Treatment of gout provides a differential strategy depending on the stage of the disease (acute attack or interictal period, chronic form).

Gout therapy.

Gout therapy consists of relieving an attack of arthritis and measures in the interictal period (prevention of repeated exacerbations of articular syndrome, treatment of extra-articular manifestations of gout - gouty tendinitis, myositis, gouty nephropathy, etc.). There are 3 main tasks in the treatment of this disease:

1. stop an acute attack of gout as quickly as possible;
2. prevent its relapse;
3. prevent or reduce the manifestations of chronic gout (primarily the formation of tophi and kidney stones).

Successful treatment of gout is possible only with the joint efforts of the doctor and the patient. One of the important components of success is the patient’s adherence to the diet.

Therapeutic nutrition for gout.

For gout, therapeutic nutrition is prescribed within table No. 6. This diet involves excluding foods containing large amounts of purines (200 mcg), limiting the consumption of salt (5-8 g), fats (fats have a hyperuricemic effect); the total protein content is normal, but with a reduced quota of animal proteins (the ratio between plant and animal proteins approaches 1:15); sufficient amount of vitamins.

The diet includes alkaline mineral waters and citrus fruits to enhance the removal of urates from the body. Food is given to the patient in uncut form, steamed or boiled in water. Vegetables and fruits are consumed raw, boiled or baked.

The total amount of free fluid increases to 2.5 l, if there are no contraindications from cardiovascular system. It is recommended to take the liquid in the form of tea, cranberry juice, juices, alkaline mineral waters.

The diet is split, 5-6 times a day in small portions, drinking in between meals.

• Bread and flour products: wheat, rye bread, limited to puff pastry and pastry products.
• Meat and poultry: low-fat varieties, no more than 1-2 times a week in boiled form. Boiling meat and poultry leads to the transfer of up to 50% of the purines contained in the products into the broth.
• Fish: low-fat varieties, 1-2 times a week, boiled.
• Dairy products: milk, kefir, yogurt, cottage cheese, sour cream, mild cheese.
• Fats: butter, vegetable oil.
• Cereals: any in moderation.
• Vegetables: any culinary processing, salted and pickled vegetables are limited.
• Fruits and sweet dishes: any fruits and berries, fresh and in any culinary preparation; creams, jelly, marmalade, marshmallows.
• Drinks: weak tea, juices, fruit drinks, kvass, rose hip decoction, alkaline mineral waters.

Prohibited: liver, kidneys, brains, tongue, smoked meats, canned food, fatty, salted, smoked fish, canned fish, meat, fish, chicken, mushroom broths, beef, pork and cooking fat, legumes, sorrel, spinach, figs, chocolate , cocoa, strong tea, coffee.

When gout is combined with obesity, hypocaloric table No. 6e is prescribed (the amount in the diet is reduced bakery products, cereals, easily absorbed carbohydrates, fats).

Medication relief of gout attack.

To relieve an acute attack of gouty polyarthritis, it is used colchicine- a colchicum preparation, which is a powerful phosphatase inhibitor and inhibits the processes of cell division. It is recommended to strictly adhere to the following rules when using colchicine (Wallace S., Singer J., 1984):

• a single dose should not exceed 2 mg, and the total dose should not exceed 4 mg (first, 1 mg of colchicine dissolved in 20 ml of isotonic sodium chloride solution is administered over at least 10 minutes);
• if the patient received colchicine orally the day before, this drug should not be used intravenously; after intravenous administration full dose Colchicine should not be used in any form for at least 7 days;
• in the presence of kidney and liver disease, the dose of colchicine should be reduced (by 50% if creatinine clearance is below 50 ml/min). If this indicator is below 10 ml/min, colchicine is not used. In elderly patients, it is advisable to study creatinine clearance before intravenous colchicine use;
• Precautions should be taken to avoid the risk of colchicine getting into nearby tissues. The onset of action of intravenously administered colchicine is observed within 6-12 hours.

There are several regimens for using colchicine:

1) orally 0.5 mg every hour until arthritis subsides or until maximum permissible dose- 6 mg;

2) 1.0 mg orally every 3 hours until the maximum permissible dose is reached - 10 mg;

3) safer scheme:

Day 1 - colchicine orally 1 mg 3 times a day after meals;

Day 2 - 1 mg in the morning and evening, then 1 mg per day.

Improvement usually occurs within 12 hours from the start of treatment. The effect of colchicine is extremely specific for gout (in no other arthritis does the drug have such a relief effect as in gout). The drug is effective in 90% of patients. Most often, the lack of therapeutic effect is due to late use of the drug.

Colchicine causes side effects from the gastrointestinal tract (diarrhea, nausea, and less commonly, vomiting), as a result of which it is necessary to reduce the dose or even discontinue the drug. Diarrhea can be persistent and painful, and to prevent it, bismuth preparations are prescribed simultaneously with colchicine.

Absolute contraindication for the prescription of colchicine is a combination of renal and hepatic failure, a pronounced decrease in glomerular filtration and extrahepatic biliary obstruction.

With long-term treatment of gout with colchicine, anemia and leukopenia may develop..

The toxicity and frequency of side effects of NSAIDs, which are also used to treat gout attacks, are significantly lower. Widely used in clinical practice found drugs of the pyrazolone (butadione, reopirin, ketazol, phenylbutazone) and indole (indomethacin, methindol) series.

To relieve acute gouty arthritis, NSAIDs are used in large doses, but even with this use they are better tolerated than colchicine. Moreover, in case of development side effects or intolerance to one of these drugs, it can be replaced with others, and a more pronounced therapeutic effect is often achieved.

Voltaren is widely used to relieve gout attacks, which is prescribed on the first day at 200 mg, and then at 150 mg/day. The advantage of the drug is its good tolerability and increased clinical effect as the dose increases. Voltaren can also be administered intramuscularly, 3 ml 1-2 times a day, which is especially important when concomitant diseases gastrointestinal tract. The use of prolonged forms of drugs is very effective: voltaren-retard, methindol-retard, etc.

In terms of safety, taking into account the development of side effects, especially from the gastrointestinal tract, preference is given to selective COX-2 inhibitors (nimesulide, meloxicam).

Good effect The use of GCS during an acute attack has been known for a long time, this method is considered safe and is indicated when it is impossible to use NSAIDs or colchicine due to intolerance to these drugs, the presence renal failure, ulcerative lesions of the gastrointestinal tract. Their parenteral administration is most effective. D. Werlen (1993) showed that the effect of their administration is rapid and persistent, even when using single intramuscular doses (7 mg of betamethasone). The drugs are well tolerated, the frequency of adverse reactions is low, and isolated cases of transient hyperglycemia are possible.

GCS can be used in the following options:

1. prednisolone 40-60 mg on the first day (tablet form), followed by a dose reduction of 5 mg every other day;
2. triamcinolone IM 60 mg, repeat administration after 24 hours if necessary;
3. methylprednisolone IV 50-150 mg, and also in severe cases in the form of small pulse therapy: once 250-500 mg;
4. periarticular or intra-articular (with mandatory exclusion septic arthritis) administration of GCS (diprospan, hydrocortisone).

Treatment of chronic gouty arthritis.

In long-term therapy of gout, to prevent repeated attacks of polyarthritis, it is necessary to achieve a decrease in plasma uric acid levels. Antigout (long-term, basic) therapy is carried out in patients with frequent (3-4 times a year) attacks of arthritis and especially with chronic tophi gout and nephrolithiasis. Important indications for starting therapy for gout are also persistent hyperuricemia, even with a history of one attack of arthritis, or a reduction in the intervals between attacks.

There are currently two groups in use medicinal substances: uricosuric drugs that increase the excretion of uric acid by the kidneys, and uricodepressive drugs that reduce its synthesis.

Allopurinol(hydroxypyrazolopyrimidine, milurite) inhibits the enzyme xanthine oxidase, as a result of which the conversion of hypoxanthine into xanthine and further into uric acid. Its content in the blood decreases, and uricosuria decreases at the same time, so there is no risk of the formation of urate stones in the urinary tract. The drug can also be used in the presence of renal pathology (but without severe renal failure). The allopurinol metabolite oxypurinol also inhibits xanthine oxidase.

