Deposition of salts in joints: arthrosis, calcification, gout?

The concept of “deposition of salts” in organs and tissues does not apply to medical terminology. This is what people in the vast majority of cases call the formation of osteophytes - growths of the edges of bones in various types of degenerative-destructive pathologies of the musculoskeletal system, accompanied by pain, crunching in the joints, and their deformation. However, an osteophyte is not a deposit of “salt”, but is a newly formed, physiologically inferior tissue that is structurally vaguely reminiscent of bone. The symptoms described may be associated with various diseases that have their own causes of development.

Thus, disturbances in purine metabolism lead to the development of gout, in which crystals of urates (uric acid compounds) are deposited in the joints and periarticular tissues. Being a foreign body, urate provokes the development of an inflammatory process (gouty arthritis) with severe pain and limitation of motor activity. The small joints of the hands and feet are most often affected. In addition, urate deposits in soft tissues and subcutaneous fatty tissue result in the formation of yellow nodules (tophi), which appear in the elbows, ears, extensor surfaces of the forearms, thighs, legs, Achilles tendons, and on the forehead.

Disorders of calcium metabolism with precipitation of calcium salts from the dissolved state and deposition in tissues and organs are characteristic of calcinosis (metabolic, metastatic and dystrophic). Thus, local disturbances in metabolic reactions lead to the deposition of calcium salts in muscles, subcutaneous fat, and skin. Most often the hands, elbows, ears, lower limbs, buttocks, back, and large joints are affected. A high concentration of calcium salts in the blood (hypercalcemia) is fraught with calcification of blood vessels and internal organs. The causes leading to hypercalcemia may be diseases of the parathyroid and thyroid glands, bones, kidneys, intestines, and hypervitaminosis D.

Why does salt deposition occur in the body?

Salt deposition in joints is not a myth, and there are many reasons for this pathology. The problem may be caused by:

• poor diet or excess weight;
• genetic disorders of water-salt metabolism;
• hypothermia;
• injuries;
• diseases of the kidneys or circulatory system;
• endocrine disorders;
• wearing uncomfortable shoes, which leads to microtrauma of the articular surfaces.

Knee injuries often lead to salt deposits in the joint

Drinking regime

In case of purine metabolism disorders, you need to receive at least three liters of fluid per day, as this speeds up the release of urate deposits from the joints. In addition to clean water, it is recommended to drink alkaline mineral waters, vegetable and fruit juices, and infusions of medicinal plants.

Herbalists recommend using rose hips, mint, bearberry, and birch buds. Dried fruit compote is very useful. It is better to postpone taking any liquid for 30-45 minutes after a meal. This will improve the digestion process.

The exception is alkaline mineral water, which should be drunk warm before meals or regardless of meals.

Or maybe it's calcification?

Sometimes pathological processes occur in the joints that are directly related to impaired salt metabolism. Calcinosis is the deposition of calcium salts in tissues and organs due to malfunction of the parathyroid glands. Other causes are diseases of the bones, kidneys, hypervitaminosis D.

There are two types of the disease:

• metabolic calcification develops due to a local metabolic disorder in tissues, with salts being deposited in muscles, skin and subcutaneous fat;
• metastatic - caused by a high concentration of salt in the blood (hypercalcemia), so they are deposited on the walls of blood vessels and in the internal organs.

If the concentration of salts in the body is normal, they are dissolved in the liquid and participate in various processes. When oversaturated, they are deposited in organs and tissues, on teeth and in blood vessels, forming growths ranging in size from small peas to formations the size of a walnut. The most common locations are the hands, elbows, lower extremities, ears, back, buttocks and large joints.

Such areas with “salt deposits” are mobile and dense to the touch, and their palpation does not cause pain in a person, with the exception of the shoulder joint. The skin over them stretches and takes on a blue tint, but there is no inflammation. Over time, the formations become softer, whitish grains are released from them - lime, which helps to diagnose “calcinosis”.

Calcification in the shoulder joint is always accompanied by pain

Cause of osteoporosis

Calcium and phosphorus together form the mineral basis of the skeleton. In most cases, the cause of osteoporosis is a violation of calcium and phosphorus metabolism.

