Acute gout. Gout and its prevention Liver and gout connection

Second stagegout called intermittent, or "interval" gout. There is already a gradual deposition of urates in the area of ​​​​the joints and in the tubules of the kidneys. The disease proceeds in the form of exacerbations ( acute gouty attacks) and periods of remission. During an exacerbation, joint symptoms are usually observed, which will be detailed below. The formation of kidney stones in intermittent gout is rare.

Exacerbations and acute symptoms from the joints are usually caused by the following reasons:

• injury;
• excessive alcohol consumption ( even disposable in large quantities);
• surgical intervention;
• acute infectious disease usually ARI - acute respiratory disease, or ARVI - acute respiratory viral infection).

The attack lasts 3-7 days, after which there is a complete remission, and patients do not experience any pain or any discomfort even with a load on the affected joint.

Third stage of gout called chronic. It occurs when the patient actually forms tophi with uric acid crystals. Outwardly, they look like bumps that are hard to the touch, which can reach large sizes and severely deform the joint. It should be noted that tophi are externally determined only in 50-60% of patients, and they are not the main criterion for the onset of the third stage. For orientation in the diagnosis, the frequency of acute gouty attacks and their duration are taken in comparison with periods of remission. Also in the third stage, urolithiasis develops with a corresponding clinical picture.

The main symptoms of gout on the part of the joints are:

• pain;
• joint redness;
• formation of tophi;
• inflammation of the periarticular tissues;
• limitation of mobility in the joint;
• local rise in temperature.

Pain

Gout pain can be very severe. The attack begins, as a rule, at night, often under the influence of external factors. The pain radiates distributed by) throughout the limb. Increased pain can be caused by even light pressure on the affected joint. Conventional painkillers are ineffective during an attack.

As noted above, the small joints of the feet and hands are usually affected. In more than 55% of patients, the first attack of gout is localized in the region of the I metatarsophalangeal joint ( base of the big toe). As a rule, the joint on only one limb is affected, the symmetrical development of the inflammatory process on both limbs is not typical for gout.

The frequency of damage to various joints with gout in the early stages

Gout pain is caused by deposits of urate in the soft tissues and the presence of crystals in the joint fluid. Solid particles directly injure tissues and cartilaginous surfaces inside the joint, leading to severe pain. To a lesser extent, the pain is due to inflammatory edema.

Joint redness

Redness of the joint develops quickly, in parallel with the increase in pain. It is more characteristic during the period of exacerbation, while during remission it may disappear. Redness is due to a rush of blood to the affected area. Due to microtraumas of soft tissues, cellular elements of blood migrate to the focus ( mostly neutrophils). These cells are able to secrete biologically active substances that increase the permeability of the walls of blood vessels and the expansion of capillaries. Under the influence of these substances, the blood supply to the affected area increases, which causes redness and swelling.

Formation of tophi

Tophi is a symptom specific to gout. As mentioned above, they are an accumulation of uric acid salts located subcutaneously or intradermally. Usually from the first symptoms of the disease ( first seizure) before the formation of tophi takes at least 3 - 5 years ( in rare cases 1 - 1.5 years). These formations increase slowly, but in advanced cases, gout can reach several centimeters in diameter. Trophic ulcers may appear due to impaired blood supply to the skin over tophi. A white paste-like mass is released from them, or even just urates in the form of a white powder.

The predominant places for the formation of tophi are:

• phalangeal joints on the fingers and toes;
• metacarpophalangeal and metatarsophalangeal joints ( base of the finger);
• area of ​​the knee joints;
• area of ​​elbow joints;
• ankle joint;
• auricles;
• superciliary arches.

With atypical forms of gout, early formation of tophi can also be observed ( one year after the first attack of the disease).

The early appearance of tophi is typical for the following categories of patients:

• patients with juvenile gout cases of gout in children and adolescents);
• elderly women who developed gout while taking diuretics ( diuretics);
• patients with severe diseases of the hematopoietic system;
• in chronic renal diseases accompanied by hyperuricemia.

Inflammation of the periarticular tissues

The inflammatory process can affect not only the joint area, but also other anatomical structures located nearby. Against the background of gout, diseases such as tendinitis are often observed ( tendon inflammation), tendovaginitis ( inflammation of the tendon sheath), bursitis ( inflammation of the joint bag, characteristic mainly of large joints).

Limitation of mobility in the joint

The main cause of limited mobility of a joint affected by gout is a sharp pain. It appears mainly in the acute period of the disease and does not allow you to make any movements, or even give an insignificant load on the entire limb.

During remission, when the pain subsides, joint stiffness can still be observed. It is partly due to inflammatory edema, partly due to concomitant inflammatory processes in the tendons and other periarticular anatomical structures.

Local temperature increase

Local temperature increase is explained by increased blood supply to the affected joint and acute inflammatory processes. By touch, the patient can easily determine that the reddened area of ​​\u200b\u200bthe skin is much hotter than the surrounding surface tissues. Above the tophi, the skin temperature is also almost always 1 - 2 degrees higher, regardless of their location.

Depending on the causes of gout, concomitant diseases and the individual characteristics of the patient's body, the course of gout can take several clinical forms. Each of them is characterized by some features and a set of symptoms typical of it. Often, it is the clinical form of gout that becomes the main criterion for choosing a treatment.

Currently, the following clinical forms of gout are distinguished:

• typical acute attack;
• subacute form;
• rheumatoid-like form;
• pseudophlegmonous form;
• infectious-allergic polyarthritis;
• asymptomatic form.

Typical acute attack

This clinical form occurs in 60 - 80% of patients with gout. In fact, it includes symptoms that are not observed constantly, but during the exacerbation phase. With an intermittent course of gout, exacerbations are observed quite rarely. In the chronic stage, most symptoms are observed constantly. The duration of attacks, depending on the severity of the disease and the nature of the treatment, varies from several days to several weeks.

The main symptoms during an acute attack are:

• acute pain in the joints;
• general weakness;
• headache;
• a sharp rise in temperature from subfebrile level ( 37 - 38 degrees) up to 38.5 - 39 degrees;
• the skin over the affected joint quickly turns red, and then acquires a bluish tint.

During an acute attack, there are characteristic changes in these laboratory tests, which will be discussed in detail below ( increased ESR - erythrocyte sedimentation rate, increased levels of sialic acids in the blood, fibrin, seromucoid, and the appearance of C-reactive protein).

Subacute form

The subacute form differs from the attack in less intense symptoms. In particular, the inflammatory process is usually limited to one joint ( monoarthritis), the pain is moderate, and the swelling is not so strong. Subacute involvement of several joints can occur in the early stages in young people. Gradually, the subacute form passes to more severe variants of the course with frequent acute attacks.

Rheumatoid-like form

The rheumatoid-like form is called so because gout in this course is difficult to distinguish from some rheumatic diseases. Features of this form is the defeat of small joints ( finger and toe joints, wrist joint) at the onset of the disease, as well as prolonged attacks of moderate intensity. The duration of attacks in rheumatoid-like form can be up to several months. This creates serious problems for doctors with the correct diagnosis.

Pseudophlegmonous form

The pseudophlegmonous form is characterized by an acute inflammatory process around the joint, while the symptoms typical of gout fade into the background. The leading symptom in this course of the disease will be a temperature of 39 - 39.5 degrees, chills, an increase in the level of leukocytes in the blood up to 12 - 15 million / ml, an increase in ESR. All these symptoms are more like a phlegmon - an acute diffuse purulent inflammation of the soft tissues. However, tissue necrosis and pus formation usually do not occur with this form of gout.

