis is observed with a shift of the formula to the left.

Confirm the diagnosis allows the study of intraarticular( synovial) fluid: with gout it defines needle crystals of sodium urate.

Radiography is also used to determine the stage of the disease by the degree of joint damage.

How to treat gout?

Gout is primarily treated with diet therapy. It is necessary to exclude from the diet products with a high content of purines: liver, meat and fish broths, jelly, meat, sausages, fish, mushrooms, lentils, green peas, beans, beans and pickles. It is also recommended to limit the use of strong tea, coffee, cocoa and chocolate. They contain methylpurins, which excite the nervous system. Alcoholic beverages are excluded, in particular - dark beers, port wine, sherry. It is recommended to increase the amount of liquid( preferably sugar-free) to 2-3 liters per day, which will accelerate the excretion of uric acid.

Another manifestation of impaired metabolism in gout is the increased content of oxalate in the blood, so it is better to restrict sorrel, spinach, rhubarb, celery, pepper and radish in the diet. The basis of nutrition should be vegetables and sour-milk products. You need to eat small portions, but complete hunger, even for a short time, is harmful - because of it, the urate content in the blood rises. It is also important to normalize body weight.

During an acute attack of gout, non-steroidal anti-inflammatory drugs( NSAIDs) are prescribed: diclofenac( voltaren, diclouran, tilfen).Ibuprofen( dolgite) is also prescribed for this purpose;Indomethacin( methindol, methindol-retard).Naproxen( naprosin, apranaks);Diclofenac( voltaren, veral) is used mainly at the peak of gout attacks.

For a short period in conjunction with NSAIDs, glucocortecosteroids are used with dexamethasone( dexamethasone phosphate) and prednisolone( prednisolone hemisuccinate) preparations.

Allopurinol is a drug that reduces the formation of uric acid. In the period between seizures use allopurinol( algohexal, allupol, alopron).The dose of allopurinol is reduced after lowering the level of uric acid in the blood. Benzbromarone( dezurik, hipurik, normurat) inhibits the synthesis of purines and reduces the absorption of uric acid in the renal tubules. Allopurinol and benzbromarone can also be used in a combined preparation( allomaron).Allopurinol and benzbromarone are used for a long time with the purpose of stable reduction of uric acid level in the blood.

Sulfinpirazone( anthuran) in combination with 2-2.5 l of alkaline liquid per day enhances the excretion of uric acid. Etobenecid( etamid) inhibits the absorption of uric acid and improves its excretion.

For chronic gout( but not during an exacerbation) physiotherapy procedures are indicated: hydrocortisone phonophoresis, diathermy, diadynamic currents.
Sanatorium treatment with radon and hydrogen sulphide baths( "Khmilnik" of Vinnitsa region, "Nemyriv" of Lviv region, "Tskhaltubo" in the west of Georgia) has a positive effect.

If necessary, perform arthroplasty - surgical removal of deposits of uric acid from the joints.

What is the danger of gout?

Gout in chronic course with frequent exacerbations leads to permanent deformations of the joints. Gout can cause complications from the urine-excretory system, up to the development of kidney stones and other kidney complications.