Indications for the use of allopurinol are:

• reliable diagnosis of chronic gouty arthritis;
• hyperexcretion of uric acid (more than 800 mg/day - without diet and more than 600 mg - on a low-purine diet);
• kidney damage with a decrease in creatinine clearance below 80 ml/min:
• formation of tophi in soft tissues and subchondral bone;
• nephrolithiasis;
• a persistent increase in uric acid levels of more than 13 mg% in men and more than 10 mg% in women;
• contraindications to the use of uricosuric drugs;
• carrying out cytotoxic therapy or radiotherapy for lymphoproliferative diseases;
• gout not controlled by uricosuric agents and colchicine, manifested by prolonged attacks or uncontrolled hyperuricemia;
• identifying signs of gouty nephropathy.

Allopurinol is available in tablets of 0.1 and 0.3 g.

It is necessary to adhere to the following basic principles when treating gout with allopurinol:

1. It is not recommended to start therapy with allopurinol in the presence of an acute articular attack; it is necessary to stop the articular syndrome. If an attack develops during allopurinol therapy, then you can reduce the dose and not completely stop the drug.
2. To prevent acute attacks of arthritis, which sometimes occur at the beginning of taking the drug, and the occurrence of allergic and severe adverse reactions, it is recommended to start therapy with a small dose (usually 100 mg per day). A reflection of the correct selection of the dose of the drug is the rate of decrease in the level of hyperuricemia no more than 0.6-0.8 mg% or 0.1-0.6 mg/dl, or 10% of the initial figures within 1 month. therapy.
3. To prevent an acute attack of gout, low doses of colchicine or NSAIDs may be used when starting allopurinol.
4. When allopurinol is discontinued, uric acid levels increase rapidly (within 3-4 days).
5. It should be remembered that during an attack of arthritis, the level of uric acid is usually lower than in the inter-attack period, so repeated studies of its level are required after the arthritis has stopped.

The initial dose of the drug is 50-100 mg/day, then daily the daily dose is increased by 100 mg and adjusted to 200-300 mg for mild forms of the disease and to 400-500 mg for severe forms of the disease. moderate severity and heavy.

The level of uric acid in the blood begins to decrease on the 2-3rd day and reaches normal numbers on the 7-10th day. As uricemia decreases, the dosage of allopurinol is reduced; stable and complete normalization of uricemia usually occurs after 4-6 months, after which a maintenance dose of allopurinol is prescribed - 100 mg/day.

A decrease in the intensity of attacks, softening and resorption of tophi is observed after 6-12 months. continuous treatment with allopurinol. After prolonged treatment, chronic joint manifestations may completely disappear. Treatment with allopurinol continues for many years, almost continuously.

The drug does not have a noticeable effect on gouty nephropathy. In case of insufficiency of renal function, the dose of allopurinol is determined in accordance with the clearance of creatine: for clearance values ​​of more than 60 ml/min, 200 mg/day is sufficient; for clearance values ​​of less than 40 ml/min, the daily dose should not exceed 100 mg. When creatinine clearance decreases below 10 ml/min, allopurinol intake is limited to 100 mg for 3 days. The use of higher doses may worsen chronic renal failure. This is due to the fact that allopurinol blocks purine breakdown to xanthine, the level of the latter in the blood and urine increases many times, and xanthinemia and xanthinuria can have harmful effects on the kidneys.

Allopurinol is well tolerated, in rare cases Possible side effects:

• allergic reactions (itching, skin rashes, allergic edema Quincke, vasculitis);
• dyspeptic symptoms;
• increased body temperature;
• acute renal failure;
• agranulocytosis;
• Steven-Johnson syndrome.

During treatment of gout with allopurinol, it is necessary to ensure diuresis within 2 liters and a slightly alkaline urine reaction to avoid the formation of xanthine stones (when urine is alkalinized, hypoxanthine and xanthine remain dissolved).

Contraindications to the use of allopurinol:

• severe liver dysfunction,
• hemochromatosis,
• pregnancy,
• children's age (except malignant diseases with hyperuricemia).

Clinically significant drug interactions allopurinol with other drugs:

• when combined with cyclophosphamide, bone marrow suppression is aggravated;
• with simultaneous administration of azathioprine - potentiation of immunosuppressive and cytolytic effects;
• when taken in combination with ampicillin, the frequency of skin rashes increases.

Thiopurinol- allopurinol derivative in tablets of 0.1 g.

The drug inhibits the synthesis of uric acid, inhibits glutamine phosphoribosyltransferase, is as active as allopurinol, but is much better tolerated by patients. Used in a daily dose of 300-400 mg.

Uricosurige drugs have the property of reducing tubular reabsorption of urate, resulting in increased excretion of uric acid by the kidneys.

Indications for use:

• renal (hypoexcretory) type of gout in the absence of severe gouty nephropathy;
• mixed type of gout with daily excretion of uric acid less than 2.7 mmol (less than 450 mg).

When treating gout with uricosuric drugs, the following must be taken into account. The main way to increase the excretion of urate by the kidneys is to increase diuresis. With high diuresis, the concentration of urates in the urine decreases and their tendency to crystallize decreases. Minute diuresis also increases, which contributes to an increase in urate clearance. In addition, to enhance the excretion of urates, it is necessary to alkalize the urine (for example, by taking 1 teaspoon of sodium bicarbonate daily in the morning).

Thus, to enhance the removal of urates from the body, it is necessary to take a sufficient amount of fluid (at least 2-2.5 liters per day) and alkalize urine using sodium bicarbonate and alkaline mineral waters.

Probenecid(benemide) is a derivative of benzoic acid, an analogue of phenylbutazone. Initially, it is prescribed at a dose of 0.5 g 2 times a day; later, depending on the magnitude of hyperuricemia, the dose can be increased, but not more than 2 g/day. The most commonly used daily dose is 1-2 g. Daily dose 1 g increases the excretion of uric acid in urine by an average of 50% and reduces uricemia. The drug should be used long-term, for a number of years.

Benemide is well tolerated, but in some cases, dyspeptic symptoms and allergic reactions (skin reactions, itching, fever) are possible.

Long-term treatment of gout with benemide is not recommended for moderate and transient hyperuricemia, reduced glomerular filtration (less than 30 ml per minute), and frequently recurring articular crises.

Benemide is contraindicated in chronic renal failure, pregnancy, hyperuricosuria (800-1000 mg per day).

Anturan(sulfinpyrazone) - available in tablets of OD g, administered orally in a daily dose of 0.3-0.4 g (in 2-4 doses) after meals, preferably washed down with milk. The uricosuric effect lasts about 8 hours. Salicylates weaken the effect of anturan. The drug is well tolerated, but exacerbation is possible chronic diseases stomach and duodenum.

Anturan also has an antiaggregation effect.

When treating gout with anturan, you must take at least 2-2.5 liters of alkaline liquid per day.

Contraindications to the use of Anturan:

• peptic ulcer of the stomach and duodenum,
• hypersensitivity to pyrazolone derivatives,
• severe damage to the liver and kidneys.

Benzobromarone(desuric) has a strong uricosuric effect due to inhibition of the absorption of uric acid in the proximal renal tubules. In addition, the drug inhibits enzymes involved in the synthesis of purines. Under the influence of benzobromarone, the secretion of uric acid through the intestines also increases.

The drug is available in tablets of 0.1 g, prescribed with meals, starting from 0.05 g (1/2 tablet) 1 time per day, if the urate level in the blood is not sufficiently reduced - 1 tablet per day.

Benzobromarone is well tolerated; in some cases, dyspeptic symptoms, allergic skin reactions, and diarrhea are possible. In the first days of treatment, joint pain may intensify; in these cases, NSAIDs should be taken.

When treating gout with benzobromarone, you must drink at least 2 liters of alkaline liquid per day to prevent the deposition of stones in the urinary tract.

Contraindications to the use of benzobromarone are severe liver and kidney damage.

Hipurik- micronized benzobromarone in tablets of 0.8 g. Treatment is carried out in the same way as benzobromarone.

Losartan- angiotensin II antagonist. IN recent years it was shown that ACE inhibitors increase the excretion of uric acid. M. Nakashima (1992) found that the uricosuric effect of losartan is dose-dependent and reduces serum uric acid levels.

Using a test system, it was found that losartan acts on the urate/lactate and urate/chloride exchange systems. The IC50 of losartan for these two metabolic systems is much lower than that of probenecid, indicating that losartan has a much stronger affinity for these urate metabolic systems than probenecid and is a potent inhibitor of urate reabsorption.