Infectious-allergic polyarthritis

Infectious-allergic polyarthritis is an independent disease in which one or more joints become inflamed one by one. In rare cases ( up to 5%) gout can mimic such a clinical picture. In this case, the defeat of new joints appears quickly ( during the day), however, the inflammatory process is not as intense as with a typical exacerbation of gout.

oligosymptomatic form

The oligosymptomatic form of gout also presents serious difficulties for diagnosis. With it, patients complain of moderate pain, usually in one joint. On examination, there may be no signs of inflammation such as swelling or redness of the skin.

It should be remembered that these six clinical forms of gout are mainly characteristic of the initial stages of the disease. Gradually, the disease progresses with the formation of tophi and an increase in typical attacks. However, the above forms can be observed for several years, until the disease takes a more characteristic course.

In addition to damage to the joints with gout, damage to the urinary system often occurs. This occurs in the later stages of the disease and is characterized by the deposition of urate in the tissues of the kidneys ( tubules, renal pelvis). gouty nephropathy ( kidney damage due to gout) occurs according to various data in 30-50% of patients with this pathology.

The main symptoms of gouty nephropathy are:

• Sharp pains in the back. Pain is a consequence of the movement of stones in the renal pelvis. Crystals damage the epithelium of the renal pelvis, leading to the development of inflammation.
• Hematuria ( detection of blood in the urine). Hematuria is manifested by reddening of urine or the detection of blood elements in it during a laboratory test. The cause of hematuria is minor bleeding that occurs as a result of the movement of stones.
• Renal colic. This syndrome involves the sudden onset of severe lower back pain for no apparent reason. Renal colic in gout is caused by blockage of the ureter by a large stone, or by its getting stuck directly at the mouth of the pelvis. Colic may be accompanied by vomiting, urination disorders, moderate fever.
• The appearance of tofus-like formations in the kidneys. Sometimes, against the background of gout, urates are not formed in the pelvis, but directly in the brain tissue of the kidneys. In this case, this gradually leads to overgrowth of the renal tubules with connective tissue and chronic renal failure.

Diagnosis of gout

As mentioned above, the diagnosis of gout often presents serious difficulties even for experienced doctors. The fact is that when contacting a doctor, patients most often complain of pain in the joints, which can be caused by a variety of diseases. To significantly increase the chance of making a correct diagnosis, it is best to contact the rheumatology department. Rheumatologists have more experience with arthritis than other specialists and will be able to recognize gout more quickly.

The diagnosis is made directly on the basis of clinical and paraclinical ( laboratory and instrumental) surveys. For some patients, the diagnosis does not take much time, while others have to undergo a series of tests and examinations. First of all, it depends on the cause of the disease, and on the severity of the symptoms.

In the diagnosis of gout, the following stages can be distinguished:

• anamnesis ( patient interview);
• assessment of the clinical picture of the course of the disease;
• instrumental research;
• laboratory research.

Anamnesis

Taking an anamnesis plays an important role in making a diagnosis, as it allows you to immediately exclude several joint diseases with similar symptoms. During the interview of the patient, the doctor necessarily specifies what the first symptoms of the disease were and in what order they appeared. Most patients manage to recall joint pain in the past. Usually it is a sharp pain in the small joints of the feet and hands. large joints ( knee, elbow, hip) and the spine are rarely affected first.

Another important point in the collection of anamnesis are cases of gout in the family. As mentioned above, hereditary factors play an important role in the pathogenesis of this disease, so such cases facilitate diagnosis.

An indispensable issue that the doctor will try to clarify during the examination is the patient's nutrition and some bad habits. In particular, the abundance of meat food, alcohol abuse, smoking and significant physical exertion suggest gout. Another dietary pattern that plays a role in the onset of gout is inadequate fluid intake throughout the day.

Often the doctor also asks about illnesses that have occurred in the past. In gout, major surgery, kidney disease with reduced filtration, and long-term use of certain drugs are of greatest importance ( cytostatics, thiazide diuretics).

Assessment of the clinical picture of the course of the disease

The clinical picture of the course of the disease is a set of symptoms of a disease and a change in the patient's condition over time. An experienced doctor, carefully observing the patient, can make a correct diagnosis with a high degree of probability even without paraclinical studies.

The main criterion in assessing changes in the state over time is the staging of gout. In almost any of the patients who undergo regular medical examinations and tests, it is possible to identify the following three stages of the development of the disease:

1. Hyperuricemia and accumulation of urates in the body. This stage can last for years without causing serious inconvenience to the patient. Nevertheless, it is she who sooner or later leads to the second stage. Occasionally, in medical practice, there are cases when gout appears without a preliminary increase in the level of uric acid.
2. Deposition of urates in tissues. Urates, as mentioned above, are small crystals that begin to make themselves felt as soon as the first of them are deposited in soft tissues. It is at this stage that the first obvious symptoms of gout appear, which usually lead the patient to a doctor.
3. Acute gouty inflammation. This stage occurs only with the accumulation of a significant amount of urates. In addition to multiple microtraumas caused by crystals in soft tissues, there is also a response of the body to foreign substances. The main role is played by neutrophils and tissue phagocytes, which capture ( phagocytize) crystals.

Kidney damage, as noted above, occurs after several years of the course of the disease.

Instrumental Research

Instrumental studies are assigned to almost all patients who have applied for pain in the joints. With gout, most instrumental methods are uninformative in the early stages, since morphological ( structural) changes in the tissues are practically not observed. However, this type of diagnosis makes it possible to exclude a number of other rheumatological pathologies. The appointment of one or another method of instrumental diagnostics is done by the attending physician if necessary. With a pronounced clinical picture with typical manifestations of gout, instrumental diagnosis may not be necessary.

In the diagnosis of gout, the following instrumental research methods are used:

1. ultrasound ( ultrasound examination of the joints);
2. scintigraphy with technetium pyrophosphate;
3. x-ray of the affected joints.

ultrasound
With an intermittent course of gout, changes in ultrasound will be noticeable only during an exacerbation of the disease. In the first 3-4 days of an acute attack, there is an expansion of the joint space, swelling and hardening of the soft tissues around the affected joint. Already 5-7 days after an acute attack, the above changes are hardly noticeable, and after 10-12 days, ultrasound of the joint may not reveal any abnormalities.

In the chronic form of gout in the later stages, ultrasound of the joint can reveal moderate deformation of the articular surfaces and deeply located tophi. In addition, ultrasound can detect stones ( clusters) urates in the kidneys and bladder in urolithiasis.

Scintigraphy with technetium pyrophosphate
This study is prescribed mainly for patients with a blurred clinical picture of the disease, when the doctor has problems with an accurate diagnosis. Scintigraphy involves the introduction of a specific substance into the blood ( technetium pyrophosphate), which selectively accumulates in places where urates are deposited. Subsequent scanning of the body allows you to accurately determine the localization of the pathological process. Scintigraphy can indicate gout even in the early stages, when tophi have not yet begun to form. In addition, it can be used to quickly identify urate accumulations in atypical places ( spine, sternoclavicular region). The disadvantages of this study include its high cost.

CT scan
Computed tomography provides a series of high-precision x-ray images. With its help, it is possible to determine the degree of deformation of the joints in the later stages of the disease and the exact localization of tophi. In the early stages, the pictures will show only the thickening of the soft tissues around the joint during the period of exacerbation.

X-ray of affected joints
Single x-rays at an early stage of the disease are prescribed for the purpose of differential diagnosis with other arthropathies ( joint diseases). With gout, they do not reveal significant changes. Only in the chronic course of the disease, an X-ray image can suggest a diagnosis.

