With a violation of purine metabolism in the body develops a disease called gout. It is characterized by the accumulation of salts of uric acid in bone tissues and leads to attacks of arthritis. In the chronic course of pathology, peculiar nodules are formed on the joints - gouty tofus. They indicate a critical level of urate in the blood.
Medical certificate
Tofus is a gouty nodule made up of uric acid crystals. They are limited to connective tissue. Tofuses appear with a prolonged course of gout, usually after 6 years from the moment of the first attack of the disease. However, under the influence of adverse factors, gouty nodules appear within 2-3 years. We are talking about non-compliance with the diet, a violation of the excretory function of the kidneys and taking diuretics.
These unaesthetic formations worsen the appearance of a person and disrupt the full mobility of the joints. In the absence of treatment, they begin to grow, destroy cartilage tissue. Often provoke the formation of ulcers and even necrosis of the skin.
Main reasons
Uric acid is a breakdown product of purines and is present in every body. Normally, in an adult, its content is 1000 mg. Purines are synthesized as a result of metabolic processes. They also enter the body with food. Uric acid is present in plasma as sodium urate. Otherwise they are called “free” salts. With an increase in uric acid levels, hyperuricemia develops. Over time, it leads to gout.
The onset of the disease is usually asymptomatic. Many people are not even aware of abnormalities in the body. Clinical manifestations are detected only after a few years. All this time, urate crystals accumulate in the tissues and joints, causing significant harm to the body. Gouty tofus is a clear sign that the disease has moved from an acute stage to a chronic one.
Clinical picture
Tofus are dense rounded formations. Their size can vary from 2 mm to 8 cm. Most often they are located in the subcutaneous tissue near the joints. Superficial localization of gouty nodes helps to diagnose them during a physical examination. Tofus protrude under the skin in the form of yellowish tubercles. The dermis above them is usually rough and dry.
In the period of remission, formations have a static position, do not show a tendency to increase in size. The progression of the disease and inadequate treatment contribute to the growth of gouty nodes, the impact on the surrounding tissue. Perhaps an increase in pain.
The active course of the pathological process leads to the opening of gouty tofus and the formation of fistulas. Of the latter, a yellowish secret is highlighted. This complication is accompanied by fever and severe pain in the affected area. The fistulous course is sometimes delayed on its own. However, most often its development assumes a chronic nature with regular opening and subsequent scarring.
Localization area
Urate deposits are most often observed in areas with a poorly developed vascular network. The temperature in these areas is lower compared to other parts of the body.
In most patients, tofuses are localized in the following areas:
- fingers and toes;
- ears
- feet;
- knees;
- area of the elbow joint.
In especially serious cases, when the level of uric acid in the body exceeds all permissible norms, urates begin to accumulate in the internal organs. It's about the kidneys and bone tissue.
Possible complications
Patients diagnosed with gout should understand how dangerous this disease is. Tofus is an accumulation of urate salts. At high concentrations of uric acid in the seals, a moment comes when this component begins to flow back into the blood.
If untreated, gouty tofus over time begins to spread to new areas. They can cover not only the fingers of the limbs, but also the ears and elbows. Formations quickly destroy skeletal elements, significantly worsen the condition of the skin and joints. In advanced cases, when the mobility of the limbs is lost, the patient receives a disability group.
Treatment methods
The appearance of gouty tofus on the body, the photo of which is presented a little higher, indicates an active accumulation of sodium monourate in the body. Ignore these manifestations is not worth it, you must immediately seek help from a doctor. Inattention to the signs of gout can lead to the development of complications.
Diagnosis of formations includes an external examination, as well as conducting instrumental examination methods. The patient must take blood and urine tests to determine uric acid counts. In order to identify deeply located nodules, an x-ray is prescribed. Gouty tofus can also be found on MRI scans and with an ultrasound of the ligamentous apparatus, joints. Based on the results of the examination, comprehensive treatment is selected. It usually consists of the following activities:
- Lifestyle changes (rejection of addictions, alcohol).
- Compliance with a special diet that excludes the use of foods high in purines (fish, mushrooms, legumes).
- Drug therapy.
- Strengthening immunity.
- Physiotherapy, massage.
- Surgical intervention.
The main goal of such a comprehensive treatment is to prevent the development of complications, stop symptoms.
