“Disease of Kings” and more: what do we know about gout?

Published: 06/17/2021 12:50:00 Updated: 06/17/2021

Gout is a systemic disease characterized by impaired purine metabolism in the body and the deposition of urate crystals in the joints. The main manifestation of the disorder is considered to be repeated attacks of arthritis with intense pain in the joints and the appearance of tophi - gouty nodules. Also, with this disease, accumulation of salts in the kidneys is possible with the development of urolithiasis and renal failure.

The prevalence of the disease among adults in Europe ranges from 0.9 to 2.5%, and in the United States reaches 3.9%. Gout is most often diagnosed in men over 40 years of age. Among women, the pathology occurs 6-7 times less often.

General information about the disease

Gouty arthritis is a systemic metabolic disease associated with the deposition of uric acid salts in articular and periarticular tissues. Men get sick more often after 40 years of age. In women, gout is less common and begins later - in the postmenopausal period after 50-60 years. In total, gout affects about 2.5% of these populations. With age, this percentage increases significantly and by the age of 80 it is 9% in men and 6% in women. The ICD-10 code is M10.

Gouty arthritis is comorbid (often combined) with kidney diseases and chronic renal failure, cardiovascular diseases (angina pectoris, high blood pressure), type 2 diabetes mellitus, and obesity.

Despite the fact that treatment for this disease has been developed, it is not always possible to keep gout attacks under control. This mainly occurs due to patients’ misunderstanding of the mechanism of development (pathogenesis) of gout and refusal or irregular maintenance therapy.

Read more about arthritis, its symptoms and treatment in this article.

Causes of gout

• Taking medications:
  thiazide diuretics, aspirin (2 g per day), cyclosporines.
• Diseases leading to the appearance of gout symptoms:
  coronary heart disease (CHD), arterial hypertension, metabolic syndrome, chronic renal failure, psoriasis, some blood diseases. The development of gout can also be promoted by organ transplantation and the introduction of a contrast agent during X-ray examinations.
• Abuse of foods rich in purine bases can provoke and aggravate the development of this disease:
  fatty meats and fish, alcohol, carbonated drinks, legumes, eggs, chocolate, mushrooms.

Cause and mechanism of development (etiology and pathogenesis) of the disease

The cause of gouty arthritis is a disorder of purine metabolism. Purines are chemical compounds that form the basis of nucleic acids necessary for the formation of DNA and RNA molecules. As cells break down, purines are broken down into uric acid (UA). The latter enters the intercellular space and into the blood plasma, where it combines with sodium, forming a salt - monosodium urate (MUN).

An increased level of urate in the blood (hyperuricemia - GU) may be a consequence of a genetic predisposition (the kidneys do not eliminate MUN completely), high blood pressure (BP), consumption of large amounts of animal food, and alcohol.

With an excess of urates, when they can no longer dissolve in the surrounding fluid (EOR concentration more than 0.4 mmol/l), the salts crystallize, deposit in the articular and periarticular tissues and are surrounded by protein rings. This formation is called tophi. The release of MUN from the tophi causes an immunological reaction: a large number of neutrophils (one of the types of leukocytes responsible for cellular immunity) appear in the synovial membrane and joint fluid.

Neutrophils ingest MUN crystals, which causes the release of proinflammatory (inflammation-causing and maintaining inflammation) cytokines and the development of an acute inflammatory response in the synovium. Acute attacks in the form of synovitis are very painful, but do not leave any consequences. The long-term chronic course of the disease with frequent repeated attacks leads to the destruction of articular cartilage, proliferation of bone tissue, deformation and dysfunction of the joint. Deposition of MUN in the kidneys causes a decrease in their function.

Factors contributing to increased urate levels in the blood:

• the presence in the diet of a large number of meat dishes, offal, eggs, alcoholic beverages,
• overweight;
• taking certain medications - diuretics, aspirin, nicotinic acid, medications to lower blood pressure (Concor), etc.;
• lead poisoning;
• increased breakdown of purines in blood diseases, psoriasis, etc.;
• increased formation of purines;
• impaired renal function and uric acid excretion.

Medicines

Medicines that lower uric acid levels include colchicine and artrosylene. They are taken systemically to prevent attacks.

• To suppress excessive production of uric acid in the treatment of gout, probenecid, benzbromarone, alopron, adenuric, and allopurinol are prescribed.
• To remove uric acid from the body, the drugs allomaron, allupol and analogues are indicated.
• To stop the inflammatory process, NSAIDs (movalis, diclofenac, ibuprofen, nimesil and others) are prescribed.