X-ray signs of gout

Laboratory research

Laboratory studies of peri gout are very informative, as they allow us to trace the process of formation and excretion of uric acid at various levels. Changes in the analysis of blood and urine are also valuable from the point of view of differential diagnosis, as they make it possible to distinguish gout from other inflammatory diseases of the joints with similar symptoms.

Laboratory studies for gout include the following tests:

1. blood chemistry;
2. biochemical analysis of urine;
3. examination of the synovial fluid of the joints;
4. study of the contents of tophi.

General blood analysis
In the general analysis of blood at first, no changes may be observed. During periods of exacerbation against the background of the inflammatory process, leukocytosis appears ( an increase in the number of leukocytes in the blood) with a shift of the leukocyte formula to the left. This means that the percentage of immature stab forms is increasing. Adult segmented leukocytes migrate to the focus of inflammation and are destroyed there. In addition to leukocytosis, an intense inflammatory process leads to an increase in ESR ( erythrocyte sedimentation rate). Other changes in the general blood test are observed only with concomitant severe kidney damage or when the patient has a secondary form of gout against the background of severe diseases of the hematopoietic system.

Blood chemistry
A biochemical blood test is the most important laboratory test for gout. It is within the framework of this study that the level of uric acid in the blood is determined and hyperuricemia is detected.

Possible changes in the biochemical blood test for gout are:

• increased levels of C-reactive protein;
• hyperglycemia ( increase in sugar levels) occurs in 15-25% of patients with hyperuricemia and is often due to hereditary fermentopathies;
• an increase in the level of creatinine and urea is observed mainly with kidney damage;
• the amount of lipids and lipoproteins in the blood is usually increased;
• elevated calcium levels.

In addition, with a biochemical blood test, it is recommended to check the level of prothrombin, fibrinogen, liver enzymes ( AlAT and AsAT) and bilirubin. These substances indicate the work of other internal organs and can help to make a correct diagnosis in case of secondary gout.

Separately, it should be said about the determination of uric acid in the blood. In gout, in most cases, there is an increase in its content ( hyperuricemia). Normally, the content of uric acid in the urine varies from 0.18 to 0.38 mmol/l in women and from 0.27 to 0.48 mmol/l in men. The determination of the serum level of uric acid is carried out before the start of treatment to clarify the diagnosis and after the start of treatment to monitor its effectiveness. Hyperuricemia has been proven to be a risk factor for gout. But, despite this, the serum level of uric acid cannot serve as an indicator that excludes or confirms gout. During the period of an acute attack, the determination of the serum level of uric acid is not informative, since almost half of the patients during this period have increased excretion ( selection) uric acid by the kidneys, due to which the level of uric acid in the serum can reach normal levels.

General urine analysis
In the general analysis of urine, pathological changes appear after kidney damage. The definition of urate crystals in the urinary sediment is characteristic. Possible albuminuria ( urinary excretion of albumin fraction of blood proteins), moderate hematuria ( detection of blood in the urine), cylindruria ( detection of columnar epithelial cells in urine). The reason for the appearance of these changes is direct damage to the epithelium of the renal pelvis with stones.

Biochemical analysis of urine
First of all, this analysis is necessary to determine the level of uric acid in the urine. Usually determine the clearance of uric acid - the amount of excreted substances during the day. Normally, it is 250 - 750 mg. Depending on the reasons that led to the appearance of gout, this figure varies. If the kidneys are not affected by the pathological process, then filtration occurs normally, and the level of uric acid in the urine will rise in parallel with the level of uric acid in the blood. With increased intake of purines in the diet, the amount of uric acid increases. If the patient developed gout a second time, against the background of chronic renal diseases, then less than 250 mg of uric acid will be excreted in the urine during the day due to insufficiently effective filtration.

Examination of the synovial fluid of the joints
In the synovial fluid obtained by puncture of the joint, an increased content of leukocytes, mainly neutrophils, is found ( 10 - 16*10 9 /l). Polarizing microscopy is performed, which reveals a precipitate of needle-like crystals of uric acid salts ( size 3 - 30 microns), which have the property of negative birefringence. Individual neutrophils are also visible, containing crystals of sodium urate in the cytoplasm. This analysis is the most reliable for confirming the diagnosis of gouty arthritis.

Examination of the content of tophi
When puncturing or opening tophi, a white pasty mass or even a white crystalline powder is found. This symptom is also characteristic only for gout, but it can be detected only in the later stages of the disease.

In addition to the classical stages of diagnosing gout, there are a number of criteria recommended by WHO ( world health organization). According to WHO, there are 12 key points that a doctor should pay attention to during an examination. If at least 6 out of 12 points are confirmed, the doctor can reasonably make a preliminary diagnosis of gout without additional research. The advantage of diagnosis according to WHO criteria is the speed and high accuracy of diagnosis, the disadvantage is the ability to confuse an asymptomatic form of gout with some rheumatic diseases.

• More than one acute attack of arthritis in history. If the patient recalls at least two episodes with similar joint pain, this criterion is considered positive. Information is taken from the words of the patient during the survey.
• The maximum inflammation of the joint is already in the first day. With gout, inflammation develops quickly, which is not so typical for arthritis in other diseases. If the patient turned on the 2nd - 3rd day of the attack, then information about the inflammation on the first day is taken from his words. If he arrived on the first day, the doctor independently assesses such signs of inflammation as the intensity of redness, swelling of the joint, and local temperature increase.
• Monoarticular nature of arthritis. Gout almost always affects only 1 joint at first. Parallel inflammation of several joints is characteristic of other rheumatic diseases.
• Hyperemia of the skin over the affected joint. The criterion is considered positive if the skin over the inflamed joint is bright red and differs sharply in color from the surrounding healthy tissues.
• Swelling or pain localized in the I metatarsophalangeal joint. As noted above, it is this joint that is most often affected during the first attack of gout.
• Unilateral damage to the joints of the arch of the foot. Inflammation and pain appear only on one leg. Bilateral lesion is more characteristic of rheumatic diseases.
• Nodular formations resembling tophi. For a positive assessment of this criterion, the doctor may prescribe a puncture of the nodule.
• Hyperuricemia. For a positive assessment of this criterion, the doctor prescribes a biochemical blood test.
• Unilateral lesion of the I metatarsophalangeal joint. The joint is affected in the first attack on one side only. Only in advanced cases with chronic gout are both first metatarsophalangeal joints inflamed in parallel. However, even then the intensity of inflammation is different.
• Asymmetric swelling of the affected joint. Even within one joint there is asymmetry of swelling. This is due to the uneven deposition of urates in soft tissues.
• Detection on radiographs of subcortical cysts without erosion. These cysts look like dark spots against the background of the epiphysis ( extreme thickened part) bones. Most often, cysts are an intraosseous accumulation of urates.
• Absence of flora in joint fluid. To confirm this criterion, bacteriological seeding of the joint fluid taken during puncture is carried out on nutrient media. If, after a day, colonies of pathogenic microbes appear on the medium, then they are considered to be the cause of inflammation, and the criterion is assessed as negative.

As noted above, some rheumatic diseases have similar symptoms and manifestations, so it can be difficult to distinguish them from gout. These diseases are rheumatoid arthritis, psoriatic arthritis, and chondrocalcinosis ( also called pseudogout). To facilitate the diagnosis, special criteria for the differential diagnosis between these diseases have been developed.

Criteria for the differential diagnosis of gout and some rheumatic diseases

The treatment of gout requires an integrated approach with an impact on the pathological chain at various levels. Whenever possible, doctors try to determine the underlying cause of the disease and eliminate it. However, with hereditary enzymopathies, even an accurate determination of the missing enzyme does not allow to eliminate the root cause, therefore, one has to limit oneself to symptomatic treatment ( aimed at eliminating the symptoms and manifestations of the disease and improving the quality of life of the patient).

