Gout is a complicated form of arthritis, characterized by a sudden acute onset with the appearance of severe soreness, redness and stiffness in the joints. Usually starts with the big toes.
Often, patients described the onset of an attack as "a feeling of unbearable heat in the big toe, causing them to jump off the bed."
Gout was termed "a disease of kings", as it was supposed that it was developed because of excessive consumption of food and drinks. And only rich people could afford it. Now it is proved that this disease equally affects representatives of all strata of the population. About gout, symptoms and treatment of this systemic disease is our article.
Gout is 5% in the structure of the incidence of arthritis.
The incidence of the disease in the world is 275 per 100 thousand of the population. In the United States, there are 840 patients per 100,000 residents, or 748,000 patients per entire population.
Over the past decade, the incidence of gout has increased significan
The top ten countries in the number of deaths from gout include:
- Thailand( 86);
- United States( 69);
- Mexico( 49);
- Japan( 36);
- South Korea( 24);
- Brazil( 24);
- Australia( 15);
- Canada( 8);
- Chile( 7);
- Germany( 6).
Men are sick 9 times more often than women. The most vulnerable are men aged 40-60 years, although the disease can develop in the post-pubertal period due to a physiological increase in the level of uric acid.
In women, gout attacks often develop in postmenopausal women. Also, the risk of developing an attack is higher in patients with concomitant kidney disease.
A repeated similar or more severe gout attack develops in 60% of patients within 1 year after the first attack.
The cause of the disease is the deposition of uric acid crystals( urates) in the cartilaginous tissue of the joint. Their accumulation leads to inflammation, accompanied by severe pain. These crystals are the final product of the disintegration of purines - substances normally present in the human body and coming in with certain foods( meat, anchovies, herring, asparagus, mushrooms).
In a normal amount, the urate decays and is excreted by the kidneys with urine. But with increased production of uric acid, kidney work is not enough to completely evacuate the exchange products, and some of them remain in the body in the form of dense sharp crystals that surround and damage the cartilaginous tissue. In response to irritation in the joint develops inflammation and swelling.
The disease is closely related to obesity, hypertension, diabetes and hyperlipidemia.
The provoking factor of an attack can become:
- Reception of certain medical preparations;
- Dehydration( dehydration);
- Elevated body temperature;
- Injury to the joints;
- Recently transferred surgical intervention;
- Radiation therapy;
- Changing the drug to treat gout.
Although treatment with drugs that reduce the level of uric acid, allows you to reliably control and prevent the progression of the disease, the transition to a new drug may cause an exacerbation. If there is no improvement after taking the medication, or if there are more severe symptoms of the disease, you should immediately contact your doctor to review the treatment tactics.
There is a family predisposition, which confirms the genetic factor of the onset of the disease.
The risk factors for developing gout are:
- Hyperuricemia - vyskoi level of uric acid( above 68 mg / l) can lead to the development of exacerbation of the disease. The optimal concentration of uric acid is 60 mg / l, regardless of age and sex;
- Heredity. Every fourth patient has a relative, a patient, or previously noted symptoms of gout;
- Age. The disease can develop at any age, but more often the symptoms are observed in people older than 45 years;
- Gender. Men are more often ill, but in postmenopausal women the incidence rate becomes almost the same with men;
- Race. Because of the greater predisposition of Spaniards and African Americans to fullness and obesity, they are more likely to have gout;
- Obesity. A body mass index of more than 30 significantly increases the risk of morbidity. In people with obesity, the risk of developing a disease increases by 4 times.
Less likely causes provoking an attack, can become:
- Abuse of alcohol, especially beer;
- Eating foods high in protein and purines - liver, kidneys, sardines and anchovies;
- Gastrointestinal or gastrointestinal bleeding( peptic ulcer disease);
- Diseases accompanied by massive destruction or degeneration of cells( leukemia, lymphoma, psoriasis).
How much is the treatment of gout
Along with the frequency of gout development, the cost of its treatment is also growing. Although large-scale studies of economic peculiarities of treatment and diagnostics have not yet been carried out, several analyzes of health workers have revealed a decrease in the effectiveness of gout treatment.
