Gouty Arthritis - Symptoms, Diet & How To Treat Gouty Arthritis?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Gouty arthritis

Content:

• What is gouty arthritis?
• Symptoms of gouty arthritis
• Causes of gouty arthritis
• Diagnostics of the gouty arthritis
• How is gouty arthritis treated?
• Diet for gouty arthritis

One of the diseases of modern society is gout. And although it belongs to metabolic diseases, its main manifestation is joint damage.

The process is very specific, characterized by a persistent and prolonged course. It can cause severe destructive processes in the joints, which requires acquaintance with the true face of this enemy of humanity.

What is gouty arthritis?

Gouty arthritis is one of the types of inflammatory damage to the joints, which is caused by the accumulation of uric acid crystals in the articular structures, its destructive effect on hyaline cartilage and periarticular tissues. In the above definition of the disease, all the key mechanisms of development and manifestation of this process are clearly indicated.

If we explain everything in order, then the complex of pathological changes consists of a sequential chain:

1. Violation of the exchange of uric acid in the direction of increasing its amount in the blood;
2. The settling of its crystals (urates) on the surface of the hyaline cartilage of the joints;
3. Irritation and damage to articular structures with the development of an inflammatory response, which is actually called arthritis;
4. The development of the consequences of a destructive process;
5. Periarticular tumor growths.

Gout is also characterized by kidney damage, accompanied by the development of nephritis and urolithiasis, since urate stones are deposited in the renal pelvis and ureters.

In most cases, gouty arthritis affects the small joints (toes), less often the ankle and knee joints, fingers, wrist joint, and elbow.

The disease is more susceptible to males in adulthood (25-50 years). The manifestation of gouty arthritis can occur in an earlier period. Characterized by a long course of the process with constant relapses. The small joints of the feet are mainly affected, less often the ankle joint.

True gout is quite rare; older people often refer to gout as a manifestation of arthrosis. Women get it 5 times less often than men. The risk group includes men 40-50 years old and women over 60 years old (postmenopausal), since this disease has some connection with male sex hormones.

There are also such forms of gouty arthritis, when almost all large and small joints of the upper and lower extremities are exposed to the process. With a slowly progressive course, only small joints are gradually involved in the inflammation. The disease rarely causes severe systemic reactions, although they can also occur. In addition to articular manifestations, gout is characterized by renal symptoms that result from the formation of urate stones.

Medical practice knows cases of severe gout with severe intoxication and massive destructive processes in several large joints simultaneously. Fortunately, such cases are rare. But, nevertheless, long-term current gouty arthritis sooner or later leads to dysfunction of the affected joint with possible disability of patients.

Symptoms of gouty arthritis

Three periods are distinguished in the development of the disease:

• Latent, when there are no clinical symptoms and the onset of the disease can be diagnosed only by the increased content of uric acid in the blood (hyperuricemia);
• Acute recurrent, when joint damage causes severe gouty attacks;
• Chronic, in which long periods of remission are possible.

The frequency of attacks can vary from 1 time per week or month to 1-2 times a year.

The clinical picture of the disease is quite typical, which allows it to be diagnosed in time.

The first manifestations are acute and consist of:

1. Pain in the joint of the big toe;
2. Redness of the skin over the inflamed joint;
3. Increased pain with movement;
4. An increase in body temperature above normal numbers;
5. Unilateral defeat;
6. The appearance around the joints, which are inflamed, whitish subcutaneous growths (tophus);
7. Consecutive recurrent pains in various small joints.

It is worth dwelling on some of these manifestations of the disease separately and detailing the main points. First of all, it is the manifestation of the process. The thumb suffers first in 90% of cases. If, against this background, adequate diagnostic and treatment measures are not taken, then the disease will surely acquire a progressive course. Gradually, other small joints will begin to become inflamed and hurt.

When gouty arthritis is characterized by high activity, the skin over the affected joint necessarily turns red, which is complemented by a general temperature reaction. The prolonged course of inflammation in gout leads to the formation of tophuses (subcutaneous nodules) around the joints. They are represented by elements of articular tissue and uric acid.

