Gout is a disease that is associated with impaired purine metabolism. It is characterized by an increase in the concentration of uric acid in the blood (hyperuricemia) and the deposition of urate in articular or periarticular tissues, kidneys and other organs. To identify gouty tophi, rheumatologists at the Yusupov Hospital use modern methods of instrumental and laboratory diagnostics.
During their stay at the therapy clinic, patients are kept in rooms with a European level of comfort. Rheumatologists draw up an individual treatment regimen for each gout patient. Doctors use the most effective medications registered in the Russian Federation, which allow for the reverse development of gouty tophi and have minimal side effects. The medical staff is attentive to the wishes of each patient.
Histologically, tophi in gout is a chalky nodule that consists of crystals of monosodium urate, proteins and mucopolysaccharides. Gouty tophi are formed during the “natural” course of gout and the absence of adequate urate-lowering therapy 7–10 years from the onset of the disease. Their frequency reaches 34% and increases in parallel with the duration of the disease. Sometimes gouty tophi can be the first clinical manifestation of gout, preceding typical attacks of arthritis
Some information about gout
Gout is a disease caused by elevated levels of uric acid (hyperuricemia) in the body. It can be either genetically determined or appear as a result of taking certain medications, poor lifestyle, or against the background of other chronic diseases.
The classic symptom of gout is damage to the joint at the base of the big toe.
Important! Since the tendency to develop gout can be inherited, close relatives of the patient should regularly check the level of uric acid in the blood (every 3-4 years). Then the onset of the disease can be prevented at a stage when symptoms have not yet appeared.
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Prevention
To prevent the chronic course of gout from leading to the development of complications, you should:
- lead a healthy lifestyle,
- prevent obesity
- follow a diet and drinking regime,
- give up alcoholic drinks, especially beer,
- undergo a relaxing massage course annually,
- take courses of uricosuric or uricodepressive drugs,
- Visit your doctor regularly.
Despite the fact that gout cannot be cured, these recommendations can reduce the risk of relapses and, accordingly, avoid the appearance of tophi.
What are tophi?
Gout can last for years without any symptoms and worsen in case of injury, increased stress, excessive consumption of alcohol or meat products. After 4-5 years from the onset of the disease, excess uric acid in the form of crystals begins to be deposited in the tissues. Clusters of such crystals are called gouty tophi (tophus is the general name for an area of skin thickening).
The auricle is one of the favorite places for the formation of gouty nodules
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Answers on questions
Is it possible to use devices for home treatment of gout?
To combat the disease, you can use portable devices ALMAG, Vitafon, Milta.
How can you remove tophi on the ear if it is still small in size?
When the size of the gouty nodule is from 2 to 5 mm, drug treatment in combination with laser and magnetic therapy is effective.
Can gouty nodules be treated with iodine?
Traditional medicine offers a recipe for reducing cones with the help of iodine. To do this, grind 5 aspirin tablets and mix with 10 ml of iodine tincture. The resulting mixture is applied to the affected areas.
Why do nodules appear?
As the body processes meat, mushrooms, alcohol and other foods, uric acid is formed. Normally, it is excreted by the kidneys. However, if the body does not have enough enzymes to remove it (inherited genetically), or too many purines come from food, or kidney function is impaired, then uric acid salts - urates - begin to circulate in the blood in large quantities. When the concentration of urate in the blood is elevated for a long time, nodules form.
The process of deposition of uric acid crystals in a joint
Recovery period and rehabilitation
Therapeutic massage in the postoperative period is very useful
The time allotted for rehabilitation depends on the extent of the surgical intervention. If the operation was performed only on the metatarsus, the patient will have to wear a splint for a month. For a more serious amount of work, the joints can be fixed for up to 2.5 months.
During the postoperative period, the patient should avoid any stress on the injured limb. It is necessary to limit movement if possible using crutches. The patient will have to follow the following recommendations for several months:
- Wear orthopedic shoes that reduce the load on the 1st toe.
- Take medications prescribed by your doctor, lubricate the affected area with special compounds.
- Carry out finger exercises, which will restore the motor functions of the foot. Massage therapy is also recommended.
The described actions will allow the patient not only to restore the body, but will also help ensure that gout does not reappear after surgery.
How to distinguish a gouty nodule from other formations?
Diagnosis of tophi is not difficult if the diagnosis of gout has already been established. If not, then you need to:
- Blood test to determine uric acid levels.
- Urine analysis to determine the degree of urate excretion.
- Examination of the contents of the nodule for the presence of sodium urate crystals.
- X-ray of the affected joint for bone tophi and the degree of bone damage.
It is important to examine the formation itself, since gout nodes have their own characteristics:
- clear outline;
- they are much denser than the surrounding tissues;
- yellow tint of formation;
- peeling of the skin over the nodule;
- arrangement alone or in groups.
