Gout: signs, symptoms and treatment in men and women

More than once at an appointment I came across a situation where a patient without any obvious cardiovascular pathology prescribed cardiomagnyl (or thromboASS, cardio aspirin, etc.), being sure that absolutely everyone at his age (that is, “after 45 -50 years"), this is exactly the kind of prevention of cardiovascular diseases that is needed. After all, the neighbor also drinks, they say on TV that it’s necessary, and so on...

Is it really necessary?

The fact is that modern recommendations for the treatment of cardiovascular diseases (CVD) speak of the need for lifelong use of aspirin by those people who have already suffered any cardiovascular events. These include heart attack, stroke, transient ischemic attacks. As for the use of aspirin by people who do not have a history of any cardiovascular diseases, including those listed above, today the routine administration of aspirin (or other antithrombotic drugs) to such patients is not recommended due to the lack of evidence supporting First of all, the safety of such prophylaxis in this category of patients.

The most common side effect when taking aspirin is a negative effect on the gastric mucosa. Also, with its long-term use, the risk of bleeding of various localizations (gastrointestinal, hemorrhoidal, nasal, etc.) increases, and this fact cannot be neglected, because in certain situations such bleeding can become life-threatening.

In this regard, before prescribing aspirin to a patient, the doctor must assess the benefits and risks of taking it. In patients who have had a heart attack or stroke, the benefits of prophylactic aspirin have been shown to outweigh the possible risk of bleeding and are therefore recommended. And the role of aspirin in people who have no history of either one has not been fully studied. The scientific data that we have today indicate that there is no clear benefit from such prevention and, at the same time, an increased risk of bleeding of various locations. However, the issue remains poorly understood; large studies are ongoing, and we are waiting for their results.

As for patients of older age groups who have any risk factors for the development of cardiovascular diseases (arterial hypertension, high blood cholesterol, etc.), patients with diabetes mellitus, the situation is approximately the same: it has not yet been revealed that The benefit of taking aspirin outweighs the risk of bleeding in such patients, and therefore its use cannot be recommended routinely.

Gout

The manifestation of signs of gout and treatment of the disease depends on the intensity of the development of the pathology. Diagnostic measures begin with collecting anamnesis. The doctor determines the presence of chronic diseases, genetic predisposition, provoking factors, lifestyle and eating habits. The signs and treatment of gout are similar in men and women. Laboratory and instrumental studies consist of:

blood tests (general and biochemical);
general urinalysis;
studies of synovial fluid;
uric acid level tests;
determination of serum urate levels;
bacteriology of synovial fluid;
joint puncture (as prescribed by a doctor);
MRI of joints;
Ultrasound of joints;
MRI of the kidneys;
Ultrasound of the kidneys.

Purpose of treatment

For the disease gout, treatment is prescribed depending on the test results obtained. Therapy is prescribed by a rheumatologist. Gout cannot be completely cured. With the help of supportive therapy and compliance with medical recommendations, nutritional control, painful attacks, their intensity and regularity of occurrence can be stopped. For gout, clinical recommendations include the use of pharmacological and non-pharmacological techniques. The main task is to stabilize the level of uric acid in the blood and reduce the amount of crystalline deposits. Treatment of gout can be roughly divided into three stages:

relief of an acute attack and reduction of pain;
prevention of disease development;
prevention of pathology.

Medicine for gout is prescribed by a rheumatologist depending on the severity of the attack, the number of affected joints, and the presence of renal failure. In drug therapy, the following are used in various combinations and concentrations: colchicine, prednisolone, NSAIDs, intra-articular corticosteroids, xanthine oxidase inhibitors, etc. Treatment of gout on the legs in men and women largely depends on adherence to a special diet.

Treating gout at home involves following medical recommendations: taking medications as prescribed and following a diet on an ongoing basis.

Specifics of diet composition

Special control requires nutrition for gout in order to reduce the level of uric acid in the blood to an acceptable level. The rheumatologist conducts a detailed consultation with each patient, because the result of therapy depends on self-control. It is recommended to adhere to dietary nutrition - table No. 6 and No. 8.

