Gout occurs when there is a violation of purine metabolism in the human body. At the same time, an increased concentration of uric acid is found in the blood, and articular and / or periarticular tissues, kidneys and other organs suffer from deposits of urates - sodium uric acid salts.
Causes of Gout
Excess uric acid is formed under the influence of increased synthesis of endogenous purines, decreased urinary excretion, or a combination of these processes. The symptoms of primary and secondary disease are recognized. The latter case requires you to pay attention to medicines taken by a person who has been affected by gout. The causes of the disease require detailed consideration.
Gout caused by overproduction of uric acid
An excess of purine bases and nucleosides is the main reason for the high concentration of uric acid. With unlimited food consumption, in abundance containing substrates that form purines, hyperproduction of acid naturally occurs.
Symptoms of secondary hyperproduction are caused by excessively high cell decay that occurs against the background of certain diseases (for example, hemoblastosis, paraproteinemia, hemolysis, alcoholism, anti-cancer chemotherapy become a provocateur). 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 are burdened by gout disease have a reduced acid extraction. To leave the body, uric acid helps the kidneys, intestines and skin integuments. With reduced excretion of urate 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 jade.
Such a phenomenon is sometimes caused by diuretics, alcohol, acetylsalicylic acid, aminophylline, caffeine, diazepam, diphenhydramine, L-dopa, dopamine, vitamins B 12 and C in small doses. Lead leads to epidemic outbreaks. Lead gout is caused by paints, surrogate alcohol and other sources containing heavy metal.
Symptoms of gout: signs of seizures
The onset of symptoms is associated with deposits of salts formed by uric acid. Crystals settle in the joints and kidneys. The first attack of gout usually does not occur before the age of thirty. It is more often experienced by patients who have reached 40-60 years.
The attack is accompanied by swelling and redness of the joint, acute soreness. Without treatment, it does not pass for several days or even weeks. Evening and night are the main times when transient seizures occur.
An attack of gout is provoked by plentiful meat food, alcoholic beverages, certain varieties of fish, coffee and other products enriched with purine bases. The disease in most cases affects the big toe, although damage to other joints is not at all excluded. Its bright symptom is acute arthritis, which adversely occurs with kidney pathologies.
Acute gout
Arthritis is an acute form of gout. It is expressed in a sudden onset of gout attack - a painful inflammation of the joint. With gouty arthritis, urate crystals fall out of the tissues into the joint cavity, causing inflammation. Gouty attacks usually occur in the middle of the night.
It is provoked by alcohol, injuries, physical overload, surgical operations, and a number of gout medications. Medication can relieve seizures and alleviate the condition. During attacks, the joint and adjacent tissues swell, the skin at the site of the focus reddens, pain increases.
Attacks of acute arthritis disappear within a few days (sometimes weeks), even if they are not treated. The second attack returns after six months or a year. Although periods of calm sometimes last up to 10-20 years. In people who are not puzzled by treatment, the frequency of seizures increases, several joints are involved in them simultaneously. The duration of the attacks increases, they become more pronounced.
Chronic gout
The chronic course of the disease is accompanied by characteristic signs:
- chronic arthritis;
- the accumulation of urate crystals;
- kidney damage.
Prolonged gout is accompanied by all the symptoms at the same time. Chronic arthritis affects those who have survived the secondary form of the disease, untimely or inadequately treated.
With affected kidneys, 3 types of changes are observed:
- Kidney tissue is overgrown with urate crystals. A mild inflammatory reaction flows in them.
- The intrarenal pathways of the outflow of urine are clogged with urate crystals.
- Urinary stones formed in the urinary tract.
Modifications are combined in various variations, resulting in the clinical term "gouty kidney." Stones lying in the urinary tract are asymptomatic or show signs inherent in urolithiasis.
Treatment methods
The goal of the treatment is to prevent gouty attacks and relieve acute arthritis. Maintaining an adequate drinking regimen, overloading, diet therapy, reducing medications that increase hyperuricemia, eliminating alcohol prevents gout. Medication helps eliminate inflammation and pain.
Water reduces the concentration of urates, preventing them from precipitating into crystals deposited in tissues and organs. In addition, it promotes their leaching and elimination from the body. Alcohol is capable of a diuretic effect. In large doses, it dehydrates the body, contributing to the crystallization of salts, initiating gouty 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 recurring gout attacks. In the diet, you should reduce fats and reduce calories. The diet is combined with regularly performed aerobic exercises.
Drug therapy
The main aspects by which gout is controlled is the treatment with pain relieving medications, eliminating inflammatory reactions, controlling the disturbed metabolism, leading to hyperuricemia. Anesthesia is carried out with acetaminophen (tylenol) or other more powerful analgesics.
Of the non-steroidal anti-inflammatory drugs, indomethacin is recommended. True, it is not suitable for patients with an allergy to aspirin and patients with polyps in the nose. Colchicine is good for relieving a gouty attack.
Reviews of patients focus on the fact that oral administration of the drug causes serious side effects associated with the frequency of its administration (once an hour or two hours, until the pain significantly subsides or unwanted 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 who have concomitant ailments of the liver and kidneys.
For long periods, patients take drugs that reduce the concentration of uric acid in the blood. They contribute to the dissolution of heavy tofus deposits, prevent stone formation and the development of pathologies in the kidneys. Thanks to them, gout does not occur again. Treatment with medicines from this category either increases the excretion of urates, or reduces their synthesis from food purines.
These drugs can worsen a gouty attack, so their intake begins after the attenuation of the inflammatory process. If they were treated before the attack, the course is not interrupted, but they try to adjust the dosage (especially after its extinction). Since many patients with a high level of uric acid are not prone to stone formation in the kidneys and are not burdened by gout, treatment with medicines that affect the level of urate is exclusively individual.
With the help of probenecid and sulfinpyrazone, uric acid excretion is enhanced. These drugs are not suitable for treating people with urolithiasis. They sometimes provoke the formation of calculi. A heavy drink, combined with their intake, promotes an accelerated passage of acid through the urinary system and prevents the formation of conglomerates.
Thanks to allopurinol, uric acid synthesis is prevented. They block the metabolic conversion of purine bases into acid. It is carefully prescribed because of the risk of side effects to those who have impaired renal function.
Using home remedies
Home treatment methods help relieve the symptoms of gout, which is acute. The inflamed joint is lifted up, provide him with peace. Soreness is reduced by applying ice. Exclude the use of aspirin-containing drugs (they inhibit the excretion of uric acid).
They are treated with medicinal plants: wild rose and sea buckthorn, lingonberries and wild strawberries, mountain ash and blueberries, barberries and St. John's wort, birch and linden, chicory and other herbs. Use homeopathic remedies.
Dietotherapy for gout
Compliance with diet provides a stable remission. Ideally, they achieve the complete elimination of products enriched in purines. If an absolute exception is not possible, a maximum restriction on their consumption is introduced. 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. With a diagnosis of gout, tomatoes are eaten in moderation.
Tomatoes are full of organic acids. There are not so many purines in them as, for example, in meat. Therefore, nutritionists do not prohibit the use of tomatoes for those who suffer from gout. On the contrary, they believe that a reasonable amount of tomatoes and their dishes are useful for such patients.