The rheumatologist prescribes medications for the treatment of gout, taking into account age, the nature of the development and course of the pathology, the presence of relative contraindications to health conditions and some other factors. Complex treatment includes tablets, injection solutions, topical agents (ointments, gels) in various combinations.

Glucocorticosteroids are rarely prescribed, only if NSAIDs are ineffective and the inflammatory process is eliminated. Hormonal drugs can cause negative side reactions, which limits their use in therapeutic practice.

Classification

Based on the causes of occurrence, gouty arthritis is divided into forms:

• primary
  – associated with hereditary characteristics of purine metabolism and excretion of MUN by the kidneys;
• secondary
  – the cause of development is some other diseases, nutritional disorders, bad habits, etc.

According to the mechanism of accumulation of MUN, gout is divided into types:

• metabolic
  – increased internal production of purines during their normal excretion by the kidneys;
• renal
  – impaired excretion of uric acid by the kidneys;
• mixed
  .

By severity:

• mild course
  - attacks of gouty arthritis no more than 2 times a year with damage to no more than two joints; single tophi no more than 1 cm in diameter; there are no complications from the kidneys or impaired joint function;
• moderate severity
  - no more than 5 attacks per year affecting no more than 4 joints with minor changes in cartilage and bone tissue; a large number of small tophi; stones in the kidneys;
• severe
  – attacks of gouty arthritis more than 5 times a year, multiple large tophi and arthritis; decreased kidney function.

Clinical picture

The most typical clinical manifestation of gout is an acute attack (observed in 50–80% of patients). Unbearable pain in the foot area (joint of the first toe) occurs at night, against the background of complete health. When examining the painful area, redness and swelling of the joint are clearly visible.

As a rule, the first attack appears after hypothermia, drinking alcohol or heavy food. Unpleasant sensations, like pain, can go away on their own within three to ten days. The intervals between attacks can be long (from several months to several years), but as contractile arthritis progresses, the intervals become shorter.

The subacute form is characterized by unpleasant sensations in the area of ​​the big toe, moderate pain that worsens at night. In young and middle-aged people, large and medium-sized joints are involved in the painful process. Rheumatoid gouty arthritis causes painful damage to the small joints of the wrists and hands. The course of the attack is protracted.

The course of gout is sometimes similar to infectious arthritis or phlegmon. The affected joints swell, swelling and hyperemia of the surrounding tissues are observed. Body temperature rises, chills and fever appear.

Symptoms of gouty arthritis

The appearance of the first symptoms of gouty arthritis is sometimes preceded by a long-term increase in the concentration of urate in the blood. Therefore, men after 40 years of age, and women after menopause, need to periodically check the content of uric acid salts (UA) in the blood. This is especially important for those who have close relatives suffering from gout. Gouty arthritis develops when the concentration of urate in the blood exceeds 0.4 mmol/l. But with such an indicator, arthritis manifests itself only in a fifth of patients; the rest may not be aware of their risk of developing gout.

Primary signs

The first attack of acute gouty arthritis begins suddenly. Sharp pain appears in the affected joint, the tissue over it swells, and the skin turns red. The pain is very strong. The body temperature may rise and the general condition of the patient may be disrupted.

Severe pain in the affected joint, high body temperature and poor condition of the patient are the first signs of gouty arthritis.

In half of the cases, gouty arthritis begins with damage to one joint. This is usually the first metatarsophalangeal joint of the foot. The knee, elbow, small joints of the hand, etc. may also be affected.

Symptoms of gouty arthritis are especially pronounced at night.

Obvious symptoms

The attack of gouty arthritis lasts from 2 days to 2 – 3 weeks. Then complete remission occurs without any consequences. The next attack usually develops within a year, but sometimes remission lasts several years.

Acute gouty arthritis can recur over a number of years, but gradually its course becomes chronic. Several joints are asymmetrically affected, including the first metatarsophalangeal joint on the lower extremities.

Under the skin on the extensor surface of the joints, as well as in the area of ​​the ears, tophi appear - small superficial nodules or larger subcutaneous nodes with a cartilaginous consistency. They are painless, but can become inflamed during an exacerbation of gouty arthritis. In this case, they become painful and sometimes break through to the surface of the skin in the form of a whitish mass.

