Causes, symptoms and treatment of gout on the legs
What is gout?
Gout is a metabolic disease in which uric acid salts (known as urates) are deposited in the joints. Gout is also called "the disease of kings", it is an old disease that was known back in the days of Hippocrates. Now gout is considered a rare disease, it affects 3 people out of 1000. And most often it affects men over the age of 40, in women it most often manifests itself after menopause. Gout itself is a type of joint disease caused by salt deposition.
All joints are affected by gout, from the joints of the fingers to the joints of the toes.
It was known back in the days of Hippocrates and is called the "disease of kings" due to the fact that the main source of its occurrence is immoderation in food and alcohol. Gout is often chronic.
Video: who is at risk of disease of kings (gout)?
Causes of gout
- Diseases that provoke the development of gout
- Seizure-provoking medications
- Obesity has a direct relationship with seizure
Symptoms of gout
- Symptoms, depending on the stage of development of gout
- Possible complications
- Pain with gout
- Gout in men on the legs
- The role of uric acid in the development of gout
- Diagnosis of gout
- What to do with an acute gout attack?
Prevention of exacerbations of gout
Mineral water for gout
- Medication to lower uric acid levels
- Treating gout with decongestants and pain relievers
- How to prevent gout attacks?
- Latest data on gout treatment
- Allopurinol: pros and cons
- Disease prognosis
- Which doctor treats gout?
Causes of gout
Gout is caused by elevated and persistent levels of uric acid in the blood. During the course of the disease, urate crystals (a derivative of uric acid) are deposited in the joints, organs and other systems of the body. Sodium urate crystallizes and is deposited in small particles in the joints, which ultimately leads to partial or complete destruction of the joint. For the same reason, such situations are called microcrystalline.
A large amount of uric acid in the body can be for two reasons: the first is when healthy kidneys cannot cope with the excretion of unusually large amounts of uric acid, the second is when uric acid is excreted in normal amounts, but the kidneys are unable to excrete it.
Every year there are more and more gout patients. Doctors explain this phenomenon by the fact that in recent years people are more likely to eat foods rich in purines (for example, meat, fatty fish) and a huge amount of alcoholic beverages. This is confirmed by the fact that during the wars the percentage of people with gout dropped sharply due to the fact that meat products, and even more so alcohol, were very difficult to get.
Purine is a complex organic compound, part of which is broken down in the body, and part of which is transformed into uric acid. A healthy body separates purine through renal filtration and excretes it from the body in urine.
In the case of gout, uric acid is produced much faster. Its elimination is difficult, which contributes to the accumulation in the body. Uric acid salts are converted into crystals and cause gout attacks. Individual food components and drinks can act as provocateurs of this process:
Foods with a high concentration of purine are a key risk factor. Some of the seafood, bacon, veal, beef are not recommended for patients with gout.
Beer - more often than others, it becomes the cause of the development of gout attacks. This is caused by brewer's yeast, which is very high in purine. It is important to remember that any alcohol increases the likelihood of developing a gouty crisis.
Drinks with a high concentration of fructose, sugar, sodas, sweet fruit juices. They impede the excretion of uric acid by renal filtration and provoke the development of hyperuricemia.
Diseases that provoke the development of gout
Certain physical disorders can lead to the development of gout. Diseases of internal organs that affect the function of the kidneys or cause pathological foci of inflammation, cause the active production of uric acid. The most likely causes of gout are:
- Chronic kidney disease;
- Chronic heart disease;
- Hemolytic anemia;
- Decreased thyroid function - hypothyroidism;
- Lymphoma, leukemia;
- Psoriasis, psoriatic arthritis.
The development of a gout attack can be caused by the use of certain drugs that have a diuretic effect, increase the content of uric acid or lead to impaired renal function. The most dangerous are the following pharmacological agents:
- Diuretics (diuretics) are the most provocative drugs, as they increase the concentration of uric acid, especially furosemide and hydrochlorothiazide.
- Levodopa is the main treatment for Parkinson's disease.
- Nicotinic acid (vitamin B3).
The listed drugs cause an increase in the content of uric acid.
