Gout: treatment, symptoms, diagnosis, prevention in St. Petersburg

Why is gout dangerous?

Without adequate treatment, gout progresses rapidly, especially in mature and elderly patients. Without appropriate therapy, serious complications are possible.

Major complications

Gouty arthritis Uric acid, in the form of crystals (tophi) is deposited in all parts of the body. When such deposits become lodged in joints or periarticular tissues, severe inflammation occurs. This leads to severe pain and fever

Urolithiasis Crystals that occur with gout often form in the kidneys. They become the main cause of kidney failure and ultimately lead to the death of the patient.

With gout, kidney stones can form at all stages of the disease, excluding the first

Peculiarities

This disease is due to the fact that uric acid salts begin to be deposited in the body. These processes are caused by metabolic disorders. Failures in metabolism provoke the accumulation of urates in the blood and tissues. At the same time, the kidneys are not able to effectively remove them. Deposited in the cavities of the joints, urates cause gout on the hands, which also affects the movable joints on the limbs:

toes;
ankle area;
knee and elbow joints;

The greatest impact from the disease is taken by the hands, which over the years of a person’s life regularly face increased physical activity. Moreover, this can be both standard elementary movements and lifting loads. The pathology is localized in the carpal area and on the fingers. Due to the development of gout, a complete loss of mobility of the joint elements can be provoked. Therefore, a complication is a limitation in a person’s fine motor skills with subsequent complete or partial loss of performance. It is important to timely assess all the risks of developing the disease and prevent its development in order to avoid serious complications.

Stages of the disease

Asymptomatic hyperuricemia As the name suggests, it occurs without symptoms. But at this time, uric acid accumulates in the body. This period ends with the first attacks of gout.

Acute gouty arthritis First attack of gout. It occurs due to a sharp jump in the level of uric acid in the patient’s body. As a rule, exacerbation occurs at night. The attack worsens over the course of a day and only goes away after a few days.

Intercritical period This is the time period between exacerbations of gouty arthritis. There is usually no pain during this period, but the joint continues to deteriorate. This period is considered the most suitable for effective treatment of gout.

Chronic gouty deposits in the joints Appear when there is a high level of uric acid in the blood, which persists for several years. At this time, gout attacks become stronger, and the intervals between them become shorter.

The progression of the disease leads to the fact that people eventually cannot move without the help of crutches or a wheelchair

Gout, gouty arthritis: symptoms, signs and treatment

Gout, or gouty arthritis, is a disease in which metabolic disorders occur in the body and uric acid salts are deposited in the joints. This is a very unpleasant but easily treatable disease.

Gout is relatively uncommon. Although I hear the word “gout” almost every day. For example, most grandmothers call arthrosis of the big toe “gout.” This is what they usually say: “Gout has grown on my leg.” In fact, gout, although it affects the same big toes, most often affects men. In women, gout (real, true gout) is several times less common.

Previously, some 100 years ago, gout was generally considered an exclusively male disease. But in our time, due to the fact that women began to eat better, eat more meat and sausages, gout began to occur much more often among them than, for example, a century ago.

In addition, gout in women has become more common due to the use of certain medications, primarily medications for high blood pressure. Some drugs to reduce high blood pressure, when used for a long time, lead to an increase in the concentration of uric acid in the body.

But still, in men, gout manifests itself much more acutely and “aggressively”, since the concentration of uric acid is significantly influenced by male sex hormones.

Below I will tell you about the symptoms, signs and treatment of gout, as well as what diet you should follow for this disease.

Signs of gout

“Classical” gout belongs to the group of arthritis. It develops in people who have a hereditary predisposition to this disease. Moreover, the potential patient may not even be aware of his heredity.

For example, if his parents or relatives lead a healthy lifestyle, do not abuse alcohol and eat properly, then the disease may not manifest itself in them and will exist all their lives only in a latent, hidden form. And our potential patient, who has a predisposition to this disease, will provoke the disease in himself only if he leads a not entirely healthy (from the point of view of a tendency to gout) lifestyle.

Thus, a typical gout is often (but not always) an overweight man who abuses either alcohol or so-called “purine foods”: meat, meat soups, smoked meats, fish and salted foods, offal (liver, kidneys), beans, beans , chocolate, grape wine.

When these products are abused, there is an increased formation of uric acid in the blood , which, in turn, forms a poorly soluble salt of sodium urate. When the concentration of uric acid in the blood reaches a maximum level, its salts in the form of microcrystals are deposited in the joint cavity, forming a kind of “depot” there.