Prohibited foods for gout:

fatty varieties of fish, meat, offal;
alcohol in any form and quantity;
canned food, lard, meat broths;
legumes (beans, soybeans and peas) and mushrooms;
chocolate, cocoa, strong tea, coffee;
sorrel, spinach, eggplant, radish, lettuce;
smoked meats and sausages;
raspberries and pastries with rich creams.

When else should you not take aspirin?

- With high blood pressure.

Because taking it may increase the risk of hemorrhagic stroke in this case. If you have hypertension, you should take aspirin only when your blood pressure is adequately controlled.

- If you suspect a stroke.

If we are dealing with a suspected stroke (a person suddenly developed severe weakness in an arm or leg, speech, motor disturbances, the corner of the mouth is drooping, he cannot smile, etc.), in no case should aspirin be given in this situation. There are no objective signs that allow one to clearly differentiate between hemorrhagic (associated with cerebral hemorrhage) and ischemic (associated with blockage of a cerebral artery by an atherosclerotic plaque) type of stroke. And if the stroke is hemorrhagic, and we give such a person aspirin, then it’s scary to imagine how it could end...

All you need to do if you suspect a person is having a stroke is to lay him in a horizontal position, try to calm him down and call an ambulance as soon as possible.

TREATMENT AND PREVENTION OF GOUT: DRUGS OF CHOICE (Part 2)

Preferanskaya Nina Germanovna

Associate Professor, Department of Pharmacology, Faculty of Pharmacy, First Moscow State Medical University named after. THEM. Sechenova, Ph.D.

To increase the effectiveness of treatment and reduce the manifestations of pathology, the patient should be warned that taking anti-inflammatory drugs (
Diclofenac, Indomethacin, Ibuprofen, Ketoprofen, Naproxen, Meloxicam, Celecoxib, Nimesulide, etc. ) should be started at the first sensation of pain.
NON-STEROID drugs

Diclofenac sodium

(
Voltaren
,
Ortofen
) - NSAID, a derivative of phenylacetic acid, has a strong analgesic and anti-inflammatory effect. Indiscriminately inhibits COX-1 and COX-2, disrupts the metabolism of arachidonic acid, and reduces the amount of Pg at the site of inflammation. The anti-inflammatory effect develops after 7–14 days. 50% undergoes presystemic elimination. The half-life is very short, T½ = 1.5–2 hours, so 100 mg extended-release, film-coated retard tablets have been created that provide a high concentration over a long period of time. In acute conditions, to relieve exacerbation, the drug is administered intravenously (once), then 25–50 mg 4 times a day. For inflammatory processes of non-infectious etiology, it is recommended to use 5% gel or 1.2% ointment for external use, which reduces swelling and pain. Apply 2–4 g of ointment or gel to the area of inflamed joints 2–3 times a day.

Indications for use are osteoarthritis; rheumatoid arthritis, articular syndrome with exacerbation of gout, inflammatory and degenerative diseases of the joints.

Important!

When taken, allergic reactions occur: itching, skin rash, hyperemia, angioedema, exudative erythema multiforme, fever, chills, photosensitivity, nausea, vomiting. With long-term use in large doses - ulceration of the gastrointestinal mucosa, bleeding (gastrointestinal, gingival, uterine, hemorrhoidal).

Indomethacin (Metindol retard, Indobene)

- a derivative of indoleacetic acid, an inhibitor of prostaglandin synthesis in the kidneys - prescribed orally after meals at a dose of 75 mg, and then every 6 hours. 50 mg each. Treatment continues until the pain disappears. On the next day, the dose is reduced to 50 mg 3 times. Then switch to a maintenance dose of 25 mg 3 times a day.

Side effects of Indomethacin include gastrointestinal disorders (bloating, colitis, enteritis, ulcers), bleeding in internal organs, sodium retention in the body, allergic reactions, confusion, convulsions, forgetfulness, hallucinations. These doses may cause side effects in up to 60% of patients. However, Indomethacin is easier to tolerate than Colchicine, and in acute gouty arthritis it is often the drug of choice.

