When the first symptoms of gout on the legs appear, the question arises which doctor should be consulted. According to the rules, the treatment of any disease begins with a visit to the therapist. He conducts an initial examination, collects an anamnesis of the disease (complaints) and directs him to a consultation with narrow specialists.
You can directly contact any of the doctors. But many patients do not know which doctor treats gout. Some people refuse to seek medical help. Such neglect of one’s health can cause gout to progress and complications to occur.
- Symptomatology of the disease
- Which doctor should I contact
- Gout Specialist
- Collegial therapy
- Gout Treatment Technique
- Stage I – the removal of pain
- Stage II – main therapy
- Stage III – additional treatment methods
- Which doctor to go for with gout
- What does a rheumatologist do during treatment
- What doctors are involved in the diagnosis of gout
- Possible consultations of related specialists
- Dispensary registration at the rheumatologist
- Primary sources of information, scientific materials on the topic
- Which specialist treats gout?
- When is it necessary to see a doctor?
- Which doctors treat gout?
- Who is a rheumatologist?
- Therapist for gout
- How does an orthopedist treat?
- Surgeon: treatment features
- What is gout?
- History of Gout
- Pathogenesis of gout
- Causes of Gout
- Hereditary predisposition for gout
- The provoking factors
- Signs of Gout
- What kind of doctor treats gout
- How can a doctor help?
- What specialists treat gout
- What tests does the doctor direct?
- What can appoint
- Chronic gout
Symptomatology of the disease
Gout on the legs is characterized by a number of symptoms. You should consult a doctor with these signs:
- Pain in the legs or toes of a aching character that occurs at night;
- The formation of gouty tofus (cones);
- The diseased joint is limited in movement.
An integral sign of gout is a gouty attack, which manifests itself as a sharp pain in the joint. Externally, the joint looks swollen and reddened. Of the general symptoms of the patient, headache, fever up to 38-39 ° C are disturbing.
Sometimes gouty attacks go away on their own, but this is not a sign of recovery. Gout attacks are repeated again, after some time (from 6 months to 1 year). To prevent the progression of the disease, it is necessary to visit a doctor who treats gout in a timely manner.
Which doctor should I contact
Most patients who first experience gout will see a GP or family doctor for an appointment. The doctor interrogates the patient, examines and probes the affected joint.
At the first visit, the therapist makes a preliminary diagnosis. After this, the patient is referred for consultation by a rheumatologist, who prescribes a number of laboratory and instrumental studies to clarify the diagnosis, and also determines the tactics of therapy.
Timely medical care of a rheumatologist will help to avoid complications and the progression of the pathological process.
A gout specialist is a qualified rheumatologist. He conducts differential diagnosis, determines the exact diagnosis, select the appropriate therapy. For this, a number of studies are prescribed:
- General blood test – allows you to determine the presence or absence of an inflammatory process;
- Biochemical blood test – determines the content of uric acid in the blood;
- Urinalysis – shows the presence of deviations characteristic of gout;
- Radiography – allows you to assess the condition of the joint, the degree of damage, deformation;
- Joint puncture – helps to detect the presence of sodium urate in the tissues of the joint;
- Ultrasound is a mandatory kidney test that helps to rule out or confirm the accumulation of uric acid salts in the renal tubules.
Based on the results of instrumental and laboratory studies, a final diagnosis is established and treatment is prescribed.
For complex therapy requires the collaboration of several doctors. The first joint treatment is carried out by a rheumatologist and therapist. They monitor the patient during the initial exacerbation of gout, choose the appropriate therapy. If there is no rheumatologist, the therapist leads the patient on his own.
When a patient has concomitant diseases or the development of complications of gout has begun, he will need to consult other doctors:
- The orthopedist prescribes a set of therapeutic measures in case of complications in the musculoskeletal system;
- Surgeon – in severe stages of the disease, the doctor combines conservative and surgical methods of therapy;
- The nutritionist determines the individual diet for a particular patient, excludes prohibited foods and replaces them with safe analogues;
- The urologist helps with the choice of medications that are safe for the kidneys, but effective for excretion of urea salt;
- A cardiologist can eliminate possible complications with the cardiovascular system while taking certain medications that can adversely affect the functioning of the heart.