The articular cartilage is gradually destroyed, and so-called "punches" are formed in the bones adjacent to the joint - cavities filled with sodium monourate crystals. Also, crystals of uric acid salts can be deposited in the tissues surrounding the joint and directly under the skin above the joint in the form of whitish dense nodules - tofuses. Nodular deposits and bony growths lead to significant changes in the appearance of the leg. If untreated, the result can be a complete loss of ability to work and the ability to self-care.

In women, the disease is much easier than in men. The attacks are not so strong and sharp, tofuses and punctures are extremely rare. Therefore, in women, it can be difficult to differentiate gouty arthritis from arthrosis.

Causes of gouty arthritis

The etiology of the disease is not fully understood. The main risk factors for its occurrence include:

• Hereditary predisposition;
• Improper diet: excessive abuse of meat products, sausages, chocolate, strong coffee and tea, alcohol. (Previously, gout was called the "disease of the aristocrats");
• The presence of concomitant diseases such as heart failure, hemoblastosis, kidney disease, hormonal abnormalities;
• The use of certain medications: drugs for high blood pressure, diuretics, cytostatics, etc.

There are also primary and secondary gouty arthritis:

• Primary gout develops as a result of a combination of genetic predisposition and high intake of purines with the foods listed above;
• Secondary gout occurs due to the presence of the listed diseases and medication.

The accumulation of sodium urate microcrystals in the joint cavity can be asymptomatic for a long time, until some factor provokes an acute attack: physical fatigue (prolonged walking), trauma, infection, stress, hypothermia, starvation, or the use of large amounts of "purine" foods in combination with alcohol.

Diagnostics of the gouty arthritis

The key point of diagnostic procedures is the detection of sodium urate crystals in the synovial fluid of the joints, both during an attack and during remission. For analysis, synovial fluid can be taken from any large joint, even never subject to inflammation, for example, from the knee. Also, the contents of tofus or any other biological material can be taken for research.

Hyperuricemia (elevated blood uric acid) combined with recurrent inflammation of the big toe joint is not considered to be evidence of gout; it is only a marker of impaired purine metabolism. Many people with hyperuricemia do not have gout.

With a long course of the disease, it makes sense to conduct an X-ray examination. At an early stage of the disease, there are no characteristic changes. Then X-ray images show signs typical of gout: destruction of cartilage, defects in the end portions of the bones, punctures.

With the development of gout on the upper extremities, it is rather difficult to differentiate it from other joint diseases: rheumatoid arthritis, osteoarthritis, etc.

How is gouty arthritis treated?

For many decades, official medicine has not come up with anything new in the treatment of gout and gouty arthritis. The entire treatment process also consists of two stages: the removal of inflammation and supportive anti-relapse therapy.

When an exacerbation or primary onset of gouty arthritis occurs, it is necessary:

1. Administration of non-steroidal anti-inflammatory drugs. The most effective for gout are indomethacin, ibuprofen (imet, nurofen), movalis, rheumoxicam. It is good to use their step-by-step appointment with the step-by-step use of injection forms with replacement for tableted ones;
2. The use of the drug colchicine is a specific anti-inflammatory agent for gout;
3. Local use of NSAID-based ointments: indomethacin, dip-rilif, dolobene, remisid;
4. Lotions and compresses based on a semi-alcohol solution or Dimexide in 25% concentration;
5. Physiotherapy procedures: paraffin and other thermal procedures, laser therapy, magnetic therapy, exercise therapy, massage, gymnastics.

Treatment of the disease itself includes the following components:

• Diet (normalization of purine metabolism);
• The use of drugs that reduce the synthesis of urate;
• Elimination of the causes of hyperuricemia.