The presence of microcrystals of sodium urate in the joint cavity is a serious irritant for it. But nevertheless, crystals can remain in the joint for a long time asymptomatically - until some provocation (physical overload, stress, prolonged fasting or, conversely, too much “purine foods” and alcohol) provokes an acute gouty attack, that is attack of gout. Regular acute attacks of gout are the main symptom of this disease.

Gout symptoms

The first attacks of gouty arthritis are almost always short-lived. The attack usually begins suddenly, most often at night. In most cases, the joint of the big toe becomes inflamed (sometimes one, sometimes both). Less commonly, the thumbs, knee, ankle, elbow joints, heel tendons, and very rarely the wrist joints become inflamed.

The pain is such that, according to my patients, it makes you want to literally “climb the wall.” The affected joint swells, turns red, and the skin over it becomes bright red or purplish and hot to the touch. Even a light touch to the inflamed joint or the slightest movement in it causes unbearable pain. The patient suffers for 3-4 days, when suddenly the attack passes, as if nothing had happened.

However, after some time, the pain just as suddenly recurs. Moreover, if at the beginning of the disease the intervals between attacks are quite long, from one to eight months, and the attacks themselves are short-lived, then over time everything changes. The attacks are becoming longer and longer, and the intervals between them are becoming shorter.

Eventually, there comes a time when the pain in the joints becomes constant, and there are practically no intervals between attacks. This condition is called "status gouty", or chronic gouty arthritis. In chronic gouty arthritis, articular cartilage is destroyed , and special defects are formed in the bones adjacent to the joint - “punches”, which are a cavity filled with microcrystals of sodium urate.

In addition, sodium urate crystals can be deposited even under the skin, forming whitish, hard nodules filled with a pasty mass. Such nodules are called tophi, and most often they are located on the ears or near the joints. Sometimes tophi break through and uric acid crystals are released through the resulting fistula. Fortunately, usually within a few days after the tophi breaks through, the wound heals without consequences.

In addition to the above troubles, gout, especially advanced ones, is almost always accompanied by the deposition of urate in the kidneys, which leads to urolithiasis , and sometimes to inflammation of the kidneys (pyelonephritis).

It is important to know!
Female variants of gout are usually much milder. Women very rarely have acute gouty attacks, and tophi and punctures in the bones are much less likely to form. Most often, female gout manifests itself as mild chronic pain in the knee or ankle joint. And an experienced doctor can guess that this is not arthrosis only by the severe swelling of the inflamed joint, which is uncharacteristic of arthrosis.

Diagnosis of gout

Having assumed that the patient has gouty arthritis (and in classic cases this is quite easy), a competent rheumatologist or arthrologist will refer the patient for an x-ray of the hands and feet, as well as a biochemical blood test.

With advanced gout, the doctor can easily detect characteristic gouty “punches” in the periarticular bones on x-rays of the hands and feet. A blood test will show an increase in uric acid levels. If such an increase is clearly expressed and is combined with the presence of “punches” in the bones and characteristic gouty symptoms, then the diagnosis is considered reliable, and then we only need to select the correct treatment.

The problem, however, is that if you do a uric acid test at the very moment of the attack (and usually it is at this time that the patient goes to the doctor), then such an analysis may not record any abnormalities. That is, at the time of an attack, the level of uric acid in the blood may turn out to be normal (after all, at the time of an attack, the maximum amount of uric acid goes into the inflamed joint).

Therefore, it is necessary to measure the level of uric acid in the blood several times, including between attacks. But gout patients often don’t have the patience for this. As soon as the next attack “subsides,” they often completely stop thinking about their health again.

Meanwhile, without correct diagnosis and without proper treatment, gout can lead to very undesirable consequences not only for the joints, but also for the kidneys.

Continuing the topic, I would like to note that, despite the frequent mention of the term “gout” in the literature and in conversations, in reality it turns out that the correct diagnosis of gout patients is not always made and is often very late. Sometimes you have to deal with monstrous diagnostic errors.

For example, at the time of an attack, surgeons managed to diagnose one of my patients with “gangrene of the big toe” and amputated the toe inflamed by gout. Literally 3 weeks later, his big toe on his other foot became inflamed, and the patient was about to amputate that too! Fortunately, the man realized that this time he should consult another doctor, and turned to me for help. Upon examination, it immediately became clear that the patient did not have gangrene, but classic gout. I prescribed the anti-gout drug colchicine to the patient, and the attack was eliminated literally in one day! The next day there was no trace left of the imaginary gangrene.