Attacks of urolithiasis may occur - urates are deposited on the walls of the urinary tract, as well as in the kidneys, which leads to disruption of their function.

When you need to see a doctor urgently

You should seek medical help if:

• joint pain appeared, accompanied by severe redness and swelling of the tissues; body temperature increased, chills and malaise appeared;
• severe paroxysmal pain appeared in the lower back - an attack of urolithiasis;
• joint pain also bothers you during the interictal period - a sign of the chronic course of gouty arthritis.

Criteria for the diagnosis of gout

Example of using diagnostic criteria:

• Attack of arthritis of the first metatarsophalangeal joint - +2 points
• Characteristics of the episode: erythema over the joint, inability to tolerate touch/pressure, great difficulty walking/inability to use the affected joint +3 points
• More than 1 “typical episode of arthritis” – +2 points
• Hyperuricemia (548 µmol/l) – +3 points

Stages of gouty arthritis

Gouty arthritis occurs in 4 stages:

1. Asymptomatic
   - Increased levels of MUN in the blood without the presence of crystals and gout attacks.
2. Asymptomatic
   - increased levels of MUN in the blood with the presence of crystals in the synovium and joint fluid, but without signs of gouty arthritis and the presence of tophi.
3. Intermittent
   - deposition of MUN crystals in tissues in combination with attacks of acute gouty arthritis.
4. Chronic tophi
   - the presence of tophi in articular and periarticular tissues in combination with chronic arthritis, destruction of cartilage tissue, impaired joint function and kidney damage.

Any form of arthritis has serious complications, so you should not delay treatment.
See how easily the disease can be cured in 10-12 sessions.

If gouty arthritis is not treated

If you suspect gouty arthritis, you should immediately contact a rheumatologist. The disease requires treatment, both during an attack and in the interictal period. The main reason why the development of gout attacks cannot be brought under control is the refusal of patients to undergo treatment in the inter-attack period, which inevitably leads to:

• hyperuricemia – increased urate levels in the blood;
• resumption of attacks of gouty arthritis;
• transition of acute gouty arthritis to chronic;
• joint destruction and disability;
• severe complications from the kidneys and cardiovascular system.

What to do during exacerbations

If severe joint pain occurs in combination with severe swelling and redness of tissues, increased body temperature, and malaise, you should:

• take any sedative + medicine from the group of non-steroidal anti-inflammatory drugs (NSAIDs) - Diclofenac (oral tablet or rectal suppository), Ibuklin, Nise, etc. Apply ointment or gel from the same group (Voltaren, Pentalgin, etc.) to the skin over the sore joint. ;
• call a doctor at home;
• lie down and take a position that minimizes joint pain.

Drugs for the treatment of exacerbation of gouty arthritis

Recommendations for antihyperuricemic therapy

The goal of antihyperuricemic therapy is to prevent the formation and dissolution of existing monosodium urate crystals by maintaining uric acid (UA) levels below 360 µmol/L.

• Allopurinol

  – promotes adequate long-term antihyperuricemic therapy. The drug is recommended at a dose of 100 mg daily, if necessary, the dose is increased by 100 mg every two to four weeks. Patients with renal failure require dose adjustment of this drug.

• Uricosuric agents

  (probenecid, sulfinpyrazone) are used as an alternative to allopurinol in patients with normal renal function. These drugs are relatively contraindicated in patients with urolithiasis.

• Benzbromarone

  - powerful uricozourik; the drug is more effective than allopurinol. It is used for moderately reduced renal function, but requires monitoring due to hepatotoxicity.

• Colchicine

  can be used as a prophylaxis for joint attacks during the first month of antihyperuricemic therapy (0.5-1.0 grams per day) and/or NSAIDs.

It is worth noting that in patients with gout, diuretics should be discontinued if possible (except for cases where diuretics are prescribed for health reasons).

• Losartan and fenofibrate
  have a moderate uricosuric effect. These drugs are recommended for use in patients who are resistant to or intolerant of allopurinol or other uricosurics, in the presence of hypertension or metabolic syndrome. However, the clinical significance of such therapy and its cost-effectiveness are still unknown.

At the Clinic of High Medical Technologies named after. N.I. Pirogov patients will be able to determine the serum level of uric acid and other important biochemical blood parameters, as well as undergo clinical blood and urine tests, and receive qualified advice from a rheumatologist on treatment both during the interictal period of the disease and during the attack of an acute gouty arthritis.