Obesity has a direct relationship with seizure
Being overweight is a major concern when you are at risk of developing gout. Obesity is directly related to persistent increases in uric acid levels. Research in 2015 identified a direct relationship between a person's waist size and the likelihood of developing gout. The risk of developing a gouty crisis is higher in patients with an abdominal fat concentration of more than 47%. With a normal waist, the chance of gout is 27%. The development of the disease is not affected by the body mass index (BMI).
Symptoms of gout
The symptom of gout is a common attack of gouty arthritis - this is usually an inflammation of one joint, most often it is the joint of the big toe, knee or ankle. Usually an attack of gout occurs in the early morning or at night, it manifests itself in the form of unexpected severe pressing pain in one or another joint, the affected joint swells, the temperature in the joint area rises, the skin turns red and begins to shine. Usually, the pain becomes a little less during the day, but by the night it intensifies again, the duration of the gout attack lasts from two to three days to a week, sometimes more. With a second attack, other joints can also be involved in such inflammation, this can lead to partial destruction of the joint.
Signs of gout are the appearance of a kind of growth on the hands or feet, while the level of uric acid is significantly increased. When the growths, in other words, tofuses burst, a person can see whitish crystals of uric acid. The patient may feel quite intense pain in the affected areas. Such salt deposits in the joints make it difficult to lead a fulfilling life.
Symptoms, depending on the stage of development of gout
The clinical picture of gout is very diverse and depends on the stage of the disease. At the onset of the disease, attacks pass easily and can be controlled by the patient. Over time, symptoms worsen, and the course of the disease worsens with each new attack.
The development of gout takes place in accordance with certain stages:
Asymptomatic hyperuricemia. The patient has no specific complaints, since the disease practically does not manifest itself in any way. A high content of uric acid is found in the blood. The development of the disease can take up to 30 years, so no specific treatment is carried out. It is important to consider that hyperuricemia may not always cause gout.
Acute gouty arthritis. A large amount of uric acid accumulates in the joints. Patients complain of intense pain, swelling. Possible development of intoxication of the body, febrile fever. If the body is exposed to provoking factors for several days, a gout attack can develop suddenly, most often at night. More about gouty arthritis ➤
Intercritical period. The disease does not give acute symptoms, the patient has no complaints of unpleasant, painful sensations. The joints maintain physiological mobility. Uric acid salts accumulate in the tissues during this time. A gouty attack can occur over a long time - months, years. The patient can control this process by following diet and specific medications.
Chronic gouty arthritis. This condition is caused by the lack of special therapy in the early stages of gout, failure to observe monitoring of the uric acid content. The disease develops rather quickly. Other joints, bladder, kidneys, and other organs are involved in the pathological process. Gouty nodes - tophuses - increase in size, damage articular cartilage, ligaments, can lead to bone deformities, destruction of joints.
Timely treatment of gout, compliance with all the prescriptions of the attending physician makes it possible to reduce the intensity of attacks or eliminate them completely. Violation of therapeutic procedures, errors in diet lead to an increase in gouty crises, a reduction in the time intervals between them, and intense pain.
The main and strongest complication of gout is the appearance of gouty arthritis, it is also possible the occurrence of urolithiasis, in which the resulting stones consist of urate or crystallized uric acid.
Gouty nodes, also called tofus, are nothing more than conglomerates of sodium urate crystals, which have the ability to be deposited in all parts of the body. And in cases where such deposits get stuck in the joints or periarticular tissues, an immune reaction occurs, since these deposits are perceived by the body as a foreign body, which causes the accumulation of leukocytes and begins a severe inflammation, which is called gouty arthritis.
It is worth paying special attention to the fact that kidney stones that occur with gout can become the main cause of kidney failure and can ultimately lead to death.
Pain with gout
You can understand about the beginning of gout by the sudden pain in the joint. They are accompanied by intense redness, swelling and fever. Not only the affected area can "burn", but also the areas of the body in the immediate vicinity. In this case, the body temperature can rise to 39-40 ° C. In most cases, symptoms develop within an hour. Most often, the big toe suffers from this. Conventional pain relievers like aspirin won't help.
