Acute gouty arthritis

Description:

Acute gouty arthritis is the most acute rapid inflammation caused both by direct influence of crystals of uric acid, and mediated — activation of neutrophils and cells of synovial fluid. Phagocytosis of crystals leukocytes with destruction of lysosomes and release of lizosomalny products, and also hemotaksichesky substances, complement activation, kallikreinovy system promote bystry development of acute inflammatory process.

One of joints, preferential lower extremities, with almost obligatory (and in half of cases and debuting) damage of a joint of 1 finger of foot is surprised, as a rule. The sharpest pain, impossibility of the slightest movement in the affected joint, even the sheet touches, a bright hyperemia and hypostasis arising sharply (within several hours, usually at daybreak) — here typical symptoms of acute gouty arthritis.

Symptoms of Acute gouty arthritis:

Acute gouty arthritis lasts several days and completely passes even without treatment. After the first attack of gout approximately at 10% of patients long-term remission is noted, but at the majority within 1 year attacks are registered 1 — 3 recurrence or monthly (is more rare — weekly). At an epidemiological research (Framingham stady, 1967) revealed direct dependence between the level of a lithemia and a possibility of development of gouty crises. So, at the level of uric acid in blood of 6,0 — 6,9 mg/dl gout was registered in 1,8%, and at level 7,0 — 7,9 mg/dl — in 11,8% of cases.

In process of accumulation of uric acid in an organism the cook the frequency, and character of exacerbations of gout can change; continuously recurrent attacks and in rare instances — unusually heavy attacks are possible. At 4 of the patients observed by us gouty crisis proceeded extremely hard, with simultaneous development of multiple arthritis, formation of tofus, their inflammation, an ulceration and allocation of dense melopodobny weight with a large number of crystals of uric acid (the pseudo-phlegmonous form of the gouty attack described in literature), to Distinguish gouty arthritis from other acute monoarthritises (pyrophosphatic, at adjournment of calcium, septic arthritis, etc.) the joint puncture with a research of synovial fluid by means of polarization microscopy allows. Existence of typical crystals of monourate of sodium in or out of leukocytes is a final pathognomonic sign of acute gouty arthritis, X-ray inspection of the joint affected with an inflammation at this disease has no diagnostic value and only at late stages reveals periartikulyarny deposits, reduction of density of a bone tissue, existence of bone cavities, Despite brightness of clinical symptomatology of the gouty joint attack the diagnosis of gout quite often happens overdue. So, from 100 patients observed by us in recent years with gout more than at 80% as data of the anamnesis testify, it was succeeded to distinguish a disease in 8 years and more from the beginning of attacks of arthritis. At the first addresses to the doctor the diagnosis of "faceless" arthritis prevailed, quite often patients were directed to the surgeon with traumatic arthritis, to the infectiologist with suspicion to an erysipelatous inflammation, very often made the diagnosis of a pseudorheumatism.

After the first attacks the patient having the gout remaining not distinguished in the subsequent easily copes with joint crises up to transition of a disease to a chronic form with deformation of joints and gouty tofusa. In addition to the developing chronic damage of joints, characteristic damage of kidneys — a gouty nephropathy is noted.

Reasons of Acute gouty arthritis:

The factors provoking emergence of the joint attack at gout is an alcohol, excess of animal protein in food and consumption of other food rich with purines, dehydration (hot climate, a sauna), overcooling, an injury. Overcooling of joints and their physical overwork, including static, for example, walking in close footwear are most significant.

Treatment of Acute gouty arthritis:

• Bystry relief is given by colchicine: on 0,5 mg each hour before subsiding of arthritis or before emergence of by-effects (vomiting, a diarrhea), but no more than 6 — 8 mg/days, • Non-steroidal anti-inflammatory drugs (indometacin, an ibuprofen. Naproxenum, piroxicam, сулиндак, but not salicylates) apply usually in high doses and a short course (2 — 3 days). At associated diseases of a liver and kidneys, especially at patients of advanced age, it is necessary to observe extra care.

• Introduction of glucocorticosteroids to a joint cavity at acute gouty arthritis is effective, but extreme morbidity of a joint at gout complicates any manipulations.

• Allopyrinolum is the main drug for normalization of content of uric acid in an organism now, however during a bad attack it is not applied as any fluctuations of concentration of uric acid in blood are capable to prolong a gout attack, Purpose of Allopyrinolum during the poslepristupny period has to be followed by an exception of all risk factors of the gouty attack, in some cases it is recommended 1 — 2-month preventive reception of colchicine in a dose of 1 mg/days. Constant, lifelong reception of Allopyrinolum is the main method of effective treatment of gout and the prevention of the new attacks of acute gouty arthritis. Treatment of secondary gout is possible at elimination of the reason of a hyperuricemia.

In our observations there was a full remission of the gouty attacks to essential reduction of a lithemia or full normalization of an indicator at cancellation of diuretic drugs, refusal of alcohol or removal of lead from an organism by means of complexons (at a saturnite gout).

• The Sredneterapevtichesky dose of Allopyrinolum makes 300 mg/days, as criterion at the choice of a dose serves achievement of level of uric acid in blood of 4 — 5 mg/dl.

Achievement of the target objective of a lithemia is promoted by a low-purine low-calorie diet. In the presence of initial symptoms of a chronic renal failure with increase in level of creatinine to 2 — 3 mg/dl the dose of Allopyrinolum should not exceed 100 mg/days; regular control of level of creatinine in blood is obligatory, at its further increase drug is cancelled.