Gouty nodules seen closely
Important! Tophi in gout develop 4-5 years after the onset of the disease, but if you do not follow the doctor’s recommendations, the first nodes may appear much earlier - after 2-3 years. In addition, the disease will be more severe.
Inflammation of periarticular tissues
Gout attacks are often accompanied by such a pronounced inflammatory process that the ligamentous-tendon apparatus is involved. When the synovial bursa (bursa) is damaged, bursitis develops. It is characterized by the accumulation of pathological exudate inside. The joint swells, range of motion decreases, and the pain intensifies. When the tendons become inflamed, tendonitis is diagnosed, and tendon sheaths are diagnosed as tendovaginitis. But most often, synovitis occurs - inflammatory processes in the synovial membrane with the accumulation of fluid (effusion) in the joint cavity.
Treatment
Successful treatment of gout requires a comprehensive approach. In addition to medications, physiotherapy, surgical removal, great attention must be paid to lifestyle changes and diet. Traditional methods will be of considerable help in treatment.
Lifestyle
The basic rule in therapeutic nutrition for hyperuricemia is to reduce the amount of foods rich in purines: meat, poultry, fish (no more than 300 g per week). It is necessary to minimize the amount of legumes, coffee and tea, cocoa and chocolate, spinach, sorrel, organ meats, and alcohol in the diet. Salt is limited to 7 g per day.
The consumption of vegetables and fruits, dairy products, alkaline mineral waters, juices (especially citrus fruits), and various cereals is increasing.
Small meals, 6-8 times a day. The most preferred methods for processing foods are boiling, baking, and steaming. Fasting is strictly prohibited. More detailed recommendations are given in table form.
Previously, we wrote about the treatment of gout on the leg and recommended bookmarking the article.
What you can and cannot eat if you have gout
Medicines
Treatment with drugs is carried out strictly under the supervision of a doctor. Medicines are selected individually, taking into account the cause and level of increase in uric acid. Reducing the amount of urate in the blood prevents the formation of nodules and helps remove tophi in case of gout.
The most effective remedy for combating existing nodules is allopurinol. The active ingredient of this drug prevents the formation of uric acid. It is used during the interictal period, long-term (sometimes for life). It is well tolerated by most patients and can be used in patients with impaired renal function. If the dosage is correctly selected and taken continuously, the urate level drops, articular manifestations go away, and the nodules either significantly decrease or disappear altogether.
Drugs that enhance the excretion of urates, such as butadione and ketazone, are used slightly less frequently. They have less effect on the resorption of existing gouty nodules and cannot be used in the presence of impaired renal function.
Allopurinol is the best way to combat tophi
Important! You cannot prescribe medications on your own or on the advice of friends and relatives. If a medicine helps one person, it will not necessarily help another. But it is very easy to aggravate the condition with improper treatment.
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Folk remedies
Treatment of tophi for gout with folk remedies has long found a wide response among patients. The use of recipes is aimed both at reducing the level of uric acid (infusions, decoctions) and at relieving symptoms, primarily pain (rubbings, compresses, pastes, ointments). Here are some folk remedies for gout.
- 2 tablespoons of burdock root (dry) are poured with 3 glasses of warm water. After 3-4 hours, the mixture is boiled for 15 minutes and consumed half a glass after meals three times a day.
- 10 g of birch buds are poured into 2 glasses of water. Next, the mixture is boiled for 10-15 minutes and infused for an hour. Take 4 times a day, a quarter glass, an hour after meals.
- Freshly squeezed apple juice is a very effective remedy. It should be taken on an empty stomach, 1 glass half an hour before meals.
- Mix 1 cup of mashed birch buds with half a kilogram of fresh lard (fat rendered from lard). The mixture is simmered in the oven or in a water bath for 3 hours every day. After 7 days the ointment is ready. You should rub it on your joints morning and evening.
- Blue clay is diluted with warm water to a dough-like consistency and applied to the joint overnight. 7-8 such procedures are carried out.
- Infuse 1 tablespoon of elecampane roots in a glass of boiling water. Then the infusion is added to the bath. You should steam your feet in such a bath in the evenings for 12 days, then put on warm socks.
An example of a compress for gout
Important! If you experience a rash, redness, or other allergic reactions to the drug or folk remedy, you should immediately stop using it and consult a doctor to select an alternative treatment.
Massage
Self-massage is used as a means of self-help in the period between exacerbations. The process begins with stroking and light rubbing. First of all, the areas surrounding the nodule are warmed up, then a smooth transition is made to the tophi itself. You should massage the affected joint especially carefully if there is pain. You can also apply anti-inflammatory and analgesic creams, gels, and ointments with light massaging movements.