Gout Treatment Technique
The doctor treats gout on the legs in stages. Therapy depends on the severity of the pathological process. Treatment is carried out with the help of medications, physiotherapy, physiotherapy exercises (exercise therapy), diet.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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Stage I – the removal of pain
During an exacerbation or gouty attack, a burning pain is felt in the area of the affected joint. To alleviate the condition, non-steroidal anti-inflammatory drugs (NSAIDs) are used.
The best of these is colchicine. This drug reduces pain time to 2 days.
Stage II – main therapy
The goal of basic therapy is to use medications that lower the uric acid salt level in the body. These medicines include:
- Uricodepressive drugs – slow down the formation of excess uric acid (Tiopurinol, Allopurinol);
- Uricosuric drugs – contribute to the removal of urea from the body (Sulfinpyrazone).
The choice of the drug and its dosage is set only by the doctor! Self-medication can lead to serious consequences.
Stage III – additional treatment methods
In addition to pharmacy drugs, complex therapy also includes other treatment methods. These include:
- Spa treatment.
Also an important component that helps to cure gout on the legs is diet therapy and compliance with a special water regime. During the entire treatment course, the patient should drink at least 2-3 liters of water daily. Diet therapy includes the following recommendations:
- Minimize the consumption of meat fatty foods;
- Completely abandon alcohol, coffee, cocoa, strong tea, chocolate;
- Increase the consumption of dairy products;
- Enrich the diet with herbal products.
Treating gout on your own is not recommended. The disease requires an effective integrated approach. Knowing which doctor to contact with gout on the legs, one should not delay and begin a course of complex treatment as soon as possible. The doctor will individually select the appropriate treatment methods. This is the only way to cope with this ailment.
Which doctor to go for with gout
From this article you will learn: which doctor treats gout on the legs, on the hands and the disease of other localizations. Who to contact if there is no specialist rheumatologist in the clinic. What other doctors are involved in the treatment process.
The author of the article: Victoria Stoyanova, category 2 doctor, head of the laboratory at the diagnostic and treatment center (2015–2016).
Which doctor should I contact for gout? A specialized, narrow specialist in systemic diseases (which occur with damage to the connective tissues of all body systems) is a rheumatologist, he treats various manifestations of gout (arthritis, nephropathy, hyperuricemia):
- makes a diagnosis;
- prescribes the necessary examinations and medications;
- he observes the patient in the period between exacerbations (gout is an incurable disease, it will have to be fought with all his life).
What if there is no rheumatologist in the medical institution of a small village or city, who treats the disease in this case? The patient needs to see a therapist who will establish a preliminary diagnosis, and then be referred to a specialist rheumatologist at the nearest diagnostic center or clinic.
A preliminary diagnosis can be made by such doctors as a traumatologist or surgeon, but treating gout on the legs or arms, renal nephropathy and other manifestations of the disease of any localization is the task of a rheumatologist.
What does a rheumatologist do during treatment
Often patients have a question – what is the work of a rheumatologist? This specialist treats all manifestations of gout – articular (arthritis), kidney (nephropathy), and asymptomatic hyperuricemia (elevated uric acid in the blood).
- Establishes a preliminary diagnosis (by interviewing and examining the patient).
- Selects an examination to confirm it (analyzes, instrumental studies).
- Prescribes treatment.
- Controls the process (adjusting the dosage of drugs).
- Gives recommendations that help regulate the content of urinary urine in the blood and urine, prevent exacerbations and complications of the disease (arthritis, arthrosis).
After the acute symptoms of the disease subside, the patient is registered, and the rheumatologist continues to observe him:
reduces or increases the dosage of the taken uricostatic drugs (Allopurinol) depending on the result of the tests (for uric ac >
Gout cannot be completely cured, so a rheumatologist monitors the patient throughout his life.
What doctors are involved in the diagnosis of gout
What other doctors treat gout (except for a specialist) and how to establish a diagnosis? The rheumatologist establishes a preliminary diagnosis on the basis of a survey and examination of the patient, revealing the classic signs of the disease:
- the presence of articular nodules or tofuses (tissue deposition of urates);
- recurring attacks of gouty arthritis;
- damage to the joint of the big toe;
- hyperuricemia (a positive response is an increase in the level of urinary to-you in blood tests above 0,40 mmol / l).
The doctor confirms the diagnosis by prescribing:
- X-ray of the joints.
- Ultrasound of the kidneys.
- Laboratory tests (blood and urine).