The most important link in providing the body with calcium is its sufficient absorption in the intestines, which is possible in the presence of at least three prerequisites: sufficient calcium in the diet; the body's supply of vitamin D, including its active metabolites; absence of diseases of the gastrointestinal tract with malabsorption. If there is a lack of calcium in the body, the latter is extracted from its own bone tissue. As a result, bone mass decreases and bones become brittle.

There are many factors for the development of osteoporosis. The division into primary and secondary osteoporosis is relative. Primary osteoporosis includes postmenopausal, senile (senile), and idiopathic osteoporosis. Secondary osteoporosis includes a decrease in bone mass as a result of genetic disorders, certain diseases of the endocrine system, rheumatism, circulatory system, kidneys, excessive alcohol intake, prolonged immobilization, taking medications, especially corticosteroids, immunosuppressants, as a result of mental disorders (anorexia nervosa) , as well as insufficient dietary intake or impaired absorption of certain nutrients in the intestine, primarily calcium and vitamin D.

The role of protein deficiency as an independent factor is debated. The most common causes of the development of osteoporosis are violations of the consumption of certain nutrients from foods, the postmenopausal period, senile syndrome, pathological metabolic disorders as a result of taking glucocorticosteroids, as well as excessive amounts of alcohol.

Recommended norms

Special studies have shown that women of all age groups consume significantly less calcium from food than recommended. Men of all ages consume more calcium than women, possibly due to their higher energy intake in general. Less than 15% of women under the age of 50 and less than 5% of women under the age of 70 consume foods with adequate calcium.

Low dietary calcium intake among adolescents is of particular concern because calcium deficiency coincides with a period of rapid skeletal growth. This is an opportune time to gain maximum peak bone mass and protect yourself from the future risk of osteoporosis. Approximately 90% of women's complete bone mineralization is achieved around age 17, 95% by age 20, and 99% by age 26. Consequently, the period for optimization of peak bone mass by calcium decreases rapidly after adolescence. It should be noted that current dietary recommendations for adequate calcium intake have been increased to 500 mg for children aged 1–3 years, 800 mg for children aged 4–8 years, 1300 mg for adolescents aged 9–18 years, 1000 mg for adults aged 18–60 years and 1200 mg for adults aged 60 years and older. Unfortunately, these dietary recommendations are not being followed.

Scientific evidence suggests that consuming adequate amounts of calcium or calcium-rich foods (milk and other dairy products) promotes peak bone mass before age 30 and earlier. This slows down age-related bone loss and reduces the risk of fractures later in life.

Individualization of diet therapy

The pathogenetic principle of individualization of diet therapy at the preparatory stage of treatment is as follows:

1. Finding out the possible causes of impaired calcium absorption in the small intestine:
   malabsorption syndrome due to enteropathy (enteritis, involutional atrophy of the intestinal mucosa, chronic renal failure, etc.);
2. food supply with vitamins D, C;
3. the presence of acidic bases in food (citric, ascorbic, oxalic and some other acids);
4. analysis of the consistency of hormonal regulation of calcium metabolism (hormones that regulate Ca metabolism in the body: parathyroid hormone, calcitonin, glucocorticosteroids, thyroid hormones, growth hormone, insulin, estrogens).
5. Study of possible causes of excess calcium requirements in metabolic processes:
   arterial hypertension;
6. increased excretion of Ca from the body (with urine, bile);
7. diseases accompanied by an increased need for calcium (for example, colon tumors, hyperparathyroidism).

We should not forget that the etiopathogenetic variants of the development of osteoporosis are different. Therefore, approaches to drug therapy will also be different. This can be either hormone replacement therapy or treatment of the underlying disease. Diet therapy as an independent method of treatment is generally not used, but is used as a reliable support for drug therapy and for prevention.

Areas of diet therapy for calcium metabolism disorders:

1. Water mineralization.
2. Using foods rich in calcium.
3. Activation of calcium absorption in the body.
4. Dietary stimulation of gastric secretion, enzymatic activity of the pancreas.
5. Restoration of disturbances in the absorption function of the small intestine.
6. Prescribing diets taking into account possible enzymopathies (for example, lactase deficiency).
7. Dietary correction of food intolerance.