The main directions in the treatment of gout are:

• dieting;
• anti-inflammatory drugs;
• anti-gout drugs;
• local treatment;
• folk remedies.

Dieting

In the prevention of gout, the main role is given to dietary nutrition. The main goal of the diet is to reduce the content of uric acid compounds in the body. If the diet is observed, purine bases practically do not enter the body from the outside. Thus, the diagnostic process is also facilitated. If on the 5th - 7th day of the diet the level of uric acid in the blood does not decrease, then we are most likely talking about secondary gout caused by a strong decrease in filtration in the kidneys or a massive breakdown of the body's own tissues.

Diet for gout implies several rules:

• Exclusion or limitation of the amount of foods rich in purine bases. It is these foods that in most cases are responsible for the increase in the level of uric acid in the blood. With their limited consumption, exacerbations of the disease are observed much less frequently and proceed more easily.
• The introduction of products that do not contain purine bases or with a low content of them. These products also need to be selected by a nutritionist. It is on them that the main emphasis is placed in the diet, and they must fully cover the body's needs for calories and nutrients ( proteins fats carbohydrates).
• The introduction of a sufficient amount of liquid. When consuming large amounts of liquid ( at least 2 liters of water per day, not counting liquid meals) increases the amount of circulating blood and accelerates filtration in the kidneys. Due to the increased blood volume, the concentration of uric acid falls, and its deposition in the form of salts in the soft tissues does not occur. Intensive filtration in the kidneys flushes the urinary system, does not allow urine to stagnate. This prevents the deposition of urate in the renal pelvis and bladder. In the presence of chronic kidney disease, it is necessary to clarify the need for abundant drinking from the attending physician, since in this case it can lead to a sharp rise in blood pressure.
• Weight loss. In most cases, getting rid of excess weight improves the functioning of internal organs, so that uric acid is better excreted from the body. In addition, the amount of lipids and lipoproteins circulating in the blood and contributing to the accumulation of uric acid is reduced. The most effective method of losing weight for patients with gout is selected individually by the attending physician.

Foods that are high in purines(more than 150 mg per 100 g of product), are :

• beef internal organs brains, kidneys, liver, tongue, pancreas);
• sardines;
• anchovies;
• small shrimp;
• mackerel;
• legume crops.

Moderate Purine Foods (50 - 150 mg per 100 g of product):

• most types of meat beef, lamb, chicken);
• fish;
• crustaceans.

Foods low in purines(0 - 15 mg per 100 g of product):

• milk;
• eggs;
• fish caviar;
• cereals;
• nuts;
• vegetables and fruits.

The meat of young animals contains more purine bases than the meat of adult animals, so its consumption should be avoided or at least limited. It is also recommended to limit the intake of saturated fats ( sunflower oil, butter), since in conditions of hyperlipidemia, excretion becomes difficult ( selection) uric acid by the kidneys.

Gout- a disease caused by a violation of purine metabolism in the body and characterized by the deposition of uric acid salts (urates) in bones, joints, cartilage, tendons, etc.

Symptoms and signs of gout

The development of gout is usually accompanied by pain attacks.

The pain attack usually begins acutely, often at night. Suddenly, for no apparent reason, there is a sharp pain in the affected joint, swelling is formed, accompanied by redness and severe pain.

Chills appear with a significant increase in temperature. By morning, the pain subsides, in order to resume at night with renewed vigor. This goes on for several days in a row. Then the attacks stop; breaks between attacks can last from several days to 1-2 years.

Causes and types of gout

There are two types of gout: metabolic - the production of uric acid is significantly higher than normal and renal - an insufficient level of excretion of the substance in the kidneys. In general, the examination reveals both types of causes.

Purines are a group of nitrogenous bases that are characteristic components of nucleic acids. The end product of the breakdown of purine compounds is uric acid, which is excreted by the kidneys.

The breakdown of purine compounds to uric acid is multi-stage. It is believed that the main factor regulating this metabolism is the concentration of the intermediate metabolite 5-phosphoribosyl-1-pyrophosphate, an increase in which enhances the synthesis of uric acid or vice versa. An excess of 5-phosphoribosyl-1-pyrophosphate is formed as a result of increased or decreased activity of some key enzymes (synthetase, transferase) involved in purine metabolism.

Gout can be primary (a disease as such) or secondary (a symptom of another disease or a consequence of taking certain medications, in particular diuretics). Secondary gout is a consequence of excessive activation of the nucleic acid cycle, for example, due to increased activity of the bone marrow or a decrease in the normal lifespan of cells in various tissues. These processes occur as a result of diseases such as mononucleosis, multiple myeloma, some types of anemia, hemoglobinopathies, carcinomas, etc.

Causes contributing to the development of gout:

• Renal failure (major factor).
• Defects in the filtration of uric acid in the renal tubules.
• Diseases of the blood. In addition to some types of anemia (hemolytic, pernicious) and myeloma, chronic myeloid leukemia is a risk factor.
• extensive psoriasis.
• Lead poisoning through prolonged exposure or high concentrations.

Diagnosis of gout

Typical signs of gout: attacks of acute arthritis, more often at night; the appearance of tophi (seals of subcutaneous tissue); signs of impaired kidney function and the presence of stones in them.

A method that clearly confirms the presence of gout in a patient is a histological examination to detect uric acid crystals in the joint fluid or tissues. However, X-ray examination of the joints (usually the hands and feet) and soft tissues is used to establish the diagnosis. As a result, we find:

• Gouty "punches" (bone erosion, resembling cysts).
• Sclerosis joints (tissue damage).
• Signs of tophi (compaction, darkening).

Be sure to check the content of uric acid in the blood. The study is carried out several times for the reliability of the results. At the time of the attack, the acid content is often normal, since the excess of the compound penetrates into the joints.

Treatment of gout

The main goals of therapy: treatment of the underlying disease, normalization of uric acid levels and relief of pain.

Medicines

The first stage of therapy is aimed at reducing pain and swelling, normalizing joint mobility.

Treatment of an acute attack of the disease is eliminated with the use of:

• Non-steroidal anti-inflammatory drugs: Ibuprofen, Nimesulide for 5 days - 1 week. With the defeat of several joints at once, the use of Nimesulide in the form of granules is recommended. The use of Aspirin to relieve inflammation and pain is contraindicated, since this drug affects the level of uric acid.
• Drugs that contribute to the provision of anti-gout and analgesic effect - Colchicine.
• With the ineffectiveness of drugs from the group of NSAIDs and Colchicine, corticosteroid injections are prescribed. The use of drugs in this group can contribute to the re-exacerbation of the disease, so therapy should be carried out in a hospital under the supervision of the attending physician.

In the event that gout has developed against the background of carbohydrate metabolism disorders, lipid-lowering drugs (Metformin) are used.

Prevention of attacks and drug therapy of the chronic form of gout are carried out using antihyperuremic drugs (Allopurinol) in combination with diet therapy.

Physiotherapy

Physiotherapy cannot be prescribed in the acute course of the disease.

In the period between attacks, it is advisable to carry out the following procedures:

• Reception of salt and hydrogen sulfide baths.
• The imposition of mud or paraffin applications.
• In the case of the development of pain syndrome - taking radon baths, ultraviolet irradiation.
• Massage.
• Physiotherapy.

In severe cases, surgery may be required followed by removal of the nodes. It should be taken into account that this procedure leads to a limitation of joint mobility.

