It is curious that gout on the legs is usually manifested by acute arthritis of the metacarpophalangeal joint of the big toe. Most often the inhabitants of developed countries suffer from it. The peak incidence in men is 35-50 years old, in women – 55-70 years old. The low incidence in young women can be explained by the influence of estrogen on the excretion of urate by the kidneys. With the onset of menopause, the hormonal background of women changes, and the level of uric acid (MK) approaches that of men.
According to statistics, gout is detected in 0,06-3% of the adult population of different countries. Men suffer from pathology 20 times more often than women. The incidence of asymptomatic hyperuricemia is 2-5% in the United States, 7% in Spain, 17% in France and 19,3% in Russia. Especially often, a high level of MK in the blood is detected in residents of New Zealand, the Philippines, and the islands of the Pacific Ocean. In these regions, the prevalence of hyperuricemia is 60%.
An attack of gouty arthritis is one of the most painful among all diseases of the musculoskeletal system. It seems to the patients themselves that their leg is “trapped in a trap” or “a dog is chewing on it”.
Where does the disease come from
The appearance of typical manifestations of gout on the legs is preceded by serious metabolic disorders. Initially, a person’s level of MK in the blood rises, and a large amount of urate accumulates in the body. Against the background of hyperuricemia, needle-like crystals of sodium monourate (MUN) are deposited in articular cartilage, ligaments, tendons, auricles and even internal organs.
Exacerbation of gout on the leg can trigger alcohol consumption, trauma, hypothermia, a visit to a bath or sauna. The first attack occurs several years after the development of asymptomatic hyperuricemia. Over time, seizures occur more often. Especially unfavorable gout occurs in people younger than 30 years old.
According to the development mechanism, three forms of purine metabolism are distinguished:
- Metabolic. It develops due to excessive production of uric acid in the body. The reason is the abuse of purine-rich foods (sardines, fatty meats, offal, dry wine, beer, coffee, chocolate, caviar). Hyperuricemia can occur due to active cell destruction in chronic hemolytic anemia, alcoholism, hemoblastosis.
- Renal. It develops due to impaired excretion (excretion) of uric acid by the kidneys. Pathology may be due to kidney disease, arterial hypertension, dehydration, the effects of alcohol or certain medications.
- Mixed. With a mixed form of impaired purine metabolism, the synthesis of uric acid increases simultaneously and its excretion by the kidneys decreases.
Persistent hyperuricemia can occur in patients who take diuretics for a long time. Pathology develops even in young women trying to use these drugs for weight loss.
Signs of gout on the legs
In 50-80% of cases, an acute attack of gout occurs against the background of complete health, for no apparent reason. Most often, unpleasant symptoms appear at night or early in the morning. Metatarsophalangeal joints of the foot are usually involved in the pathology.
Symptoms of an acute attack of gout:
- pain. Pain syndrome has a pronounced character. Patients cannot move normally and lead a familiar lifestyle;
- severe swelling of the soft tissues. Periarticular tissues during an attack become sharply swollen and painful on palpation;
- redness of the skin. The skin in the area of the inflamed joint acquire a crimson hue, become hot to the touch;
- fever. During an acute attack, body temperature can rise to 38-39 degrees.
The first attack lasts from three to ten days and usually goes away spontaneously, even if untreated. After him comes remission – for several months or even years. Over time, exacerbations occur more often, and the disease gradually becomes chronic. In advanced cases, the body is covered with gouty tofuses – cones or nodules containing uric acid salts.
In many people, the skin over the tofus is thinning, which leads to the formation of fistulas. Of these, content spontaneously stands out in the form of a white pasty mass.
Table 1. The stages of development of pathology
Diagnosis of the disease
It is easy to identify acute gouty arthritis by the characteristic symptoms of the disease. However, before treating gout on the legs, you still need to confirm the diagnosis.
Criteria of the American College of Rheumatology recommended by the WHO:
- The presence of EOR crystals in the synovial fluid.
- Tofus containing urate crystals.
- The presence of at least 6 positive symptoms out of 12 of the following:
- at least two history of acute arthritis;
- swelling or pain, which are localized in the region of the first metatarsophalangeal joint;
- the maximum manifestation of symptoms a day after the onset of the attack;
- involvement in the inflammatory process of only one joint;
- the presence of subcutaneous nodules that look like tofus;
- hyperemia of the skin over a sore joint;
- unilateral damage to the joints of the foot;
- the presence of subcortical cysts on radiographs;
- asymmetric edema of a diseased joint;
- unilateral damage to the joint of the big toe;
- lack of bacteria in the intraarticular fluid.
Even “neglected” joint problems can be cured at home! Just remember to smear it once a day.
During an acute attack, the level of MK in the blood is within normal limits. This can confuse doctors and even make diagnosis difficult. Therefore, the identification of EOR crystals in the synovial fluid and the presence of proven tofuses play a crucial diagnostic value.
During the study of intraarticular fluid, doctors identify signs of inflammation. To distinguish infectious arthritis from gouty, bacteriological examination is necessary. For this, synovial fluid is sown and the growth of pathogenic microflora is observed. Lack of bacteria suggests gouty arthritis.
A reliable method for diagnosing gout is polarization microscopy. With its help, yellow crystals and needle-shaped crystals located extra- and intracellular are detected.