More about calcium

In dietary therapy for osteoporosis, the main role is played by calcium and vitamin D, the use of which can weaken the process of osteoporosis progression, although there are many nutritional factors that affect bone development (proteins, vitamins and other minerals).

Information about dietary sources of calcium and factors affecting its bioavailability is important.

Food Sources of Calcium

The population receives more than half of the amount of calcium consumed from dairy products. Other sources include some green vegetables (broccoli, cabbage), nuts, calcium-precipitated bean curd, bone meal.

Calcium-fortified foods (juices and flours) may make a significant contribution to calcium intake in some people. In food products, calcium is contained mainly in the form of sparingly soluble salts (phosphates, carbonates, oxalates, etc.). The bioavailability of calcium from a number of non-dairy sources is insufficient. The list of foods high in calcium is presented in Table 1

Food Components that Increase the Bioavailability of Calcium

Lactose increases calcium absorption. Absorption also increases after the addition of lactase, which can be explained by the fact that the most metabolized milk sugar increases calcium absorption. These data were obtained for infants. It is unclear whether lactose improves the absorption of calcium from dairy products in adults? The higher prevalence of osteoporosis in people with lactose intolerance is likely due to low dairy intake rather than to the effect of lactose on calcium absorption.

Food components that reduce the bioavailability of calcium

Dietary fiber reduces calcium absorption. Replacing white flour (22 grams of dietary fiber per day) with whole wheat flour (53 grams of dietary fiber per day) in a regular diet causes a negative calcium balance even at higher calcium intakes.

Dietary fiber from fruits and vegetables has a similar effect on calcium absorption. Several fiber constituents bind calcium. Uronic acids bind calcium strongly in vitro. This is probably why hemicellulose inhibits calcium absorption. 80% of pectin uronic acids are methylated and cannot bind calcium. Therefore, pectin does not affect calcium absorption. In theory, a typical vegetarian diet contains enough uronic acids to bind 360 mg of calcium, but most of these acids are digested in the distal intestine, so some calcium is still absorbed. A balanced diet that contains moderate amounts of various fibers does not likely affect calcium absorption.

Table 1. Food sources of calcium

*Foods rich in oxalic acid, which slows down absorption.

Phytic acid is another plant component that binds calcium. The high phytin content of wheat bran explains its adverse effects on calcium absorption. Interestingly, adding calcium to wheat dough reduces phytin degradation by 50% during fermentation and baking. Wheat bran interferes with calcium absorption to such an extent that it has been used therapeutically for hypercalciuria.

Dark green, leafy vegetables often have relatively high calcium content. But the absorption of calcium from most vegetables is prevented by oxalic acid. Spinach, beet tops, and rhubarb are rich in it. Foods low in oxalic acid (cabbage, broccoli, turnips) are good sources of calcium. For example, calcium absorption from cabbage is almost as high as from milk.

Sodium increases urinary calcium excretion, so dietary salt intake should be reduced.

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Caffeine and other drugs. Caffeine, found in coffee, tea, chocolate, cola and many over-the-counter medications, increases the amount of calcium lost in urine and feces. However, reasonable coffee consumption is a minor risk factor for osteoporosis. Up to 2 cups of black coffee per day may result in small urinary calcium excretion (up to 110 mg). This amount is easily covered by milk, which can be used with coffee, or calcium supplements.

The nicotine in tobacco reduces the body's ability to use calcium. Additionally, women who smoke tend to have lower estrogen levels and lower bone mass. It has been suggested that in smokers, estrogens are broken down more quickly in the liver and, as a result, fail to stimulate the secretion of enough calcitonin to prevent bone destruction.

Excessive alcohol consumption is a risk factor for osteoporosis and osteoporotic bone fractures. The development of osteoporosis is associated both with general metabolic disorders (malnutrition, liver cirrhosis, gastropathy, endocrine disorders) and with the direct effect of alcohol on bone tissue (a decrease in the volume of trabecular bone mass). Alcohol has been shown to have a direct toxic effect on osteocytes. Excessive alcohol consumption can also cause bone loss by impairing the absorption of calcium and vitamin D. Moderate alcohol consumption does not have a negative effect on bones.