On average, the expected reduction in serum uric acid levels during treatment with losartan is 1 mg/dL (60 µmol/L), i.e. 10-15% at a dose of losartan 50 mg per day (Wurzner G., 2001).

Allomaron- combination drug, containing 100 mg allopurinol and 20 mg benzobromarone; inhibits the synthesis of uric acid and increases its excretion in the urine. The combination of two drugs in allomaron - a uricodepressant and a uricoeliminator - reduces the risk of side effects of allopurinol and eliminates the risk of kidney stones.

Allomaron effectively reduces the synthesis of uric acid, due to which its excretion remains within normal limits (despite the use of benzobromarone in the drug). In this regard, no precautions are required ( drinking plenty of fluids, alkalinization of urine), necessary when carrying out therapy with uricosuric drugs to prevent the formation of stones.

With severe uricemia, the dose is increased to 2-3 tablets per day. Patients with nephrolithiasis should be advised to drink plenty of fluids and alkalinize their urine during the first 10-14 days of treatment with allomaron.

The use of allomaron allows you to achieve greater reduction uric acid levels than monotherapy with allopurinol (100 mg/day) or benzobromarone (20 mg/day). Allomaron at a dose of 1-3 tablets per day ensures normalization of uricemia within 3-4 weeks. in most patients with gout and hyperuricemia. Treatment lasts 3-6 months. and longer.

Allomaron is used for gout, hyperuricemia of any origin and to prevent relapses of arthritis, as well as for kidney damage and the formation of tophi.

Contraindications to the use of allomaron:

• pregnancy and lactation;
• increased sensitivity to the drug;
• age up to 14 years;

Allomaron is well tolerated. In rare cases, it causes allergic reactions, dyspeptic disorders, and a decrease in the number of leukocytes and platelets in the blood.

Local application medicines for gout.

It is advisable to use local (on the joints) applications of anti-inflammatory ointments (Dicloran, Fastum, Dollit, Voltaren, etc.). To relieve a gouty attack, compresses with a 50% dimexide solution are used, which has a pronounced analgesic and anti-inflammatory effect (applications consist of 1 tablespoon of a 50% dimexide solution, 1 tablespoon of water and an ampule of analgin or novocaine; applied as a compress for 30-40 minutes ). The course is 10-20 procedures.

Physiotherapeutic treatment in the acute period of gout is limited.

Ultraviolet irradiation joint in an erythema dose, started as early as possible, before the appearance of swelling and redness of the joint, sometimes allows you to interrupt the beginning attack.

Use phonophoresis with calcium, diphenhydramine; iontophoresis with lithium; reflexology, acupressure, transcranial stimulation of opioid structures.

Physiotherapeutic treatment in the inter-attack period of gout includes diathermy, mud and paraffin applications. Phonophoresis with hydrocortisone has a pronounced anti-inflammatory effect. Hydrocortisone received through the procedure, due to its immunosuppressive effect, helps to weaken the inflammatory process, enhance local blood and lymph circulation, and accelerate the removal of urate crystals from the affected tissues. Phonophoresis with hydrocortisone also helps improve kidney function, remove urate from the body and reduce its level in the blood. The course of treatment is 6-8 procedures.

Thermal therapy (applications of mud, paraffin, ozokerite, combination of mud applications with inductothermy) contributes to a significant improvement in joint function, reduces pain and inflammatory processes in the periarticular tissues, and reduces the urate content in them.

Thermal treatment of gout is especially effective when chronic gouty polyarthritis is combined with osteoarthritis, and with joint deformities. The course of treatment is 6-8 procedures.

In complex treatment, it is advisable to carry out balneotherapy, use radon, hydrogen sulfide, iodine-bromine sodium chloride baths.

Balneotherapy for patients with gout is carried out in the inter-attack period. Balneotherapy helps improve the microcirculation system, have a uricosuric effect, improve trophism of tissues and synovial membranes, and improve blood supply to the tissues of affected joints. This in turn helps remove uric acid salts from the synovial membranes and tissue depots. Under the influence of balneotherapy, inflammation in the joints decreases, the activity of lysosomal enzymes decreases, the functionality of the liver and kidneys increases, and the indicators of purine and lipid metabolism improve.

Radon baths for gout.

Main active factor When taking radon baths, a-radiation is generated. Radon enters the body through the skin and lungs, which causes internal irradiation of the body. The decay products of radon are deposited on the patient’s skin, and an active plaque is formed, causing external irradiation of the skin. Radon baths normalize uric acid metabolism, improve liver function, have a beneficial effect on lipid metabolism, normalize blood pressure, and improve blood circulation in the tissues of affected joints. Radon baths have an analgesic, sedative, and anti-inflammatory effect. Radon baths are prescribed with a radon concentration of 1.5 kBq/l, a temperature of 36-37 ° C, lasting 10-15 minutes for two days in a row followed by a break day or three days in a row, 4 or 5 baths per week; course of treatment - 12-14 baths.

Hydrogen sulfide baths for gout.

The specific effect of these baths is due to hydrogen sulfide, which enters mainly through the skin. Hydrogen sulfide has a positive effect on the liver, which affects the state of purine and other types of metabolism. Hydrogen sulfide baths enhance microcirculation, trophic processes in joint tissues, improve cartilage nutrition, reduce the level of uric acid in the blood, and have a uricosuric effect. Hydrogen sulfide baths are prescribed with a concentration of 50-100 mg/l, temperature 36-37 ° C, duration 10-15 minutes, two days in a row followed by a day off; course of treatment - 10-12 procedures.

Contraindications to hydrogen sulfide baths for gout are:

• acute attack of gout;
• phase of incomplete remission;
• impaired renal and liver function;
• chronic hepatitis;
• cholelithiasis and urolithiasis.

Iodine-bromine sodium chloride baths for gout have an effect on the body through skin receptors. The trace elements iodine and bromine, forming a depot in the skin, partially penetrate into the humoral environment of the body. Being part of various enzyme systems, they influence metabolic processes. Sodium chloride, which is the main mineral component of iodine-bromine chloride-sodium baths, promotes the penetration of iodine and bromine into the body. Iodine-bromine baths have a positive effect on the nervous, cardiovascular, sympathoadrenal and pituitary-adrenal systems, stabilize hepatocyte membranes, improve kidney function, increase urate excretion, reduce the level of urate in the blood, and normalize lipid metabolism. Iodine-bromine baths, having anti-inflammatory, antitoxic and bactericidal effects, promote rapid cleansing and scarring of tophi, and are well tolerated by patients. Patients' pain quickly subsides, tophi decrease, and signs of inflammation decrease.

Iodine-bromine baths are indicated for patients with gout in remission, as well as when gout is combined with stage 1-2 hypertension, obesity, urolithiasis, coronary artery disease no higher than class II without heart rhythm disturbances. Iodine-bromine baths are prescribed with a sodium chloride content of 20 g/l, iodine - 10 g/l, bromine - 25 g/l; bath temperature - 37 °C, procedure duration - 10-15 minutes, two days in a row followed by a day off. If baths are well tolerated, patients are given 5 baths per week, for a course of treatment 10-12 baths.

Iodine-bromine baths in combination with hydrocortisone phonophoresis are used to treat gout in the phase of incomplete remission; hydrocortisone phonophoresis in this case reduces the risk of exacerbation during treatment, reduces the activity of inflammation and improves functional state joints.

Methodology complex treatment gout using hydrocortisone phonophoresis (on the affected joints) and iodine-bromine sodium chloride baths: hydrocortisone phonophoresis (UZT-1 device) with a frequency of 880 kHz is prescribed to the area of ​​the affected joints in a continuous mode with an intensity of 0.4-0.7 W/cm2 (labile technique ) 5 minutes for each field (no more than two joints per day) daily. The course of treatment is 12 procedures.

This method of complex treatment of gout is also used for gout-related obesity, spinal osteochondrosis, urolithiasis.

Spa treatment is prescribed to patients with gout in remission with preserved functional ability of the joints. The main therapeutic factors are balneotherapy, mud therapy, drinking alkaline mineral waters, and nutritional therapy.

Physiobalneotherapy in sanatoriums and resorts is carried out against the background of ongoing treatment with anti-gout drugs.

Efferent methods of treating gout.