How to treat gout on the legs
Treatment of gout on the legs varies during periods of exacerbation and remission. If in the first case, anti-inflammatory therapy is important, then in the second case, nutritional correction and taking drugs that affect uric acid metabolism. As for asymptomatic hyperuricemia, there is still no generally accepted opinion on the advisability of its treatment.
According to the recommendations of the European Anti-Rheumatic League (EULAR), indications for a decrease in uric acid levels in the blood:
- recurrent articular attacks;
- the appearance of tofus;
- the development of arthropathy;
- the presence of typical radiographic changes in the bones.
The main objective of treating gout on the leg is the rapid relief of an acute attack in the onset of the disease and the prevention of its relapse. Of great importance is also the prevention of chronic disease and the complications that follow.
Basic principles of nutrition
Good nutrition helps to reduce hyperuricemia and significantly facilitates the course of gout. Doctors prescribe diet No. 6 to all patients with this pathology. It eliminates purine-rich foods and limits sodium and animal fats. Along with this, a person receives a sufficient amount of vitamins. Proper nutrition is an important part of treatment for gout on the legs.
It should be completely excluded from the diet:
- beer, dry wine and other alcoholic beverages;
- fatty meat, game, young veal;
- all offal;
- sweet soda;
- trout, cod, sardines, mussels, herring, anchovies.
With gout, it is also necessary to limit the consumption of all types of meat, broths, fish and crustaceans (shrimp, crabs, lobsters). Patients need to eat less mushrooms, lentils, beans and spinach. Boiled meat and fish can be in small quantities (200-300 grams) and not more often 2-3 times a week.
Approximately 60% of patients who have suffered an attack of gout, a relapse occurs within 12 months. To prevent it in the interictal period, one should switch to dietary nutrition.
For faster elimination of uric acid from the body, diuresis must be stimulated. For this purpose, it is recommended to drink at least 1,5 liters of fluid per day. Very useful teas, fruit drinks, juices and alkaline mineral waters. The latter alkalize urine, further stimulating the excretion of MK.
Products recommended for gout:
- low-fat varieties of meat and poultry in boiled form;
- bread and flour products;
- boiled low-fat fish;
- milk, cottage cheese, sour cream, kefir, cheese, yogurt;
- vegetable and butter;
- fresh vegetables;
- fruits and berries in any processing;
- coffee and chocolate in small quantities.
Proper nutrition reduces the frequency and severity of attacks, but does not cure the disease. Therefore, in addition to diet, a person also needs basic drug therapy.
Drugs that regulate the level of MK in the blood
How to cure gout on the legs with medications? See a doctor and get tested. After that, the specialist will prescribe the necessary medicines and tell you how to take them. In no case do not self-medicate, as this can lead to unforeseen consequences.
Table 2. Medicines that can be prescribed to treat gout on the legs.
|Preparation||Description||Feature of application|
|Allopurinol||According to the recommendations of EULAR, it is the main uricodepressive drug for lowering uric acid levels in chronic hyperuricemia. The drug blocks the xanthine oxidase enzyme, disrupting the formation of MK||Treatment begins with a dose of 50 mg. Then, under the control of the level of MK, every 2 weeks it is increased by 50 mg until normouricemia is achieved. The maintenance dose of the drug should not exceed 100 mg|
|Febuxostat||It is a new non-purine xanthine oxidase antagonist, not inferior in effectiveness to allopurinol. The drug is recommended for patients with chronic renal failure who have a high level of MK for a long time.||Initially, the drug is prescribed in a dose of 80 mg. If after 2 weeks the level of MK has not decreased enough, the dose is increased to 120 mg|
|Probenecid||The drug inhibits the reabsorption of uric acid in the renal tubules, stimulating its secretion. Used to combat hyperuricemia in chronic gout and diuretics.||First, it is prescribed in an amount of 250 mg 2 times a day. After a week, the dose is doubled. With insufficient effectiveness, the dosage is increased every month. The maximum daily dose of the drug is 2 g|
|Sulfinpyrazone||It acts similarly to the previous tool. Contraindicated in renal failure, urolithiasis, leukopenia, gastritis, stomach ulcer||Treatment also begins with small doses. At first, the patient is given 50 mg of the drug 2-3 times a day, then daily 100 mg more to normalize the level of MK in the blood. The maximum dose is 800 mg per day|
Not sure how to treat gout on your leg? Go to the doctor! Only he can choose the most effective treatment regimen for you. The specialist is better than you versed in the drugs and knows better than you what and how to take.
How to cure an acute attack of gout on the leg
In acute gouty arthritis, doctors prescribe colchicine to their patients. This drug is especially effective in the first 12-24 hours after the onset of unpleasant symptoms. With adequate use of the medicine, the patient notes an improvement in well-being after 6-12 hours.
Colchicine can be used in pill form or by intravenous injection. The drug is given to the patient strictly according to the scheme. Taking the medicine on your own, without first consulting a doctor, is prohibited.
How to treat acute pain with gout on the legs? For the relief of pain, high doses of drugs from the NSAID group (Indomethacin, Diclofenac, Nimesulide) are usually used. For severe pain that cannot be relieved by Colchicine and non-steroidal anti-inflammatory drugs, corticosteroid hormones (Methylprednisolone, Kenalog) are prescribed to the patient. Medicines are injected into the synovial cavity of a diseased joint.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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