To eradicate the problem completely, you need to act on its basis - an excess of uric acid. To do this, appoint:

• Allopurinol. Refers to drugs that reduce the production of uric acid in the body. Its counterpart is zilorik;
• Probenecid. Promotes the excretion of excess uric acid crystals in the urine, which reduces the manifestations of gout. The drugs in this group include sulfinpyrazone, etebenecid, anturan;
• Uricozime. It has a direct destructive effect on the already existing urate crystals in the body.

Allopurinol (Allupol, Purinol, Remid, Milurit), belonging to the drugs of the first group, is most preferred. Indications for its use are high hyperuricemia (over 0.6 mmol / l), frequent acute attacks of arthritis, the presence of tophus, renal failure. The starting dose is 300 mg / day. In case of ineffectiveness, it is increased to 400-600 mg / day, and when significant results are achieved, it is gradually reduced. The maintenance dose is 100-300 mg / day, depending on the level of hyperuricemia.

Allopurinol helps to weaken seizures and soften tofus, normalize uric acid levels. In the first week of taking it, a slight aggravation of symptoms is possible, therefore, at this stage of therapy, it is combined with anti-inflammatory drugs, low doses of colchicine or NSAIDs. If a gout attack occurs for the first time, and Allopurinol has never been taken before, you should definitely not start taking it to relieve pain. If an attack occurs while taking Allopurinol, you must continue to take it at the same dosage. Allergic reactions (skin rash) are possible during treatment.

The drugs of the second group are of less importance in the treatment of gouty arthritis. They are not used for high levels of uric acid in the blood, for nephropathy and renal failure. Sulfinpyrazone is taken at 200-400 mg / day in 2 divided doses with a large amount of alkaline liquid. An additional contraindication is stomach ulcer.

Probenecid (a derivative of benzoic acid) is prescribed at 1.5–2.0 g / day. Benzoic acid is found in cranberries, as well as in lingonberries and their leaves. Therefore, cranberry and lingonberry decoctions and fruit drinks are very useful for patients with gout.

Drugs of different groups can be combined with each other, however, as mentioned above, in case of serious kidney pathology, uricosuric drugs are contraindicated. Also, they can be used only after the complete relief of an attack of acute arthritis, otherwise another exacerbation can be provoked. During treatment with drugs of this group, the daily water consumption should be at least 2.5-3 liters.

Treatment is long (from several months to several years), interruptions in treatment usually lead to relapses. Subject to all medical recommendations, the condition of patients is normalized within the first month. It is recommended to carry out monthly monitoring of the level of uric acid and, depending on the test results, adjust the dosage of drugs. The main therapy can be supplemented with physiotherapy, massage, exercise therapy.

In the presence of excess weight, it is recommended to lose weight, since there is a connection between excess weight, increased synthesis of urates and their reduced excretion by the kidneys. You should also stop taking thiazide diuretics to lower blood pressure and aspirin. These drugs increase the amount of uric acid in the body and can trigger an attack.

During exacerbations, the stress on the affected joint should be minimized as much as possible. Additionally, you can do ice compresses several times a day for 5-7 minutes.

Only a comprehensive approach to treatment, including anti-inflammatory therapy, topical treatments, diet and medications that affect uric acid metabolism, can help fight gouty arthritis.

Diet for gouty arthritis

Given that gout is a consequence of improper nutrition, then its complete cure cannot be achieved without a clear implementation of the necessary dietary recommendations. That is why gouty arthritis in most cases has a progressive course. But I would like to focus the attention of patients on the importance of such a therapeutic measure as diet therapy. According to the medical nomenclature, it belongs to the dietary table No. 6.

The most important principle is the exclusion of foods that are a source of purines. Indeed, during their decay, a powerful release of uric acid occurs, which does not have time to bind and be excreted from the body. Its approximate composition is shown in the table.