Currently, in the treatment of various pathological conditions of gout, methods of extracorporeal hemocorrection are widely used, which are more effective in purifying the blood of various toxins and toxic substances. When treating gout, it is preferable to use plasma exchange with extracorporeal modified autoplasma(POEMK). This method was developed based on cryoplasmasorption technology. Plasma is obtained by performing hardware plasmapheresis. Indications for POEMK:

• development of resistance to drugs that relieve articular gout attacks;
• intolerance or poor tolerability of basic therapy drugs;
• steadily progressing course of gout;
• progressive gouty nephropathy.

Patients with gout undergo plasmapheresis - 3-4 sessions every 6 months.

When performing POEMK, it is necessary to take into account the type of dyslipidemia. Thus, the use of POEMK for isolated elevated levels of triglycerides and very low-density lipoproteins (VLDL) is inappropriate. It should be borne in mind that in familial hyperlipidemia (type lib or IV), plasma freezing and cryoprecipitate formation may worsen due to increased triglyceride levels. This significantly reduces the efficiency of removal of cholesterol and low-density lipoproteins (LDL) during plasma exchange.

Evaluation of the effectiveness of therapy is determined by a decrease in the level of uric acid in the blood serum, a decrease in the frequency of gout attacks, resorption of tophi, the absence of progression of urolithiasis, and a decrease in the need for NSAIDs, colchicine, and corticosteroids.

Prognosis for gouty arthritis generally favorable. The following are considered unfavorable prognostic factors for gout:

• development of the disease before the age of 30 years;
• persistent hyperuricemia more than 0.6 mmol/l;
• persistent hyperuricosuria more than 1100 mg/day;
• the presence of urolithiasis in combination with a urinary tract infection;
• progressive nephropathy, especially in combination with diabetes mellitus and arterial hypertension.

Urolithiasis develops in 20-50% of cases, and renal failure is the cause of death in 18-25% of cases.

Joint diseases
V.I. Mazurov

Gout is a condition in which excessive accumulation of uric acid metabolic products occurs in the body. Now there are quite a few that help improve the condition of this disease. But one of the best complementary treatments for the disease is therapeutic diet, which should not be neglected. Today we will tell you what it includes, what foods you can and cannot eat if you have gout.

To achieve a quick therapeutic effect, patients with gouty arthritis are prescribed appropriate dietary food. Thus, there are cases where only a strict diet for gouty lesions of the joints or kidneys gave a good therapeutic effect. This can be explained by the fact that dietary nutrition for gout limits the intake of exogenous purines, which has a beneficial effect on the level of these compounds in the blood serum and their content in tissues.

A strict diet for gouty arthritis does not mean strict fasting either during an attack of the disease or in the inter-attack period.

Proper nutrition is an important element of treatment

In the case when increased level uric acid may be detected in a person by chance, he should adhere to the diet that is recommended for patients suffering from gout.

Compliance with this rule allows you to several times reduce the likelihood of developing an attack of the disease and prevent massive deposition of purine compounds in the tissues of the body.

Basic principles of nutrition:

• It is important to eat regularly and divide the entire daily diet into 3-4 meals - in this case, peak surges in the concentration of purine bases in the blood serum can be avoided.
• Overeating (it provokes excess weight in the patient) and fasting is unacceptable.
• It is necessary to reduce body weight, but gradually, no more than 1-2 kg per month.
• During the day, the patient should receive a sufficient amount of fluid - at least 1.5-2 liters during remission and 3 liters when an exacerbation occurs.
• Be sure to use alkaline mineral water - alkalization of the blood helps remove urates from the body.

Fasting is a prohibited element of treatment

Some patients, during an exacerbation of gouty arthritis, completely unjustifiably decide to use fasting, trying to “cleanse” their body of excess amounts of purine bases. This practice only leads to the fact that the patient’s condition sharply worsens, and the cause of the exacerbation is hidden in the peculiarities of the physiology of the human body.

When the body stops receiving food, it begins to consume its own reserves to meet its own energy needs, and protein compounds become the most accessible material.

That is why, in the first days of fasting, the level of uric acid in the blood serum increases sharply, and it begins to be deposited in the synovium of the joints and body tissues, causing an exacerbation of the disease.

In this case, massive deposition of urates occurs in the synovium of the joints, and at the same time in the glomeruli of the renal tubules, which provokes the occurrence of acute gouty nephropathy.

Allowed and prohibited foods for gout

Products prohibited for this disease

Selecting a treatment menu for patients with disorders purine metabolism in the body, it is important to simultaneously reduce the amount of products containing a large amount of purine bases and products that stimulate the “release” of urates from the blood serum and their deposition in the peripheral tissues of the body.

Foods containing excess amounts of purine bases include:

Products that change the acid-base state of the body include:

• spices - pepper, mustard, horseradish;
• vegetable sauces;
• sorrel, spinach, fresh herbs in large quantities;
• salted fish and any salted products made from it (caviar, canned food);
• alcohol in any form and quantity, especially beer and wine;
• products containing large amounts of cocoa butter;
• sharp and salty cheeses.

When dieting in the presence of gouty arthritis, you are allowed to eat baked or stewed meat or fish once a week, but in no case should you eat fried foods!

Authorized Products

Among the products that are poor in purine bases, milk should be highlighted, chicken eggs, bread, caviar, Swiss cheese, forest and walnuts. It is allowed to eat carrots, buckwheat and pearl barley, millet.

In the diet of patients, the amount of fat must be limited, table salt, which promotes the accumulation of urates in tissues. They increase the amount of fluid, which helps the body more intensively remove uric acid compounds from the body.

The total calorie content of the food consumed by the patient is mandatory, especially in cases where he has concomitant obesity.

Often patients do not include tomatoes in their diet, considering them harmful, although tomatoes can be consumed, just not in large quantities, since they actually contain a small amount of purines. It should be remembered that it is more advisable to exclude various sausages and smoked foods from your diet; you should also not use seasonings (this does not apply to bay leaves and vinegar).

It is useful to do fasting days for yourself from time to time and consume raw vegetables and fruits. You can, for example, hold rice-apple fasting days.

Diet if available of this disease includes a ban on alcohol because it retains uric acid in the body. This is especially true for wine and beer. You should also exclude strong tea, cocoa or coffee, which can aggravate the pain syndrome.

It is useful to eat foods containing vitamin B1 and ascorbic acid.

At therapeutic nutrition for gouty arthritis, use diet No. 6 according to M. Pevzner, which meets all the above conditions.

It is worth noting that some researchers believe that dietary therapy for this disease is not necessary. But as practice shows, dietary nutrition for gout significantly facilitates its course, which is why most doctors include diet in general scheme complex treatment of this disease.

In the human body. At the same time, an increased concentration of uric acid is detected in the blood, and articular and/or periarticular tissues, kidneys and other organs suffer from deposits of urates - sodium urate salts.

Causes of gout

Excess uric acid is formed under the influence of increased synthesis of endogenous purines, decreased excretion of urates, or a combination of these processes. Recognize the symptoms of primary and secondary diseases. The latter case requires you to pay attention to the medications taken by a person who is affected by gout. The causes of the disease require detailed consideration.

Gout caused by overproduction of uric acid

Excess of purine bases and nucleosides - main reason high concentration uric acid. With unlimited consumption of food, which contains substrates in abundance that form purines, hyperproduction of acid naturally occurs.

The symptoms of secondary overproduction are caused by excessively high cell breakdown that occurs against the background of certain diseases (provokers, for example, are hemolysis, alcoholism, anticancer chemotherapy). Hyperuricemia is often accompanied by psoriasis. However, the clinical pathology of gout in these cases develops infrequently.

Gout caused by decreased uric acid excretion

90% of people who suffer from gout have decreased acid production. The kidneys, intestines and skin help uric acid leave the body. With reduced excretion of urates by the kidneys, they accumulate in excess in the body and crystallize. Tiny crystals are deposited in the joints, leading to inflammation and pain. And the kidneys are affected by urate nephritis.

This phenomenon is sometimes caused by diuretics, alcohol, acetylsalicylic acid, aminophylline, caffeine, diazepam, diphenhydramine, L-dopa, dopamine, vitamins B 12 and C in small dosages. Lead leads to epidemic outbreaks. Lead gout is caused by paints and other sources containing heavy metals.

Gout symptoms: signs of attacks

The occurrence of symptoms is associated with deposits of salts formed by uric acid. Crystals settle in joints and kidneys. The first attack of gout usually does not occur until the age of thirty. It is experienced more often by patients aged 40-60 years.