Thus, other specialists are involved in the treatment process – radiologist, ultrasound diagnostician, laboratory assistant.
Possible consultations of related specialists
If during the examination, concomitant diseases, metabolic disorders were found, the patient is prescribed consultations of related specialists:
- nutritionist for obesity;
- cardiologist with ischemic disease (lack of blood supply to the heart);
- nephrologist with renal pathologies;
- arthrologist or orthopedist for arthrosis of the joints.
In the process of rehabilitation (recovery) after exacerbations of gout, other doctors take part:
- physiotherapist (restores joint mobility);
- nutritionist (advises on a diet on which the effectiveness of treatment depends).
Dispensary registration at the rheumatologist
A person with gout is put on a dispensary record: several times a year he must visit his attending physician (in this case, a rheumatologist). Planned treatment is necessary so that:
- Take another examination (take blood and urine tests, do an ultrasound of the kidneys, if necessary – an x-ray of the joints).
- The doctor assessed the general condition of the patient and adjusted the dosage of the drug (canceled, decreased, increased, prescribed another, more effective).
- Get a referral to preventive spa treatment (with gout it helps a lot to drink mineral alkaline water courses).
Frequent recurrence of gouty arthritis can be the basis for registration of 2 or 3 disability groups. The first specialist who decides to refer the patient to a commission on disability is the attending rheumatologist.
Primary sources of information, scientific materials on the topic
- On approval of the Procedure for providing medical care to adults in the profile of “rheumatology”. Order of November 12, 2012 N 900n.
- Gout, clinical recommendations. Association of Rheumatologists of Russia, 2016.
- Changes in gout treatment approaches. E.V. Zhilyaev.
- How to quickly help a patient with gouty arthritis and not make mistakes, recommendations to a practitioner. Barskova V.G., Russian medical journal.
- Nasonova V. A., Barskova V. G. Early diagnosis and treatment of gout – a scientifically substantiated requirement to improve the labor and life prognosis of patients. Scientific and practical rheumatology, 2004; No. 1, pages 5-7.
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Which specialist treats gout?
The accumulation of uric acid in the body leads to its deposition in the joints and the appearance of gout. The disease is characterized by severe pain in the area of the damaged joint, redness of the skin, swelling at the site of inflammation. In case of suspicion of such a disease, you should contact several doctors. Basically, the pathology is rheumatic in nature, so you need to visit a rheumatologist. If this is not possible, then you need a therapist who is available in any hospital or general practitioner, surgeon, orthopedist.
When is it necessary to see a doctor?
It is a misconception that gout affects women wearing uncomfortable high-heeled shoes. The risk group includes people suffering from overweight, high blood pressure or with joint injuries. The disease begins imperceptibly, in the early stages the probability of its diagnosis is low. As the disease develops, a person suffers from bouts of aching pain in the affected joint at night and in the morning. Such a pain syndrome is an occasion to go to the doctor. The following symptoms of gout are distinguished:
- redness and fever in the area of the damaged joint,
- sharp pain on palpation,
- joint size increase
- swelling at the site of the lesion.
The disease has negative consequences, therefore, at the first signs of gout, you need to see a doctor.
Which doctors treat gout?
Gout is caused by a violation of metabolic processes in the body. Therapy to alleviate the symptoms of the disease requires an integrated approach. The correct choice of which doctor to turn to depends on the signs of the disease and the presence of narrow specialists in the clinic. A rheumatologist, therapist, orthopedist or surgeon will help solve the problem of gout. Depending on the presence of other health problems, other doctors participate in the complex therapy: nutritionist, gastroenterologist, nephrologist. During the first examination, any doctor finds out the features of the patient’s lifestyle. The patient should most accurately describe the symptoms of the disease. Combined therapy consists not only in prescribing medications, but also in following a special diet.
Who is a rheumatologist?
A narrow-profile doctor who treats arthritis, arthrosis and other diseases of the joints and connective tissue. During the first dose, a rheumatologist establishes a preliminary diagnosis and prescribes a set of diagnostic measures:
- biochemical and general analysis of blood and urine,
The collection of examination results gives a complete picture of the degree of the disease, helps to prescribe effective therapy and develop motor exercises. Patients with acute gout are placed in a hospital until the condition is relieved. At the remission stage, treatment is carried out at home under the supervision of a rheumatologist.