According to data provided in 2013 by the Canadian Center for Arthritis Research, the University of British Columbia and Boston University, the annual economic loss due to irrationally prescribed treatment is $ 2,021 for each patient with gout.
If the patient has six or more exacerbations per year, the cost of treatment increases to $ 12,020.Most of these costs can be avoided simply by identifying the cause of the disease and immediately starting treatment at the first attack.
Cost reduction strategy for patients with
- If you think you are sick with gout or feel the symptoms described, contact your doctor immediately. Begin treatment as early as possible;
- Twice a year check the level of uric acid. Adhere to the mark of 60 mg / l;
- Maintain a healthy lifestyle, follow a diet;
- Take prescribed medications regularly. Sometimes patients stop taking drugs that reduce the level of uric acid, because of the risk of causing another attack. Although ongoing treatment is often necessary for long-term prevention of exacerbations.
Symptoms and stages
Gout is a disease that causes terrible pain to the patient. There were recorded cases when attacks in patients lasted for several days, with the pain so severe that most of them rated it at 9 points out of 10 possible on a standard scale.
Symptoms of gout include:
- Sudden and severe joint pain;
- Stiffness and swelling;
- Sealing of tissues around the hearth;
More than half of patients with the primary focus of the disease is the thumb on the leg. If the first attack did not affect the thumb, this symptom will develop at a certain stage in the progression of the disease in 90% of patients.
Other common joints prone to gout are:
- Joints of feet;
- Achilles tendon;
- Phalanx of the fingers;
- Elbow joint.
For classification according to severity, gout is divided into 4 stages.
- Stage 1 - asymptomatic hyperuricemia. At this stage, the patient does not notice any symptoms of the disease, but the level of uric acid in the blood exceeds 60 mg / l. This condition does not require special treatment, it is enough only to regularly monitor the level of uric acid and maintain a healthy lifestyle with diet. With a properly organized regimen, the symptoms of gout may not even be realized, or years will pass before the development of the first attack of the disease.
- Stage 2 - acute attack. At this stage, the uric acid crystals deposited in the joints activate the inflammatory process, which leads to the appearance of severe pain and swelling in the area of the affected joint. The pain subsides independently, even without treatment, for 3 to 10 days. Since the first attack is followed by others, it is recommended to immediately seek help from a specialist. The interval between attacks can last several months, but the probability of repeated attack increases every day, so it is important to start treatment in time and control the level of uric acid.
- Stage 3 - subacute current. This stage implies a period between seizures. At this time, the symptoms of the disease are absent, and the joints work normally. Nevertheless, the deposition of uric acid crystals continues, and this can lead to repeated, more pronounced and painful bouts of gout in the future.
- Stage 4 - chronic nodular gout. In advanced cases, the disease takes on a chronic form, the outcome of which is deformation and destruction of bone and cartilaginous tissue in the affected area. As the continuing inflammation continues and increases the intensity, kidney damage with the development of renal failure is not ruled out.
Effect on other organs of
In the absence of treatment, gout leads to irreversible damage to the joints, along with other problems in the form of kidney stones, etc. The continued destruction of the joint and the increased deposition of uric acid crystals under the skin leads to deformations, usually of the hands and feet. Subsequently, the violation of mobility becomes so pronounced that the patient can not perform even simple limb movements.
Cardiovascular system. Heart problems of various types, including high blood pressure, vasospasm and heart failure, can be associated with gout. Even asymptomatic hyperuricemia increases the risk of complications from the heart and blood vessels, up to cardiac arrest and stroke. Studies conducted by the Association of Rheumatological Diseases revealed that women with gout 3.5 times more likely to develop a heart attack than men. Kidney and urinary system. One in five patients with gout develop kidney stone disease. Stones consisting of uric acid crystals cause severe pain and can lead to blockage of the ureters. In addition, hyperuricemia is a sign of already existing renal failure.
Gout is not amenable to complete cure, so maintenance therapy is carried out throughout the life of the patient( read also folk remedies for gout).
Medical therapies include etiotropic and symptomatic therapy. The first is aimed at reducing the level of uric acid in the patient's body, the second - to relieve pain and reduce inflammation.
It is important to begin treatment immediately after diagnosis. In addition, it is important to change the lifestyle, it will help control the level of uric acid and prevent repeated attacks.
