Gouty arthritis

One of the diseases of modern society is gout. And although she refers to diseases of metabolism, the main manifestation of it is the damage to the joints.

gouty arthritis

The process is very specific, is characterized by persistent and prolonged course. It can cause severe destructive processes in the joints, which requires familiarity with the true face of this enemy of humanity.

What is gouty arthritis?

Gouty arthritis is one of the varieties of inflammation of the joints, which is caused by accumulation in the articular structures of crystals of uric acid, its destructive effect on hyaline cartilage and periarticular tissues. In the above definition of disease clearly all the key development mechanisms and manifestations of this process.

If you explain everything in order, the complex pathological changes consists of a sequential chain:

  1. Violation of uric acid metabolism in the direction of increasing its quantity in the blood;
  2. The deposition of its crystals (urate) on the surface of hyaline cartilage of the joints;
  3. Irritation and damage of the articular structures with the development of an inflammatory response, which actually is called arthritis;
  4. The development of the consequences destructive of the process;
  5. Periarticular tumor growth.

For gout is characterized by the kidney accompanied by the development of nephritis and kidney stones as the stones are laid in the pelvis of the kidney and the ureters.

In most cases, gouty arthritis affects the small joints (toes), less ankle and knee joints, fingers, wrist and elbow.

Disease are more prone to males in adulthood (25-50 years). Manifest gouty arthritis may occur in the earlier period. Characterized by long duration of the process with constant recurrence. Mainly affects the small joints of the feet, less often the ankle joint.

The symptoms of gouty arthritis

the symptoms of gout

In the development of the disease is divided into three periods:

  • Latent, when clinical symptoms and to diagnose the onset of the disease is possible only by increased blood levels of uric acid (hyperuricemia);
  • Acute recurrent when joint damage causes severe gouty attacks;
  • Chronic, in which the possible long periods of remission.

The frequency of attacks may vary from 1 time per week-month to 1-2 times per year.

Clinical picture is quite typical, which allows it to diagnose.

First symptoms are acute and consist of:

  1. Pain in the joint of the big toe;
  2. Redness of the skin over the inflamed joint;
  3. Increased pain during movement;
  4. The increase in body temperature above the normal figures;
  5. Unilateral lesion;
  6. The appearance around the joints that are sick, white subcutaneous growths;
  7. Consistent recurrent pain in various small joints.

Some of these manifestations of the disease is to focus and Refine the main points. First and foremost is the demonstration of the process. The thumb is the first victim in 90% of cases. If on this background are not taken adequate diagnostic and treatment activities, the disease will certainly find progressive course. Will gradually become inflamed and sore other small joints.

When gouty arthritis is characterized by high activity, the skin over the affected joint is definitely red, which complemented the overall temperature response. Long duration of inflammation in gout leads to the formation of subcutaneous nodules around the joints. They are represented by elements of the joint tissues and uric acid.

The cartilage is gradually destroyed, and adjacent to the joint of the bones formed the so-called cavity filled with crystals of sodium. Also crystals of uric acid salts may be deposited in the surrounding joints and tissues right under the skin above the joint in the form of a whitish solid nodules. Nodular deposits of bone growth and lead to significant changes in the appearance of the legs. If untreated, the result can be total disability, and ability to self-care.

In women, the disease is much easier than men. The attacks are not as strong and sharp, seals, and cavities are formed very rarely. Therefore, women can be difficult to differentiate gouty arthritis with osteoarthritis.

Causes of gouty arthritis

The etiology of the disease is not fully understood. The main risk factors for its occurrence are:

  • Genetic predisposition;
  • Improper diet: excessive abuse of meat products, sausages, chocolate, strong coffee and tea, alcohol. (Previously, gout was called "the disease of the aristocracy");
  • The presence of comorbidities such as heart failure, leukemia, kidney disease, hormonal abnormalities;
  • Use of certain drugs: funds from high blood pressure, diuretics, cytostatics, etc.
diagnosis

There are also primary and secondary gouty arthritis:

  • Primary gout develops as a result of a combination of genetic predisposition and the large consumption of purine with the products listed above;
  • Secondary gout occurs due to the presence of these diseases and medication.

The accumulation in the joint cavity index of microcrystals of sodium urate may occur without symptoms for a long time until any factor you do not provoke an acute attack: physical fatigue (the long walk), trauma, infection, stress, hypothermia, starvation or eating large amounts of "purine" foods in combination with alcohol.

Diagnosis of gouty arthritis

The key point of diagnostic procedures is detection of index crystals sodium urate in the synovial fluid of the joints, both during attack and in remission. Synovial fluid for analysis can be taken from any major joint, never prone to inflammation, for example, of the knee. Also for the study can be taken as the contents of the seal or any other biological material.

Hyperuricemia (high blood uric acid in the blood) in combination with periodic inflammation of the joint of the big toe is not considered a confirmation of gout, it is only a marker of disorders of purine metabolism. Many people with hyperuricaemia gout is missing.

In the long course of the disease, it makes sense to conduct x-ray studies. In the early stages of the disease there are no characteristic changes. Then the x-rays show signs of typical of gout: degradation of cartilage defects of the end parts of bones, cavity.