Localizations

With gout, gouty arthritis of the joints of the lower extremities most often develops. There may be other localizations, including damage to the joints of the upper extremities. Gout is also characterized by asymmetrical joint lesions.

Gouty arthritis of the lower extremities

During a primary gouty attack, the pathological process in half of the cases involves the 1st metatarsophalangeal joint of the foot. And even if this joint is not the first to be affected, gouty arthritis will still develop in it later. The periarticular tissues swell, the skin turns red. Subsequently, small and large tophi appear on the dorsum of the foot.

Gouty arthritis of the ankle is less common and most cases occur with repeated attacks. The ankle becomes inflamed, swollen and red, and the inflammation spreads to the heel. There is severe pain and the inability to step on the foot.

The knee is often affected, the lesions are asymmetrical, often combined with lesions of the 1st metatarsophalangeal and elbow joints. Severe pain, swelling and redness are initially combined with impaired limb function due to pain, but with prolonged gout, joint deformation and ankylosis (immobility) occur.

Hip gouty arthritis is rare and the redness and swelling are not so noticeable under the thick layer of muscles and ligaments. But the pain can be severe.

Chondroprotectors: what are they, how to choose, how effective are they?

Joint pain at rest

Gouty arthritis of the upper extremities

The small joints of the hand and fingers often become inflamed, and the fingers become like sausages. The pain, inflammation and swelling are very severe. Large tofuses appear on the back of the hand.

The elbow is no less often affected. The lesions are asymmetrical and are often combined with the involvement of small joints of the hand and foot. Small and large tophi appear on the extensor surface of the shoulder and forearm.

Brachial gouty arthritis develops much less frequently, but is painful. Swelling and redness are not expressed, tophi appear on the flexor surface of the shoulder.

Lesions in gouty arthritis of the upper extremities are usually asymmetrical

Tofus lesion of the spine

In the mid-50s of the last century, spinal damage due to gout was first identified. In this case, tophi grow in the soft tissues and joints of the spine with the destruction of their structures.

The lumbar region is most often affected, followed by the cervical region. Pain appears in the back, which is often mistaken for symptoms of osteochondrosis. When the vertebrae are destroyed and the spinal nerves and spinal cord are compressed, neurological symptoms appear. When the cervical spine is affected, this results in paresis and paralysis of the upper limbs, and radicular pain.

When the lumbosacral region is affected, it can be complicated by compression of the final part of the spinal cord - the cauda equina. In this case, the function of the pelvic organs is disrupted - involuntary urination, defecation, and potency disorders occur.

Gout pain

Pain is a direct consequence of the inflammatory process occurring in the joints. Swelling forms, which compresses nearby sensitive nerve endings. Therefore, it is felt not only in the joint, but also in neighboring areas of the body. If the uric acid crystals are large, they directly injure the joint tissue. This not only leads to increased pain, but also predisposes to the introduction of infectious pathogens.

Gout primarily affects the small joints of the fingers and toes, and symmetrical inflammation is not typical for it. The skin is located close to their surface, which soon affects its condition. It swells greatly, turns red, and when touched, a piercing pain is felt. It will not be possible to get rid of it with conventional analgesics - the use of drugs that dissolve crystals and evacuate uric acid from the body (Colchicine, Allopurinol) is required.

Diagnostics

Despite the fact that gouty arthritis has pronounced symptoms, only 10% of patients can be correctly diagnosed during the first attack. In other cases, a diagnosis of other types of arthritis is made. Diagnostic criteria for gout are:

• acute arthritis of the 1st toe;
• the presence of large and small tophi;
• increased levels of uric acid in the blood;
• detection of EOR crystals in joint fluid and tissues.

If at least two criteria are identified, the diagnosis of gouty arthritis is considered reliable.

Laboratory research:

• general blood test
  - signs of inflammation;
• biochemical blood test
  - uric acid content more than 0.32 mmol/l; increased levels of C-reactive protein (a sign of an inflammatory reaction);
• general urine analysis
  ;
• examination of synovial fluid using polarization microscopy
  - identification of MUN crystals and a large number of leukocytes.

Instrumental studies:

• Ultrasound of joints
  - detection of EOR crystals on the surface of cartilage and tophi;
• radiography of the joints
  - in the early stages there are no changes; later, bone changes are revealed;
• computed tomography (CT)
  - reveals the presence of changes in the spine.