Interaction between the absorption of calcium and other nutrients

Squirrels. The protein content in the diet of patients with osteoporosis should be at a physiological level, since protein deficiency leads to a negative nitrogen balance and a decrease in reparative processes. It is recommended to include in the diet specialized food products consisting of proteins with high biological value and digestibility (dry protein composite mixtures [GOST R 53861-2010]).

With an adequate amount of protein in the diet, about 15% of calcium is absorbed, with a low protein content - about 5%. Excessive dietary protein (especially purified amino acids) increases urinary calcium loss and causes a negative calcium balance; surprisingly, it does not result in a compensatory increase in the efficiency of intestinal calcium absorption. A pure vegetarian diet fails due to insufficient amounts of calcium and other nutrients. Adding dairy products to a vegetarian diet improves bone health in postmenopausal women.

If you have excess fat, you need to increase the calcium content in your diet. In the presence of fat malabsorption (steatorrhea), calcium precipitates with fatty acids, forming insoluble soaps in the intestinal lumen. A lack of fat in the diet can lead to a deficiency of fat-soluble vitamins, including vitamin D, which is necessary for the absorption of calcium.

Long-term, continuous dietary intake of large amounts of phosphorus leads to hyperparathyroidism and secondary bone resorption.

Since both calcium and iron are commonly recommended for women, the interactions between these supplements are interesting. In one study, calcium carbonate and hydroxyapatite supplementation reduced iron absorption by approximately 50% in postmenopausal women. In another study, milk calcium inhibited iron absorption by 30%. When taken additionally with food, calcium inhibits the absorption of iron from its preparations (ferrous sulfate), dietary non-heme and heme iron. But if calcium carbonate was taken without food, even in high doses it did not inhibit the absorption of iron from ferrous sulfate. Thus, the use of dietary calcium supplements significantly affects iron absorption. Calcium likely affects intracellular iron transfer by the enterocyte.

Essential calcium salts

In terms of content and completeness of absorption, the best sources of calcium are milk and dairy products. 100 mg of calcium is contained in 85–90 g of milk and fermented milk drinks (kefir, yogurt, etc.), 70–80 g of cottage cheese, 10–15 g of hard cheese, 20–25 g of processed cheese, 110–115 g of sour cream or cream, 70–75 g milk or cream ice cream. Thus, if the daily diet includes 0.5 liters of milk and fermented milk drinks, 50 g of cottage cheese and 10 g of hard cheese, then this provides more than half of the recommended calcium intake, and in an easily digestible form.

The calcium content in the green mass of plants is significantly lower than the content in dairy products. Therefore, dairy products are the main ones. But the daily amount of calcium is difficult to cover with food alone. In this regard, calcium salts are used for medicinal purposes. The calcium content in its various salts is presented in Table 2. According to some data, it is best to add calcium carbonate to food in small doses, according to others, it is preferable to take it in the evening or at night. Persons with achlorhydria are prescribed calcium citrate, which is better absorbed when gastric secretory activity is low.

It has been shown that additional use of calcium supplements in the diet leads to a decrease in bone loss in older women. The greatest effect was observed in those who consumed little calcium in their diet.

Calcium supplementation to women early after the onset of menopause slightly reduced bone loss at the radius and femoral neck, but not at the spine. An analysis of prospective studies of postmenopausal women found that adequate vitamin D intake reduced the risk of hip fractures associated with osteoporosis, and milk consumption and a high calcium diet did not affect the incidence of hip fractures. The authors emphasize the need for supplemental vitamin D or increased consumption of fatty fish.

Table 2. Calcium content (Ca) in its various salts (Smolyansky B.L., Liflyandsky V.G., 2004)

You can't do without vitamin D

Vitamin D deficiency in the diet or disorders of its metabolism are of great importance in the pathogenesis of many forms of osteoporosis, but especially senile osteoporosis. Vitamin D is necessary for the absorption of calcium in the intestines, as well as for its absorption by cells, including bone cells.

In medical practice, active metabolites of vitamin D3 (calcitriol, alpha-calcidol) are more often used. It is these metabolites that are widely used in the treatment of osteoporosis.

The best sources of vitamin D in the diet are fatty fish, liver, fish roe, milk fats, and eggs. Vitamin D deficiency is easily prevented by eating these foods and/or taking small doses of vitamin D supplements.