The attack is accompanied by swelling and redness of the joint, acute pain. Without treatment, it does not go away for several days or even weeks. Evening and night are the main time for the occurrence of fleeting attacks.

A gout attack is triggered by eating a lot of meat, alcoholic drinks, certain types of fish, coffee and other products enriched with purine bases. The disease in most cases affects thumb legs, although damage to other joints is not at all excluded. Her a clear symptom is considered acute arthritis, which occurs unfavorably with kidney pathologies.

Acute gout

Arthritis - acute form gout It is expressed in a sudden onset of gouty attack - painful inflammation of the joint. In gouty arthritis, urate crystals fall out of the tissues into the joint cavity, causing inflammation. Gout attacks usually occur in the middle of the night.

Gout is provoked by alcohol, injuries, physical overload, surgery, and a number of medications. Treatment with medications can relieve attacks and alleviate the condition. During attacks, the joint and neighboring tissues swell, the skin at the site of the outbreak turns red, and pain increases.

Attacks of acute arthritis disappear within a few days (sometimes weeks), even if they are not treated. A repeated attack returns after six months or a year. Although periods of calm sometimes last up to 10-20 years. In people who do not bother with treatment, the frequency of attacks increases, and several joints are simultaneously involved in them. The duration of attacks increases, they become more pronounced.

Chronic gout

The chronic course of the disease is accompanied by characteristic symptoms:

• chronic arthritis;
• accumulation of urate crystals;
• kidney damage.

Prolonged gout is accompanied by all the symptoms simultaneously. Chronic arthritis affects those who have experienced the secondary form of the disease and were treated untimely or inadequately.

With affected kidneys, 3 types of changes are observed:

1. The kidney tissue is overgrown with urate crystals. They have a weakly expressed inflammatory reaction.
2. The intrarenal urine outflow tract is clogged with urate crystals.
3. Uric acid stones have formed in the urinary tract.

Modifications are combined in various variations, resulting in the clinical term “gouty kidney”. Stones lodged in the urinary tract may be asymptomatic or exhibit signs characteristic of urolithiasis.

Treatment options

The goal of treatment is to prevent gout attacks and relieve acute arthritis. Supporting an adequate drinking regime, relieving overweight, diet therapy, reducing medications that increase hyperuricemia, and eliminating alcohol prevent gout. Treatment with medications can eliminate inflammation and pain.

Water reduces the concentration of urates, preventing them from precipitating into crystals that settle in tissues and organs. In addition, it helps to wash them out and remove them from the body. Alcohol has a diuretic effect. In large dosages, it dehydrates the body, promoting the crystallization of salts, which initiates gout attacks. In addition, it slows down the removal of urates from the body, giving them the opportunity to be deposited in the joints.

Losing weight helps reduce the risk of recurrent gout attacks. You should reduce fats and calories in your diet. The diet is combined with regularly performed aerobic exercise.

Drug therapy

The main aspects by which gout is controlled are treatment with medications that relieve pain, eliminate inflammatory reactions that control impaired metabolism, leading to hyperuricemia. Pain relief is carried out with acetaminophen (Tylenol) or other more powerful analgesics.

Indomethacin is recommended among non-steroidal anti-inflammatory drugs. True, it is not suitable for patients with nasal polyps. Colchicine is suitable for relieving gout attacks.

Reviews from patients focus on the fact that when taking the medicine orally, serious side effects occur, associated with the frequency of its administration (once an hour or every two hours, until the pain significantly subsides or undesirable reactions appear).

Corticosteroids, which are powerful anti-inflammatory agents, relieve acute attacks. To avoid severe long-term side effects, they are prescribed in short courses. They are prescribed to patients with concomitant liver and kidney diseases.

For long periods, patients take drugs that reduce concentration. They help dissolve heavy tophi deposits, prevent stone formation and the development of pathologies in the kidneys. Thanks to them, gout does not reoccur. Treatment with medications from this category either increases the excretion of urates or reduces their synthesis from dietary purines.

These medications can worsen a gout attack, so they should be taken after the inflammatory process has subsided. If they were treated with them before the attack, the course is not interrupted, but they try to adjust the dosage (especially after its extinction). Since many patients with high level uric acid are not susceptible to kidney stone formation and they are not burdened by gout; treatment with medications that affect the level of urate is entirely individual in nature.

With the help of probenecid and sulfinpyrazone, they enhance the excretion of uric acid. These drugs are not suitable for treating people with urolithiasis. They sometimes provoke the formation of stones. Drinking plenty of fluids, combined with their intake, promotes accelerated passage of acid through the urinary system and prevents the formation of conglomerates.

Allopurinol prevents the synthesis of uric acid. They block the metabolic conversion of purine bases into acid. It is prescribed with caution due to the risk of side effects in those with weakened kidney function.

Using Home Remedies

Home treatments help relieve symptoms of acute gout. The inflamed joint is lifted upward and rested. Pain is reduced by applying ice. Avoid taking aspirin-containing medications (they inhibit the excretion of uric acid).

Are being treated medicinal plants: rose hips and sea buckthorn, lingonberries and strawberries, rowan and blueberries, barberry and St. John's wort, birch and linden, chicory and other herbs. Use homeopathic remedies.

Diet therapy for gout

Dieting ensures stable remission. Ideally, complete elimination of foods enriched with purines is achieved. If absolute exclusion is not possible, a maximum restriction on their consumption is introduced. They try to balance the amount of fat and drink plenty.

Anchovies, sardines, goose, chicken and any fatty meat, offal, meat extracts, legumes and dry wine are rich in purines. If you are diagnosed with gout, eat tomatoes in moderation.

Tomatoes are full of organic acids. There are not as many purines in them as, for example, in meat. Therefore, nutritionists do not prohibit those who suffer from gout from eating tomatoes. On the contrary, they believe that a reasonable amount of tomatoes and dishes made from them is beneficial for such patients.

Gout - a chronic metabolic disease associated with impaired metabolism of uric acid and its accumulation in the body, occurring with repeated attacks of acute arthritis, crystal-induced synovitis, and deposition of urate in tissues.

There are primary and secondary gout. Primary gout - independent disease, secondary gout develops in other diseases (myeloid leukemia, psoriasis, chronic renal failure), as well as in long-term use some medicines (riboxin, cytostatics, saluretics, etc.).

Treatment program for primary gout.

1. Relief of an acute attack of gout.
2. Long-term permanent treatment.
   1. Mode.
   2. Normalization of body weight.
   3. Elimination of alcohol.
   4. Medical nutrition.
   5. Treatment with drugs that reduce hyperuricemia (uricodepressants and uricoeliminators).
   6. Physiotherapeutic treatment.
   7. Phytotherapy.
   8. Sanatorium-resort treatment.
   9. Surgical treatment.
3. Clinical examination.

1. Relieving an acute attack of gout

1.1. General events

During an acute attack of gout, the patient must be given complete rest, especially the affected limb. You should elevate the sore leg, place a pad under it, and in case of a severe inflammatory reaction, apply a bubble with ice or snow to the sore joint, and after the pain subsides, apply a warm compress. It is also recommended to drink plenty of food tier (2-2.5 l. liquids per day - alkaline solutions, diluted lemon juice, jelly, compotes, milk).

1.2. Medication relief of gout attack

1.2.1. Uses of colchicine

Colchicine - a drug obtained from colchicum, available in tablets of 0.5 mg, is the most powerful remedy for acute gouty arthritis. The mechanism of action of colchicine is to inhibit the migration of leukocytes, hinder the phagocytosis of urate crystals, and delay the degranulation of lysosomes.

In addition, colchicine has antihistamine, antikinin and mild anti-inflammatory effects.

Treatment with colchicine for a gout attack should begin as early as possible (optimally in the prodromal period).

At the beginning of a joint crisis, before swelling of the joint occurs, the patient immediately takes 2 tablets of colchicine (1 mg), then 1 mg every 2 hours or 0.5 mg every hour, but no more 8 t tablets (4 mg) on ​​the first day, followed by a gradual dose reduction, i.e. on the 2nd and 3rd days the dose is reduced by 1 and 1.5 mg per day, on the 4th and 5th day - by 2 and 2.5 mg per day, respectively. After the attack has stopped, colchicine therapy is continued for 3-4 days, gradually reducing the dose of the drug.