The pain usually starts at night and becomes almost unbearable. In the daytime, some improvement is often observed, the pain recedes, but you should not think that everything has passed. Such acute symptoms can torment the patient for about a week.
Gout in men on the legs
Gout is a chronic condition. It is almost impossible to cure it completely. This ailment most often manifests itself on the legs. After the onset of the disease, the symptoms may recur again after six months or a year. The disease can go into a dormant state, but, without any doubt, it will make itself felt. With each attack, the time between them will decrease. The person will have gout more and more often.
The damaged places on the legs are often destroyed more and more, the disease can also affect the neighboring joints. With a long-term illness, over time, on the affected areas, a kind of bumps may appear under the skin, which are called "gouty nodes" or "tophus".
This happens due to the fact that the body begins to perceive large salt deposits in the joints on the legs as a foreign body, the immune system begins to inevitably react - to accumulate leukocytes, after which severe inflammation begins. Sometimes tophuses burst and whitish dust is released from them - uric acid crystals.
Gout often develops in old age. In men, it occurs much more often and at an earlier age. The male population is susceptible to this disease by the age of 40. It should be noted that women begin to suffer from gout closer to 55, mainly after menopause, when the amount of estrogens and female hormones in the body is sharply reduced. Children and young guys are practically not affected by gout. There are rare exceptions in cases of hereditary disorders of uric acid metabolism.
The role of uric acid in the development of gout
This disease severely disrupts metabolism. Purines enter the human body with food, but they are also produced by him. Purines are then broken down into uric acid, which is excreted by the kidneys. In people with gout, the content of this uric acid is significantly higher than the norm. Excess uric acid is deposited in tissues where there is no blood supply. It is there that the crystals are most easily fixed.
The joints, cartilage and tendons are most affected. As a result of this disease, not only these places are affected, but also the kidneys. Most often, with gout, urolithiasis develops, with a lower percentage of the likelihood the patient may suffer from renal colic.
This can happen for two reasons: if too much uric acid is produced and the kidneys cannot cope with the volume of excretion, so it has to be deposited in the human body. And the second reason is that the amount of uric acid is normal, but the kidneys cannot excrete it.
However, too much uric acid in the body is not the only cause of gout. Several other factors play a decisive role here: excessive nutrition, fatty foods, overweight, a sedentary lifestyle, and hereditary predisposition.
Diagnosis of gout
The diagnosis is confirmed by a rheumatologist, based on the results of a comprehensive examination of the body. First of all, the doctor collects anamnesis data, examines the damaged joints. Laboratory diagnostics can differentiate gout from other diseases that have similar symptoms. This requires the following studies:
- Blood test for creatinine and uric acid. For men, the uric acid content rate is up to 0.42 mmol / l, for women - up to 0.36 mmol / l.
- Analysis of synovial fluid obtained by puncture of a joint affected by gout. Urate crystals are found in the contents.
- Hardware methods. X-ray, ultrasound, CT, MRI can exclude other diseases, fix the location, parameters of gouty tophi.
What to do with an acute gout attack?
Even if the recommendations are followed, an acute attack will not go away instantly. But this will significantly reduce the time during which the disease will torment a person. Mainly, strict bed rest must be observed. Sore limbs are best kept in an elevated position, for example, by placing a pillow under them.
In case of unbearable pain, ice can be applied. After that, it is advisable to make a compress on the sore spot with Vishnevsky ointment or Dimexidum. It is better to limit your food intake, you can use liquid cereals and vegetable broths. It is worth drinking as many alkaline drinks as possible, for example, a decoction of oats, jelly, milk, mineral water or plain water, but with the addition of lemon juice (lemon juice dissolves uric acid deposits in rheumatism and gout). Black radish juice is very useful. You need to drink at least 3 liters per day (in the absence of kidney disease).
No pain relievers will help. You can take modern anti-inflammatory drugs without steroids. The most popular NSAIDs are diclofenac, ibuprofen. New generation drugs: Ksefokam, Movalis, Nimesulide, Celecoxib. If you took any prophylactic drugs prescribed by a doctor, then you should continue taking it.