Folk remedies

• Garlic and lemon. Required: 4 lemons; 3 heads of garlic. Pass lemons and garlic through a meat grinder (lemons are taken pitted). Pour the whole mass with 7 cups of boiling water, mix and let it brew for 1 day. Strain and take 50 ml 3 times a day.
• Geranium (infusion). Required: 2 teaspoons of chopped dry geranium herb; 2 cups cold boiled water. Pour geraniums with water, leave for 8 hours, strain. Take in small sips throughout the day.
• Garlic (tincture). Required: 40 g minced garlic; 100 g of alcohol or vodka. Pour garlic with alcohol or vodka, insist in a closed vessel for 5-7 days. Strain. Take 10 drops 2 times a day 30 minutes before meals. Cannot be used for anemia, pregnancy and epilepsy.
• succession. Required: 2 tablespoons of chopped grass string; 500 g of boiling water. Pour boiling water over the string, insist for 12 hours, wrapped, then strain. Take 1/2 cup 3 times a day.
• Lovage (roots). Required: 5 g of dry crushed lovage roots; 300 g of boiling water. Pour the roots with boiling water, cook over low heat for 15 minutes from the moment of boiling. Insist for 3 hours, wrapped, then strain. Take 1 tablespoon 3 times a day half an hour before meals.
• Sabelnik (tincture). Required: 250 g of dry crushed cinquefoil root; 500 g of vodka. Sabelnik pour vodka, insist in a dark place for 3 weeks. Take 25 g 3 times a day before meals. The course of treatment is 2-3 months.
• Birch buds (ointment). Required: 1 glass of birch buds; 0.5 kg of fresh interior fat. Grind birch buds into powder and grind with fat. Put in the oven in a clay pot and simmer for 3 hours a day (in the absence of an oven - over low heat in a water bath) for 7 days. After that, pour the hot fat into jars. The ointment can be used for diseases of the joints, both rheumatoid and gouty.
• Flax (seeds). Required: 2 teaspoons of flax seeds; 1.5 cups of boiling water. Pour boiling water over flax seeds, cook for 15 minutes. Infuse for 10 minutes, shake and strain. Take 1 tablespoon 4-5 times a day. Prepare a decoction once a day.
• Aspen bark (tincture). Required: 1 part of the crushed inner bark of young aspen branches with leaves; 10 parts of 70% alcohol. Mix the ingredients, insist for a week, strain. Take tincture of 25-30 drops in water 3 times a day.
• Sage. Required: 100 g of sage; 6 liters of boiling water. Pour boiling water over sage and boil for 10 minutes. Let it cool down a bit. Pour 1-2 liters of decoction into a separate container to pour it into the basin during the procedure to maintain the temperature. Steam sore hands or feet in the resulting broth for 30-60 minutes 1 time per day before going to bed for 1-2 months. After the procedure, put on warm woolen gloves or socks and go to bed in them.
• apple tea. Required: 3-5 unpeeled apples; 1-1.5 liters of boiling water. It is necessary to pour slices of apples with boiling water, boil in a sealed container for 10 minutes. Then insist 4 hours. Take warm several times a day. Apples prevent the formation of uric acid, therefore, they can achieve a positive effect in diseases associated with the accumulation of uric acid salts in the body, including gout.
• Currant (leaves). Required: 1 tablespoon of crushed black currant leaves; 0.5 l of boiling water. Pour currant leaves with boiling water, insist for 2 hours, wrapped, then strain. Take 1/2 cup 4-5 times a day. Blackcurrant leaves have a strong diaphoretic and diuretic effect. They relieve the body of purine substances and excess uric acid, which are characteristic of gout.
• Hops (cones). Required: 1 tablespoon powdered hop cones; 1 tablespoon butter. Mix and grind ingredients. Use as a pain reliever.
• Lilac (flowers). Pour lilac flowers into a half-liter jar to the top, pour vodka, leave for 3 weeks in a dark place, then strain. Take 30 drops 3 times a day before meals. The course of treatment is 3 months. The same tincture can be used for rubbing and compresses.
• bee venom. We recommend that you go to a specialist for treatment with bee stings. Bee venom not only helps to relieve the patient, but also significantly strengthens his immunity.
• hot pepper. Required: 10 pods of bitter capsicum; the same amount of honey. Take 10 peppers and boil in 300 ml of water for 10 minutes (on low heat). Insist 5 hours. Strain and mix with the same amount of honey. Take 1 teaspoon 2 times a day. The medicine significantly increases the body's defenses in the fight against gout.
• cabbage or turnip. Raw cabbage leaves are recommended to be applied to sore spots to reduce pain. It is also recommended to apply turnips to sore spots - in the form of a boiled pounded mass.

Proper nutrition for gout

Healthy foods

It is necessary to eat as much as possible fresh strawberries, grapes, coleslaws.

Regularly consume juice and blackcurrant fruits.

The fruits and juice of apples prevent the further formation of uric acid in the body, which contributes to the deposition of salts in the joints.

Eat 100 g of carrots daily with 1 tablespoon of vegetable oil, which helps the body absorb vitamin A better.

Drink watermelon juice and eat the pulp.

What to exclude

Since gout develops as a result of a violation of purine metabolism, foods rich in "bad" purines, which as a result of metabolism are converted into uric acid (hypoxanthine, adenine, guanine and xanthine), should be excluded from the diet. The daily intake of purines in the treatment of gout should be in the range of 100-150 mg (daily intake for a healthy person is about 600-1000 mg).

Residents of the Maori people from New Zealand rarely suffered from gout. Nowadays, gout is diagnosed in 10-15% of the population. A strange thing: seafood is considered one of the provocateurs of gout. But the Maori have been eating seafood for centuries.

What has changed?

The amount of consumption of one product has changed. Today Maori people consume 50 times more than a hundred years ago.

Recent studies have shown that fructose inhibits the excretion of uric acid. This provokes an increase in the level of circulating uric acid and the deposition of its crystals in the joints and surrounding tissues.

Only the liver can metabolize fructose in the body. With an excess of dietary fructose, the liver does not have time to absorb it and numerous by-products and toxins are formed, including a decent amount of uric acid.

The liver increases its production of uric acid when it becomes inflamed and under nutritional stress.

And what foods are the enemies of the liver?

First of all, it is fructose and cheap.

In this regard, it becomes clear why alcohol aggravates the course of gout. After all, alcohol is toxic to the liver.

Foods containing gluten protein often join the company of enemies of the liver: wheat, rye and barley. The latter compromise the integrity of the intestinal epithelium and ultimately lead to inflammation of the liver.

Plus, it's a missing link. I would even say a tragic link. After all, the knowledge of practitioners is only enough to limit purines. And the pathogenesis of gout is much more complicated than the direct causal relationship of gout with purines.

For example, toxic liver damage

Animal proteins such as poultry, pork, lamb, white fish, cheese and eggs contain less purines.

Representatives of plant foods also contain purines, although in smaller quantities. These include mushrooms, peanuts, asparagus (asparagus), cauliflower, soybeans, legumes (especially peanuts, which are also legumes), and foods that contain yeast.

The theory of a direct link between purines and gout is undermined by a study that did not find a significant increase in the risk of gout when eating purine-containing vegetables. It is believed that this is due to the lower bioavailability of vegetable purines, as well as the presence in vegetables of compounds that neutralize the harmful effect of purines.

Do not discount the alkalizing effect of vegetables. Alkalis are known to neutralize acids.

Fruit is another matter. An abundance of fruits should not be present in the diet of gout patients. Especially sweet fruits. Indeed, in the latter a lot of fructose. And juices from sweet fruits are generally a concentrated solution of fructose. Sorry, but it's time to say goodbye to your morning glass of (liver toxic) orange juice.