Improvement usually occurs within 12 hours from the start of treatment. The effect of colchicine is extremely specific for gout (in no other arthritis does the drug have such a relieving effect as in gout). The drug is effective in 90% of patients. Most often, the lack of therapeutic effect is due to late use of the drug.

Colchicine causes side effects from the gastrointestinal tract (diarrhea, nausea, and less commonly vomiting), as a result of which it is necessary to reduce the dose or even discontinue the drug. Diarrhea can be persistent and painful. To prevent it, bismuth preparations are prescribed simultaneously with colchicine or a combination drug is used. colchimax (composition: 1 mg colchicine, 15 mg phenobarbital, 12.5 mg opium).

With long-term treatment with colchicine, anemia and leukopenia may develop.

For severe gout attacks, colchicine can be used intravenously(in 1 a ampule contains 3 mg of the drug), it should be re-administered throughout the day o 1 mg (daily dose is 5-6 mg).

Treatment with colchicine is contraindicated in renal failure with azotemia, heart failure, peptic ulcer stomach, pregnancy.

The therapeutic effect of colchicine is used as a diagnostic test: in case of timely use in sufficient doses inflammatory changes joint problems caused by gout disappear within 48 hours.

1.2.2. Use of NSAIDs

Pyrazolone drugs are considered the most effective among NSAIDs for relieving a gout attack. Among pyrazolone compounds, preference is given to butadiene (phenylbutazone).

Butadione is quite effective and less toxic than colchicine. It has a pronounced anti-inflammatory, analgesic, antipyretic effect. It is quickly absorbed into the gastrointestinal tract, the therapeutic concentration of the drug is achieved within 2 hours. The half-life is 72 hours, due to which butadione remains in the body for 21 days. In addition, butadione also has a uricosuric effect. Considering all these properties, K. Kinew (1980) calls butadione an ideal anti-gout drug.

Butadione is prescribed as follows: 1st dose - 200-300 mg, then 0.15 g every 4-5 hours (up to 800-1000 mg per day). In subsequent days, the dose is gradually reduced (by 0.15 g daily). Treatment with butadione lasts about a week. Due to the fact that the drug has a cumulative effect, sudden cessation of treatment with it does not lead to the occurrence of the “ricochet” phenomenon.

You can use a combination of butadione with amidopyrine- rheopirin1 tablet 4 times a day; if inflammation is severe, 5 ml of reopirin can be administered intramuscularly.

When treating with butadione, one should remember the possibility of developing leukopenia and agranulocytosis, but this is rare due to the short course of treatment.

Other NSAIDs may also be used.

Indomethacin(methindol) - on the first day it is taken in a daily dose of 150 mg (0.05 g 3 times a day), then the dose can be reduced (0.025 g 3-4 times a day). Convenient to take methindol retard (indomethacin retard) in tablets of 0.15 g - 1-2 tablets per day.

When treated with indomethacin, damage to the gastrointestinal tract (erosion, ulcers) and increased blood pressure are possible. However, patients with gout tolerate indomethacin well even in large doses and side effects are rare.

Ibuprofen(brufen) - at the height of an attack, 1200-2400 mg per day is prescribed,naprosin- from 500 to 1000 mg per day,Voltaren- 150-200 mg per day.

1.2.3. Use of glucocorticoids

Glucocorticoids have a clear anti-inflammatory effect, but do not provide a lasting effect; after their withdrawal, signs of arthritis may reappear, and cortico-dependence may occur. In this regard, glucocorticoids are prescribed according to strict indications - in the absence of an effect in relieving a gout attack using the above remedies.

In these cases, prednisolone 20-30 mg per day can be prescribed for several days (the first 1-2 days), followed by a dose reduction. V. A. Nasonova (1989) recommends prescribing prednisolone (according to indications) against the background of small doses of butadione or indomethacin. After the end of the gout attack and the withdrawal of prednisolone, the use of butadione or indomethacin continues for another 7-10 days.

A person with gout should always carry with him a drug that helps him, because an attack can develop unexpectedly. It is useful, without waiting for an attack, to check the tolerability of one or another drug.

1.2.4. Local use of drugs

Locally, to relieve a gout attack, you can use compresses with a 50% solution of dimexide (has a pronounced analgesic and anti-inflammatory effect), applications of a 50% solution of dimexide with analgin, novocaine, indomethacin.

Gout is a disease resulting from metabolic disorders. This condition is characterized by the deposition of large amounts of uric acid in the joints. An attack of gout develops under the influence of certain negative causes. More often than not, this is preceded by food and alcoholic drinks.

ICD-10 code

M10 Gout

Causes of a gout attack

Various factors can influence an acute attack of the disease. They are based on the consumption of products with high content purines and overconsumption alcohol. Taken together, they can cause a serious attack of gout, being the main causes this process. A person suffering from a disease must constantly maintain his own condition and follow a special diet.

Excessive physical activity can affect an acute attack. If the affected joint is constantly overstressed, this will make the situation worse. Severe trauma and the presence of acute diseases can affect an attack. Infectious lesions can contribute to the process.

Seizures accompany a person throughout his life. In particular, if we are talking about its acute course. The person himself is able to control this process and influence the duration of the attack. Following the basic rules will help alleviate the condition.

Pathogenesis

The basis of this process is a significant increase in the production of uric acid. Moreover, it is not eliminated from the body, but gradually accumulates in it. As a result of this process, acid is deposited in the joints. All this provokes the development of an inflammatory process with acute attacks. This is the pathogenesis of the disease.

Hyperuricemia can be observed not only with gout; this process also occurs with other diseases. Today, there are three main elements that precede the development of the disease. This process is influenced by the amount of uric acid compounds in the body. The rate of their accumulation is also taken into account. The second factor is the deposition of acid in organs and tissues preceding them. The third element is the development of an acute attack. They arise at the site of the lesion. As a result, so-called tophi are formed. These bumps are located around the inflamed joint and are characterized by increased pain.

Symptoms of a gout attack

Most people draw a fine line between gout and arthritis. However, these are slightly different diseases. Gout begins its development abruptly, this is facilitated by breathing problems, increased heart rate and nausea. Not all people experience gout attacks with these symptoms. More often it is an acute pain that appears preferably at night or in the morning. At the same time, the person seems to be climbing the wall. The pain is so aggravating that it feels as if the joints are being twisted.

The pain syndrome is localized at the site of the lesion. These are mainly the joints of the thumbs. Sometimes the elbow, interphalangeal and knee joints. If a person does not take measures to eliminate the attack, the consequences can be severe. To the point that any movement of the affected joint will be accompanied by severe pain.

In addition to all the symptoms described above, gout is characterized by the formation of tophi. These are painless nodules located on the feet, hands and elbows. It is extremely rare that the lesion involves the tongue, scrotum and tendons. The size of tophi can vary, from small in diameter to quite large.

First signs

Gout may begin to manifest itself various symptoms. An acute attack is characterized by severe pain, sometimes it is simply unbearable. In this case, the person is not able to touch the affected joint. In this case, it is difficult to even take any measures to eliminate the pain. The first signs include not only pain, but also general deterioration health status.

The victim feels excessive weakness and increased body temperature. The affected area turns red and the skin becomes hot. The periarticular tissues often become inflamed and mobility is limited. This symptomatology indicates the presence of an acute attack. Stress, injury and hypothermia can contribute to its development. The duration of the attack depends on the factor that provoked it and the actions taken by the person to eliminate the symptoms.

Acute attack of gout

An acute attack of the disease does not just happen. This process is influenced by certain negative factors. Most often, an acute attack of gout develops against the background of eating foods rich in purines. Such food accelerates the production of lactic acid and its deposition in the joints. Alcohol has a similar effect. Even if a person eats properly and does not drink alcohol, an attack can develop.

The process is negatively affected by excessive physical activity, injuries, surgical interventions and hypothermia. When the first symptoms appear, it is necessary to begin basic measures to eliminate them. This will speed up the process of relief and reduce the duration of the attack. Medicines alone will not be enough; it is necessary to remove excess acid from the body, in this case only a large amount of liquid will help.

Duration of a gout attack

In this case, it all depends on the reason why the acute attack began. Typically, the duration of a gout attack does not exceed 3-7 days. During this period, it is necessary to perform certain actions aimed at relieving pain and inflammation.

