Medication treatment for gout. Methods for treating gout during exacerbation: effective pills and ointments, folk recipes against painful attacks

With this pathology, salt deposition occurs in different tissues of the body. The big toes are often the first to be affected. Accumulating salt crystals cause inflammation and pain in the joints. Therapy of gout should be complex, in addition to diet, include the use of medicines.

How to treat gout

With drug treatment of the disease, the doctor prescribes the intake of certain medications. All drugs for gout are divided into several groups - depending on the effect they have on the patient's body. So, conventionally, anti-gout drugs can be divided into two varieties: drugs used in the onset of an attack of the disease, and medicines for the treatment chronic pathology. The specialist selects the appropriate complex, based on the symptoms of a particular patient, so you should not self-medicate at home.

Gout medication to relieve an attack

Medications of this group:

1. help bring down the temperature;
2. have anti-inflammatory and analgesic effect;
3. shorten the duration of a gouty attack.

Below are the names of the drugs and their recommended dosage. If you experience symptoms of an attack of gout, you should immediately visit a doctor. It is strictly forbidden to self-medicate, as this can lead to unpredictable consequences:

• aggravate the patient's condition;
• cause the manifestation of side effects;
• trigger inflammatory or allergic reactions, another impact.

gout tablets colchicine

As part of the treatment of gout, medications are prescribed Colchicine, a drug based on plant substances that stops cell division. The action of the drug is aimed at relieving inflammation and pain during an exacerbation of gout. To stop an attack, you need to take 0.5 mg tablets every hour. It is impossible to deviate from the established dose, since Colchicine has a lot of side effects and is one of the most potent. The course of treatment with tablets is continued until the moment when:

• the patient will feel better, the attack will end;
• appear adverse reactions organism on the drug (often there are problems in the work of the gastrointestinal tract, while the doctor replaces Colchicine with another drug that can anesthetize);
• quantity taken drug reaches 6 mg, and the therapeutic effect will not appear (this indicates the ineffectiveness of the tablets for the patient).

Painkillers for gout

If Colchicine is ineffective or the patient develops adverse reactions to it, the doctor prescribes another to stop an acute attack of arthritis. drug treatment. As a rule, NSAIDs are used for this purpose ( nonsteroidal drugs analgesic action), which include:

• Indomethacin;
• Naproxen;
• Sanaprox;
• Indobene;
• Apranax or others.

Anti-gout painkillers are prescribed during an exacerbation of the disease in a specific dosage for each patient. After the first dose, the patient is given the drug after 6 hours. The sooner it is possible to start the use of NSAIDs when an attack of gout occurs, the faster it can be stopped. After a day after the manifestation of a therapeutic effect, the dosage of medications begins to be reduced.

Glucocorticosteroid drugs for gout

If the treatment of gout with medications during an exacerbation with use of NSAIDs and Colchicine did not give the expected effect, the doctor prescribes drugs based on glucocorticoid hormones. These drugs are given either as a single injection or taken as tablets in short courses. In the second option, the drugs Methylprednisolone and Betamethasone are used, which can reduce the pain syndrome and eliminate inflammation. Therapeutic effect occurs, as a rule, within 2-3 days.

Ointment for gout on the legs

For the treatment of the disease are used along with tablets local funds that differ in composition. Ointment for gout helps:

• remove puffiness;
• eliminate pain syndrome;
• relieve redness, local inflammation.

The therapeutic effect of ointments depends on the stage of the disease and the composition of the medication. modern medicine offers the most effective local means to combat unpleasant symptoms pathologies that, when used simultaneously with tablets, give an excellent result. To treat a gouty attack, the doctor may prescribe ointments such as:

• Butadion;
• Diclofenac;
• Piroxicam;
• Ketoprofen;
• ointment Vishnevsky or others.

Preparations for removing uric acid from the body

The main reason for the development of gout is an increase in the amount of uric acid in the blood, the crystals of which accumulate in the joints. Chronic disease occurs as a result of a persistently elevated level of this substance in the body. Pills for gout help to remove excess uric acid from the blood and prevent complications of the pathology and the recurrence of attacks. For this purpose, medicines of two groups are used:

1. uricosuric drugs (stimulate the excretion of urea);
2. xanthine oxidase inhibitors (reduce uric acid production).

Uricosuric drugs

Treatment of gout with medications is aimed at reducing the volume of uric acid. Uricosuric agents contribute to the removal of this substance by the kidneys. The group of such drugs includes:

• Sulfinpyrazone;
• Quebuzon;
• Urodan;
• Zinhofen.

