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Gout is an illness which affects joints of the person. This process happens in connection with adjournment of urates — salts of uric acid.
Gouty arthritis for the first time was described in the seventeenth century in the English work which was called "The treatise about gout". In it pain at gout was compared to pains "at an extremity clip a press".
Generally gout affects males. At the same time the disease is noted approximately at three people on one thousand population. As a rule, gout is shown at people who already were forty years old. Women have gout during the period after a menopause. If at the person gout develops, symptoms of a disease are expressed by damage of any joints in a human body: it can be joints of brushes, fingers, knees, elbows, a foot. But most often the disease affects joints of fingers of a foot.
The factors provoking developing of gout is the diabetes mellitus, an arterial hypertension. Gout often develops at the people having a hereditary favor to a disease and also at those who regularly incorrectly eat. Generally the attack of gout is shown after acceptance by the person of alcoholic beverages, a strong overeating. Especially badly influences a condition of the patients inclined to gout, beer. Attacks of gout disturb patients mainly at night. At such attack of people feels severe and sudden pain, heat in joints. His joints redden. At a repeated attack of gout initially in the affected joint the pricking is felt. In the absence of treatment of gout the symptoms described above are felt even more often. At the same time aggravations become longer. Gradually the disease affects new joints, also kidneys and urinary tract sometimes suffer.
The first attack of arthritis is considered the beginning of intermittent gout. In this case at the person remissions and bad attacks of an illness periodically alternate. During remission of the patient does not complain of a state of health at all. Sometimes after the first attack before repeated displays of a disease there pass years. However most often such attacks repeat one or two times a year. Gout progresses, and its attacks repeat more often.
In most cases at the person having gout, symptoms are initially shown by damage of the I metatarsophalangeal joint. At the same time acute monoarthritis develops. The reason of damage of these joints consists that in these joints degenerative and dystrophic changes of a cartilage arise first of all. Therefore in them urates are laid earlier, than in other joints. In more exceptional cases the first other joints of legs are surprised, is even more rare — joints of hands. By the way, the word "gout" is translated from Greek as "a trap for a leg".
Joint pain at gout develops sharply, the attack can begin in the morning or at night, is more rare – in other time of day. The person suffers from very intensive and sharp pain. Pain can sometimes be intolerable, and analgetics do not help to get rid of it. Very quickly there is also a development of signs of a local inflammation which in several hours is shown as much as possible. In certain cases also the body temperature of the patient increases – it can rise even to forty degrees. Often hypostasis and a dermahemia over a joint are expressed so strongly that can remind phlegmon. Owing to so unpleasant feelings mobility of a joint is considerably limited. Several days (3–7–10 days) later all symptoms of a disease completely disappear.
If an illness not to treat, then after a while it can provoke a destrukturization of bones. And at more than four-year course of a disease over skin of the patient there are hillocks, quite dense to the touch. In them crystals of uric acid accumulate. Such hillocks arise over sore joints. They have yellowish color. Sometimes hillocks burst, and they leave white crumbs. At some patients at gout over time stones in kidneys are also formed. At the same time the person is disturbed by periodic attacks of the increased arterial pressure, renal gripes. Sometimes, rather seldom, gout also affects a cardiac muscle.
Diagnosis of gout
External displays of gout – hypostases, swelling – the doctor finds already at survey. During poll existence at the patient of symptoms of a disease becomes clear.
The most exact criterion for diagnosis of gout is identification by microscopic examination of urate of sodium in a tofus or synovial fluid. Tofus is an adjournment of crystals in soft tissues of uric acid: they are postponed in the form of small knots. The elastic dense weight which fills a cavity of joints is called synovial fluid.
There are also other symptoms of gout which are very important in the course of establishment of the diagnosis. First of all, a hyperuricemia at which blood contains too high level of uric acid. However at this phenomenon gout arises not always, therefore, it is impossible to consider this phenomenon as the main criterion to establish the diagnosis. In the course of diagnosis of gout the daily level of release of uric acid decides on urine. During an exacerbation of gout results of blood test demonstrate existence of increase of SOE, the increased quantity of leukocytes. X-ray inspection also is one of important points at diagnosis of gout. However in this case symptoms of an illness can be revealed if it progresses for several years.
It is important to distinguish gout from other illnesses with similar symptoms. So, sometimes gout is taken for rhematoid or traumatic arthritis.
Treatment of gout
Treatment of gout provides the gradual embodiment in life of several stages of therapy. First of all, it is very important to remove acute displays of a disease. Further treatment is directed to preventing an exacerbation of a disease further. Also attending physician takes measures for treatment of complications of a disease and prevention of further unpleasant displays of gout – for example, deposits of urates in joints or in other body tissues. Besides, treatment of gout provides parallel therapy of a number of the accompanying illnesses – the hung-up arterial pressure, obesity, a diabetes mellitus, etc.