Another patient was treated for arthrosis for seven years, despite the fact that his joints became inflamed in attacks, alternately, about once a month, and the inflammation never lasted longer than 5-7 days. The most surprising thing in this story was that in numerous tests of blood taken from a vein, the patient’s uric acid simply went off scale. She was more than 2 times higher than normal! But doctors managed to ignore this over and over again. And they continued to stick to their line. During one of the attacks, the man even had time to have his knee operated on and a completely healthy meniscus was removed. But the operation, naturally, did not bring any relief to the patient. The knee periodically continued to become inflamed along with other joints.

Only after the man came to see me and laid out a pile of tests in front of me, which clearly showed a constant increase in uric acid levels, was the patient finally given adequate anti-gout treatment. And just a month after the start of treatment, gout attacks, for the first time in all the past years, began to disappear. And then they stopped altogether. Treatment of gout

After diagnosing a patient, I usually say, without any irony, “Congratulations, you have gout.” I’m really not being ironic, because of all the possible diagnoses, this is one of the most favorable. Gout is very easy to treat and is not particularly difficult for a competent specialist.

Although here, as often happens, there is a “fly in the ointment.” Yes, gout is very treatable, but many gout patients do not want to accept the conditions that are necessary for recovery - since the “conditions” are the refusal of those foods (and alcohol) that caused metabolic disorders. And when I tell patients that to get rid of the disease they need to give up their favorite foods and alcohol, they often simply don’t want to hear me.

That’s why every time I have to patiently explain that without a diet there can be no talk of recovery, no matter what “cool” medications are used. Another thing is that in many cases the diet is a temporary measure, and if certain conditions are met, after a year or two the strict restrictions can be lifted.

The classic but outdated version of the gout diet is here >>

The diet for gout updated and corrected by Dr. Evdokimenko is here >>

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Drug therapy for gouty arthritis consists of two components: treatment of an acute attack and therapy of the gout itself.

To relieve an acute gout attack, non-steroidal anti-inflammatory drugs (Voltaren, ibuprofen, Movalis, Nimulide, etc.) or a special short-acting anti-gout drug - colchicine - are successfully used. A vodka compress can be applied locally to the sore joint.

Drugs to relieve an acute attack are used for a short period of time, in a short course of three to seven days. And directly for the treatment of gout, in the absence of contraindications, for several months or years a drug is used that reduces the formation of uric acid in the body - purinol, also known as allopurinol .

Following a diet and using purinol (allopurinol) leads to normalization of the patients' condition within the first month of therapy. Although during the first week, during therapy with purinol or allopurinol, an exacerbation of the disease may even occur. But then the attacks become weaker and occur less and less often, and over time they stop altogether.

And after about a year, if my ward is feeling well, I allow some relaxations in his regime. I ask the patient what he would like to stop - diet or medication, since we can limit ourselves to one thing or the other. If the patient is already accustomed to the diet, then there is no point in breaking it. In this case, it is better to reduce the dose of medications taken or stop them altogether.

If the patient finds it difficult to tolerate dietary restrictions, then you can abandon the diet, but continue taking medications. However, the medications will have to be used for several years - which, in general, is not scary, since purinol (allopurinol) rarely causes any side effects and is generally well tolerated by patients.

READ MORE:

Diet for gout: nutrition, products and menu
No more medications needed?
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Treatment methods for gout

Doctors at the DaliMed clinic have developed unique methods to relieve patients from this serious illness. An acute gouty attack resolves within three visits. After this, the main treatment occurs.

After completing the full course and restoring normal uric acid levels, the patient can even allow himself to deviate somewhat from the prescribed diet.

A course of treatment

Diet for the period of treatment: Avoid consumption of fatty animal products, offal (canned food, sausages), carbonated drinks, and alcohol.

It is necessary to consume enough water and plant products.

Drug therapy for gout is aimed at reducing the level of uric acid in the patient’s body, stopping the acute inflammatory process and relieving pain.

Treatment methods are selected individually

Innovative drugs aimed at reducing uric acid in the patient's blood.
Medicines developed in Europe that promote the resorption of crystals in the body (tophi).
Specialized medications that relieve inflammation and restore tissue.
Laser therapy.
Ozone therapy.
Reflexology.
Physical activity prescribed by the doctor.