Treatment of gout with drugs that reduce uric acid level
- Allopurinol. Is taken orally, reduces the rate of uric acid production by the body. This is the most common medicine, which is the drug of choice when planning therapy. Recommended for use by patients with kidney stones.
- Febuksostat - acts similarly to allopurinol. It is recommended for use by patients with kidney and liver lesions of medium and mild degree.
- Pelotectic is an intravenous solution containing enzymes that dissolve uric acid crystals. It is used for progressive, hard-to-control gout.
- Probenecid - taken internally, promotes the accelerated excretion of uric acid by the kidneys. It is not recommended to use the drug in patients with kidney stones and other serious kidney diseases.
Provided that the patient is assigned the right treatment for gout, the drugs in the above list can effectively prevent the development of a re-attack for an indefinitely long period of time.
The use of these drugs can significantly reduce the risk of developing a recurrence of the disease.
Symptomatic treatment of gout with analgesics and proprietary drugs during an attack of
- Colchicine - Accepted orally, most effective within the first 12 hours from the onset of an exacerbation. Usually, two tablets are prescribed at the same time, then an hour later - another tablet. In the future, the dosage is 1 tablet 2-3 times a day. Common side effects are nausea, vomiting, diarrhea.
- Glucocorticosteroids( Cortisone) - Is taken by mouth or as an intravenous injection. A hormonal drug that suppresses the activity of the immune system and quickly removes inflammation. Effective for quick effect.
- Non-steroidal anti-inflammatory drugs - Are taken orally, reduce the severity of the inflammatory reaction with gout, have analgesic effect.
- Rest. Do not load the damaged joint within a day or until the moment when the pain subsides;
- Give sick joints an elevated position;
- Apply ice wrapped in a towel to the joint for 20-30 minutes. Repeat several times a day;
- Do not take aspirin in high doses. This can lead to a sharp change in the concentration of uric acid and worsen the symptoms of the disease;
- Constantly monitor the level of uric acid - not more than 60 mg / l;
- Regularly exercise - adults are recommended daily moderate intensity training lasting 30 minutes. Increasing the intensity or duration of a period of physical activity can bring a much more pronounced result for better health and prevention of bouts of the disease. In addition, regular exercise can get rid of excess weight.
- Drink enough water - Nutritionists recommend daily consuming at least 2 liters of water. If you train, this amount increases by 1.5 - 2 times. In addition to the transport of nutrients, water helps to remove body fluids, including uric acid, thereby reducing the risk of exacerbation of the gift.
- Take vitamins. The risk of developing the disease was significantly lower in men taking vitamin complexes on a daily basis. As a reliable assistant, choose vitamin C at 500-1000 mg / day.
- Refuse to drink alcohol, as well as beverages that contain fructose;
- Observe a diet with the exception of potentially hazardous products. Add more useful ingredients - cranberries, coffee, juices;
Tips for reducing pain during an attack
In addition to medical therapy, especially if there is gout on the legs, treatment should be supplemented with lifestyle adjustments:
Future developments of
Currently, many studies are under way in various areas related to gout and hyperuricemia( elevated uric acid in the blood).
Scientists have determined that increased protein intake by animals increases the risk of developing gout. Further studies have shown that taking calcium in a physiological dosage prevents the development of seizures. Reduce the level of uric acid allows the intake of vitamin C.
Clinical trials are undergoing new drugs designed to remove uric acid from the patient's body( eg, Benzbromarone).In addition, the development of experimental drugs affecting interleukin proteins, which cause inflammation in gout, has been reported.
Medication for gout reduces the risk of death of the patient
The study, published in the journal Annals of the eumatic Diseases, found that allopurinol reduces the risk of death of patients with elevated uric acid levels in the blood. According to the data received, the benefits of using the drug significantly exceed the potential harm from the development of rare serious side effects.
Gout is associated with an increased risk of death of the patient, so it is important to carefully monitor the patient's condition and prevent the development of severe complications. Allopurinol is the most commonly used drug for reducing uric acid levels, while at the same time has a number of serious side effects. According to the analysis, an adverse reaction from taking allopurinol, leading to severe disorders and death of the patient, is observed in 1 of 260 patients. This was the reason for the refusal of many doctors to prescribe this medicine, despite its advantages.