Therapist for gout
This is a general specialist who conducts a comprehensive examination of the patient’s body. It is important to contact him immediately after the first gouty attack. The doctor prescribes an examination, and if the diagnosis is gout, he can be referred to a rheumatologist or other specialist, depending on the characteristics of the disease. Therapy for gout consists of medication with drugs to reduce the amount of uric acid in the body and follow a strict diet. For this, the therapist refers the patient to a nutritionist.
How does an orthopedist treat?
Gout is characterized by a change in the shape of the foot. A characteristic bump grows on the leg, the gait changes. With this pathology, the therapist writes out a referral to an orthopedist. He appoints an additional examination to determine other signs of diseases of the musculoskeletal system. In complex cases, gout on the legs is treated with joint replacement.
Surgeon: treatment features
The therapist and rheumatologist in their practice interact with the surgeon. This is a specialist who deals with treatment through surgical operations. If the patient did not go to the doctor on time and allowed the accumulation of uric acid in the joint – tofus, they are removed from the soft tissues by surgery. This is a cardinal measure, which is accompanied by a long recovery process.
Timely diagnosis of gout prevents the development of complications. At the first signs of the disease, you need to see a doctor to establish a diagnosis and prescribe therapy. The specialist profile should be chosen depending on the symptoms, but at the beginning of the disease, a general practitioner or a rheumatologist will help to conduct a comprehensive examination.
What is gout?
Gout is a disease characterized by signs of arthritis amid increased levels of uric acid and its salts (hyperuricemia) in the body. Not in all cases, an increase in the level of uric acid in the blood leads to the development of gout, but with age, the risk of disease formation increases significantly. To date, the incidence of gout is 3 cases per 1000 people. It is proved that gout is much more common in men (about 20 times), however, in women in recent years there has been an increase in the incidence. The inter-gender difference in incidence after 50 years is reduced.
Gout can affect any joints: fingers, hands, elbows, knees, but most often the joints of the fingers of the foot, especially the thumb, suffer from gout, which is associated with a greater tendency to degenerative-dystrophic changes in their cartilaginous tissue.
History of Gout
Gout was already described in the th century BC. Hippocrates, but it was only a description of the symptoms. At the end of the th century, scientists found an increase in blood, and then in intraarticular fluid in patients with gout, the content of uric acid salts. A detailed study of the pathogenesis of gout and the development of drug treatment date back to the middle of the twentieth century.
Various theories are curious, linking the likelihood of developing gout with various lifestyle characteristics and personal qualities. For example, as far back as the Middle Ages, gout was called the “disease of plenty”, as its exceptionally wealthy people were ill. Later, this was explained by the connection between the development of gout and the ingestion of a large amount of protein and the participation of alcohol in its pathogenesis. Another theory was to identify the dependence of the frequency of the disease on the level of intelligence and the overall success of a person. Many famous personalities (Franklin, Newton, Darwin, etc.) suffered from gout, which gave reason to assume such a connection.
Pathogenesis of gout
Hyperuricemia can be associated with a variety of reasons, from intense physical exertion and dietary errors to severe kidney disease or oncology. The symptom complex characteristic of gout is not always formed. This diagnosis is made when there are signs of joint inflammation (arthritis), which is the result of the deposition of uric acid salts (urates) in the tissues of the joint. Uric acid crystals have an irritating effect on tissues, resulting in their chronic aseptic inflammation and proliferation with the formation of gouty “cones” or tofuses. Tofus can also be located in internal organs (for example, heart valves). Tofus itself is painless, the pain is associated with inflammation in the periarticular bags (bursitis) or tendons (tendovaginitis). The inflammatory process becomes the cause of severe pain and limited mobility of the joint.
Causes of Gout
Risk factors for the formation of gout include all conditions that increase the level of uric acid in the blood. This may be an increase in its intake, for example, when eating a large amount of protein, especially red meat. Uric acid can be endogenous, that is, it is formed from the tissues of your own body, for example, during antitumor therapy, autoimmune processes. If the pathological process develops as a result of any disease or its therapy, they speak of secondary gout.
Hyperuricemia can result from a violation of the normal elimination of urates in kidney diseases complicated by renal failure. There are situations when an increase in the production of uric acid is accompanied by a violation of its excretion – in case of shock conditions, alcohol consumption. For this reason, combining gout and alcohol is not recommended.