Prevention of exacerbations of gout
Most often, gout appears in those places where the joint was injured. Therefore, treat such places with caution. You should not wear tight and uncomfortable shoes, as they can severely damage the big toe, which “loves” gout. Mainly for the prevention of gout attacks, diet and balanced nutrition are used.
The lifestyle will have to be completely revised, to make it healthy. You should reconsider your taste preferences. Diet No. 6 is recommended, which helps to reduce uric acid and urate in the body. Products containing purine bases - the main source of urates - are strictly limited, if not completely excluded. But poor in purines, and therefore permitted milk, cheese, eggs, vegetables, fruits and cereals will not leave you hungry. The patient's diet should contain whole grains, eggs, vegetables, fruits, and low-fat dairy products.
In food, you should limit the intake of meat, fish, caviar, mushrooms, legumes. In addition, you need to limit the consumption of: smoked meats, marinade, anchovies, cauliflower, asparagus, sorrel, chocolate. Such a diet will lead to normalization of body weight and significantly reduce the stress on joints during an exacerbation of gout.
Detailed information on what you can and cannot eat, as well as other features can be found here
Alcohol and smoking inhibit the excretion of uric acid from the body. Consequently, its crystals are more deposited in the joints. For prevention, you should completely eliminate alcohol, especially beer, as well as quit smoking. Drinking tea, coffee, cocoa is not recommended. In addition to the diet, it is worth doing a fasting day at least once a week with the use of a mono-product.
Small joints are primarily affected. Therefore, it is worth paying special attention to the development of their mobility. Attention should be focused on those areas where pain attacks occur. It is worth doing gymnastics for the joints every day. At first, this will be strange, as the joints become more and more difficult to move due to deposits. It is recommended to be outdoors and take walks more often.
Mineral water for gout
Mineral waters are excellent for removing unnecessary purines from the body. Give preference to alkaline and organic waters. These include, first of all, Narzan, Essentuki and Borjomi. Remember that any liquid should be consumed at least 2.5 liters per day.
A diagnosis of gout means that a person will have to significantly change their lifestyle and constantly take medications, because, unfortunately, it is impossible to achieve a complete cure for this disease. However, timely started treatment allows you to take control of gout, reduce painful attacks to a minimum and insure against serious complications.
The main principle of gout treatment is to control the level of uric acid in the body. For drug treatment, you should consult a rheumatologist. His prescriptions will be aimed at reducing the volume of uric acid and its speedy elimination from the body. Only a qualified specialist can prescribe medications that, with possible concomitant diseases, will not cause the greatest harm to health.
Most often, doctors prescribe non-steroidal anti-inflammatory drugs for 1-2 weeks, such as metindol, diclofenac, butadion, indomethacin, naproxen. To quickly reduce the concentration of uric acid in the body, allopurinol, orotic acid, thiopurinol, hepatocatazal, and miluritis can be prescribed. Doctors recommend colchicine to relieve acute symptoms of gout.
Drug therapy for gout is aimed at solving two main tasks:
- Decrease in the level of uric acid in the patient's body;
- Relief of acute inflammation and pain relief.
The earlier the patient is examined, revises his habits and starts treatment, the more likely it is to achieve a stable remission. Without adequate therapy, gout progresses rapidly, especially in patients of mature and old age, therefore, it is by no means possible to reason according to the principle of "grabbed and let go".
Medication to lower uric acid levels
Since the root cause of gout is precisely the excess of uric acid, solving this problem in 90% of cases leads to the cessation of attacks of excruciating pain and allows you to count on a comfortable life in the future.