How to treat gout on fingers and toes

In principle, the stages of treatment for toes and hands are approximately the same.

During an exacerbation, you should place pillows or bolsters under the inflamed area so that they are in an elevated state - this reduces the severity of the pain. If you have ibuprofen-based tablets at home and the patient has no contraindications to them, you can give a loading dose, two tablets at once.

Cool compresses are helpful to draw out the heat. Be sure to drink plenty of fluids, but not sour ones (from now on you will have to forget about citrus fruits, sour berries, and any foods with a sour taste!). Herbal tea based on chamomile, St. John's wort, passionflower or regular tea without sugar, as well as mineral or simply bottled water will help restore the water balance in the body and strengthen the patient's strength.

As soon as possible, take the patient to the hospital emergency room; it is difficult to fully control the attack at home.

In case of severe inflammation, synthetic hormonal drugs are prescribed to quickly relieve the exacerbation. They are not indicated for everyone (therefore, the doctor must name all the medications that the patient receives constantly, inform about allergies to something, warn if the woman is expecting a child or is breastfeeding).

NSAIDs are a milder method of treatment, non-steroidal anti-inflammatory drugs. The enzyme cyclooxygenase, which triggers the synthesis process, is suppressed, and the body is gradually restored to normal.

Also shown are tablets and ointments based on ibuprofen, voltaren, colchicine - as prescribed by a doctor, for internal and external use. They are especially effective for treating gout of the fingers.

Advice from a doctor

Do not put stress on the sore joint. It is necessary to periodically fix it in an elevated position and apply ice for 15-30 minutes 2-3 times a day until the pain subsides.
Eliminate aspirin. It can cause spikes in uric acid levels in the blood and worsen attacks.
Regularly measure your uric acid level - it should not exceed 60 mg/l.
Do exercises. Dedicate at least half an hour to physical education every day.
Drink at least two liters of clean water per day.
Get a blood test to determine your levels of essential minerals and vitamins.
If necessary, supplement your diet with a good vitamin and mineral complex . It is especially important for gout patients to provide themselves with vitamin C.
Avoid carbonated drinks and juice powders containing fructose.
Avoid alcohol.
Review your diet in favor of vegetables, fruits and cereals.
Consume no more than 120 grams of animal protein per day , avoid offal and fatty sausages.

After our course of treatment, the pain will go away, your former mobility will return, and if you follow the doctor’s recommendations, you can forget about gout forever.

What does this disease mean?

There is a lot of literature about gout of the toes. Nevertheless, briefly about this manifestation of it.

Tophi are painless soft nodules outside the period of exacerbation. If you find them, do not brush them off or hide from the disease, consult a doctor immediately. A general blood test allows you to determine the concentration of uric acid; if it is elevated, you are on the verge of a disease. As a rule, 1-2 additional examinations are prescribed to confirm the diagnosis and treatment is prescribed. If the disease is caught at an early stage, before exacerbations, there is a chance that attacks can be avoided altogether.

Gout of the toes is painful: bones begin to deteriorate, ulcers open to any infection can occur, attacks can be long and debilitating.

But gouty changes in the fingers are an even more serious process. The joints swell, become painful, their mobility gradually decreases, to the point of complete disability and inability to care for oneself. Now, when an increasing percentage of the population works on computers, complex units, CNC machines, and in assembly shops, it is especially scary to lose the opportunity to do what you love. Therefore, if you notice subcutaneous tumors in the area of the joints of your fingers or wrist, if swelling, redness, or pain occur, you should begin treatment immediately.

Diagnosis of gout of the hands

Treatment of gout on the hands is carried out by a rheumatologist. He is able to visually assess the condition of the hand joints after a thorough examination of the patient. A thorough medical history is taken, after which the optimal method of diagnostic examination is determined. Typically, the diagnosis of gout on the hands is carried out comprehensively and includes:

X-ray examination of the limb in order to identify and evaluate the nature of bone changes, to identify the presence of urates;
blood test (general and biochemistry) - informative during an exacerbation of the disease, as it can show an increase in ESR parameters, changes in the level of leukocytes, and uric acid saturation during an attack;
analysis of urine for the presence of uric acid crystals in it;
Ultrasound of the kidneys, which allows you to determine the presence of stones in the organs, their size and location;
MRI of the bone and soft part of the hand to identify abnormalities and pathologies in the form of tumors, deformities, and associated abnormalities.