Proven and hereditary predisposition to gout, consisting in the features of purine metabolism. Genetically determined gout is called idiopathic. It is quite rare, accounting for approximately 10% of all cases of primary gout (the remaining 90% are associated with impaired uric acid excretion).
Hereditary predisposition for gout
The source of uric acid in the human body is purine bases (adenine and guanine), which are part of nucleic acids, and purine nucleosides (a structural component of ATP). Nucleic acids enter the body with food or are synthesized endogenously (predominantly). Several enzymes are involved in the metabolism of purine bases; defects in the structure of two of them have been shown to enhance the synthesis of uric acid: a deficiency of hypoxanthine-guanine phosphoribosyl transferase (HCGFT) and increased activity of 5-phosphoribosyl-1-synthetase. In the presence of these transformations, the development of gout in children is possible. Both of these enzymes are controlled by genes linked to the X chromosome, therefore more often males suffer from hereditary gout.
The provoking factors
An attack of gout is usually preceded by the influence of provoking factors:
- alcohol intake (the mechanism is presumably associated with an increase in the formation of urate due to the intense breakdown of ATP when alcohol enters the body, as well as an increase in the content of lactic acid, which disrupts the excretion of urate by the kidneys);
- changes in nutrition, while an attack of gout can provoke both overeating (especially fatty meat or fish), and starvation;
- trauma or overload of the joint (for example, with long walking);
- taking certain medications, especially diuretics.
Signs of Gout
The deposition of uric acid crystals does not immediately lead to pain. At the initial asymptomatic stage, the disease is diagnosed extremely rarely, although almost half of the patients have attacks of renal colic before the appearance of pain in the joints – urolithiasis is formed earlier than gout.
Most often, the diagnosis of gout is made after the first attack of arthritis. The affected joint swells, the skin above it becomes hyperemic and hot, severe pains appear that limit mobility in the joint. Symptoms of gout depend on the location of the lesion. Most often, isolated monoarthritis of the metatarsophalangeal joint is found (up to 65% of cases), other joints of the legs (gout in the knee, ankle, and other joints of the foot) are much less likely to be affected. Gout on the hands is extremely rare, which is associated with the structural features of the cartilage.
What kind of doctor treats gout
The question, which doctor treats gout, begins to excite a person when he has joint changes, and bones appear on his feet. The changed shape of the legs gives the patient a lot of painful discomfort and inconvenience when selecting and wearing shoes. If the problem is not resolved, then it can lead to a number of complications in the future.
How can a doctor help?
The bones on the legs grow over time, not only causing discomfort in a person, but sometimes causing him severe pain. This happens because gout is not just a deformation of the joints, but also an inflammatory process, as well as the deposition of salts and urinary crystals, which gradually leads to the destruction of the joint. Therefore, at the first signs of the disease, you should make an appointment with the doctor. The specialist identifies the degree of joint inflammation and prescribes the necessary treatment.
What specialists treat gout
Among the doctors the patient may contact: a therapist, an experienced orthopedist, a professional rheumatologist, traumatologist, and surgeon. But this list is not complete, because the cause of gout is often malnutrition. This means that the patient should also visit a nutritionist.
What tests does the doctor direct?
An experienced specialist identifies gout after the first visual examination, but in order to get an exhaustive picture of the disease, the doctor directs the patient to a diagnosis that involves several types of studies. First of all, you need to donate blood for biochemistry, conduct a general and x-ray examination of the joints, make an ultrasound of the kidneys.
The most accurate diagnosis confirming the presence of gout in a patient is arthrocentesis – testing of the synovial articular component, revealing the amount of uric acid. This method does not apply if the patient has a swelling or redness of the affected area.
What can appoint
To get rid of gout, an integrated approach to treatment, which depends on the stage of arthritis, should be used.
There are several ways to combat the disease:
Drug therapy, which involves the appointment of non-stero >
Medications have a quick and powerful effect, but side effects are not ruled out when the patient may suffer kidney damage. Gouty nephropathy, which develops during treatment, sometimes leads to death, so it is so important to examine the kidneys and strictly follow all the doctor’s recommendations.
If the disease arose in a pregnant and lactating woman, drugs can harm rather than benefit. In such cases, the specialist prescribes an alternative treatment, including the use of chondroprotectors. These drugs repair damaged cells and tissues, regenerating and stimulating them, restoring lost joint functions.