Classification of gout

Considering the mechanism of accumulation of uric acid in the body, gout is distinguished between metabolic and mixed types. According to the nature of the manifestation of the pathology, they are classified:

• acute arthritis (an intermittent form in which attacks of the disease are replaced by periods without any symptoms);
• chronic form (periarticular thickenings called tophi are formed, the kidneys are affected).

Asymptomatic disease is detected during laboratory diagnosis in approximately 8–14% of examined middle-aged and elderly men.

Toxic gout caused by lead and molybdenum poisoning is classified into a separate category. These two subcategories of the disease develop in people who come into contact with metals due to their professional activities.

Treatment of gouty arthritis

The goal of treatment for gouty arthritis is to improve disease outcomes. For this purpose, mainly medicinal treatment methods are used. Non-drug methods are of auxiliary value.

Drug treatment

The main objectives of drug treatment of gouty arthritis are:

• relieving inflammation and pain in acute arthritis;
• preventing attacks of arthritis by reducing uric acid in the blood.

Treatment of an acute attack of arthritis

The following drugs are used to relieve an attack of gouty arthritis:

1. Colchicine
   is a dry extract of autumn crocus seeds. Available in tablets. Effective in the first 12 hours from the onset of a gout attack. The result of its use is the elimination of swelling and pain. The drug is prescribed in small dosages. The daily dose is divided into several doses. First, most of the daily dose is prescribed, then an hour later - a smaller one. If necessary, the dose can be repeated several times a day. A day after the onset of an attack, minimum dosages cannot be used; they are increased, which contributes to the manifestation of side effects, mainly from the gastrointestinal tract. All dosages are selected by the doctor.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs)
   – relieve inflammation, pain and swelling. These drugs are divided into 2 groups: non-selective and selective. Non-selective or 1st generation NSAIDs suppress the action of biologically active substances - prostaglandins, which support inflammatory processes. But they do not act selectively, also suppressing the action of prostaglandins that protect the gastric mucosa. Therefore, drugs such as Diclofenac, Indomethacin, Ibuprofen have side effects from the gastrointestinal tract (GIT). However, they are suitable for some patients and are often prescribed, both orally and intramuscularly. Selective NSAIDs (Nimesulide, Etoricoxib, Celecoxib) belong to the second generation. They act selectively on pro-inflammatory prostaglandins and have almost no effect on the gastrointestinal tract. The selection of the drug is carried out individually, in accordance with the characteristics of the patient’s body.
3. Glucocorticoid hormones (GCs)
   - quickly relieve inflammation, pain and swelling, but are not suitable for everyone, as they can increase blood pressure, blood sugar and cause exacerbation of peptic ulcer disease. Prescribed in short courses orally (Prednisolone), intramuscularly (Betamethasone), in the form of intra-articular injections. Currently, they are trying to use mainly drugs from the NSAID group and only if there are contraindications for their use, GCs are used.
4. Canakinumab (trade name Ilaris)
   is a monoclonal antibody to interleukin-1beta (IL-1b). IL-1b is a messenger protein molecule (cytokines) responsible for the inflammatory response. Antibodies bind to IL-1b and neutralize its action, which leads to the elimination of inflammation and pain. Canakinumab is used in an individually selected dosage for patients who have contraindications to the use of Colchicine, NSAIDs and GCs.

Drugs for the treatment of gouty arthritis

Decrease in uric acid levels in the blood during the interictal period

Outside of attacks, patients suffering from gouty arthritis are prescribed long-term courses of urate-lowering therapy (UST), which lower the content of uric acid (UA) in the blood serum, preventing the formation of UA crystals in tissues. With a low content of uric acid in the blood, the crystals already present in the tissues gradually dissolve. In the presence of chronic gouty arthritis and tophi, the UA content is reduced to a minimum (below 0.3 mmol/l), which contributes to the accelerated elimination of tophi. In the absence of tophi, an acceptable UA content of 0.36 mmol/l is acceptable.