Meloxicam
(Movalis, Mirlox)
belongs to the oxicam class;
enolic acid derivative. The mechanism of action is inhibition of Pg synthesis as a result of selective suppression of the enzymatic activity of COX-2. When prescribed in high doses or with prolonged use, the selectivity of the drug decreases. Suppresses Pg synthesis in the area of inflammation to a greater extent than in the gastric mucosa or kidneys, which is associated with relatively selective inhibition of COX-2. Important!
Side effects are common to all NSAIDs. Selective NSAIDs are less likely to cause erosive and ulcerative damage to the gastrointestinal tract. Eating does not affect absorption. Plasma concentration is dose-dependent, TCmax is 5–6 hours. The maximum daily dose is 15 mg. Metabolized in the liver to inactive metabolites. Excreted through the intestines and kidneys (in equal proportions), unchanged - 1.6% of the daily dose.

Nimesulide
(Actasulide
,
Nise
,
Nimulid)
is a non-steroidal anti-inflammatory drug, a sulfonanilide derivative. It has a pronounced anti-inflammatory, antipyretic, analgesic and antiplatelet effect. When prescribed in high doses, long-term use or individual characteristics of the body, selectivity decreases. Selectively inhibits cyclooxygenase-2, reduces the amount of prostaglandins (mainly at the site of inflammation), suppresses the exudative and proliferative phases of inflammation. Reduces capillary permeability; stabilizes lysosomal membranes; inhibits the production of ATP in the processes of oxidative phosphorylation; inhibits the synthesis or inactivates inflammatory mediators (prostaglandins, histamine, bradykinins, lymphokines, complement factors and other nonspecific endogenous damaging factors). Blocks the interaction of bradykinin with tissue receptors, restores impaired microcirculation and reduces pain sensitivity at the site of inflammation.

Important!

Side effects: hepatotoxicity, NSAID gastropathy, dyspepsia, abdominal pain, nausea, vomiting, heartburn, tinnitus, dizziness, allergic reactions: skin rash, itching, urticaria, Quincke's edema, headache, hematuria, agranulocytosis, leukopenia.

Combining NSAIDs with each other is contraindicated, because the risk of developing ulcerative lesions of the gastrointestinal tract increases, the activity of serum transaminases increases and bleeding time prolongs.

GLUCOCORTICOSTEROIDS

In acute gout, especially when NSAIDs are contraindicated or ineffective, systemic or local (intra-articular) administration of glucocorticosteroids is resorted to. For systemic administration (orally or intravenously), moderate doses are prescribed over several days, because the concentration of glucocorticosteroids quickly decreases and the effect decreases. Intra-articular injection of the long-acting (3–4 weeks) steroid drug Triamcinolone hexacetonide

Menu for the week

Monday

Breakfast - an omelette cooked in the oven or steamed, you can add 50 ml of milk + a couple of slices of bread, 150 g of vegetable salad.
Lunch – minestrone soup (vegetable), 130 g of low-fat fish, steamed or boiled.
Dinner – sautéed vegetables with zucchini and eggplants 300 g, a slice of bread.

Tuesday

Breakfast – bulgur or oatmeal porridge with fruit or dried fruit.
Lunch – pilaf of wild rice and chicken fillet without frying.
Dinner – vegetable sauté with potatoes and low-fat cheese, baked in the oven, a slice of bread.

Wednesday

Breakfast - yogurt with fruits and nuts.
Lunch – cream soup of pumpkin, zucchini and potatoes, chickpea cutlets, you can add 2 teaspoons of pumpkin or flax seeds to the soup.
Dinner – stewed cabbage with tomatoes, onions and turkey.

Thursday

Breakfast – bulgur or rice porridge, can be boiled in water or water + milk, berries or dried fruits.
Lunch – bean lobio, vegetable salad.
Dinner – bulgur or wild rice pilaf with chicken breast and vegetables.

Friday

Breakfast - cottage cheese or cheesecakes baked in the oven, fruit, 1 teaspoon of sesame seeds, 1 tablespoon of sour cream.
Lunch – durum wheat pasta with seafood, vegetable sauce.
Dinner – buckwheat with fish baked in the oven.