And about all kinds of sweet drinks, such as Coca-Cola and Pepsi-Cola, you should forget if your liver is dear to you. FRUCTOSE IN LIQUID FORM, REGARDLESS OF ITS ORIGIN, IMMEDIATELY INCREASES THE LEVEL OF URIC ACID!

If suddenly you find high fructose corn syrup in the list of ingredients on the product packaging, then be sure that the manufacturing company does not care about your health, but about its own profits.

On the other hand, low-fructose fruits such as avocado, lemon, lime, grapefruit, and berries are quite suitable for a gout patient.

The principal recommendation for gout is to limit the amount of fructose to 25 grams per day. It is even wiser to limit the amount of fructose to 15 grams. After all, not everyone is guaranteed to avoid hidden sources of fructose from drinks and industrial products.

SUGAR AND GRAIN PRODUCTS SHOULD BE LIMITED IN THE DIET OF PATIENTS WITH GOUT.

Their place should be taken by antioxidant-rich vegetables, as well as natural fats. Recommended sources of fat are butter, coconut products, avocados, extra virgin olive oil, nuts and seeds.

Raw vegetables (if you tolerate them) enhance the effect of the treatment. It is not bad to bring the share of raw vegetables up to 80%. Vary your diet with salads, vegetable juices, seed sprouts, and sprouted crackers. Thermally processed vegetable dishes should be saved for the evening meal.

Fermented foods (sauerkraut, kefir, pickles, kimchi, coconut kefir) will also benefit a compromised digestive system.

WARNING:

switch to low fructose / should be gradual.

In the initial phase, the amount of acidic metabolic products increases. The kidneys give priority to excretion of the latter, and uric acid is in the queue for excretion and therefore temporarily lingers in the body. This condition can trigger an attack of gout. To save from an attack at the beginning of a low-fructose diet, a radical restriction of animal flesh products will also help.

Before we move on to the non-drug treatment of gout and its attacks, I would like the readers to grasp the main point:

DIETARY CREDO FOR THE TREATMENT OF GOUT: LIMIT SWEET AND ANIMAL FLESH.

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Sincerely yours:

, candidate of medical sciences - doctor, specialist in natural medicine

Once upon a time, only rich and noble people suffered from gout - the disease of kings. Indeed, the higher the standard of living of people, the more often it occurs.

It is known that during the war, in difficult economic conditions, this disease practically does not get sick.

Gout is 20 times more common in men than in women. The predominant age of the first diseased is 40-50 years. In children, gout is very rare, usually in cases of hereditary disorders of uric acid metabolism.

The disease was first described by Hippocrates, who called it a "foot trap" ("podos" - foot, "agro" - trap). The great healer believed that the causes of the disease lie in gluttony and alcohol abuse. Only in the nineteenth century, medicine established a connection between gout and high levels of uric acid in the blood, which is formed during the breakdown of proteins and is a white powder that is poorly soluble in water. If uric acid is formed more than normal or its excretion from the body is not enough, it begins to be deposited in the joints in the form of sodium monourate. The process of deposition of monourate in the tissues and causes an attack of gout. People who are prone to crystallization are especially susceptible to this.

gout classification

Clinically, there are three stages in the course of the disease:

• I - acute gouty arthritis;
• II - interictal gout;
• III - chronic tofus gout.

Acute attack of gout

As a rule, an exacerbation of gout begins suddenly at night, after a plentiful feast with the use of a large amount of meat and alcohol. The pay for a good time is truly terrible. The pain grows rapidly, the joint “fallen from the trap” turns red, swells, becomes hot to the touch. The patient does not find a place for himself, the slightest touch, even bed linen, to the affected joint is extremely painful ("a symptom of the sheet"). Body temperature may rise, chills occur. It seems to the unfortunate that a dog bites into his body with fangs and tears the tendons to pieces. An attack of gout can cover other joints, and after a few hours a person becomes almost immobilized. At first, such an attack can pass in a day or two, gout temporarily recedes only if a protein-free diet is followed and without any treatment, but after a while it will return again. Chronically proceeding, the disease affects the entire body, therefore, starting from the first metatarsophalangeal joint, gout gradually involves other joints with a similar picture of inflammation in the process. For example, gout of the knee joint is characterized by redness, swelling, pain, severe limitation of movement, effusion in the joint. When puncturing the joint in the synovial fluid, sodium urate crystals are detected.

tophus gout

One of the characteristic symptoms of gout is the formation of tophi - gouty nodules, which are local accumulations of urate crystals in the subcutaneous tissue. Tophi are localized on the hands - in the area of ​​the elbow and metacarpal joints, forearms, on the legs - in the area of ​​the Achilles tendons, over the joints of the feet, on the extensor surface of the thighs and legs, on the forehead, in the area of ​​the auricles, as well as on the internal organs, including the kidneys, heart, pericardium and blood vessels.

As a rule, gouty nodes are painless. Soreness can occur if nearby tissues are involved in the inflammatory process.

Currently, much attention is paid to the treatment of patients in the period between attacks, despite the fact that they feel normal. This is the insidiousness of gout, that even in the absence of acute symptoms, the metabolism of uric acid remains impaired and, without proper treatment, microtophi continue to form in the tissues. The disease, like a clever hunter, freezes in anticipation that the victim will break the diet or, for example, get injured. And having waited, he slams his hellish trap on the next joint even more diligently. But if only this. Much more terrible consequences of the disease are damage to internal organs, including the heart and kidneys. Chronic kidney failure, for example, can be fatal.

Diagnosis of gout

The diagnosis of gout is made in the presence of specific complaints and symptoms, laboratory data, radiography, positive dynamics in response to colchicine treatment. Unfortunately, in some cases, the patient's medical history may not describe arthritis characteristic of the disease, and gout is diagnosed at a late stage, when its consequences are identified: severe kidney damage and chronic renal failure.

Treatment

Treatment of gout should be comprehensive. First of all, it is a diet with the exclusion of foods that break down a large amount of uric acid: meat of young animals, fish, beans, peas, fish caviar, beer, etc. It is necessary to observe bed rest and take plenty of fluids to improve the excretion of urate from the body and prevent the formation of urate and oxalate kidney stones. In addition, the treatment of a patient diagnosed with gout involves the normalization of body weight, preferably under the supervision of a physician, in order to prevent rapid weight loss, which leads to excessive production of uric acid and gouty crises. Of the medications, the doctor may prescribe non-steroidal anti-inflammatory drugs, colchicine, in some cases glucocorticoids, and in the interictal period - allopurinol to maintain a normal level of uric acid in the blood.

In addition, much attention should be paid to changing the patient's lifestyle. This should be the focus of psychotherapy. It is quite difficult to work with such patients, because we are talking about changing habits and stereotypes of behavior. And the patient is ready to change only when he is in pain. The episodes of the acute manifestation of the disease are short enough to have time to rebuild your life and develop new habits, and even at the time of the attack, it’s not up to it. Therefore, only the joint work of the psychologist and the patient himself can bring results.

Diagnosis of gout

Currently, medicine has everything necessary for the diagnosis of gout. The diagnosis is made taking into account the patient's complaints, the history of the disease and life, visual examination data, laboratory diagnostics and other research methods.

Usually the patient complains of a sudden onset of acute pain in the joint, most often in the first metatarsophalangeal joint. As a rule, the strongest pain occurs at night, after a heavy feast and alcohol intake. The joint turns red, swells, becomes hot to the touch. The first attack is relatively quickly stopped. But over time, the effectiveness of anti-inflammatory drugs decreases, the interictal periods are reduced, other joints are involved in the process.

Seeing such a clinical picture, one can suspect that a person has an attack of gout, further diagnosis will confirm or exclude the diagnosis.