For urate-lowering therapy for gouty arthritis, the following groups of drugs are used:

• A group of drugs that interfere with the formation of uric acid. They suppress the action of the enzyme involved in the formation of uric acid. When prescribing them, constant monitoring of UA content in blood serum is necessary. These medications include:
  Allopurinol is a drug that has been used to treat gout for more than 50 years. It is prescribed in long courses 2 weeks after the end of a gout attack with small doses, which are gradually increased to the required levels. Sometimes it gives side effects from the kidneys, liver, severe allergic skin reactions. At the initial stage of treatment, it often causes an exacerbation of gouty arthritis, so it is combined with the prescription of NSAIDs.
• Febuxostat (trade names: Adenuric, Azurix) is a more modern drug of this group; it acts selectively on only one enzyme involved in the synthesis of uric acid. It does not inhibit other enzymes, so it has fewer side effects. It works softly and effectively. Doses are selected individually and initially combined with the use of NSAIDs.
• Drugs that enhance the excretion of sUA through the kidneys. Prescribed for intolerance to drugs of the first group or ineffectiveness of their use:
  Probenecid - prescribed in long courses, contraindicated in the presence of kidney stones.
• Enzymes that are absent in humans can reduce the level of sUA in the blood. The enzyme uricase is present in the blood of some mammals and reduces the level of UA in the blood, but it is not present in human blood. The drug rasburicase (recombinant bacterial uricase) was produced using genetic engineering from bacteria, which is used for gouty arthritis if other methods fail to reduce UA in the blood. The disadvantage of the drug is increased allergenicity, so it is used strictly according to indications.

Peguricase is a uricase with polyethylene glycol, which suppresses increased allergenicity. A more modern drug, but it is also used strictly according to indications.

Crunching in joints - when to worry

Intra-articular injections of hyaluronic acid

Non-drug treatment

This type of treatment includes:

• diet;
• control over the course of comorbid (often combined with gout and aggravating its course) diseases;
• physiotherapeutic procedures;
• folk remedies.

Diet for gouty arthritis

Patients suffering from gouty arthritis should not consume foods rich in purine bases. But recent studies have found that only animal products have a negative effect. This is fatty red meat, offal (liver, kidneys, heart, brains), strong meat broths, canned fish in oil, canned meat and pates.

On the contrary, plant foods containing purine bases should not be completely excluded from the diet. These are nuts, peas, beans, lentils, legumes, cocoa and coffee. Dairy-vegetable diets with low-fat dairy products, a variety of vegetables and fruits are very useful. Especially useful are foods rich in vitamin C, which helps eliminate uric acid.

Alcohol should be excluded from the diet: strong spirits and beer, including non-alcoholic beer. Only a small amount of dry wine is allowed. You should not consume sweets, baked goods, and especially sweet carbonated drinks. It is also necessary to stop smoking.

Monitoring the course of comorbid diseases

Gouty arthritis is often combined and aggravated by obesity, diabetes mellitus, cardiovascular and kidney diseases.

Obesity requires constant monitoring of body weight. This includes following a diet with a reduced daily caloric intake, an active lifestyle, and courses of therapeutic exercises.

Diabetes mellitus also requires constant monitoring, laboratory monitoring and supportive treatment.

Frequent concomitant diseases with gouty arthritis are also arterial hypertension (consistently high blood pressure) and coronary heart disease with angina attacks. Currently, there are medications that can stabilize the condition of such patients, but this requires constant monitoring by a cardiologist.

Any renal pathology also complicates the course of gouty arthritis. She also needs to be observed and treated.

Physiotherapeutic procedures

Physiotherapy is an additional treatment for gouty arthritis. During a gouty attack, electrophoresis with glucocorticoid hormones and ultraviolet irradiation of the affected area are prescribed.

Electrophoresis with glucocorticoid hormones and ultraviolet irradiation are used to treat gouty arthritis.

During the period of remission, courses of magnetic and laser therapy are prescribed to improve blood microcirculation and restore damaged joint tissue.

In the absence of gout attacks, sanatorium treatment can be carried out for six months. The Caucasian Mineralnye Vody and Crimea sanatoriums are suitable.

Read about other methods of treating arthritis in this article.

Folk remedies

To relieve inflammation, swelling and pain during a gout attack, traditional medicine recommends compresses with activated carbon. Previously, charcoal was used for this purpose, today it is enough to take 50 tablets of activated carbon, crush, dilute with water to the consistency of homemade sour cream, add a tablespoon of vegetable oil, mix and apply to the inflamed area, apply a napkin, compress paper, cotton wool on top, bandage and leave all night long. Perfectly relieves inflammation, swelling, reduces pain.

Surgery

For large tophi, which often suppurate and compress surrounding tissues, disrupting their function, they are removed.

Surgical operations aimed at restoring joint function are carried out strictly according to indications, in case of destruction of cartilage tissue, proliferation of bone tissue with articular deformation and loss of limb function. If the joint is completely destroyed, it is replaced with an artificial one (endoprosthetics).

