Gout is a chronic disease that is accompanied by an increase in the concentration of uric acid in the blood. As a result of its accumulation, urate salts begin to be deposited in the joint area. Subsequently, destruction of the joint tissue and impairment of functional abilities occurs.
Fatty foods, a sedentary lifestyle and alcohol abuse lead to an increase in morbidity among the population. The Yusupov Hospital provides a full course of diagnosis and treatment of gout at any stage of development. Modern equipment, a professional team and high quality services distinguish the clinic from other medical institutions.
According to statistics, men are several times more likely to suffer from gout compared to women. The onset of the disease occurs at 40 years of age. In women, gout is diagnosed closer to 60 years of age. This is explained by a set of certain hormones that help remove excess uric acid from the body. In recent years, doctors have been talking about diseases. Gout can be diagnosed at the age of 20-30 years.
Reasons for the development of the disease
Hyperuricemia is the main cause of gout. This condition occurs in the following cases:
- Obesity. The diet of a gout patient included an excessive amount of fatty foods, simple carbohydrates and high-calorie foods. In addition, eating large amounts of meat increases the risk of developing gout;
- Alcohol abuse;
- History of psoriasis and hypertension;
- Hereditary predisposition.
An increase in the concentration of uric acid occurs as a result of the fact that healthy kidneys are not able to filter its sharply increased amount. Kidney pathology does not allow them to process even normal amounts of uric acid.
Gout trigger chain
There are many reasons for the development of the disease (hereditary predisposition, metabolic disorders, poor functioning of the urinary tract, etc.). Most often, we ourselves are to blame for its occurrence:
- We violate the drinking regime.
- We eat a lot of spicy, smoked and fatty foods.
- We consume more than necessary amounts of table salt.
- We do not deny ourselves alcohol, both strong spirits and beer.
- In order for the metabolism to be normal, you need not only to balance the menu, but also to move more, but we forget about this.
- Frequent stress is also one of the risk factors, especially if we “eat up” the stress with something tasty and high in calories.
- We don’t pay attention to being significantly overweight or using poorly studied quack diets and pills that may not only not help, but also harm us.
For quite a long time, the intestines and kidneys have been working under overload, in force majeure mode. At some point, they stop coping with the load, and the body’s metabolism becomes unbalanced. One of the manifestations of this is the deposition of uric acid crystals (monosodium urate) in the joints with the formation of specific tophi nodules. As a rule, the disease first manifests itself in the small joints of the legs, but often urates are deposited near the joints of the fingers.
The disease is characterized by painful attacks, with severe pain, feverish temperature (from 38 to 40 degrees). The acute stage passes quickly enough, but the disease does not go away; it is your “friend” for the rest of your life. It is up to you and the doctors to make this “friend” a silent and as rare guest as possible.
Classification
Depending on the nature of the course of the disease, primary gout is distinguished - an independent disease that occurs against the background of exposure to provoking factors, and a secondary form of the disease, which develops against the background of concomitant pathology. Based on the prevalence of the pathological process, gout is divided into the following types:
- Monoarticular arthritis. Urates accumulate in the area of one joint. Characteristic of the onset of the disease. The most common site of monoarticular arthritis is the big toe joint;
- Polyarticular arthritis. Inflammation affects more than 2 joints. Polyarticular arthritis is characteristic of chronic gout. Localized in the joints of the elbows, wrists, legs, feet and hands.
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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.
Symptoms in men
At the initial stages of the disease, there are no clinical signs of gout in men. During preventive examinations or examinations for other pathologies, a biochemical blood test detects an increased level of uric acid - hyperuricemia.
The first sign of gout in men that forces you to see a doctor is pain in the joints. Acute gouty arthritis at the initial stage is most often short-term. The attack develops suddenly, mainly at night. The pain syndrome is intense, constant, pronounced. Target joints affected:
- big toe;
- Thumb;
- Knees;
- Elbows;
- Ankle.
The skin over the joint is hyperemic, swollen, and hot to the touch. The joint is limited in movement, since any mobility provokes increased pain. After a few days, the pain goes away, and the patient returns to his usual way of life.
Further progression of the disease leads to a longer exacerbation of gout symptoms in men, and periods of calm are constantly decreasing. Over time, periods of remission are completely absent, and the pain becomes chronic.
In the stage of chronic arthritis, urates are deposited in connective tissue, organs in the form of nodules, which are called tophi. Deposition of urate in the kidneys is the cause of urolithiasis. Sometimes kidney inflammation develops.
Expert opinion
Author:
Elena Yurievna Panasyuk
Rheumatologist, doctor of the highest category, member of the Association of Rheumatologists of Russia
According to WHO data, 5-20% of Russian residents suffer from pathological accumulation of monosodium urate crystals. They are at risk of developing gout. The disease is registered in 0.1% of the population. Similar statistics in Europe and the United States indicate a more deplorable situation.
The number of newly diagnosed cases of gout is growing every year. The main role among the reasons for the early onset of the disease is given to a person’s lifestyle. The prognosis for recovery and quality of life after diagnosis depends on the stage at which the pathology is diagnosed. Severe gout can cause loss of self-care and normal skills. Late access of the population to a doctor is associated with the absence of a specific clinical picture of the disease in the early stages of development.