Tests for gout

In the general blood test during an attack, there will be an increase in the number of neutrophils with a shift to the left, an acceleration of ESR. Protein and oxalates may be present in the urine. A biochemical blood test will reveal an increase in the content of uric acid, seromucoid, sialic acids and some other indicators. Acicular crystals of uric acid salts are found in the synovial fluid.

Gout is characterized by a special x-ray picture: the formation of tophi in the tissues, the destruction of cartilage, the occurrence of marginal bone erosions. With gouty nephropathy, chronic renal failure can be detected. Not only for the treatment, but also for the diagnosis of gout, the drug colchicine can be used. The rapid effect of taking it in acute arthritis indicates the presence of this disease, because. the drug is very specific.

Diagnostic criteria

In 1961, the "Roman criteria" were adopted for diagnosis:

• History of an episode of sudden onset of acute arthritis, which passed in 1-2 days.
• The content of uric acid in the blood is above the level of 0.42 and 0.36 mmol / l, respectively, in men and women.
• The presence of tophi (gouty nodules).
• Detection of crystals of uric acid salts in tissues or synovial fluid.

The diagnosis of gout is made if the diagnosis revealed two or more of the above points.

The American Rheumatological Association has proposed 12 diagnostic criteria:

• Two or more acute attacks of arthritis in the past.
• Localization of inflammation in the first metatarsophalangeal joint.
• Unilateral lesion of the joints of the foot.
• Asymmetric swelling of the joint.
• Arthritis in one joint.
• Unilateral lesion of the first metatarsophalangeal joint.
• The peak of inflammation falls on the first day.
• Redness of the skin over the joint.
• The presence of tophi.
• Elevated levels of uric acid in the blood.
• The absence of any flora in the joint fluid.
• On radiographs, subcortical cysts without erosions.

The diagnosis is certain in the presence of six of the twelve signs, and/or in the presence of urate crystals in the synovial fluid and/or in the tophi.

Prevention of gout

Everyone knows that the disease is easier to prevent than to treat. Gout can be called a disease of eating behavior, so its prevention should first of all change the lifestyle of a person and his taste habits. First of all, it is necessary to limit the consumption of foods rich in protein (meat, fish, meat and fish broths, legumes, sorrel, cauliflower, etc.). You should also normalize body weight. This will help improve metabolism in general, and protein in particular, and will also significantly reduce the load on the joints of the legs during an attack of the disease. Rapid weight loss can cause an increase in uric acid in the blood and provoke an arthritic crisis. Therefore, weight loss should be gradual. Alcohol inhibits the excretion of uric acid from the body, thus increasing its content in the blood. It must be completely eliminated from use.

Preventive measures also include the following factors:

• increased motor activity;
• sufficient drinking regime;
• daily exposure to fresh air;
• limiting the use of coffee and tea;
• fight against nicotine addiction.

Prevention of gout should be directed not only to the patient himself, but also to close relatives, because it is quite difficult to change your own lifestyle if everything remains the same in the family.

The psychological status of the patient is of great importance. As a rule, people prone to gout have a cheerful, friendly and sociable temperament, high sexual activity, industriousness up to workaholism. An attack of gout puts a person to bed, and he suffers not only from pain, but also from forced inactivity, by any means trying to restore his working capacity as quickly as possible. He does not have time to change his lifestyle towards a healthy diet and the elimination of bad habits. Therefore, with gout, psychological methods of influence are used not only as a prevention, but also as a treatment. The patient's motivation for a healthy lifestyle comes to the fore.

Treatment of gout

Treatment of acute gouty arthritis and chronic gout different.

In gouty arthritis, mainly anti-inflammatory drugs are used.

Non-steroidal anti-inflammatory drugs (for example, indomethacin, naproxen, diclofenac, etc.) are prescribed until signs of acute inflammation in the joints are eliminated (usually for 1-2 weeks). Since an attack can happen at any time, a patient with gout should always have one of the drugs of this group with him. Non-steroidal anti-inflammatory drugs can cause stomach pain and heartburn, but these side effects usually do not occur with short-term use.

Glucocorticoids (hormones of the adrenal cortex and their synthetic analogues, such as prednisone) have a more powerful anti-inflammatory effect, so they are used for severe inflammation. If acute gouty arthritis has developed in one or two joints, glucocorticoids are injected directly into the joint. Usually one procedure is enough to effectively stop the attack. Intra-articular administration of drugs is carried out only by a rheumatologist. If more joints are affected, the doctor may prescribe glucocorticoid tablets for 7-10 days. They should only be taken as directed by a doctor. The use of these drugs in high doses for a long time can lead to brittle bones and cause other serious complications. When used correctly, glucocorticoids are safe and very effective.

During an attack, a painful joint needs rest. Ice can help relieve pain, which is applied for 5-6 minutes several times a day, wrapped in a cloth. Sometimes ice, on the contrary, increases pain (because it can increase the crystallization of uric acid salts). In this case, dry heat helps (for example, a warm shawl).

If attacks of gouty arthritis occur 2 times a year or more often, the doctor may decide to prescribe drugs that reduce the level of uric acid in the blood for an indefinitely long period. Properly selected treatment of the disease leads to a decrease in the frequency of arthritis attacks and the resorption of tophi. In addition, against the background of treatment, urolithiasis does not progress.

Like many centuries ago gout more often chooses a victim among people with a high standard of living. Here is a portrait of a typical "gouty": an active, pleasure-loving middle-aged man with a good income, often in a leadership position, very temperamental (usually choleric). Women get gout about 10 times less often.

Read more about the symptoms of gout.

Causes of gout

The "disease of kings" gout refers to metabolic diseases, its causes are a violation of the metabolism of purine bases: guanine and adenine - compounds that are part of the DNA and RNA of all living organisms, an increase in uric acid in the blood due to these disorders and a predisposition to crystal formation.

Uric acid is a white powder, poorly soluble in water. An increase in the concentration of uric acid in the blood leads to its deposition in the tissues in the form of salt - sodium monourate. The process of deposition of monourate crystals in tissues, including joints, causes an acute attack of the disease.

Other causes of gout include:

• hereditary predisposition;
• wrong way of life;
• other diseases (kidney disease, cancer, blood diseases);
• treatment with certain drugs (for example, diuretics, certain vitamins, chemotherapy for cancer);
• violations of other types of metabolism, in particular obesity;
• stress and more.

A visit to a sauna, a trip to hot countries (due to dehydration), a joint injury, and hypothermia can provoke an attack.

Improper lifestyle as a cause of gout includes:

• excessive irregular meals, with frequent feasts;
• eating foods rich in protein, especially meat;
• hypodynamia;
• alcohol abuse;
• workaholism.

It can even be said that, despite the hereditary factors and individual characteristics of the organism, gout is a disease of precisely the wrong lifestyle, the causes of which lie in the mind of a person, in his attitude both to himself and to the world around him. Therefore, an important component of the treatment of this disease is precisely the change in the habits and worldview of a person.

Diet for gout

One of the oldest and most effective treatments for gout is diet. Even Galen recommended people suffering from this disease, moderation in eating and limiting alcohol intake. Of course, with the help of a diet alone, it is unlikely that it will be possible to achieve normalization of protein metabolism, but even without following nutritional recommendations, it is difficult to count on the success of treatment.

It should be remembered that when cooking meat and fish, half of the purine bases contained in them pass into the broth. Therefore, meat and fish broths, jelly, sauces must be excluded from the diet.