The affected joint is gently massaged from the periphery to the center
Physiotherapy
Physiotherapy is prescribed to the patient by a doctor depending on the individual characteristics, stage of the disease, as well as the goals pursued in this treatment. For example, in the acute period, magnetic therapy and ultraviolet irradiation are used to relieve pain and reduce the area of inflammation.
Outside of an attack, you can use electrophoresis with lithium and zinc - they stimulate the restoration of cartilage tissue, local barotherapy (exposure to high or low pressure) - it increases blood flow in the joint and improves metabolic processes.
Physiotherapeutic methods are actively used in the treatment of gout
Surgery
Surgical removal of tophi for gout is used when the nodes impede movement or contribute to joint deformation. The site of the lesion is numbed, and the surgeon removes the formation through an incision. The operation is performed in an outpatient setting.
Before removing the nodule, local anesthesia is performed
Tophi are an indicator of the duration and severity of the disease. It is difficult to deal with them, so you should contact a specialist as soon as possible and receive appropriate treatment recommendations. In addition to taking medications, the best thing a patient can do to help himself is to follow a diet, gradually lose weight, and moderate exercise. If you follow all the instructions, then new tophi will not appear, and old ones will stop growing or disappear altogether. So let's take care of our health!
← Medicines and diets for the treatment of gout during an exacerbation
Treatment of gout on the joint of the big toe →
Types of operations
At the moment, there are several types of surgical intervention:
- Using a laser.
- Resection of exostosis.
- Operation McBride.
Each of the listed methods should be considered in more detail.
Laser removal
Whether surgery is necessary or not is up to the doctor to decide
This procedure can be performed at any time during the development of the disease. Laser therapy is absolutely safe and can therefore be performed on patients of all ages. The technique appeared relatively recently, but is currently widely practiced by specialists from leading clinics around the world.
Laser removal of tophi is performed under local anesthesia. The operation takes little time and does not require plaster. The patient spends minimal time in the hospital.
This method has a number of advantages over traditional bone cutting:
- The incision after the laser is small, resulting in minimal scarring on the patient’s skin. During the operation, virtually no tissue is damaged.
- The patient loses almost no blood during the procedure.
- Since the laser beam has a high temperature, an ideal level of sterility is ensured in the intervention area, which significantly reduces the likelihood of complications, accelerating recovery processes.
Resection of exostosis
This operation may either involve hospitalization of the patient or be carried out without hospitalization. Before the procedure, the patient’s foot is thoroughly lubricated with an iodine solution, after which novocaine is injected into the bone.
The procedure for removing the growth involves cutting the tissue by 5 cm, after which the tophi is simply knocked down using a small chisel. Next, the damaged surface is polished and the incision is sutured. This operation involves reliable fixation of the affected fingers, so the patient wears a splint for some time.
Operation McBride
This procedure involves the use of a local anesthetic. When it is entered, the specialist performs the following actions:
- The incision is made closer to the sole.
- The muscle attached to the affected phalanx is separated from the bone. Next, it needs to be shortened, thereby cutting off the affected tissue.
- If necessary, the doctor may shorten other muscles. As a result of this procedure, a natural tension is formed, which helps straighten the affected joint.
- After the incision is stitched, the patient should wear a cast for three weeks.
Operation price
If surgical intervention is carried out on the direction of a traumatologist or orthopedist, then it can be performed free of charge, according to the compulsory medical insurance quota. However, in this case, the wait in line for treatment can last for several months.
When visiting a medical facility in person, the price of the operation will depend on its type:
- An operation to remove gout on the legs in the capital will cost 20 thousand (in some regions the price of the procedure can be half that);
- If we are talking about laser therapy, then its cost in Moscow is 25-30 thousand rubles.
Causes
Genetics is sometimes a prerequisite for metabolic disorders. In this case, the child is diagnosed with uric acid diathesis, which transforms into gout with age. If there were no diseases in childhood, but the disease still developed, you need to look for the reasons in something else.
- Eating fatty foods of animal origin (fatty meat and fish). An excess of purine appears in the body - a complex of chemical compounds that promote the synthesis of urates.
- Alcohol abuse . Water metabolism is disrupted, and uric acid compounds “get stuck” in the body.
- Kidney problems . If they do not work well, urea is not completely removed from the body.
- Hormonal imbalance . Gout sometimes occurs in pregnant women. For some this is a temporary process, for others it develops into a chronic disease.
Gout is a multifactorial disease. Those. to those that develop against the background of a combination of several unfavorable factors. Doctors also note indirect causes that may increase the risk of gout. This is a sedentary lifestyle, insufficient water intake (namely water, and not other liquids), excess weight.
By the way, men suffer from gout more often than women. And there is an explanation for this.
- Greater muscle mass.
- Hormonal factor.
- Dietary features (men eat more protein foods).
- Lifestyle (women choose active sports, and men choose strength sports).