As an element of concomitant therapy with an uncomplicated form of the disease, it is allowed to use traditional medicine methods, among which:
- An ointment based on butter with the addition of vodka or alcohol in a ratio of 1: 1. After mixing the components, the substance is ignited until the alcohol has completely evaporated and is applied to the affected areas until the pain disappears.
- Half a glass of powdered activated carbon is mixed with 1 s. l flax seeds, add some water and use as a compress applied overnight.
- Trays with iodine, reducing salt deposits. 3 tsp is taken on 3 l of water. soda and 9 drops of iodine.
- Grinding with iodine (10 ml) and Aspirin (5 tablets, powdered). After treatment, warm socks should be worn on the feet.
- Effectively acts a decoction of lemon with garlic. The products are crushed, poured with boiling water, insisted day and drink 3 times a day for 2 tbsp. l
- Infusion of birch or lingonberry leaves, dioica nettle juice.
Among other recommendations, the advice of a dietitian can help, which will make the patient a full menu that helps to improve his well-being. Of the products allowed for use:
any porr >
The following should be excluded from use:
- sausages, smoked meats;
- canned foods;
- strong coffee, tea;
- legumes, peas;
- chocolate, cocoa;
- fried fish and meat;
- alcoholic drinks;
- seasonings and spices;
Treatment of gouty arthritis is a long process, for the period of which it is necessary to stock up on patience, because an instant result is impossible here. To eliminate the inflammatory process and get rid of pain, therapy is required for 4-5 months, and in complex cases the process is delayed for years. Timely administration of medications and strict adherence to diet are indispensable conditions for the full recovery of the patient.
Gout (gouty arthritis) is the metabolic pathology of the body, which affects the exchange of purines (derivatives of uric acid), which leads to excessive deposition of salts of uric acid in some tissues of the body.
It is as a result of these deposits that disturbances in the functions of organs and tissues are formed. Joints, kidneys and some other organs (bones, ligaments, liver) are especially affected.
Gout has been known for a long time, occurs with periods of remissions and gouty attacks, more often affects middle-aged men, women suffer in no more than 1-2% of all cases of gout.
The basis of gout is a genetically inherited defect in the metabolic processes of uric acid, a defect of enzymes that help its utilization and excretion, as well as defects in the system of internal synthesis of purine substances.
In addition to genetic causes, for the development of gout, risk factors and external influences that predispose to the development of gout are equally important:
- increased intake of purine bases with food during the abuse of meat products,
- obesity and overweight
- alcoholism, excessive consumption of wine,
- bad habits, inactivity.
Possible development of secondary gout
- against the background of tumor processes with a change in purine metabolism,
- against the background of increased breakdown of body proteins,
- in the treatment of thiazide diuretics (dichlothiazide, polythiazide),
- when using cytostatics (doxorubicin, fluorouracil, hydroxyurea, cyclophosphamide).
Gout attacks can be triggered by stressful reactions to alcohol, citrus fruits, viral infections, physical or mental stress, injuries and hypothermia, bruises, pressure fluctuations, and medications.
Most often, gout affects the kidneys and joints, therefore, we can distinguish
- gouty arthritis
- gouty kidney damage.
Three types of gouty disorders are also distinguished based on the level of uric acid in the urine:
- metabolic form with the highest amount of uric acid.
- renal form, moderate uric acid with increased salts,
- the mixed form is a lot of uric acid and its salts, which give crystals.
Gout is a chronic and progressive disease, it can occur in three successive stages –
- acute arthritis of gouty origin,
- stage of interictal gout,
- chronic tofus stage of gout.
Gouty arthritis occurs suddenly: at night or in the morning, there are burning, throbbing or tearing pains of one or more joints, usually on the legs and their lesion is asymmetric.
Quite often, the joint of the big toe is the first to be affected.
The lesion usually captures the foot or ankle, knees, finger joints, elbows. There may be swelling of the veins around the joint, fever and chills.
Due to severe pain and swelling, joint movements are almost impossible. During the day, the pain subsides somewhat, and again by night, which leads to neurosis and irritability.
After 3-4 days, the pain subsides, the joint acquires a bluish tint, and swelling gradually subsides.
During seizures, blood tests change – inflammation is detected in the blood with an acceleration of ESR, high white blood cells and an increase in the proteins of the acute phase of inflammation.