To analyze the efficacy of allopurinol, a single electronic patient database was used, with the help of which 5,927 patients who received this drug and the same number of patients for the control group receiving the other treatment were identified.
As a result, it was found that the initiation of gout treatment with allopurinol was associated with a 19% reduction in the risk of fatalities. And this figure remains from the beginning of therapy and throughout the life after treatment.
Summing up this study, we can say with confidence that allopurinol allows not only to treat patients with gout, but also protect patients from premature death in the future.
The incidence of gout develops
The incidence of this form of arthritis continues to increase, predominantly among men. Now in the world more than 8 million patients are registered.50 years ago this figure was 2 times less.
Although it was once thought that gout is a disease of people in high society, it now turns out that the disease develops among all sections of the population equally, even among professional athletes and young people.
Do not become an exception and celebrities, both modern and familiar to us from the history textbooks:
- Jared Leto, 38 years old. Actor, known for the films "Fight Club" and "Requiem for a Dream."
The summer developed symptoms of gout after he scored 60 pounds for the role of Mark David Chapman, the insane killer of John Lennon, in the movie "Chapter 27".
I could not walk long distances;I had to move around in the stroller, because I was in terrible pain when walking. My body was shocked by the weight I gained.
- David Wells. Pitcher lefty, who played for the teams of New York Yankees and Toronto Blue Jays, who throughout the career of a baseball player suffered from gout.
In his best-selling book "I'm not perfect: crazy about beer, fights, back pain and baseball," Wells talks about the pain he feels.
One morning I woke up, got out of bed, took a step towards the bathroom and screamed in horrible pain, like a six-year-old girl, falling to the floor and squeezing my thumb on my left foot.
- Maurice Chicks is a patient with gout, destroying stereotypes. The athlete in excellent sports, having played 15 seasons in the NBA, Chicks suffers from gout from 46 years and still continues to work as a coach of the Portland Trail Blazers team.
"If one of you has ever had a gout attack, you know for sure that it's best to do everything possible to prevent it," Chicks said at the second annual meeting on the National Day of Fighting Gout in 2008."Because when the disease develops to the fullest, nothing can be done".
- Harry Kewell, Australian professional football player. At the age of 27 during the 2006 World Championships, a diagnosis of gout was made. Because of the attack he was forced to skip the championship.
- King of England Henry VIII.When he was not busy chopping off heads to his wives, he himself was undermined by attacks of gout.
The English monarch, who lived in 1491-1547, suffered from obesity. There are many paintings, where it is depicted with a piece of meat or a glass of wine in his hand.(All three factors increase the risk of gout).
- Benjamin Franklin, a man of the Renaissance, discovered electricity, invented bifocals, is one of the founding fathers of the United States. And he suffered from gout.
Because of it, Franklin very often missed various meetings on the implementation of the draft declaration of independence. Nevertheless, Thomas Jefferson kindly provided him with documents that allowed Franklin to make his own corrections.
- Sir Isaac Newton. In 1725, Newton, an English mathematician and physicist, suffered from a gout attack that struck both his legs at once. After 2 years he died.
- Samuel Johnson, a British writer and poet( 1709-1784), suffered from a disease he and his doctors called gout. The disease overtook him at the age of 65.
"Gout torments me as much as ever, although it never rose above my knees," he told William Bowles in 1783.
The list of patients complements:
- Ludwig van Beethoven, composer;
- Jim Belushi, actor;
- Charles Dickens, English writer;
- Don Nelson, basketball player, coach;
- Sir Lawrence Olvier, actor;
- Luciano Pavarotti, Italian opera tenor;
- Leonardo da Vinci, Italian artist, sculptor, architect and engineer.
Gout attacks usually take place during the week against the background of ongoing anti-inflammatory treatment. The recurrent course of the disease not only causes serious suffering to the patient, but also leads to irreversible damage to the cartilage and bone tissue.
In the treatment of gout with drugs that reduce the level of uric acid, it is necessary to adhere to its estimated level in the blood of the patient is not higher than 60 mg / l. This is a relatively low level, which reduces the risk of developing repeated attacks and progressive joint damage.