Gout (gouty arthritis) - this pathology exchange body, at which the affected exchange purine (Uric acid derivatives), which leads to excessive deposition of uric acid salts in certain tissues body.
As a result of these deposits formed dysfunction of organs and tissues. Particularly affected are the joints, kidneys and some other organs (bone, ligament, liver).
Gout has long been known, occurs with periods of remission and gouty attacks, more common in middle-aged men, women suffer no more than 1-2% of all cases of gout.
Causes
Basis gout - a genetically inherited defect in the metabolism of uric acid, the defect enzymes to help its utilization and removal, as well as defects in the internal system of purine synthesis substances.
In addition to genetic causes for the development of gout are no less important and more risk factors, external influences that predispose to the development of gout:
- purine bases increased intake from food during abuse meat products,
- obesity and overweight,
- alcoholism, excessive drinking of wine,
- bad habits, sedentary.
May develop and secondary gout
- against the background of the tumor process involving a change of purine metabolism,
- against the backdrop of increased body protein breakdown,
- thiazide diuretics in the treatment (hydrochlorthiazide, polythiazide),
- when using cytotoxic drugs (doxorubicin, fluorouracil, hydroxyurea, cyclophosphamide).
Attacks of gout can be triggered by stress reactions to alcohol, citrus, viral infections, physical or mental stress, trauma and hypothermia, bruises, pressure fluctuations, reception drugs.
Kinds
Most often, gout affects the kidneys and joints, therefore, can be identified
- urarthritis
- arthritic damage to the kidneys.
Also, there are three types of arthritic disorders, based on the level of uric acid in urine:
- metabolic shape with the highest amount of uric acid.
- kidney shape, a moderate amount with increased uric acid salts,
- mixed form - and much uric acid and its salts, which give crystals.
symptoms of gout
Gout is a chronic and progressive disorder, it may take place in three successive stages in series -
- acute gouty arthritis origin,
- interictal stage of gout,
- tofusnaya chronic stage of gout.
Gouty arthritis occurs suddenly: at night or in the morning, there are burning, throbbing or tearing one or more joints, usually on the legs and defeat them asymmetrically.
Quite often the first affected joint of the big toe.
Defeat usually captures the foot or ankle, knees, joints, fingers and elbows. It can be swelling of the veins around the joint, fever and chills.
Because of the severe pain and swelling, joint movement almost impossible. In the afternoon some pain subside, and the night there again, which leads to neurosis and irritability.
After 3-4 days the pain subsides, the joint becomes cyanotic hue, swelling gradually subsides.
During the attacks changed blood tests - blood revealed inflammation with ESR acceleration, high leukocytes and an increase in acute phase proteins of inflammation.
Seizures can occur in different periods - from once every six months to several years. As the progression of gout frequency of attacks is increasing, they are becoming longer and less sharp, but the process involved all the new joints.
chronic gout
Chronic gout tophi areas forms - is nodular accumulation of salts in the tissues after about 5-7 years from disease onset.
Tophi occur inside the ears, in the region of the joints of the hands and feet, elbows, knees, their dimensions may be from a couple of millimeters to a pea or more. As the progression of change joints occur deformation, curvature, limitation of motion and pain when moving.
Besides joints affects the kidneys. Changes the stronger, the higher the level of uric acid and urate in the urine, and the longer the disease.
A so-called urate nephropathy renal tissues with inflammation, release of salts, the deposition of sand and pebbles and formation urolithiasis.
there are periods renal colic with low back pain, nausea and vomiting, and can also develop secondary pyelonephritis, with fever, leukocytes in urine, Dysuria common phenomena and severe condition.
Urate may be deposited not only in the kidney pelvis, but also in the kidney tissue, its cortex and medulla, this leads to gradual atrophy of kidney function and development kidney failure.
Can be lesion tendons with the deposition of salts therein, wherein the developing erythema and swelling of tendons in zone, a strong pain and problematical movements.
It is also more likely to develop coronary heart disease, In some patients there is severe obesity.
Diagnostics
The basis of the diagnosis - typical gout with joint disease. Complementary data of blood tests with signs of acute inflammation, urine samples with high levels of urate and uric acid, creatinineIn joint detection of punctate urate salts.
In acute gout
For primary diagnostics is necessary to study the joint fluid. In attacks of gout it is transparent, its viscosity is reduced, leukocytes therein to 75%, uric acid crystals are detected.
When the duration of the current gout
Be sure to conduct X-ray to detect certain signs in the clinic:
- maximum of inflammation on the first day,
- several arthritis attacks
- loss of one joint,
- joint redness,
- inflammation in the first joint of the big toe,
- suspected tophus,
- increase in blood and urine urate,
- the typical signs of joint damage on x-ray.
Treatment
In the treatment of acute gouty arthritis are important rest and cool wraps.
Occupies an important place colchicine appointed 0.5 mg every hour until arthritis subsided or until side effects (vomiting, diarrhea), not less than 6-8 mg / day.
For the treatment of acute attacks of gout, colchicine is used not more than a day.
Indomethacin, ibuprofen, naproxen, piroxicam are normally used in large doses and short-course (2-3 days). It should be particularly careful with concomitant diseases of liver and kidneys, particularly in elderly patients.
Treatment protivopodagricakih preparations carried out in primary gout life, the secondary - depending on the situation removability, provoking the development of gout.
Under reduced excretion of urate stored kidneys and urinary stones absence possible to use allopurinol + benzbromarone used 1 tablet 1 p. / Day., Probenecid.
Urikostaticheskim recognized (ie, blocking the production of urate) The drug is considered allopurinol.
Allopurinol administered in a starting dose of 100 mg / day. followed by a gradual increase in dose to 300 mg / day. for 3-4 weeks.
With increased excretion of uric acid in the urine and / or gouty kidney preference is given to allopurinol.
Diet for gout
More detailed article about nutrition to treat gout here
Products, which is necessary to eliminate consumption:
- alcohol (especially beer),
- the internal organs of animals (liver, kidneys).
Food, which should limit the intake of:
- Fish (caviar, Baltic herring, sardines, etc.; dietary permissible larger fish),
- crustaceans,
- meat (beef, pork, poultry, soups),
- some vegetables (peas, beans, mushrooms, cauliflower, asparagus, spinach).
Foods that can be eaten without restriction:
- grains (breads, cereals, bran)
- dairy products (milk, sour cream, cheese)
- all fruits and fruit juices,
- fats (butter, margarine, cooking oil)
- coffee Tea,
- chocolate,
- most vegetables (potatoes, lettuce, cabbage, tomatoes, cucumbers, squash, onions, carrots, beets, radishes, celery)
- sugar (but: it causes weight gain!)
- spice.
Forecast
Gout - a chronic, progressive disease, it is impossible to achieve a complete cure, but it can cause disease in the state of long-term remission.
Seizures are usually treated for 2-4 weeks, but may occur once every six months and more, however the administration of drugs that lower the level of uric acid and its salts, may be even a lifetime.