Attacks can occur at different times – from once every six months to several years. As gout progresses, the frequency of attacks increases, they become longer and less sharp, but new joints are involved in the process.
Chronic gout forms the sites of tofus – these are nodular accumulations of salts in tissues in about 5-7 years from the onset of the disease.
Tofuses arise inside the auricles, in the area of the joints of the hands and feet, elbows, knees, their sizes can be from a couple of millimeters to a pea or more. As the progression changes, the joints change, their deformations, curvatures, limitation of mobility and pain during movement occur.
In addition to the joints, the kidneys are affected. Changes are the stronger, the higher the level of uric acid and urate in the urine, and the longer the disease.
There is the so-called uratic nephropathy with inflammation of the kidney tissues, the release of salts, the deposition of sand and pebbles and the formation of urolithiasis.
There are periods of renal colic with lower back pain, nausea and vomiting, and secondary pyelonephritis may also develop, with fever, white blood cells in the urine, dysuria, and a general serious condition.
Urate can be deposited not only in the renal pelvis, but also in the kidney tissue, its cortical and cerebral layer, this leads to a gradual atrophy of renal function and the development of renal failure.
There can be lesions of the tendons with the deposition of salts in them, while redness and swelling in the tendon zone develops, severe pain and movement problems.
Also, the risk of developing coronary heart disease is higher; some patients experience severe obesity.
The basis of the diagnosis is typical gout attacks with joint damage. Blood tests with signs of acute inflammation, urine tests with a high level of urate and uric acid, creatinine supplement the findings of puncture from the joint to detect urate salts.
For the initial diagnosis, a study of the joint fluid is necessary. With attacks of gout, it is transparent, its viscosity is reduced, white blood cells in it are up to 75%, uric acid crystals are found.
With long-term current gout
An x-ray with the detection of certain signs in the clinic is mandatory:
- maximum inflammation in the first day,
- several attacks of arthritis,
- damage to one joint,
- joint redness
- inflammation in the first joint of the big toe,
- suspicion of tofus,
- increase in blood and urine levels of urate,
- typical signs of joint damage on x-rays.
In the treatment of acute gouty arthritis, rest and cool wraps are very important.
An important place is taken by colchicine, prescribed 0,5 mg every hour until the arthritis subsides, or until side effects (vomiting, diarrhea) occur, but not less than 6–8 mg / day.
For the treatment of an acute attack of gout, colchicine is used for no more than a day.
Indomethacin, ibuprofen, naproxen, piroxicam are usually used in large doses and in a short course (2-3 days). Particular care should be taken with concomitant diseases of the liver and kidneys, especially in elderly patients.
Treatment with anti-gout drugs is carried out with primary gout for life, with secondary – depending on the elimination of the situation that provokes the development of gout.
With reduced excretion of urates, preserved renal function and the absence of urinary stones, it is possible to use allopurinol + benzbromarone, used in 1 tablet 1 r. / Day., Probenecid.
Allopurinol is considered a generally recognized uricostatic (i.e., blocking the production of urate) drug.
Allopurinol is prescribed in a starting dose of 100 mg / day. followed by a gradual increase in dose to 300 mg / day. in 3-4 weeks.
With increased excretion of uric acid with urine and / or gouty kidney damage, allopurinol is preferred.
A more detailed article on nutrition for gout is here.
Products whose consumption must be excluded:
- alcoholic beverages (especially beer),
- internal organs of animals (liver, kidneys).
Food products, the consumption of which should be limited:
- fish (caviar, Baltic herring, sardines, etc.; larger fish are acceptable in the diet),
- meat (veal, pork, poultry, broths),
- some vegetables (peas, beans, mushrooms, cauliflower, asparagus, spinach).
Foods that can be consumed without restrictions:
- cereals (bread, cereals, bran),
- dairy products (milk, sour cream, cheese),
- all fruits and fruit juices,
- fats (butter, margarine, cooking oil),
- coffee Tea,
- most vegetables (potatoes, lettuce, cabbage, tomatoes, cucumbers, pumpkin, onions, carrots, beets, radishes, celery),
- sugar (but: causes an increase in body weight!),
Gout is a chronic progressive disease, a complete cure cannot be achieved, but you can bring the disease into a state of prolonged remission.
Attacks are usually treated in 2-4 weeks, but can occur every six months or more often, so taking medications that lower the level of uric acid and its salts can even be lifelong.