It is impossible

Wheat and rye bread; Vegetarian, milk and cereal soups: cabbage soup, borsch, okroshka, milk noodles; Any porridge except oatmeal; Boiled beef, chicken, turkey, rabbit meat - 2-3 times a week; Boiled low-fat fish - 2-3 times a week; Eggs - 1 pc. a day, cooked in any way; Natural milk, cottage cheese, unleavened cheese, dairy products (kefir, yogurt, sour cream); Cereals and pasta prepared in any way; Potatoes, beets, carrots, tomatoes, bell peppers, zucchini, cucumbers, eggplant, pumpkin, white cabbage; Any fruits and berries other than those indicated in the above list; Jam, honey, jelly; Nuts; Cinnamon, vanilla; Weak tea and coffee with milk; Vegetable and fruit juices, lemon and cranberry juice, green, mint and linden tea, rosehip broth; Vegetable and butter; Alkaline mineral water (you can sometimes add soda to drinking water); Allowed the use of wine without exacerbations.

Meat, fish, mushroom rich broths; Pork, lamb; By-products (kidneys, liver, brains); Sausages (especially liverwurst), ham; Jelly; Fatty fish (mackerel, sardines, mackerel, herring, cod); Any canned food, smoked meats, salty and spicy dishes; Seafood (shrimp, anchovies); Salted and spicy cheese, feta cheese; Porcini and champignons; Baking from butter dough; Legumes (peas, beans); Greens: lettuce, spinach, sorrel; Rhubarb, radish, cauliflower, asparagus, lentils; Raspberries, figs; Cocoa, chocolate, strong coffee and tea; Alcoholic drinks (cognac, whiskey, beer); Pepper, mustard, horseradish; Salt.

As you can see from the above data, a lot is prohibited, but there is also enough food for a normal healthy diet. The main thing to remember is to avoid excess. Even if it happened that a person could not resist and ate prohibited food, it is advisable to immediately take appropriate drugs that remove or bind the products of uric acid metabolism.

Sample menu for gout for a week

Monday:

• Breakfast: cottage cheese with fruit jelly, coffee with milk;
• Lunch: Tomato juice;
• Lunch: vegetable rice soup, bread, compote;
• Afternoon snack: apple, weak tea with marmalade;
• Dinner: potato pancakes, green tea.

Tuesday:

• Breakfast: porridge with milk, rye bread, pineapple juice;
• Lunch: pear, walnuts;
• Lunch: Braised rabbit, vegetable stew, compote;
• Afternoon snack: Orange juice;
• Dinner: cheese sandwich, milk tea.

Wednesday:

• Breakfast: Carrot cutlets with sour cream, fruit drink;
• Lunch: Banana;
• Lunch: Vegetarian borsch with sour cream, rosehip broth;
• Afternoon snack: grapefruit, tea with jam;
• Dinner: pumpkin casserole, green tea.

Thursday:

• Breakfast: boiled egg, cheese sandwich, lemon tea;
• Lunch: a glass of cherry juice;
• Lunch: Trout baked with potatoes, vegetable salad with butter, fruit drink;
• Afternoon snack: Kefir, candy;
• Dinner: Muesli with nuts, fruit drink.

Friday:

• Breakfast: buckwheat porridge cooked in milk, green tea;
• Lunch: baked apples with honey and nuts;
• Lunch: vegetable salad, boiled rice, bread, orange juice;
• Afternoon snack: tomato juice;
• Dinner: stewed potatoes, fresh vegetable salad, a glass of skim milk.

Saturday:

• Breakfast: scrambled eggs, a piece of rye bread, jelly;
• Lunch: peach juice, almonds;
• Lunch: cabbage soup with lean meat broth, rosehip broth;
• Afternoon snack: banana;
• Dinner: cereal soup, cheese sticks, tea with milk.

Sunday:

• Breakfast: corn porridge with milk, coffee with milk;
• Lunch: kefir, candy;
• Lunch: vinaigrette, bread, fruit drink;
• Afternoon snack: apple;
• Dinner: boiled tuna with fresh or stewed vegetables.

After a year of treatment, with satisfactory health and the absence of relapses, severe dietary restrictions can be removed. In this case, you can choose: either continue to adhere to the diet and reduce the dosage of the drugs taken, or cancel them altogether, or continue taking medications and allow some relaxation in the diet.

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.