With the development of gout in the upper extremities is quite difficult to differentiate it from other diseases of the joints.

Diet for gouty arthritis

Given that gout is a consequence of malnutrition, and its complete cure cannot be achieved without a clear implementation of the necessary dietary guidelines. That is why gouty arthritis in most cases is a progressive course. But I would like to focus patients on the importance of such therapeutic measures as diet. According to the medical nomenclature it refers to dietary table No. 6.

The main principle – the exclusion of foods that are a source of purines. After all, when their decay is a powerful release of uric acid, which does not have time to contact and excreted from the body. Its approximate composition is given in the table.

As can be seen from the above data, it is prohibited, but enough food for a normal healthy diet. The main thing you need to remember is to prevent excess. Even if it so happened that the man could not resist and ate the forbidden food, it is advisable to immediately take the appropriate drugs that display or link the products of metabolism of uric acid.

Sample menu for gout for a week

Monday:

  • Breakfast: cottage cheese with fruit jelly, coffee with milk;
  • Lunch: Tomato juice;
  • Lunch: vegetable rice soup, bread, compote;
  • Afternoon snack: Apple, weak tea with marmalade;
  • Dinner: potato pancakes, green tea.

Tuesday:

  • Breakfast: cereal with milk, rye bread, pineapple juice;
  • Lunch: pear, walnuts;
  • Lunch: rabbit Stew, vegetable stew, fruit compote;
  • Snack: Orange juice;
  • Dinner: cheese sandwich, tea with milk.
diet for gout

Environment:

  • Breakfast: Carrot burgers with sour cream, juice;
  • Lunch: Banana;
  • Lunch: Vegetarian borscht with sour cream, broth hips;
  • Afternoon snack: grapefruit, tea with jam;
  • Dinner: pumpkin pie, green tea.

Thursday:

  • Breakfast: boiled egg, cheese sandwich, tea with lemon;
  • Lunch: glass of cherry juice;
  • Dinner: Trout baked with potatoes, salad vegetables, juice;
  • Afternoon snack: Yogurt, candy;
  • Dinner: Muesli with nuts, juice.

Friday:

  • Breakfast: buckwheat porridge, cooked in milk, green tea;
  • Lunch: baked apples with honey and nuts;
  • Lunch: vegetable salad, boiled rice, bread, orange juice;
  • Afternoon snack: tomato juice;
  • Dinner: steamed potatoes, fresh vegetable salad, a glass of skim milk.

Saturday:

  • Breakfast: scrambled eggs, rye bread, jelly;
  • Lunch: peach juice, almonds;
  • Lunch: soup broth from lean meat, broth hips;
  • Snack: banana;
  • Dinner: soup with grits, cheese sticks, tea with milk.

Sunday:

  • Breakfast: corn porridge with milk, coffee with milk;
  • Lunch: yogurt, candy;
  • Lunch: salad, bread, juice;
  • Snack: Apple;
  • Dinner: boiled tuna with fresh or steamed vegetables.

After a year of treatment, with the satisfactory feeling and absence of relapses, rigid dietary restrictions can be removed. In this case, you can choose either to continue to follow the diet and reduce the dosage taken drugs or even cancel them or to continue receiving medicines and to allow for some relief in the diet.

How to treat gouty arthritis?

treatment of gout

For many decades, conventional medicine has not invented anything new in the treatment of gout and gouty arthritis. The entire treatment process also consists of two stages: inflammation and supporting anti-relapse therapy.

When there is an exacerbation or first appearance of a gouty arthritis should:

  1. Administration of drugs not steroid anti-inflammatory origin. Make good use of them stepped appointment with the phased use of injections of replacement with preformed;
  2. The drug colchicine is a specific anti-inflammatory remedy for gout;
  3. The local use of ointments on the basis of the NSAIDs;
  4. Lotions and compresses on the basis of sex or alcohol solution of Dimexidum in 25% concentration;
  5. Physiotherapy: paraffin wax and other heat treatments, laser therapy, magniticent, physical therapy, massage, gymnastics.

Treatment of the disease includes the following components:

  • Diet (normalization of purine metabolism);
  • A medication that reduces urate synthesis;
  • The causes of hyperuricemia.

Prolonged treatment (several months to several years), treatment interruptions generally result in the relapse. In compliance with all medical recommendations, the patient's condition returns to normal within the first month. It is recommended to carry out a monthly control of the level of uric acid depending on the test results to adjust the dosage of drugs. The main therapy can complement physical therapy, massage, physical therapy.

In the presence of excess weight recommended to lose weight, as there is a relationship between overweight, increased synthesis of urate and reduced renal excretion. You should also abstain from taking thiazide diuretics to lower blood pressure and aspirin. These drugs increase the content in the body of uric acid and can provoke an attack.

During exacerbations should be possible to reduce the load on the affected joint. Additionally, you can make ice packs several times a day for 5-7 minutes.

Only a comprehensive approach to treatment, including anti-inflammatory therapy, local effects, diet and medication drugs influence the metabolism of uric acid, can help in the fight against arthritis.

02.08.2019