The following drugs are used to lower the level of uric acid in the body:
Allopurinol is a synthetic analogue of hypoxanthine. This substance inhibits the activity of the xanthine oxidase enzyme, which is responsible for the transformation of human hypoxanthine into xanthine, and then xanthine into uric acid. Thus, Allopurinol reduces the concentration of uric acid and its salts in all environments of the body, including blood, plasma, lymph and urine, and also promotes the gradual dissolution of already accumulated urate deposits in the kidneys, soft tissues and joints. However, this drug has a number of serious side effects and greatly increases the excretion of xanthine and hypoxanthine in the urine, therefore Allopurinol is contraindicated in patients with severe renal failure. Nevertheless, for the majority of patients with gout, it is he who remains the first-line drug to this day. Cost: 80-100 rubles per pack of 30-50 tablets;
Febuxostat (Uloric, Adenuric) is a selective (selective) xanthine oxidase inhibitor, which, unlike Allopurinol, does not affect other purine and pyramidine enzymes in the human body, moreover, it is excreted not by the kidneys, but by the liver. Febuxostat is a relatively new drug for the treatment of gout, it is not produced in Russia, and in Western Europe and the USA it has passed numerous clinical trials and has shown excellent results. Febuxostat completely dissolves the accumulations of uric acid crystals in the area of the fingers and elbows within three months and effectively prevents their re-formation. Can be used by patients with concomitant renal pathologies. The drug is not cheap - on average, from 4500 to 7000 thousand rubles, depending on the country of origin;
Pegloticase (Pegloticase, Krystexxa) is an infusion solution of enzymes that quickly dissolve urate crystals (deposits of uric acid salts). It is used intravenously twice a month to stabilize the condition of patients with severe gout who are not helped by traditional drugs. Anaphylactic shock is possible during the procedure. This is a very expensive drug that is produced exclusively abroad and sold on order;
Probenecid (Santuril, Benemid)- a drug that prevents the reabsorption of uric acid in the renal tubules and enhances its excretion in the urine. Probenecid was originally used in complex antibiotic therapy to reduce the harm caused to the kidneys by antibiotics. But then it began to be prescribed for chronic gout and hyperuricemia (increased content of uric acid in the blood). It is important to understand that Probenecid enhances the excretion of uric acid, and does not suppress its synthesis. Therefore, the treatment of gout with this drug is advisable only at the stage of remission. If Probenecid is prescribed to a patient with an acute inflammatory process, this will lead to the active dissolution of already accumulated urates, an increase in the level of uric acid in the plasma, and, as a consequence, to attacks of excruciating pain. To avoid this risk,The first months of treatment for gout with Probenecid are accompanied by additional hormonal and anti-inflammatory therapy. The drug costs from 3,500 to 7,500 rubles.
Treating gout with decongestants and pain relievers
Symptomatic treatment of gout consists in relieving seizures, relieving swelling and pain, and is performed with the following drugs:
Colchicine (Colchicum, Kolkhimine) is an alkaloid, isolated from poisonous plants of the melantium family. The most common source of colchicine is colchicum. Colchicine inhibits the formation of leukotriene, stops cell division of granulocytes, interferes with the movement of leukocytes to the site of inflammation and prevents urates (uric acid salts) from crystallizing in tissues. This drug acts as an emergency aid, and is recommended for admission in the first twelve hours after the onset of an acute attack of gout. It is necessary to drink two tablets of Colchicine at once, after an hour - another one, and then one tablet three times a day for a week. The drug very often causes unwanted reactions from the gastrointestinal tract - nausea, vomiting, loose stools. The average price of Colchicine in pharmacies is from 1000 to 2000 rubles;
Glucocorticoids (Cortisone, Hydrocortisone, Prednisone, Prednisolone) are synthetic analogs of human corticosteroids, that is, hormones produced by the adrenal cortex. The drugs of this group break the chain of the body's natural reactions to the interference of allergens, chemicals, bacteria, viruses and other foreign elements. Glucocorticoids quickly relieve inflammation, but suppress the immune system, so hormonal treatment for gout is advisable only when the expected benefit outweighs the potential risk. The cost of synthetic steroid hormones varies from 30 rubles (the oldest drug is Prednisolone) to 1,500 rubles (Cortisone);
NSAIDs (Aspirin, Analgin, Diclofenac, Ibuprofen) - non-steroidal anti-inflammatory drugs are called so in order to emphasize their difference from hormones. However, the effect of drugs in this group is somewhat similar to the effect of glucocorticoids. NSAIDs are non-selective inhibitors of cyclooxygenase, an enzyme responsible for the synthesis of thromboxane and prostaglandins. Thus, these drugs also suppress inflammation, but, unlike synthetic corticosteroids, they do it more slowly and are not immunosuppressive. For the symptomatic treatment of gout, Diclofenac and Ibuprofen are most often used, the average cost is 10-30 rubles, the price of a popular generic (drug with the same active ingredient) Nurofen can reach 150 rubles.