To quickly remove excess lactic acid from the body, you need to drink a lot of fluid. On average, this figure fluctuates between 5-6 glasses. How quickly the acid leaves the body depends only on how much of it has accumulated there.

In some cases, attacks last too long. This is due to the abuse of prohibited foods and alcohol. Some people do not try to monitor their own condition. In this case, the attack may last for long time. Moreover, sometimes only the completed acute period can immediately be replaced by a new one. Therefore, everything depends only on the patient.

Consequences

If attacks last a long time and are difficult to eliminate, the condition will only worsen in the future. The main consequences of gout arise as a result of the lack of necessary measures to eliminate and prevent the development of attacks.

If you do not deal with the decrease in uric acid levels in the body, it will ultimately lead to joint deformation. Urate deposits negatively affect the process. Over time, tophi will appear at the site of permanent uric acid deposits. The disease can become chronic and in this case you will have to constantly fight the attacks. Gradually, the process will absorb other joints, organs and systems. This will affect a person's standard of living.

All this suggests that you should not wait for the consequences to manifest themselves. It is necessary to blunt the further development of the process by all means.

Complications

The main consequence of gout is the development of gouty arthritis. As a result of this process, uric acid is deposited in the joints. This complication leads to deformation and damage to soft tissues. The possibility of rupture during mechanical loading cannot be excluded.

Gout also negatively affects the kidneys. Possible development of gouty kidney. This process is characterized by the deposition of uric acid in the tubules and glomeruli of the organ. The complication entails impaired renal function and the development of acute or chronic failure. The possibility of urolithiasis cannot be ruled out. Losses will begin to form in the kidneys. There remains a risk of developing arterial hypertension.

Other complications include: the appearance of tophi, the development of coronary heart disease, osteoporosis and metabolic syndrome. There is a risk of arterial hypertension.

Diagnosis of a gout attack

Patients who are suspected of developing gout in mandatory you need to visit a rheumatologist and urologist. Consultation with specialists will allow you to collect all the information about the patient and his type of activity. Diagnosing a gout attack does not end with collecting data.

First thing is to give up general analysis blood, it will allow you to track the level of the main components. Diagnosis of a gout attack includes a biochemical blood test. As the process worsens, the level of uric acid increases.

Following laboratory methods followed by radiography of the joints. It will allow you to track their condition, identify deviations and notice lesions. In some cases, a puncture is performed. A fluid sample is taken from the joint for examination. This process reveals the uric acid content.

Ultrasound of the kidneys is widely used. It is carried out in order to exclude the formation of urate stones in the organ. These methods can be used both in combination and separately.

Analyzes

In making the correct diagnosis great importance devoted to the study of uric acid metabolism. It is necessary to track how much acid is produced and how much is excreted. The normal content should not go beyond 0.3 mmol/l, in daily urine 3.8 mmol/day, the average normal clearance of uric acid is 9.1 ml/min. However, these data vary depending on the type of hyperuricemia. This is far from the only test that needs to be taken.

According to the standard, blood and urine can be examined. Special attention is given to the ESR indicator. During an exacerbation, it increases, and sometimes moderate leukocytosis is observed. Other indicators are in the acute phase of inflammation. Urinalysis indicates a decrease in its density, leukocyturia and microhematuria.

Synovial fluid is also examined. It is taken by puncture of the affected joint. Upon careful examination, small crystals of sodium urate are found.

Instrumental diagnostics

X-rays in the early manifestations of the disease do not show any abnormalities. Chronic urates on x-ray are signs of destruction. As a result of this process, the joint space narrows. Instrumental diagnostics indicate defects in bone tissue. At the same time, on the x-ray you can see compactions that form around the joint. These are the so-called tophi. They can be seen even without the help of diagnostic methods. Bumps on the joints are visible to the naked eye.

At the first stage of the attack, cysts form. They do not affect tissue. Often compaction is observed in deeper layers. In the second stage, large cysts are visible on x-ray. They are located around the joint and are accompanied by the development of small erosions on the surfaces. The third stage is characterized by the presence of large erosions. At the same time soft fabrics too compacted.

Just data instrumental diagnostics not enough to make an accurate diagnosis. Usually they start from the results of analyzes and differential studies.

Differential diagnosis

A gouty attack must always be differentiated from acute infectious arthritis. These diseases have identical symptoms. Properly collected data, in particular anamnesis and information about attacks, will allow them to be distinguished from each other. The differential diagnosis does not end there.

If the attack proceeds as a polyarthritis and the lesion covers the joints of the hands, it must be differentiated along with rheumatic or reactive polyarthritis. A gout attack is characterized by bright coloration. skin at the site of the lesion. This symptom is excluded in other cases.

To make an accurate diagnosis, it is necessary to take a blood and urine test. This will allow you to determine the quantitative composition of uric acid in the body. This is followed by a biopsy, through which it is possible to study the synovial fluid. These tests, together with instrumental diagnostic data, will be sufficient to make a diagnosis.

Treatment for a gout attack

For acute pain, it is recommended to take an Ibuprofen or Naproxen tablet. This will pacify the pain a little. In case of severe pain, you should never use medications based on salicylic acid. They promote uric acid retention. Treatment for a gout attack is primarily aimed at reducing pain and removing excess uric acid from the body.

Proper nutrition and drinking plenty of fluids will help in this matter. Daily diet must be filled with vegetables and dairy products. You should drink about 5-6 glasses of liquid. Will do mineral water and citrus juices. Proper nutrition plays an important role in this process. It is recommended, regardless of attacks, to do fasting days once a week.

In case of an acute attack, it is necessary to seek help traditional medicine. Make compresses aimed at relieving the inflammatory process. It is medications and special traditional medicine that underlie the treatment of an attack.

It should be noted that the disease is eliminated comprehensively. For this purpose, not only medications are used, but also physiotherapeutic procedures. The severity of the process and the presence of concomitant diseases are taken into account.

How to relieve a gout attack?

Rheumatologists recommend relieving acute attacks of gout with the help of special anti-inflammatory drugs. They should always be at hand for a person suffering from these manifestations. Diclofenac and Indomethacin have excellent effects. They are used the same way. You can take 1-2 tablets at a time, taking them regularly no more than 4 times a day. The drugs should be used until the condition improves. Every person facing this problem should know how to relieve the further course of a gout attack.

Medicines will relieve acute pain, but this is not enough. Need to calm down inflammatory process and remove excess acid from the body. A person should immediately start eating properly and eliminate foods rich in purines. Under no circumstances should you drink alcohol. Every day you need to drink 5-6 glasses of water. This will help speed up the removal of lactic acid from the body.

Compresses based on cabbage leaves will help cope with inflammation. However, not in all cases a person is able to touch the affected area. In this case, compresses are excluded. Elimination of the problem occurs through medications and large fluid intake. Most importantly, the affected limb should always be on a slight elevation.

How to relieve a gout attack at home?

If an acute attack begins, the affected joint must be provided with complete rest. Excessive movement will only aggravate the situation and add unpleasant symptoms to the picture. It is recommended to place the affected limb on a slight elevation. If there is a pronounced inflammatory reaction, a warm compress will help. Every person suffering from this disease should know how to relieve a gout attack at home.

The victim needs to drink a lot. This will speed up the process of removing excess lactic acid from the body. The total daily volume should not be less than 2 liters.

Medicines will help relieve pain. A special role is given to antihistamines and antikinin drugs. Anti-inflammatory drugs will also help. However, taking the medication does not guarantee the immediate disappearance of the attack. The main symptoms go away within 12 hours. If no effect is observed after taking the drugs, preference is given to glucocorticoids. They can relieve inflammation, but you should not expect a lasting effect from them.

It is advisable to treat the cupping site with a 50% dimexide solution. It will relieve inflammation and calm pain. Applications based on Analgin, Novocaine and Indomethacin are suitable.

Medicines

During the elimination of an acute attack of gout, medications play an important role. It is not recommended to select medications on your own; this issue is decided by the attending physician based on the patient’s condition. To relieve an attack, medications from different categories. The following drugs help reduce the level of uric acid in the body: Allopurinol, Febuxostat and Pegloticase.