Both in the treatment of osteoporosis and for preventive purposes, all women after menopause and people of both sexes after 65 years are prescribed calcium supplements in combination with vitamin D. These recommendations are especially important for people who consume little or no dairy products due to personal tastes, diseases (lactase deficiency, food allergies, etc.), strictly vegetarian diet. These drugs are often considered as dietary supplements - nutraceuticals.

Table 3. Sample menu rich in calcium content (Bergman D., 1999)

Other vitamins for osteoporosis

In recent years, soy products have been widely used in the treatment and prevention of osteoporosis. It is known that soy proteins contain isoflavones, which have estrogen-like effects. A number of studies have shown that the inclusion of soy products in postmenopausal women leads to a reduction in the incidence of bone fractures.

Experiments on animals revealed a negative effect on bone tissue from a deficiency of a number of vitamins (C, group B) and microelements (phosphorus, magnesium, zinc, copper, manganese, boron, silicon, strontium, fluorine). But a direct connection between the development of osteoporosis and a deficiency of these elements has not been found.

It has been established that vitamin K affects osteocalcin, which, being a modulator of osteoblasts, is involved in protein synthesis in bones. Low vitamin K intake is associated with low bone mineral density and an increased risk of hip fractures in women, but not in men. Therefore, taking vitamin K for osteoporosis may be important in cases of severe deficiency in the diet.

Prevent disease

Prevention of the development of osteoporosis should be carried out before the full bone mass is formed, and treatment - from the moment bone loss begins to be detected.

Early prevention should be carried out by adequate calcium supplementation, exercise and prevention of risk factors (smoking, excessive alcohol consumption, etc.). This is especially important in adolescence, when the bone gains mass. Individuals who have developed osteoporosis usually must rely on pharmacological interventions to maintain or improve bone health. Treatment of osteoporosis currently includes taking calcium supplements with vitamin D, estrogen, and calcitonin. Treatment in any case is carried out against the background of diet therapy.

Thus, all patients with osteoporosis who are not burdened with diseases requiring special dietary therapy should receive a rational, balanced diet with a physiological protein content in the diet, but with an increased content of calcium and vitamin D, including through special nutritional supplements and medications .

D. Bergman (1999) proposed a version of such a diet that supplies more than 1000 mg of calcium per day, and also meets the needs for other important minerals (Table 3).

Table 4 provides information on the effect of certain medications on calcium metabolism in the body.

Or gout?

With gout, salts are deposited in the joint tissues. This occurs due to a violation of the metabolism of uric acid salts - urates, the concentration of which in the blood increases sharply. Microcrystals of urate settle in the joint capsule and sooner or later lead to inflammation.

Gout happens:

• primary - caused by a genetically incorrect structure of enzymes that are responsible for the exchange of uric acid and urate in the body;
• secondary – develops against the background of psoriasis, chronic renal failure, myeloid leukemia, congenital heart disease or other disease.

Gout manifests itself in acute attacks that occur mainly at night. The metatarsophalangeal joint of the big toe is most often affected. The skin turns red, blue, and the local temperature rises to 39 °C. The inflammation subsides after a few days, but symptoms recur periodically. If the disease is mild, the person experiences minor pain and there is noticeable redness at the joint. In addition to the big toe, gout also occurs in other joints - wrist, elbow, hand.

If the disease is not treated, polyarthritis may develop against its background, and tophi - yellow nodules containing urates - will appear at the site of the lesion. Such formations, which are often confused with “salt deposits,” occur in the area of ​​the elbows, fingers, nasal septum and on the ears.

Gout loves people who lead sedentary lifestyles

Traditional methods of treatment

With these methods, although they are time-tested, you should be careful - not always what helped one person will easily help another. It is best to also consult with your doctor regarding the possibility of using these techniques.

1. You can make a miraculous ointment from oil and ginger root. To do this, ginger powder is fried in oil, cooled, and then mixed with a small amount of garlic. The ointment is applied to the neck area about 3 times a day, and the treated surface is tied with a scarf to retain heat.