Doctors at the Yusupov Hospital perform differential diagnostics, which makes it possible to determine the diagnosis. An individual approach to each patient is necessary to select the correct therapy. The doctor’s tasks include relieving symptoms of gout exacerbation and preventing relapses. For this purpose, the Yusupov Hospital prescribes modern drugs that have passed quality and safety control.
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.
Diagnostics
A comprehensive diagnosis of gout includes the following studies:
- Inspection of joints. It is carried out to identify painful areas;
- General and biochemical blood test. They are carried out to identify the inflammatory process in the body. This is evidenced by high concentrations of leukocytes and ESR. Biochemical analysis shows the level of uric acid and creatinine;
- Radiography. Examination of the affected joints determines the development of tophi, as well as the presence of areas with destroyed articular and bone tissue;
- Ultrasound examination of the kidneys. Against the background of severe gout, urate may begin to be deposited in the kidneys. Ultrasound diagnostics allows you to identify pathological foci in organs;
- Examination of synovial fluid. It is necessary to clarify the etiological factor of the resulting inflammation.
Differential diagnosis
Quite often, gout is mistaken for other diseases. This is due to the similarity of the clinical picture of the pathologies. Differential diagnosis is carried out between gout and the following diseases:
- Purulent arthritis. Occurs after an infectious disease. Purulent arthritis is characterized by hyperthermia. The diagnosis will be clarified with the help of additional studies;
- Rheumatoid arthritis. It occurs more often in women than in men. The final causes of the development of pathology are not fully understood. Unlike gout, rheumatoid arthritis does not increase the concentration of uric acid;
- Psoriatic arthritis. Occurs against the background of skin manifestations of psoriasis;
- Pyrophosphate arthropathy. It differs from gout by characteristic changes on x-ray and in the analysis of synovial fluid;
- Osteoarthritis. The disease not only has similar symptoms, but can also occur against the background of gout.
Only a doctor can distinguish diseases and make an accurate diagnosis. Self-medication can lead to aggravation of the condition and the development of undesirable consequences.
Treatment
Doctors at the Yusupov Hospital provide complex therapy for gout. It includes the following components:
- Medications;
- Diet food;
- Lifestyle correction.
Drug therapy for gout at the Yusupov Hospital is carried out using the most effective pharmacological drugs that are registered and approved for use in the Russian Federation. They have a minimal range of side effects. Medicines for gout are prescribed for a long term. The dosage is selected according to the levels of uric acid in the blood.
The objectives of drug therapy are:
- Reduced uric acid levels;
- Reducing the severity of pain and inflammatory syndromes.
The choice of drugs is made by the attending physician on an individual basis. The results of the diagnostics performed are taken into account. For gout, the following medications are prescribed:
- Allopurinol. The action of the drug is aimed at reducing the level of uric acid in the blood. In addition, allopurinol destroys existing urate deposits. It is a sought-after drug for the treatment of gout;
- Febuxostat. Dissolves uric acid salts and reduces the risk of their re-formation;
- Probenecid. Most often used during gout remission. This is due to the lack of effect of the drug on the formation of uric acid;
- Pegloticase. Used in cases of ineffectiveness of other medications;
- Colchicine. The drug prevents the accumulation of uric acid in the body. Due to the large number of side effects, colchicine is used exclusively for the purpose of relieving an acute attack of gout;
- Non-steroidal anti-inflammatory drugs. Reduce the severity of inflammation and have an analgesic effect;
- Glucocorticosteroids. Prescribed to relieve an acute attack of gout. Due to immunosuppression, glucocorticosteroids are used in limited quantities and according to strict indications.
Following a certain diet is an important part of the comprehensive treatment of gout. The daily menu may include:
- Vegetarian soups;
- Limited amount of chicken or duck meat;
- Lenten varieties of fish;
- Fermented milk products (kefir, fermented baked milk, yogurt, cottage cheese);
- Cereals;
- Pasta;
- A sufficient amount of fresh vegetables and fruits;
- Nuts;
- Dried fruits;
- Honey;
- Paste;
- Fruit drinks, compotes, juices;
- Weak tea.
Following a diet is necessary not only during an exacerbation of gout, but throughout life. In this way, it is possible to minimize the number of relapses of the disease.
To reduce uric acid levels, the patient is prescribed medication. Dosages of drugs are selected depending on the indicators. In order to dynamically monitor the effectiveness of treatment, it is necessary to regularly determine the level of uric acid in the blood. A decrease in its concentration indicates positive results of therapy. Control studies are recommended to be carried out every 2-4 weeks, and then once every 6 months. The dose of drugs is gradually reduced until maintenance values are reached. It is extremely rare to completely stop taking medications. Most often this is accompanied by an exacerbation of gout.
After the level of uric acid decreases and the clinical manifestations of the disease disappear, the patient can return to normal life. To prevent recurrent exacerbations, doctors recommend maintaining proper nutrition and leading an active lifestyle.
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.
Forecast
The prognosis for life with diagnosed gout is favorable. Most patients with the disease live to old age. The quality of life improves by following measures to prevent relapses of the disease and undergoing regular examinations by a doctor.
You can get tested for gout at the Yusupov Hospital. The clinic is located in Moscow. The hospital’s equipment makes it possible to accurately determine gout at the initial stages of development. After receiving the research results, experienced doctors develop individual treatment tactics. Modern therapy helps to quickly alleviate the patient's condition. The drugs used meet quality and safety standards. To make an appointment with a rheumatologist, call the contact center of the Yusupov Hospital 24 hours a day, any day of the week.
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