A specific list of tests that are necessary for a correct diagnosis is determined by a specialist based on the patient’s condition. Based on the diagnostic data, a treatment plan is prescribed.

ethnoscience

Such medications help achieve remission as an addition to drug therapy. After consulting with your doctor, you can use a variety of recipes.

Compresses

This method can be used both in the treatment of gout on the hands and during remission. Compresses are placed on areas of the hand that are prone to disease. Among the effective and affordable recipes are:

1. With activated carbon – 5-6 tablets of the product are finely ground into a powdery mass. A couple of drops of flax oil are added to it, and by subsequent addition of water, the composition is given a thick consistency. The composition is applied to gauze in a small layer, then applied to the diseased area and left wrapped overnight.

2. With castor oil. Take 1 tsp. oil, the same amount of ammonia with iodine, mix. Wrap a cotton cloth soaked in the solution onto the brush. Apply compresses every day.

3. With chamomile – take 1 tbsp. l. raw materials and pour 1 cup of boiling water. Add a pinch of sea salt. After infusing for half an hour, filter. Use the solution to soak gauze and apply it to sore fingers. A film is wrapped on top.

4. Vegetable compress with potatoes or cabbage. First you need to peel the potatoes and grate them. The potato mass is laid out on a cloth and tied to the diseased area of the limb. This compress is alternated with applying a cabbage leaf to the sore hand. The leaf should first be pricked, for example with a fork, to release the juice. Then it is lubricated with honey mass. The cabbage leaf attached to the brush is wrapped with a bandage.

The average course of treatment for gout on the hands with compresses is 7 days. If there are no positive effects, you should stop the procedures and consult a doctor for advice.

Healing ointments

These compositions are prepared and used at home:

1. Grate a piece of laundry soap using a grater and mix with 2-3 drops of vegetable oil. Heat the resulting composition using a water bath, and then add 1 spoon of kerosene.

2. Mix mustard powder with honey and soda. Use an equal ratio of components. The resulting composition is lubricated on the sore hand and wrapped in a bandage for 60-120 minutes.

3. Take 200 g of butter and mix with alcohol in a volume of 200 ml. Set fire to the composition and wait until the alcohol burns out completely. Use the product to lubricate your hands before going to bed. Use the recipe during an exacerbation of gout.

For complex treatment of gout on the hands, you can supplement the treatment plan with pharmaceutical ointments and gels. In this case, it is necessary to take medications prescribed by a doctor.

Exercise therapy

To restore the functionality of the hand and upper limb in general, it is recommended to do exercises to treat gout in the hands. They will provide effective rehabilitation, but are especially effective at the beginning of the progression of the disease. If gout worsens, then physical exercise and gymnastics are prohibited. The complex includes the following movements:

effortlessly try with one hand to help pull the other forward, making a straightening movement;
clench your limb into a fist, and after 3-5 seconds. spread your fingers like a fan;
make pressing movements on the phalanges of the fingers using the thumb;
straighten your arms and begin to make rotational movements with your hand, first in the direction of the clock, and then in the opposite direction;
Take a small ball in your hands and roll it in your palms.

Massage

It is advisable to contact experienced doctors, although simple movements in the form of stroking, tapping or kneading can be performed independently. The following condition must be observed: massage as a rehabilitation procedure is allowed only during a period of stable remission after consultation with a doctor. It is useful because it helps:

increase amplitude characteristics in arm and hand movements;
eliminate muscle spasms and tightness;
stimulate the processes of resorption of formed cones.

The standard duration of a course of procedures is up to 12 sessions. They are usually repeated twice annually.

Diet

To minimize the accumulation of uric acid, you should monitor your body weight and avoid gaining extra pounds. In nutrition, focus on table No. 6 without purine saturation. The diet should be followed both during remission and exacerbation. Doctors recommend:

do not eat red meat and fish, including broths based on them;
There should be no strong tea, coffee, cocoa, or alcoholic beverages in the diet;
It is advisable to consume natural juices from vegetables and fruits, mineral water with an alkaline base;
minimize salt intake;
focus on cereals and fermented milk products;
exclude salted foods, smoked foods, sausages and canned goods, and semi-finished foods.

It is important to follow the principles of fractional nutrition, to avoid overeating and excessive weight gain. They will help optimize your diet and fasting days.