Gout

Description:

Gout is a disease of the metabolic plan, with disturbance in system of purine exchange, the connected a lot of uric acid in an organism. Gout in most cases affects male population, statistical data indicate occurrence frequency in 0,1%.

Gout reasons:

Gout is connected with the disturbance of metabolism of purines caused by genetic defects in system of the enzymes participating in formation of uric acid and also excess receipt in an organism of products of purine exchange and excess synthesis of uric acid or disturbance of release of uric acid of kidneys.

Gout symptoms:

The picture of the first attack which arises suddenly (usually at night) at men is typical 30 years after alcohol intake, meat greasy food, emotional stresses and injuries are more senior and it is shown by severe pain in the first metatarsophalangeal joint of the I finger of foot as monoarthritis. The joint swells up, skin of bright red or crimson color, hot to the touch. The inflammation quickly extends to all foot, skin becomes thinner, becomes dry and brilliant. The megalgia, amplifies in attempt to change the provision of foot, to turn. The described symptomatology develops for several hours from the beginning of an attack, remains within a week, then spontaneously passes, function of a joint is recovered. Similar attacks can repeat several times a year, at the same time characteristic localization disappears, the inflammation can develop in small joints of foot, in knee or talocrural joints, however repeated attacks are not followed by multiple involvement in process of joints yet. At height of an attack temperature increase to 39-40C is possible. Changes of joints out of an attack are not observed.
In several years widespread polyarthritis with the advent of characteristic gouty small knots – tofus develops. At the developed picture of joint defeat expressiveness of the inflammatory phenomena changes – pain remains, however bright coloring of skin and quickly developing hypostasis are not expressed. At the same time in joints appear the expressed small crunch, pain at a palpation and loading, consolidation of periartikulyarny fabric, deformation that leads to depression of function of joints. Gouty small knots of whitish-yellowish color, size from prosyany grain to a pea, represent deposits of urates of the sodium surrounded with the connective tissue capsule without signs of a surrounding inflammation. They are localized in auricles, elbow joints (where their big size and development of a bursitis is possible), joints of brushes and feet. Tofusa can be located in periartikulyarny tissue and an epiphysis of bones, destroying the relevant structures. Tofusa in itself can ulcerate, be opened, then from them the kroshkovaty cream masses (crystals of uric acid) are allocated that confirms the diagnosis.
From visceral displays of gout are observed damage of kidneys – "gouty kidney": urolithiasis, intersticial nephrite (proteinuria, erythrocyturia, cylindruria, hypertensia). Further, later long term from the beginning of a disease, the renal failure develops.
Gout can proceed in the form of the bad attacks alternating with the remission periods. At a subacute current of an aggravation 1-2 months with involvement of many joints, their deformation and a clear X-ray pattern, tofusa, damage of kidneys last. The aggravation is followed by temperature increase and changes of laboratory indicators. At the chronic course of gout the disease begins gradually, is characterized by slow progressing of process in the lower extremities with deformations, contractures and restriction of mobility that considerably complicates diagnosis.
It is necessary to remember a possibility of development of secondary gout when due to excess endogenous disintegration of kernels of leukocytes or other cells a large number of purine derivatives is formed that leads to a hyperuricemia and is followed by an arthropathy, urate diathesis. In these cases the main are blood diseases (a leukosis, myeloproliferative processes), malignant new growths, intoxication of lead.

Diagnosis:

The specific test – increase in level of uric acid in blood is higher than 0,06-0,07 g/l after preliminary three-day stay on a bezmyasny diet. Definition of crystals of urates of sodium in synovial fluid, and also in contents of a tofus in case of its ulceration is desirable or at a biopsy. Nonspecific indicators of an inflammation reflect activity of process – increase in SOE, S-RP, a leukocytosis, etc. appears.
At the first attacks there are no characteristic radiological signs. Only in several years from an onset of the illness there are bone cavities with smooth edges located separately or groups (intra bone tofusa). Damage of sesamovdny bones which can collapse completely is characteristic of arthritis of the first finger of foot; typically also destruction of cortical substance of bones with increase in a shadow of soft tissues due to adjournment in them of urates and formation of tofus. At the long course of gout there can be changes having nonspecific character like the deforming osteoarthrosis.

Treatment of Gout:

Treatment of gout includes a diet, medicinal therapy and physiotreatment.
The special dietary principles with the lowered content of purines in products are recommended to people sick with gout. It is necessary to reduce the caloric content of the consumed dishes also. For easy extent of gouty process of these actions happens enough to prevent its further development.
Increase in the diet of milk and vegetable products is recommended. Permitted amount of protein makes no more than 1 g/kg. It is necessary to exclude tea, coffee, an offal, chocolate, rich broths, both meat, and fish, to reduce consumption of fat products, alcohol. It is necessary to remember that excess of salt adversely influences exchange processes. The optimum number of consumption of liquid makes up to 2.5 pure l that provides an adequate mocheotdeleniye. Prevention of a lithogenesis requires the use of alkaline mineral water.
Medicamentous correction at gout includes purpose of such drugs as urikodepressant. Their mechanism of action consists in suppression of production of uric acid. Allopyrinolum is most popular drug. Appoint Allopyrinolum according to the scheme of dosages, with gradual decrease. There is also a class of the uricosuric funds allocated for strengthening of removal of uric acid from an organism.
At gout register in a stage of full or unstable remission fizio-and balneoprotsedura, mud and paraffin applications, radonic or hydrosulphuric bathtubs. It is necessary to appoint UF-radiation to area of the affected joint and begin as soon as possible that can prevent the beginning attack. Use potassium-lithium-electrophoresis is capable to reduce a pain syndrome and to improve mobility of joints. Procedures of ultrasound and an ultrafonoforez of a hydrocortisone have soothing, resorptional and antiinflammatory effect on affected areas. Complex treatment and rehabilitation of patients with gout out of an aggravation have to include remedial gymnastics which promotes preservation of a physical activity.