Joint disease occurs with bouts of pain, joint deformation. Gouty arthritis (PA) can be treated with several groups of medications. A prerequisite for recovery is a low purine diet.
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Causes of Gout Arthritis
Metabolic changes in nitrogenous substances, namely purines, lead to the formation of uric acid and its salts (urates). Metabolic disorders may be accompanied by hyperuricemia, when the metabolites are not excreted in the urine enough and are retained in the tissues.
Contribute to the development of PA:
- genetic predisposition to metabolic disorders;
- animal products with an excess of purines;
- beer alcoholism;
- kidney pathology;
- high blood pressure.
Researchers suggest that female hormones protect against excess urate. The early onset of PA in men (after 35–40 years) is a consequence of an increased concentration of uric acid, even normal. Purine metabolism products turn into microcrystals, are deposited and cause inflammation.
Forms of the development of the disease
Disturbances in purine metabolism and hyperuricemia are not immediately manifested by bouts of pain. PA can last for a long time in a patient without symptoms. The absence of pain pushes the start of treatment, although metabolic disorders are already occurring in the body. Doctors call this form "asymptomatic gout."
There are two main forms of the development of the disease - primary and secondary.Primary PA develops against the background of a hereditary predisposition, a congenital metabolic defect. Secondary - due to diseases of the kidneys, blood, taking medications.
The joint of the big toe usually begins to hurt first. After the initial attack of PA, months pass before the next attack. The intensity of the pain attack depends on many conditions, especially on the sensitivity of the surrounding tissues to the accumulation of urates.
There are stages of PA:
- asymptomatic hyperuricemia;
- acute phase;
- recurrent;
- chronic with many nodules (tofus).
The toes and hands are most susceptible to the disease. With polyarthritis in women during menopause, joints of the hands are affected. Multiple tofuses are formed, other joints are involved in the inflammatory process.
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Symptoms and signs of the disease
They provoke the onset of a gouty attack of trauma, alcohol abuse, exacerbation of concomitant infectious or inflammatory diseases. Usually an attack begins in the early morning or night. If you do not take medicine, then the attack lasts from 2 to 7 days.
Symptoms of gouty arthritis:
- a sudden attack of acute pain, most often in the area of the first toe;
- increase in pain intensity;
- redness of the skin and swelling of the joint;
- spontaneous recovery.
Between attacks of acute gouty arthritis, the state of health is normal, there are no symptoms.
If PA is not treated, then attacks become more frequent, occur after physical exertion, stress, and then take a protracted course. In a recurring course, a second attack develops several months after the first episode. Without treatment, asymptomatic periods are reduced. Under the skin, tendons of urate crystals accumulate in the tendons, forming gouty nodes.
In chronic PA, the pain in the tofus area becomes constant. Sometimes fistulas appear above the nodes, a white mushy mass stands out. The chronic form of the disease is combined with the deposition of urate in the kidneys. Early diagnosis and adequate treatment will help to avoid relapse and chronic inflammation.
Diagnostic measures
The clinical picture of the acute form of PA is well known to rheumatologists - doctors who treat joint diseases. However, diagnostic errors are not excluded when patients with initial signs are treated. Experts take into account a characteristic feature - paroxysmal pain in the joint of the thumb of the foot. Different countries have developed diagnostic criteria, but none of the systems claims universality.
A patient is prescribed a biochemical blood test to determine the level of uric acid. Joint radiography may be required. Using a polarizing microscope allows you to detect crystals in tofuses.
The following symptoms are important for proper diagnosis:
- the presence of hyperuricemia;
- how many joints are affected;
- whether there is redness or swelling;
- how many attacks have occurred over the past year;
- the presence and number of gouty nodules;
- how cartilage and bones are changed.
With a mild course of the disease, gouty attacks occur no more than twice in 12 months. 1-2 joints become inflamed, but there are no tofuses, or single nodules form. Moderate PA is characterized by inflammation of 2–4 joints, a repetition of the attack 3–5 times a year. Tofuses are multiple, but small in size, the joints are moderately deformed. The severe course of the disease is characterized by seizures after a month, multiple lesions of the joints and large nodes.
How to cure gouty arthritis
It is necessary to stop pain attacks, prevent relapses and complications, and reduce hyperuricemia. Non-drug treatment of gouty arthritis includes the fight against overweight, refusal to drink alcohol, a low-calorie diet with the exception or low content of purine substances.Use drugs that reduce the intensity of inflammation in the affected joint, normalize the concentration of urate.
