Gout: signs and treatment

Tells Evgeny Zhilyaev,

Professor, MD, Doctor of the highest category.

The disease gout is translated into Russian as "foot in a trap" and is one of the most frequent joint diseases. With gout, uric acid crystals are deposited in joints and bones, causing inflammation and acute pain attacks. The cause of the disease is the absence in the human body of the enzyme uricase, which destroys uric acid.

Gout greatly reduces the patient's quality of life. At the initial stage, gout most often affects the joint of the base of the big toe and is manifested by periodic bouts of severe pain. The ankle and knee joints, and the arch of the foot may also be affected.

Gout pain occurs suddenly, increases over time, is accompanied by severe swelling of the affected joint, severe soreness when touched, and sometimes redness of the joint. The pain during an attack is comparable to a very strong blow. Pain makes it impossible for a person to move, wear shoes, or even touch an inflamed joint. Seizures are usually short-lived and last from 2-3 days to a week. The treatment of gout during seizures is to relieve pain.

Gout is more often diagnosed in men and can be primary or secondary. The development of primary gout in most cases is due to a hereditary predisposition. An enzyme capable of producing more uric acid is transmitted with the genes. Secondary gout develops due to impaired kidney function, when uric acid is produced in small amounts but not eliminated from the body. Women suffer from gout much less often than men, and in most cases it is secondary in women.

Distinguish between confirmed and suspected gout. A confirmed disease is considered to be a disease that is diagnosed using appropriate equipment in the laboratory, when uric acid crystals obtained from a joint or from their subcutaneous accumulation (tophus) are visualized under a microscope.

Complications of gout

1. Gout, if left untreated, can develop into chronic arthritis. Over time, attacks of acute pain become more frequent, and several joints are involved in the process. Pain, subsiding in one joint, occurs in another. As a result, the patient is constantly experiencing severe pain. Chronic gout is a severe joint disease that virtually bedridens the patient.

2. Uric acid in high concentrations is toxic to the kidneys and eventually disrupts their functions. The more kidney function is impaired, the lower the rate of uric acid excretion and the faster its content in the blood increases. Usually, by the time a patient shows signs of gout, kidney damage is already present.

3. With gout, the risk of developing cardiovascular diseases is increased: heart attack, stroke, etc. A patient with gout has about the same risk of stroke as a patient with diabetes mellitus. Cardiovascular diseases are not always associated only with gout. Gout is often accompanied by obesity, hypertension, or impaired glucose tolerance.

Diagnosis of gout at the European Medical Center

To confirm the presence of the disease, it is necessary to identify uric acid crystals in the joint fluid. To do this, the doctor performs a joint puncture, in which a sample of joint fluid is taken with a special needle for subsequent examination in the laboratory. In recent years, approaches to the diagnosis of gout that do not require puncture have been practiced.

Treatment of gout

Treatment of gout consists of two stages:

1. Seizure relief. Nonsteroidal anti-inflammatory drugs are used for this purpose. In some cases, Colchicine is used for cupping. It is also used to inject small doses of a long-acting anti-inflammatory hormone locally into the inflamed joint. In some cases, in the chronic stage of the disease, systemic therapy with glucocorticoid hormones is used to treat gout. The doctor decides on the choice of a particular drug individually in each specific case.

2. A decrease in the concentration of uric acid in the blood. A diet with strict restrictions on the consumption of all types of meat and poultry, with some restrictions on the consumption of fish and seafood, is recommended. It is very important to completely eliminate alcohol consumption, because alcohol blocks the excretion of uric acid and increases the load on the kidneys, thereby speeding up the process of their destruction. The attending physician will make detailed recommendations on limiting foods and changing the diet. The diet is individual in each case. Medications are prescribed to reduce uric acid levels. The goal is to reduce the concentration of uric acid below 350 mmol / l, with such indicators uric acid loses its ability to crystallize and deposit in the joints. If the target level is maintained throughout the year, all available sediments and even massive tofuses dissolve and disappear. In most patients who do not have visible tophus, complete dissolution usually occurs within 3 months. However, even when the target uric acid levels are reached, seizures may recur for a while due to the presence of acid reserves in the tissues. After the crystals are completely dissolved, seizures stop and do not occur as long as the target uric acid level is maintained. This is very important because some patients, considering themselves recovered, stop taking medications. The main drug used to treat gout is Allopurinol. It is safe even with prolonged use (up to dozens of years). To date, this is the main drug, all the others are used either as an adjunct to it, or as second-line drugs.

Advantages of the European Medical Center in the treatment of gout

• The diagnosis and treatment of rheumatological diseases at the EMC is carried out by highly qualified doctors according to modern protocols that have proven their effectiveness. All the doctors of the department have significant experience in this area.

• Multidisciplinary approach: doctors of several specialties (rheumatologist, nephrologist, nutritionist, etc.) take part in the patient's treatment, which allows achieving the best results even in the most difficult cases.

• Comfort and convenience: all diagnostic procedures and specialist consultations are carried out in the same clinic, if necessary, on the same day.

• Round-the-clock monitoring of patients and seizure relief. In emergency cases, the EMS ambulance team goes to the patient's home.

• The possibility of hospitalization in a comfortable hospital for treatment and observation. The menu in the hospital is adapted taking into account medical indications.

Evgeny Zhilyaev