Saturday

Breakfast – wheat porridge with a mixture of water and milk, dried fruits.
Lunch – cream soup of vegetables, add flax seeds or pumpkin seeds, a piece of bread or crispbread.
Dinner – vegetable sauté, seafood, boiled egg.

Sunday

Breakfast - yogurt with fruits and nuts.
Lunch – perlotto with vegetables and cheese.
Dinner – stewed cabbage with vegetables and turkey meatballs.

How to quickly relieve acute gout pain during an attack?

People suffering from gout often wonder: “Is there a remedy that can quickly relieve pain?” Before answering it, it’s worth understanding what gout is and why it occurs. In fact, this disease is associated with a metabolic disorder, which causes an increase in uric acid levels. It begins to form into crystals and accumulate in tissues. This type of disease is called paroxysmal, and the increase in indicators in this case is called hyperuricemia.

What is gout and why does it occur?

The first information about this disease has come to us since the time of Hippocrates. Today its occurrence is 0.3%. The average age of people suffering from this disease is 40-50 years. At the moment, in medicine there are two main types of this disease: gouty arthritis and the appearance of tophi. Tophi is a kind of knot that is formed due to the deposition of uric acid crystals in the soft tissues.

The main cause of the disease is an increase in the level of urate in the body. Nowadays, scientists identify two reasons for the occurrence of this type of disease:

There is an increase in the production of uric acid, which leads to the inability of the kidneys to process such an amount of incoming fluid;
Another reason for the occurrence is obesity, when a person eats absolutely everything, without thinking that the kidneys may not be able to process many foods.

Sometimes gout can also occur due to a malfunction of the kidneys themselves. In this case, urates begin to be deposited in those places that are poorly supplied with blood. It mainly occurs in cartilage, joints and tendons. The occurrence of this type of disease can worsen kidney function. The following factors can also provoke the disease:

Fatty foods;
Legumes;
Hereditary predisposition;
Coffee consumption;
Alcohol abuse;
Excessive consumption of red meat;
Physical inactivity;
Presence of obesity;
Congenital or acquired pathology associated with dysfunction of the liver and kidneys.
Lack of water consumption.

The first signs of gout and disease prevention

Nowadays, gout is considered an incurable disease. But you shouldn’t despair, because you can stabilize her and live with her calmly. At the very first stages of development, the disease proceeds almost unnoticed. Before the first pain in the joints appears, which occurs more often at night. It seems to you that someone is twisting or gnawing the joint. Then redness begins to appear on it, and it swells. Often the disease begins to appear on the big toe. During the day, the pain becomes weaker. This goes on for a whole week. And then gout goes into a kind of hibernation, which can last from three months to twenty years. But just because the disease does not manifest itself does not mean that you are healthy. It's just remission time.

How to protect yourself from the possibility of illness? The same as for most diseases. Start eating right and don't forget about exercise. He should be given no less than thirty minutes. Minimize your intake of the following foods:

alcohol;
mushrooms;
cocoa;
beverages;
fatty fish;
fat meat;
legumes and grains.

And be sure to drink more water.

What medications are most suitable for treating gout?

In order to stop attacks of the disease, it is necessary to reduce the level of uric acid. Doctors recommend using the following medications:

Allopurinol, which inhibits uric acid. Due to the fact that it dissolves acid in the kidneys and joints, the pain goes away much faster.
Very often, doctors use Febuxostat, which interferes with the synthesis of uric acid by inhibiting xanthine oxidase.
The drug Pegloticase contains enzymes that dissolve uric salts.
Probenecid, which helps uric acid be absorbed back into the kidney tubules.
To avoid incredibly severe pain, it is often recommended to use Fullflex. It relieves inflammation and swelling.
And Colchicine, which relieves pain very well. It relieves gout attacks.

What folk remedies are used to treat gout, and what can be done at home?

Doctors recommend using traditional methods of treatment not as primary, but as auxiliary, because they rather have a general application, but do not respond to a specific type of pain.

Traditional methods of treatment include: rubbing sore spots with a tincture of mullein flowers; the use of ointments made from badger fat, juniper and laurel, chestnut-based ointment; applying compresses made from fir and garlic oils, yeast and wheat flour; the use of baths with the addition of herbs; as well as teas and various tinctures.