Drug use
Drug therapy is considered a kind of foundation in the fight against gouty tofus. As a rule, treatment begins with the drug "Allopurinol" to lower uric acid levels in the body. Dosage and duration of administration are selected strictly individually.
As an additional drug therapy, uricosuric agents are prescribed. They enhance the excretion of uric acid from the blood. This group of funds is represented by Probenecid and Sulfinpyrazone.
The nature of the course of gout is changeable. In its development there are acute periods when the pain syndrome is especially pronounced, and the stages of remission. Non-steroidal anti-inflammatory drugs (Ortofen, Diclofenac) are used to stop unpleasant symptoms. They are used in the form of injections and ointments.
Physiotherapy and massage
As in the case of other disorders of the supporting apparatus, the fight against gouty tofus is not complete without physiotherapeutic effects. It helps to normalize blood circulation in the affected area, relaxes muscle muscles. The use of specific procedures depends on the stage of the course of the pathology:
- in the acute phase, impulse points and UV processing are used;
- at the stage of remission, it is advisable to use ultraphoresis and mud therapy.
In the absence of pain at home, self-massage sessions can be carried out. Procedures are recommended to start with stroking the periphery of the joint and light rubbing, gradually moving to neighboring tissues. This approach promotes overall muscle relaxation. With gout, massage should be started from distant areas, consistently approaching the focus of pain. The duration of one procedure should not exceed 15 minutes.
Consider the example of gouty tofus on the toe. In this case, massage should be started from the lower leg, gradually approaching the epicenter of pain. A mild effect on the affected joint stimulates blood circulation, which helps to remove sodium urate in the blood. Intensive movements are strictly prohibited. Also, you should not conduct sessions during an exacerbation of pathology.
Surgical intervention
When conservative treatment is ineffective, surgical removal of the lesion is recommended. In addition, they resort to surgery in the following cases:
- urate deposits have reached excessive proportions;
- severe deformation of the articular structure is observed;
- nodules sprouted into nearby tissues.
The operation itself with gouty tofus consists of several stages. First, local anesthesia is administered. Then, a small incision is performed on the affected area. Through it, a bag with pathological tissues is excised. This area is washed with antiseptic solutions and cosmetic sutures are applied.
The next 7-10 days, the patient is in the hospital under supervision. Every day he is given dressings. After 10 days, the sutures are removed, and the doctor examines the operated area. With a positive result and the absence of complication, the patient is allowed to go home.
Help traditional medicine
How to remove gouty tofus on the fingers and toes using unconventional means? Recipes of folk doctors, as a rule, are aimed at improving metabolic processes in the body. It is unlikely to completely get rid of the nodules, but it is realistic to stop the signs of tissue inflammation. Below are the most effective methods of influencing the problem.
- Decoction based on leaves of dioecious nettle, flaxseed and lingonberry. To prepare it, you need to mix all the ingredients in equal proportions and pour boiling water, insist for 2 hours. It is recommended to take a decoction in half a glass before eating.
- Bathtubs with branches of Siberian larch. As an auxiliary ingredient, oat straw can be used. The procedure should be repeated 2-3 times a week, while the duration of one session should not exceed 20 minutes.
Large tofus can be reduced by using gruel from potatoes or cabbage leaves as compresses. An excellent therapeutic effect has an iodine network. It is recommended to apply it directly to the formation itself.
Prevention Methods
In most cases, gouty tofuses on the fingers and toes are the result of a long course of the underlying disease, the presence of which a person may not be aware of. The appearance of nodules indicates a serious pathological process in the body. Therefore, it is better to take care of education prevention measures in advance. They are reduced to compliance with the following rules:
- Regularly undergo preventive examinations, take tests. In this situation, you can timely detect deviations in the concentration of uric acid and take the necessary measures to normalize it.
- If cases of gout have already been diagnosed in the family, it is recommended to take the Allopurinol course for preventive purposes. However, you must first consult with your doctor, who will select the dosage of the drug.
- A special diet helps to reduce the risk of tofus. It provides for the exclusion of purine-rich foods from the diet. These are oily fish, coffee, red meat and all kinds of legumes.
- An important role in the prevention of pathology is played by compliance with the drinking regime. Pure water rinses all parts of the body and removes excess salts of uric acid.
Gout cannot be completely cured. However, compliance with the doctor’s recommendations and basic preventive measures can maintain a state of remission for a long time.