Physiotherapy

Physiotherapy procedures prescribed as part of individual treatment programs are prescribed to alleviate pain, reduce the severity of the inflammatory process, improve metabolism, and slow down degenerative processes in cartilage tissue. Physiotherapy can also increase the effectiveness of local products (ointments, gels), as it improves their absorption.

During an exacerbation, physiotherapy is not used. Upon achieving stable remission, the doctor prescribes procedures such as plasmapheresis, UHF, laser therapy, UVT (shock wave therapy) and other methods.

A modern laser device with a power of up to 29 mW gives good results in the treatment of microcrystalline arthropathy, which most often affects the elderly. After completing the course, patients note a decrease in pain intensity and improved joint mobility. This type of treatment is valuable because it practically does not cause side effects and allows you to reduce the drug load on the body.

UHF (exposure to a high-frequency magnetic field) is used to relieve swelling, enhance microcirculation in the area of ​​inflammation, which helps to activate the removal of toxins from the body.

Plasmapheresis is the rapid purification of blood from cellular decay products, infectious agents, toxins, antibodies, inflammatory mediators using a hardware or membrane method (with the removal of “bad” blood and the return of the purified composition to the body). The procedure allows you to reduce the amount of medications taken orally, which increase the load on the kidneys, and improve the hemodynamic properties of the blood.

Shock wave therapy (SWT) is currently recognized as the most effective way to treat gout. When exposed to ultrasonic pulses, crystal formations are destroyed, pain is relieved, joint mobility is restored, and cell regeneration in the affected tissues is enhanced. The procedure is considered minimally invasive and has minimal contraindications.

Approach to the treatment of gouty arthritis at the Paramita clinic

Our clinic has developed a unique method for treating gouty arthritis. There are two opposing approaches to identifying and treating this disease. First of all, a thorough clinical, laboratory and instrumental examination of the patient is carried out. After establishing the final diagnosis and concomitant diseases, individually selected comprehensive treatment is prescribed, including:

• modern Western techniques, including the use of the latest medications; this allows you to eliminate inflammation and pain during a gout attack and maintain the desired level of uric acid in the blood serum during the inter-attack period;
• traditional oriental techniques that have a regulating effect on the body as a whole and on the site of inflammation; techniques allow you to eliminate pain after the first session; After the course of treatment, the patient feels a surge of strength and complete renewal.

We combine proven techniques of the East and innovative methods of Western medicine.
Read more about our unique method of treating arthritis

A completed course of treatment and properly selected urate-lowering therapy allows the patient to forget about gout attacks for a long time (in most cases until the end of life). You can get more detailed information about treatment at the clinic on our website.

Treatment methods for gout

Treatment for gout is aimed at:

• in case of an acute attack - to relieve it;
• in the remission stage - to normalize uric acid metabolism. Of course, one should strive to eliminate the cause of the disease. However, if the cause of gout is fermentopathy, this is impossible. In this case, treatment will be symptomatic.
• for the treatment of concomitant diseases.

A complete cure for gout is impossible. However, with medical help, it is possible to reduce the frequency of attacks and achieve a significant increase in periods of remission.

General clinical recommendations for patients with gouty arthritis

All patients suffering from gout are advised to:

• follow a diet, lead an active lifestyle;
• follow all doctor's orders, including taking prescribed urate-lowering medications;
• monitor your weight;
• treat concomitant diseases: diabetes, obesity, angina pectoris, high blood pressure, chronic kidney disease.

Prevention of gout

Gout is most often associated with hereditary metabolic characteristics. There are also no factors predisposing to the development of this disease. If you eliminate their influence, then even if you have a family history, you can significantly reduce the risk of developing the disease. To do this, you need to follow the following recommendations:

• do not overeat, reduce the calorie content of your daily diet, do not consume offal, red meat, alcohol, quit smoking;
• get rid of excess weight;
• Take any medications in consultation with your doctor - some of them increase the concentration of uric acid (diuretics, nicotine, acetylsalicylic acid, etc.);
• regularly treat chronic diseases: diabetes, obesity, kidney and cardiovascular diseases;
• men over 40 years old, and women over 50, periodically check the level of uric acid in the blood.

Treatment of gout at the MedCom clinic in Ryazan

The MedCom clinic, equipped with modern medical equipment for diagnosis and therapy, offers a course of effective treatment for gout. Our specialists will develop a personal therapeutic regimen based on the results of the examination.