• Allopurinol. The tablets are taken orally and must be washed down a large number liquids. The daily dose is 100-300 mg. It can be used either in one dose or in 3. The duration of therapy is determined by the doctor. The product should not be used in case of hypersensitivity, liver or kidney dysfunction. May lead to depression, hyperglycemia, nausea and vomiting.
• Febuxostat. This drug is relatively new in the treatment of gout. The dosage is prescribed individually depending on the patient's condition. The product should not be used if you are hypersensitive. No adverse reactions were identified.
• Pegloticase. The drug is administered intravenously. Use only with the permission of the attending physician and in individual dosage. Should not be used in case of hypersensitivity or during pregnancy. May cause nausea, vomiting and kidney and liver problems.
• The following medications will help relieve swelling and pain: Colchicine, Cortisone and Prednisolone. Preference is also given to non-steroidal anti-inflammatory drugs, in particular: Diclofenac and Ibuprofen.
• Colchicine. The product must be used according to a specific scheme. On the first day of an attack, it is used 3 times a day, one mg. On the second and third days, 1 mg 2 times a day. The medication should not be used in case of hypersensitivity, pregnancy, old age or alcoholism. May lead to the development of gastrointestinal disorders.
• Cortisone. It is prescribed orally or intramuscularly. In tablet form, it is used 3-4 times a day, 0.1-0.2 mg. 0.025-0.05 g is administered intramuscularly 1 time per day or 2 times at intervals of 8-12 hours. The product should not be used during pregnancy or hypersensitivity. May cause gastrointestinal disorders and hormonal imbalances in women.
• Prednisolone. The dose is set individually. On average, the product is used 4-6 tablets per day. The duration of therapy is prescribed by the doctor. Cannot be used when severe course hypertension, pregnancy and hypersensitivity. May cause allergic reactions and gastrointestinal disorders.
• Diclofenac. It is used intramuscularly 1-2 times a day, 75 mg or orally, 1-2 tablets per day. The duration of therapy is prescribed on an individual basis. It should not be used in case of hypersensitivity, during pregnancy, or in case of peptic ulcer of the stomach and duodenum. May lead to nausea, vomiting, and allergic reactions.
• Ibuprofen. The drug is used at a dose of 800 mg 3 times a day. At pain syndrome moderate intensity 400 mg 3 times a day. The product should not be used in case of hypersensitivity or pregnancy. ulcerative colitis and hematopoietic disorders. May lead to nausea, vomiting, and flatulence.

Traditional treatment

Folk remedies provide pronounced action. It is not for nothing that they were widely used in ancient times. For gout traditional treatment has also managed to prove itself. After all, it is not so easy to stop an attack with medications alone. It is necessary to use folk remedies as auxiliary measures.

• Recipe No. 1. Chamomile decoction. It will relieve the inflammatory process and alleviate general condition person. To prepare an effective remedy, you need to take chamomile flowers and pour boiling water over them. The resulting medicine is used in the form of baths, so the ingredients must be taken in sufficient quantities. So, chamomile flowers - 100 grams per 10 liters of water. To improve the effect, add 20 grams of salt. All ingredients are mixed together. When the solution is infused, it can be used in the form of a bath.
• Recipe No. 2. Ordinary ones have an excellent effect fir cones. Their action is aimed at cleansing the joints of excess lactic acid. To prepare the product, you need to take a pine cone with seeds and pour 1.5 cups of boiling water. Everything is left overnight. The resulting tincture is taken orally 30 minutes before meals, 3 times a day. Use until relief occurs.
• Recipe No. 3. Bay leaves will help cleanse your joints. You should take 5 leaves and pour 1.5 cups of boiling water over them. All this must be boiled for 5 minutes. It is not recommended to open the lid during this process. IN bay leaf contains essential oils; as a result of boiling, they can disappear. The resulting broth should be wrapped in a towel and left for 3 hours. Then consume throughout the day.
• Recipe No. 4. Boiled rice has a beneficial effect on joints. You need to take 2 tablespoons of the main ingredient and rinse under water. Then pour it into a 500 ml jar and fill it with water. The rice should sit overnight. In the morning it is removed, washed and the procedure is repeated again. You need to do this 4 times. Only then can the rice be eaten, but you should not add oil and salt to it.

Herbal treatment

Herbs have always been a powerful tool in the fight against many diseases. Herbal treatment involves the use of various decoctions, tinctures and compresses. Moreover, the product can be based on one component or several.

• Chamomile. A decoction of this plant can be used to make an excellent bath. It will relieve the inflammatory process and alleviate the general condition of a person. To prepare, you need to take 100 chamomile and 10 liters of water.

• Chamomile and elderberry. Together, these plants will help relieve pain. Mix the ingredients in equal parts, then pour boiling water. The resulting mixture is heated, but it cannot be boiled. The remedy is used not only for an acute attack of gout, but also for headaches and back pain.
• A series. If you regularly use the infusion from the series, you can get rid of many ailments. This plant can replace tea. You need to brew it in boiled water for 15 minutes. The result is a beautiful and tasty golden drink. During cooking, you need to monitor the sequence.
• Common lilac. The glass bottle must be filled with lilac flowers. However, they should not be compacted. Then everything is filled with 200 ml of vodka or alcohol. It is necessary to infuse the product for a week, while constantly shaking. The resulting tincture is taken 20-30 drops 3 times a day with food.

It is worth noting that treatment with folk remedies must necessarily be accompanied by walking and moderate physical activity.

Homeopathy

Gout is an acute disease characterized by severe pain. They arise as a result of the deposition of urate crystals in the joints. The affected areas appear red and shiny. The disease can affect joints in the upper and lower extremities. Homeopathy can help you fight gout wisely.

At the beginning of an acute attack, preference is given to ACONITE 30. This remedy will suppress unpleasant symptoms. At chronic course AMMON will help the disease. PHOS. 30. If the diseased joint cannot be touched, immediate assistance will be provided by ARNICA 30. For typical manifestations, BELLADONNA 30 cannot be avoided.

If severe swelling is observed, you need to use BRYONIA 30. Sharp pain and the inability to touch the sore joint will help eliminate COLCHICUM 30. In the presence of tophi, you cannot do without GUAIACUM 30.

If the condition worsens when the affected joint is exposed to heat, use LEDUM 30. Acute and chronic attacks will eliminate SABINA 30.

Detailed information about medications and treatment regimens will be provided by an experienced homeopathic doctor. It is not recommended to use the products yourself.

Surgical treatment

Surgery for gout is rarely used. This process is not necessary. However surgical treatment may be necessary if a person has large tophi. As a rule, they interfere with normal life activities. Their location on the limbs, in particular the legs, does not allow normal wearing of shoes. And in general, tophi bring a lot of inconvenience.

Formations do not resolve on their own. Often the process involves periarticular tissues. More often than not, the skin suffers, resulting in the development of fistulas. In this case, removal of deposits is recommended. Everything is done through surgery. However, eliminating tophi does not guarantee that it will not appear again in the future.

Tophi are not able to dissolve under the influence of special drugs. If they are not eliminated in a timely manner, there is a risk of limiting joint mobility. Gradually, tophi lead to deformation, and then to complete destruction cartilage. In this case, the person becomes disabled.

Prevention

The development of gout is influenced by heredity. However, additional factors are also needed for its occurrence. It could be overweight, food with high content purines and overuse alcohol. If applied preventive measures, there is a chance to prevent the development of the disease. Prevention of the disease is based on proper nutrition. It is necessary to exclude foods such as: meat, canned food, rich broths and jellied meats. You will have to exclude almost everything from drinks, of course, including alcohol. Preference should be given to vegetables, cereals and dairy products. You can drink a lot of liquid, the main thing is that it is mineral water. Citrus juices are also allowed.

Forecast

In many patients, gout occurs without any complications. In this case we mean tophi, arthropathy and pathological processes in the kidneys. This indicates that the prognosis is favorable. At the same time, the person remains functional.

If the condition is severe, disability may occur within several years. This happens when basic recommendations regarding treatment and elimination of the main signs of the disease are ignored. If you do not remove uric acid from the body, the risk of vascular deformation is high.

The patient's life expectancy directly depends on the complexity of the situation. So, if cardiovascular or renal pathology develops, life expectancy is significantly reduced. In most cases, death occurs due to the progression of uremia. However, people die just as often with coronary disease. All this indicates that the prognosis depends on the person himself and the actions taken at the right time.

Important to know!

Gout, which occurs due to the accumulation of urate crystals in joints and other tissues, is the result of systemic disturbances in the catabolism of nitrogen-containing purine nucleic acid bases. Those diagnosed with this disease should know the dos and don'ts of gout.