If at the patient the bad attack of gout is shown, first of all for treatment of a disease antiinflammatory drugs are used. Drug colchicine is often used, also the doctor appoints also other anti-inflammatory drugs, for example, indometacin, sodium diclofenac. If treatment by such drugs to the person does not give relief, system or intra joint use of glucocorticoids is applied. It is important that the person strictly observed a bed rest, and the affected extremity was in a sublime state. It is necessary to follow certain rules of food at gout.
Treatment of gout provides use urikodepressant. These drugs promote suppression of production of uric acid. Allopyrinolum is considered the most often used drug with such influence. Means which are used for treatment of gout patients have to accept a long time — for a year. Then the doctor adjusts a further route of administration of drugs. Also in addition to Allopyrinolum often appoint the uricosuric drugs stimulating release of uric acid.
In the course of treatment by these drugs it is necessary to consider that at intensive release of uric acid after the beginning of use of such drugs the risk of emergence of stones strongly increases in kidneys. Therefore, the measures directed to prevention of an urolithiasis are very important. Besides, at reception of antigouty means within a year the risk of development of attacks of gout can increase. Therefore, in parallel with such means it is necessary to accept drug colchicine or non-steroidal anti-inflammatory drugs.
Treatment of gout provides also carrying out physioprocedures, paraffin and mud applications, bathtubs with radon and hydrogen sulfide. Such procedures need to be carried out at a remission stage. At the same time UF-radiation is carried out on area of the affected joint and even in certain cases helps to prevent an attack. Pain is relieved by potassium-lithium-electrophoresis. Between aggravations for effective treatment of gout it is necessary to do exercises of remedial gymnastics.
There are also some recipes of traditional medicine which are used for treatment of gout. For everyday drink it is possible to prepare collecting from a root of an acorus, sheets of a sage and a bearberry, a St. John's Wort grass. One more collecting for drink as tea includes mix of a root of a burdock and wheat grass, a grass of a violet and Veronika. Besides, it is useful to drink periodically infusions from mint, nettles, camomiles, nine-force, a cowberry leaf, corn a rylets, flax seeds. As means which reduces pain in joints oats broth is recommended.
For treatment of gout prepare by national methods also ointments for topical administration. For this purpose use dry cones of hop from which powder should be pounded in equal proportions with unsalted lard.
Also on the affected joints it is fashionable to put compresses from broths of herbs (for this purpose use hop, elder, a camomile). It is also possible to put a burdock, cabbage leaves to sore points
Acceptance of bathtubs with addition of broths of herbs can also become one of methods of treatment of gout. In this case it is possible to add broths from a horsetail, elder, a marjoram, a burdock, a nettle, a juniper to a heat bath, etc.
Diet at gout
Patients need to keep to a special diet which will help to improve their state significantly. The diet at gout is developed so that all allowed products contained low amount of purines. Besides the diet at gout contains few calories therefore helps to normalize the weight of the person. In certain cases the healthy nutrition at gout helps to normalize production of uric acid. So, there are even data that during hunger, wars the number of patients with gout sharply decreases in connection with limited food.
Food at gout provides the use of food of a plant origin, and also dairy products. Protein needs to be limited sharply. Kidneys, brains, a liver, chocolate, cocoa, coffee should not enter a diet of the patient. Also the diet at gout does not provide the use of rich beef-infusion and fish broths. During cooking purines come out in liquid. It is desirable to carry out approximately once in one and a half weeks a fasting day. In such days it is possible to eat one of the following types of products: cottage cheese, kefir, vegetables, fruit. Also sick with gout you should not take alcoholic beverages as alcohol affects podavlyayushche the function of kidneys concerning removal of uric acid. Food at gout provides minimization of consumption of table salt therefore the food should be salted insufficiently, at least.
The diet at gout has to include a large number of fruit, different grain, fermented milk products, cheese. The use of a citrus will help to strengthen release of urates from an organism. It is desirable to include in a diet more crude vegetables and fruit. It is important to drink every day not less than two liters of water as it promotes large volumes of a mocheotdeleniye. And for prevention of emergence in kidneys of stones it is necessary to drink about a halfliter of mineral alkaline water every day. It is possible to use liquid in the form of compotes, fruit drinks, rather weak tea.
Patients with gout should not starve, the complete starvation promotes increase in amount of uric acid in blood. Food has to be fractional: it is necessary to eat up to six times every day, at the same time the portion should not be big.
Prevention of gout
To avoid displays of this unpleasant disease, it is necessary not to allow injuries of joints, not to wear too narrow and inconvenient shoes. An efficient method of prevention of gout is maintaining active lifestyle, drink of a large amount of liquid. It is not necessary to abuse products which are rich with protein. It is important to control the body weight as obesity can become one of provocative factors for developing of gout. However in this case it is important to work gradually as sharp loss of weight can become the increase reason in blood of level of uric acid.