We guarantee attentive treatment, comfortable procedures, fair prices for services, and long-term maintenance of the achieved results. Sign up for a consultation if you experience the first signs of gouty arthritis. The sooner you start taking a treatment course, the faster your recovery will come.

Frequently asked questions about the disease

Is it possible to get disability?

For chronic tophi gouty arthritis with impaired joint function.

Which doctor treats you?

Rheumatologist.

What prognosis do doctors usually give?

With proper systematic treatment under the supervision of a physician, the prognosis is favorable.

Gouty arthritis requires constant monitoring by a rheumatologist, urate-lowering therapy, diet and all doctor’s recommendations. If treated correctly, you can forget about gout attacks forever. Doctors at the Paramita clinic have extensive experience in treating gout. Contact us!

Literature:

1. Fedorova A. A., Barskova V. G., Yakunina I. A., Nasonova V. A. Short-term use of glucocorticoids in patients with prolonged and chronic gouty arthritis. Part III. Frequency of development of adverse reactions // Scientific and practical rheumatology. 2009; No. 2. pp. 38–42.
2. Eliseev M. S. Gout. In the book: Russian clinical guidelines. Rheumatology / Ed. E. L. Nasonova. M.: GEOTAR-Media, 2021. pp. 372–385.
3. Rainer TH, Cheng CH, Janssens HJ, Man CY, Tam LS, Choi YF Oral prednisolone in the treatment of acute gout: a pragmatic, multicenter, double-blind, randomized trial // Ann Intern Med. 2016; 164(7):464–471.
4. Reinders M., van Roon E., Jansen T., Delsing J., Griep E., Hoekstra M. et al. Efficacy and tolerability of urate-lowering drugs in gout: a randomized controlled trial of benzbromarone versus probenecid after failure of allopurinol // Ann Rheum Dis. 2009; 68:51–56.

Themes

Arthritis, Joints, Pain, Treatment without surgery Date of publication: 01/25/2021 Date of update: 02/02/2021

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Which doctor treats gout?

For treatment of gout, you should consult a rheumatologist. The help of an orthopedic doctor may be required (for example, if surgery is necessary).

Treatment of an acute attack

First of all, the patient needs rest. The inflamed joint should be immobilized. It is recommended to apply cold. You need to drink plenty of alkaline fluids - up to 3 liters per day. It is important to follow a diet: foods high in purine bases should be excluded. Painkillers (NSAIDs) and glucocorticoids are used as prescribed by a doctor. Local treatment is carried out using ointments and gels that have anti-inflammatory and analgesic effects.

When the patient feels better, physical therapy is included in the treatment. Electrophoresis, UV irradiation, and UHF are used.

Treatment of gout in remission

Treatment in remission includes:

• lifestyle changes (primarily giving up alcohol);
• diet (exclude foods that contain a lot of purines - fish, mushrooms, legumes). The diet must be prescribed by a doctor;
• drug therapy (anti-gout drugs);
• local treatment - applications of medications, physiotherapy, massage, medicinal baths (in sanatoriums);
• surgical treatment: removal of tophi that are not amenable to conservative treatment, surgical restoration of affected joints.

Make an appointment Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

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Prevention of gout

Along with drug treatment (but not instead of it!), the patient can try changing his diet, which will also be beneficial. Nutritionists recommend the following dietary changes to prevent gout: 1. Drink plenty of fluids. American doctors recommend drinking at least 2-4 liters of fluid per day. Moreover, half of this liquid should be clean water. It is necessary to limit sweet drinks, such as lemonades, syrups, etc. 2. Drinking alcoholic beverages is strictly prohibited. If, of course, a person is unable to give up drinking, you can talk to your doctor about the “maximum” of alcohol that a given patient can drink. It must be remembered that alcohol not only worsens the course of gout, but also increases the risk of its occurrence, especially in men. 3. Balanced diet. Your diet should include more fruits, vegetables, whole grains and low-fat dairy products. 4. Get your protein from low-fat foods like tofu or eggs. It will also protect against high cholesterol levels. 5. Limit consumption of meat, fish and poultry. A small amount of these products in the diet is allowed, but it should not exceed 110-170 grams per day. 6. Maintain a healthy body weight. It is necessary to develop a diet in which the patient will not go beyond normal weight limits. This will not only improve your overall health, but also relieve stress on joints that are affected by gout.