If you have a gout attack at home, then there is nothing to worry about. The first thing to do is to provide rest to the sore leg. Find or create an elevation using a pillow. Next, the most effective remedy will be ice. Apply it to the area of pain and repeat this until it becomes easier. Of course, you need to drink as much water as possible.

Treatment of any gout attack involves two goals: pain relief and prevention. Therefore, if you know that you have such a problem, it is better to always have a pain reliever and something for compresses in your first aid kit. Do not treat yourself, but rather consult a doctor, because even a lull does not mean that everything is fine, and it will not happen again. gout treatment

– this is a complex and time-consuming process, so it is better to protect yourself and prevent the disease.
But even if you follow all the instructions, there is still the possibility of an attack. And with it it is impossible to relieve pain immediately, so try to simply reduce the pain. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Clinical picture

The classic acute attack of gout occurs suddenly, usually at night, against a background of good general health. The development of an attack is usually preceded by events that predispose to a sharp increase in the level of uric acid in the blood - buffet tables, birthdays, feasts with abundant consumption of meat products. The latter, as you know, are often used as a snack after drinking alcoholic beverages. The combination of these factors is extremely unfavorable, since alcohol impairs the excretion of uric acid in the urine, which quickly leads to a “jump” of uric acid in the blood and creates the necessary conditions for the development of gouty arthritis. Another factor that predisposes to an exacerbation or an attack of articular gout is dehydration, which often happens with profuse sweating after visiting a bathhouse or sauna. Hypothermia and trauma, including minor trauma such as wearing tight shoes, can also trigger a gout flare-up. An attack of gout is quite similar: extremely intense pain occurs in the 1st metatarsal flange joint (thumb joint), it swells sharply, becomes hot and red, and then blue-purple. The function of the joint is impaired, the patient cannot even move a finger.

Attacks of gout usually last for 3-10 days, then the pain gradually disappears, the skin returns to its normal color, and the joint begins to function again. The next attack of gout may take several months or even years to occur. However, over time, the “bright” periods become shorter and shorter.

If gouty arthritis becomes chronic, it leads to deformation of the joints and disruption of their function.

1 General blood test

2 Immunological blood test

3 Diagnosis of gout in MedicCity

University

It has been well studied - Hippocrates once called it “the disease of Sunday evening and Monday morning” - but at the same time it is very relevant for modern society. Its carriers are called the cute word “gout,” but gout itself, by its nature, is quite insidious and capricious. The truth, fortunately, is quite manageable. Modus vivendi found out how to control this chronic disease and not allow it to affect the patient’s quality of life with the help of the famous rheumatologist and therapist, Doctor of Medical Sciences Nikolai SOROKA.

UPDATED

Uric acid is to blame for the occurrence of gout attacks - it precipitates in the joints and causes arthritis. As Nikolai Soroka notes, gout is not losing ground today: “Over the past 20 years, the disease has become twice as common. There are no exact statistics for Belarus, but in Western countries gouty arthritis is diagnosed in 1-2% of men, and in New Zealand the figure can reach up to 6%. The disease is relevant because of its sudden onset: a person feels normal, but then pain in the joints suddenly appears, which completely immobilizes the patient. There is an opinion that if you squeeze a joint in a vice until it hurts, it feels like rheumatism, and if you twist the vice again, it feels like gout. Its attacks turn a person off from active life, and if the patient is not treated, he gradually becomes disabled.”

CAUSES

“The view of gout has changed fundamentally over the past decades,” says a rheumatologist. — It is believed that in 90% of cases, the occurrence of gout is associated with a problem in the kidneys - a violation of the transport of uric acid at the level of special transporter proteins, and only 10% of patients have genetic defects in other enzymes involved in the metabolism of uric acid in the body and affecting it content in the blood.

Recently, there has been a noticeable increase in the number of patients with drug-induced gout, which is provoked by taking medications to treat other diseases. These primarily include drugs containing acetylsalicylic acid, which are often prescribed by cardiologists, but it must be borne in mind that acetylsalicylic acid blocks the removal of uric acid from the body, increases its content, and provokes gout attacks. The second group of unwanted drugs is diuretics, which are included in the combination treatment of arterial hypertension.