Drug therapy
To stop pain in PA, the doctor prescribes nonsteroidal anti-inflammatory drugs with a short course. From the NSAID group, the preferred drugs with the active substances are nimesulide, diclofenac, naproxen, ketoprofen, indomethacin and ketorolac. For treatment, the antigout colchicine, hormonal glucocorticoids (GCS) are used.
Trade names for oral and topical preparations:
- NSAIDs: Nise, Nimesil, Nimulide, Voltaren, Naklofen Duo, Metindol, Ketonal, Nalgesin Forte, Ketorol.
- Colchicum Dispersion.
- Allopurinol Aegis.
- GCS: Prednisolone, Kenalog.
- Combined funds: Ambene, Neurodiclovit.
- External ointments and gels: Dolobene, Diclofenac, Nimulide, Dolgit.
Colchicine quickly eliminates a pain attack that develops as the main symptom of a gouty attack. The drug can cause nausea, diarrhea, and vomiting. NSAIDs help relieve inflammation, pain in relapsing and chronic forms of the disease. Without medication, the attack is more painful and lasts longer.
Clinical trials have proven the benefits of nimesulide and ketoprofen over diclofenac: they are better tolerated, cause pain relief faster.
The most important anti-gout remedy, allopurinol, is used between attacks to normalize uric acid levels. Treatment helps to reduce the size and soften the tofus. Side effects of allopurinol are manifested in the form of violations of the digestive tract, allergic reactions.
Folk remedies
They help get rid of inflammation and relieve pain in gout applications with blue or red clay, salt compresses. Apply baths with chamomile broth. Water with flowers is heated on low heat for 10 minutes. Add 250 ml of strong broth in 2 l of warm water.
Folk remedies treat pain - constant companions of PA. Use alcohol and tinctures for compresses. Make baths with a solution of 2 tbsp. l sea salt in 3 liters of warm water. The duration of the procedure is from 10 to 15 minutes. Apply salt baths daily for two weeks.
Traditional medicine prescriptions can reduce the use of medications. However, even simple remedies have contraindications. It is necessary to consult a doctor.
Gout Arthritis Diet
Proper nutrition helps to cure metabolic and joint diseases. Foods containing a large number of purines should be removed from the daily menu. The most dangerous for PA are red varieties of meat, offal, several types of fish (mackerel, sardines). The broth is excluded from the diet, as purines are released into the water when boiling foods.
It is necessary to reduce the consumption of beef, poultry, sausages; cod, pike perch, sprat; porcini mushrooms, champignons; legumes; oatmeal; cauliflower, sorrel, asparagus, spinach, coffee. Beer, red wine, cognac provoke exacerbations of PA. Vodka is less harmful in small doses.
Boiled chicken, rabbit, turkey and fish can be included in the menu 2 or 3 times a week. The diet for gouty arthritis does not require restrictions on the use of wheat and rye bread, pasta, fruits, nuts and vegetables (except for the prohibited foods listed).
Healthy drinks:
- alkaline mineral water;
- currant, cranberry fruit drinks;
- tea with linden and mint;
- juices from berries and fruits.
Nutritionists believe that milk, sour-milk products are useful for patients with PA. A variety of vegetarian soups are prepared on a vegetable broth, mashed potatoes, cereal cereals. Eggs can be eaten in any form, 1-2 pcs. in a day.
Possible implications and forecasts
The danger of PA is damage to the joints, complicating the work of the kidneys and other organs.Various negative effects can be accompanied by drug therapy, especially the use of colchicine, NSAIDs, allopurinol. With prolonged treatment, ulcerative lesions of the gastrointestinal tract, atherosclerotic changes in blood vessels, nephrosclerosis, and renal failure may occur.
Preventive measures
Drug therapy, diet, weight normalization, folk remedies - the general principles of treatment of the disease. In order to prevent the chronic course of gouty arthritis, it is necessary to adhere to a low purine diet (table No. 6).
Excess weight is one of the leading risk factors for metabolic disorders and the development of secondary PA. It is better to lose weight by reducing the total calorie content of food. Additional preventive and therapeutic measures - taking vitamin C, feasible physical activity.