How to prevent gout attacks?
To keep the risk of new gout attacks to a minimum, follow a few simple rules:
- If possible, do not expose the sore joint to any stress, periodically fix it in an elevated position and apply ice for 15-30 minutes 2-3 times a day until the pain subsides;
- Do not overuse aspirin, which can cause spikes in blood uric acid levels and aggravate gout symptoms;
- Measure the uric acid level regularly - it should not exceed 60 mg / l;
- Devote at least half an hour every day to physical education: walk, ride a bike, jog, dance, swim. Be sure to exercise in the morning. Regardless of age and weight, patients with gout should give themselves a feasible physical activity every day - sports are more effective for gout than any medication;
- Drink at least two liters of clean water a day. In order for the kidneys to excrete uric acid from the body, they first of all need clean water. Without enough water, even healthy kidneys will not be able to cleanse the body;
- Take a blood test to determine the level of essential minerals and vitamins, and, if necessary, supplement the diet with a good vitamin-mineral complex. It is especially important for patients with gout to provide themselves with vitamin C;
- Do not drink carbonated drinks with sodium benzoate and powdered juices with fructose, completely give up alcohol;
- Reconsider your diet in favor of vegetables, fruits and cereals, eat no more than 120 grams of animal protein per day, avoid offal and fatty sausages.
On the subject: You can also watch popular folk remedies for gout pain
Latest data on gout treatment
According to the latest data, obesity, caused by excessive consumption of fatty foods of animal origin, is most predisposed to gout. At risk are lovers of sausages, sausages, bacon and hamburgers. It is the excess of proteins that entails an excess of uric acid, and excess weight creates an increased load on the joints and, thereby, accelerates the development of the inflammatory process.
American scientists have also established a direct link between calcium and ascorbic acid deficiency and the development of gout. With age, these essential substances for the body begin to be lacking even for those people who lead a healthy lifestyle and do not complain of being overweight. Therefore, after forty years, it is necessary to be examined annually and take multivitamins prescribed by a doctor.
Recently, a new drug was developed that suppresses the synthesis of uric acid - Benzobromarone. Now active clinical trials of this drug are underway, and in some Western countries it has already been allowed and put on stream. But before the novelty settles on the domestic pharmaceutical market, it will probably still take a long time.
It is also known about the experimental development of new non-hormonal anti-inflammatory drugs that act directly on the interleukin protein, which provokes gouty inflammation of joints and tissues. But the exact timing of the appearance of these medicines on the free market is difficult to name.
Allopurinol: pros and cons
The most popular drug for the treatment of gout, Allopurinol, is increasingly being sharply criticized by modern doctors, since the large number of side effects and complications with its regular use calls into question the advisability of such therapy. According to statistics, on average in one out of two hundred and sixty patients with gout, Allopurinol provokes sudden death as a result of renal coma or cardiac arrest.
Nevertheless, the largest international study of Allopurinol, the results of which were recently published in the scientific journal Annals of the eumatic Diseases, proves the high efficacy of the drug, moreover, the ability to prevent death. This study certainly does not disprove the side effects and high risk of kidney damage, and does not obviate the need for new development. But we have to admit that Allopurinol is still the first-line drug in the treatment of gout, if only because of good knowledge, reliability and affordable price.
Scientists tracked the fate of 5927 patients who regularly took Allopurinol, and the same number of patients who were treated for gout with other drugs that lower uric acid levels. It turned out that mortality in the first control group is 19% lower than in the second, and such results persist throughout the life of patients. That is, Allopurinol is still the most effective and safe drug, both for the treatment of acute, newly diagnosed gout, and for maintaining normal health in elderly patients with a chronic form of the disease.
Patients with gout tend to survive to old age. Almost half of the patients undergo the development of renal failure, the formation of kidney stones.
Which doctor treats gout?
Gout is treated by a rheumatologist.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.