   
   Ginger root

2. You can make a tincture from radish, vodka and honey. 200 g of radish is mixed with 130 g of honey and 2 glasses of vodka, then after mixing, 4 tsp is added to the mixture. salt and the future tincture is mixed again. Then you need to put it in a cool place and let it stand for about 3-4 days. After this, the tincture is ready for use - rub the neck area with it about 3-4 times a day.

Radish will help get rid of pain

It is worth remembering that these recipes will only eliminate pain, but will not have an effect on salt deposits. Therefore, it is important, in addition, to review your diet and include at least daily walks in your life.

Arthrosis and salt deposition

Very often, people who need treatment for arthrosis or osteoarthritis are convinced that they have a banal salt deposit, especially when it comes to the joints of the first toes. In fact, arthrosis, like the age-related changes in the joints characteristic of it, has nothing to do with this pathology. Joint enlargement is only the growth of subchondral bone.

Cartilage performs two functions - gliding and shock absorption. If it is regularly subjected to impact, the bone in this area thickens. Since mechanical impact is exerted on the joint while walking, certain parts of it are injured. This promotes the growth of cartilage tissue - the formation of spines. The cartilage is no longer able to perform a shock-absorbing function, stops sliding and gradually wears out.

The situation can be corrected through intra-articular injections of a synovial fluid substitute, for example Noltrex. The product evenly fills the joint capsule and pushes the worn cartilaginous surfaces apart. The friction stops and the joint functions are restored.

Arthrosis and salt deposition have nothing in common

Is table salt good for the body or should it be excluded from the diet forever? Opinion of authoritative osteopathic doctor Alexander Evdokimov:

Literature

1. VC. Bauman, “Biochemistry and physiology of vitamin D” Riga, Zinatye, 1989, 480 p.
2. Fleisch, Bisphosphonates in bone disease, 1997, London, 184p.
3. Feldman, D., and Mallon, P. J. and Gross, C. (1996). Vitamin D: metabolism and action.In Marcus, R., Feldman, D. and Kelsey, J. (eds) Osteoporosis, pp.205-35. (San Diego: Academic Press).
4. Bushinsky, D. A. and Krieger, N. S. (1992). Integration of calcium metabolism in the adult. In Coe, FL and Favus, MJ (eds.) Disorders of Bone and Mineral Metabolism, pp.417-32. (New York: Raven Press).
5. O.G.Arkhipova, E.A. Yuryeva, N.M. Dyatlova, “Prospects for the use of xydiphone”, J. Vses. chem. total them. DI. Mendeleeva, 1984, XXIX, 3, pp. 76-80.
6. T.A. Matkovskaya, N.P. Tatarnikova, etc. Pat. RF RU 2124881 C1.
7. E.A. Yuryeva, I.P. Dunaeva, G.I. Kulakova “The effectiveness of xydiphone depending on the method of its use”, In: New chelating agent xydiphone. Pharmacology, toxicology and therapy. Moscow, 1990, pp. 62-70.

(The article is abbreviated. The full text was published in the journal: Cosmetics and Medicine, 1999, No. 5/6, p. 71.)

How to properly treat salt deposits

No competent doctor will undertake to treat “salt deposits” until a diagnosis is established. In any case, you will need to follow a special diet to prevent relapses and speed up the removal of salts from the body. Instead of spicy, fatty, fried foods, patients are shown vegetable and dairy foods. You can rid your body of salt using parsley, dill, melon, watermelon, plums and persimmons.

Drug treatment for salt deposits includes:

• non-steroidal anti-inflammatory drugs - ointments or tablets;
• hormonal drugs;
• uricosuric medications to lower uric acid levels.

Whatever the cause of the joint pathology - calcification, gout or arthrosis - safe physical activity, such as swimming, will not be superfluous. Sports, like a massage course, will speed up the blood supply to tissues, and with it the removal of salts from the body.

Silence is not always golden?

For a long time, the stone may not show itself in any way. But this is not dangerous only in those rare cases when stones can be considered “clinically insignificant” - they are not only “silent”, but also do not impair kidney function for many years. However, everything is for the time being, so such patients need to periodically visit a urologist.

A kidney stone makes itself felt with an attack of renal colic. When it happens depends not at all on its size, as many people think, but on where exactly the stone settled, whether it blocked the outflow of urine and other factors.