Excess intake of proteins in the body leads to an increase in uric acid in the blood - the end product of their breakdown, which is an important link in the pathogenesis of this disease. Therefore, first of all, the menu for gout provides for the restriction of protein foods. The protein content should not exceed 1 g per 1 kg of the patient's body weight. The allowable amount of table salt is not more than 5-6 g per day. This means that you need to cook food without salt, and you can add a little salt already during the meal. The recommended amount of liquid is about 2-2.5 liters per day (if there are no contraindications from the heart and kidneys). Products for gout should contain a large amount of vitamins.

What not to eat with gout

• Offal (kidneys, liver, lungs, brains);
• meat of young animals (veal, lamb);
• fish: sprats, sardines, herring, pike;
• legumes, spinach, tomatoes, as well as foods rich in oxalic acid (sorrel, spinach, lettuce, eggplant, radish, rhubarb).

What can you eat with gout

• Dairy products (in limited quantities);
• eggs;
• bread;
• flour and sweet dishes in all forms;
• berries and fruits (especially lemons);
• greens and vegetables (except those included in the list of prohibited foods).

White fresh and sauerkraut has proven itself well. All kinds of salads, first and second courses are prepared from cabbage. Fresh leaves can be applied to swollen joints in the legs and arms as compresses to help reduce pain and inflammation. It is difficult for a person who is used to eating a large amount of meat to change his habits. Therefore, recipes for gout can be varied with soy products. "Steaks" and "entrecotes" from soy can satisfy the physiological craving for meat to some extent and at the same time replenish the protein reserves of the body.

For the treatment of gout, M.I. Pevzner proposed diet No. 6. Its chemical composition is as follows:

• Proteins - 79 g;
• fats - 79 g;
• carbohydrates - 409 g;
• energy value - 2739 calories.

Dishes for gout are steamed, or the products are used in boiled form.

If the patient is obese, it is recommended to spend the so-called fasting days once a week. Normalization of body weight is one of the main tasks of diet therapy for this disease. The menu of such a fasting day may consist of:

• 1200-1500 kg of apples;
• 1500 kg of watermelon or melon;
• 400 g of cottage cheese and 500 ml of kefir;
• 1500 g fresh cucumbers, etc.

There may be many recipes. The main thing is that the one-day diet does not contain prohibited foods, but consists of 1-2 allowed ones.

Nutrition for gout during an attack should be even more strict. Abundant intake of fatty and meaty foods, flavored with alcohol, can lead to an gouty crisis. During the period of a vivid manifestation of the disease, the main principle of the diet is the maximum unloading - a hungry day. On such a day, the patient should receive a sufficient amount of liquid (mineral water, vegetable and fruit juices, especially lemon juice with water). You can’t eat anything during the day, and the next day a regular anti-gout diet with a high content of vitamins is prescribed (mainly dishes from vegetables and fruits).

Treatment of gout with folk remedies

Sometimes a gout attack occurs when it is not possible to immediately consult a doctor. You can try treatment with folk remedies, of which there are many.

Gout is successfully treated with bee products. A good effect is the introduction of bee venom into acupuncture points, as well as points corresponding to the meridian of the bladder along the spine from the side of the affected joint.

Folk recipes for the treatment of gout are aimed at freeing the body of excess uric acid, reducing inflammation in the affected joint and normalizing metabolism.

To reduce the concentration of uric acid in the blood, various herbs are used in the form of decoctions, infusions and juices:

• Cowberry;
• birch drooping;
• nettle nettle;
• lilac;
• tansy;
• sequence and others.

For the same purpose, you can use eggplant.

Herbal treatment is also used to relieve inflammation in the joints.

• Calendula flowers are crushed, poured with vinegar and iodine. The growths on the joints are lubricated with the bile of poultry, and then wiped with the resulting rubbing.
• 200 g of sage insist in one and a half liters of boiling water, used for bathing.
• 300 g of chamomile is poured with five liters of boiling water. Two hours later, the resulting solution is poured into a basin and the foot with the affected joint is lowered there for 20-30 minutes.

A known method of treatment with bees. A glass of dead bees (dead dried insects) is infused in a liter of vodka in a dark place for two weeks. Strain and rub sore spots.

Treatment of gout with honey

Honey is widely used to treat the disease.

• A couple of teaspoons of honey are added to a glass of decoction of lingonberry leaves and taken orally 3 times a day.
• Insist 600 ml of white wine, 300 g of onion gruel and half a glass of honey for 2 days. Use 1 tbsp. l. 3 r / d.
• Dried and powdered duckweed is mixed with honey and made into pills. Take one 3 times a day.
• 200 g of garlic, 500 g of cranberries, 300 g of onions insist for a day, add a kilogram of honey. The mixture is taken 3 r / d before meals for a teaspoon.

Treatment with honey is usually carried out within one to two months.

Gout recedes with the combined treatment of bee products with medicinal herbs.

Treatment of gout with iodine

Iodine has long been used to treat gout. Take a bottle with 10 ml of iodine and add 5 aspirin tablets there. The resulting solution, which becomes colorless, lubricates the affected areas before going to bed and put on warm socks or gloves at night.

You can try to cure gout at home with iodine foot baths. To do this, add 3 teaspoons of baking soda and 9 drops of iodine to three liters of water. Baths are taken at bedtime for one and a half to two weeks.

Gout has been known since ancient times, so traditional medicine has accumulated a lot of ways to deal with this scourge. Folk recipes for gout include treatment with cereal straw and activated charcoal, iodized salt and lard, onion soup and propolis. It is said that gout can be cured in two weeks by making fresh fish compresses at night. Also, diseased joints can be treated with the following ointment: butter warmed to foam is poured with alcohol in a 1: 1 ratio. Alcohol is set on fire, and when it burns out, the ointment is ready.

Since ancient times, gout and rheumatism have been treated at home with apple cider vinegar, which is taken in the morning mixed with honey and boiled water. Lemons and garlic passed through a meat grinder are also mixed. The mixture is poured for a day with boiled water and taken every morning for a quarter cup.

One of the popular methods is the treatment of gout with the help of millet, ground into flour, brewer's yeast and table salt. A mixture of these products is spread on a cloth and compresses are made on the legs, changing the dough after two hours. At the same time, be sure to stay warm.

Treatment of gout with folk methods does not cancel official medicine, diet, lifestyle changes. Only complex treatment can give positive results.

Complications of gout

Being an metabolic disease, gout can be very insidious and lead to serious complications. The most formidable of them is kidney damage. Unfortunately, sometimes it is gouty glomerulosclerosis and the presence of urate kidney stones that make it possible to diagnose royal disease. The severity of kidney damage determines the prognosis. In 20% of cases, renal failure developed against the background of the disease leads to death. Arterial hypertension of nephrogenic origin occurs in 40% of patients. Urolithiasis disease with the formation of X-ray negative urates in the kidneys occurs in about 20% of cases.

Complications of gout are also manifested by gradually developing osteoporosis, the appearance of tophi in various tissues. Tophi are local accumulations of sodium monourate. Most often they occur in the skin of the fingers, in the area of ​​the feet, knee and elbow joints, on the wings of the nose and auricles, as well as in the internal organs: the kidneys, on the heart valves, in the walls of blood vessels, in the pericardium.

Consequences of gout

If the first attacks of gout pass quickly and easily, then in the future, in the absence of adequate treatment, it becomes increasingly difficult to cope with them. One of the main points of treatment is to reduce the level of uric acid in the blood. If this is not achieved, then the joints, due to the deposition of urates, will become more and more deformed, other joints will become involved over time, a tophi form of gout will form, and arthritis will become chronic. At the same time, it must be remembered that tophi occur not only in the joints, but also in other tissues, which can lead to dysfunction of various organs and their systems. Therefore, one should not wait for the consequences of gout, it is necessary to be treated not only correctly, but also on time.