SYMPTOMATICS

Men suffer from gout much more often, since female sex hormones (estrogens) have a protective effect, reducing the level of uric acid in the body. Before menopause, women rarely suffer from gouty arthritis.

“The disease usually begins at night with very severe pain, swelling, swelling of the big toe,” explains Nikolai Soroka. — Over the course of several night hours, the pain progresses noticeably and becomes unbearable, and in general, the first attack of gout lasts 5-7 days. Then the symptoms disappear, and the person may not feel anything for six months or a year, believing that he is absolutely healthy. But then, after a provoking factor (general overeating, consumption of large amounts of meat products, alcohol, physical overload, stressful situation), the patient again develops gouty arthritis, after which they usually consult a doctor, who sees that the process is serious and non-random. Gout cannot be eliminated, but it can be successfully controlled.”

DIAGNOSTICS

“Gout has a clinical diagnosis—a doctor can identify the disease based on typical clinical manifestations. Additionally, you can take a biochemical blood test to see elevated uric acid levels, although this is not detected in all patients. Unfortunately, we do not have the opportunity to use the absolute diagnostic principle - to puncture the joint and detect uric acid crystals using a polarizing microscope. Therefore, the main indicators for identifying the disease are still the clinical picture and elevated levels of uric acid in the blood. It is curious that during an attack this level can be normal or even reduced, which misleads an inexperienced doctor. Its decrease during this period is caused by the precipitation of uric acid, and then its level rises again,” summarizes the doctor of medical sciences.

TREATMENT

Nikolai Soroka divides the treatment of gout into two medicinal stages: “For the patient, the most important thing is to relieve the pain syndrome, for which non-steroidal anti-inflammatory drugs are used that can interrupt the development of an attack of gouty arthritis. Some of them have an effect within an hour; the attack can be completely stopped in a few days. The prescription of these medications is canceled immediately after the pain passes - they do not have any healing effect.

If the patient pays attention exclusively to pain, then the general condition of the person is important to the doctor, for which a second stage of treatment is carried out, including taking drugs that reduce the level of uric acid in the blood. This significantly influences the prevention of new attacks of the disease, and if, due to some stressful situations or other risk factors, an attack of gout does occur, then, firstly, it is not so pronounced, and secondly, it is easily stopped by modern anti-inflammatory drugs."

PREVENTION

“There is no primary prevention (how to avoid getting gout) - giving the entire population drugs that lower uric acid levels is illogical,” the rheumatologist sneers. “Therefore, there is only secondary prevention, which provides a number of recommendations to prevent new pain attacks. One of the main ones is diet advice, which is not as strict as before. It is important to limit the consumption of foods containing purine bases and fructose, which, especially in large quantities, increase the level of uric acid in the blood. Today, all restrictions on products with purine bases of plant origin have been lifted - asparagus, lentils, beans, beans, tomatoes, etc. Diet for patients with gout - exclusion from the diet of seafood, internal organs of animals (offal), and sweet drinks containing fructose. It is advisable to limit the consumption of meat products; tea and coffee are allowed in moderate quantities. There are no restrictions on low-fat dairy products. But fruit juices, oranges, honey, watermelons containing fructose are not shown or are noticeably limited. Among alcoholic beverages for gout, beer is strictly prohibited, as it increases the risk of developing the disease by 2.5 times; whiskey and cognac are very undesirable; Vodka can be consumed very moderately; among less strong drinks, dry wine is the least dangerous. You need to know moderation in everything, then the chances of controlling the disease significantly increase.”

REFERENCE Modus vivendi . Nikolai Soroka in 1972 Graduated from the Minsk Medical Institute with a degree in general medicine. Doctor of Medical Sciences, Professor, Head of the 2nd Department of Internal Diseases of BSMU . Author of more than 450 scientific papers, member of the editorial boards of a number of Belarusian and foreign specialized medical journals. Trained more than 20 doctors and candidates of medical sciences.

BelGazeta , June 18, 2012