The listed tablets increase diuresis (urine volume), therefore it is extremely important to maintain during therapy water balance body to avoid dehydration. The recommended minimum daily fluid intake in this case is 2.5-3 liters of alkaline liquid (mineral water without gas). Uricosuric drugs have certain contraindications, so they are not prescribed for everyone. Reception of such funds is prohibited to people:

1. with severe kidney or liver disease;
2. with ulcer pathology.

Drugs for the treatment of gout that suppress the production of uric acid

As a rule, Allopurinol, Milurit, or Hydroxypyrazolpyrimidine is prescribed to reduce the body's production of uric acid. Any of the listed gout remedies can block one of the enzymes involved in the creation of uric acid, thereby slowing down the process of its production. Indications for taking Allopurinol and its analogues are:

• frequent gouty attacks, complication of chronic pathology;
• the presence of kidney stones;
• impaired renal function (due to nephropathy, etc.);
• increased production of uric acid;
• intolerance to the components of uricosuric agents.

Already 2-3 days after the start of taking medications that suppress the production of urea, its amount in the blood is significantly reduced. After the patient has undergone a 12-14-day course of treatment, the indicators of the content of this substance in the blood are normalized. Therapy begins with a minimum dosage, gradually increasing it until the clinical effect becomes noticeable. The following factors will indicate the beginning of the action of drugs:

• improving the patient's well-being;
• decrease in the intensity of seizures;
• reducing the amount of uric acid in the body;
• reduction of pain syndrome.

Six months after the start of Allopurinol or its analogue, the dosage is reduced, switching to maintenance therapy. In some cases, such treatment is continued for life, but often the doctor cancels the medication after a few years. Contraindications to taking medications are:

• allergy to tablet components;
• kidney failure or other organ diseases;
• violations of the liver.

The cost of treating gout with medications

The cost of therapy depends on the course that the doctor prescribes to a particular patient. At the same time, prescribed drugs can be purchased at a specialized point of sale or bought at an online pharmacy by ordering home delivery. As a rule, the second option allows you to save a little, since the prices for medicines in online catalogs are slightly lower than in regular pharmacies. Examples of costs for certain anti-gout medicines:

• the average price for Colchicine (60 tab.) - 1100-1300 rubles;
• the price of Diclofenac (20 tab.) - 60-80 rubles;
• the price of Indomethacin is 30-50 rubles;
• the price of Allopurinol is 100-120 r.

Video: how to treat gout on the legs with medication

Acute pain in gout is excruciating for the patient. To reduce these sensations, apply various ways treatment. How to relieve a gout attack? What are the complications if you don't timely treatment diseases?

The development of tophi in the joint with gout

Symptoms

Gout is a disease that occurs as a result of a metabolic disorder in the body. It occurs more often in men. Metabolic disorders lead to the accumulation of uric acid salts (the kidneys cannot cope with their excretion). Urates are deposited in the joints, leading to the appearance of symptoms of the disease.

Signs of gout:

• in places where acid is deposited, inflamed gouty nodes are formed - tophi;
• in the focus of inflammation, the skin turns red, edema appears;
• fever;
• difficulty in moving the joint;
• joint hypersensitivity.

Symptoms persist for several days in a row. At the first signs of inflammation, you should consult a doctor to clarify the diagnosis and begin treatment.

Gout can provoke the development of complications:

• urolithiasis disease;
• nephrolithiasis (kidney stones);
• pyelonephritis (inflammation of the kidneys).

Joint pain is one of the symptoms of gout.

Causes

Factors affecting the development of the disease:

• Excessive synthesis of uric acid salts - the kidneys can not cope with the load.
• Kidney disease due to which normal amount Urate is not excreted in the urine, but accumulates in the body.
• Eating foods rich in purines.
• Retention of urine due to kidney failure.
• Autoimmune diseases (destruction of purine nucleotides).
• Increased blood pressure.
• Excess lipids in the blood.
• hereditary predisposition.

How to reduce pain?

What to do with an exacerbation of the disease? First aid:

1. Position the affected joint in an elevated position. Provide complete rest to the limbs.
2. Apply ice to the inflamed area: this will reduce the pain.
3. After removing the first pain make a compress based on Vishnevsky or Dimexide ointment. These drugs relieve inflammation.

You should not give painkillers injections and take analgesics inside. To relieve pain, you need to inject glucocorticoids (non-steroidal anti-inflammatory drugs) into the affected joint.

Vishnevsky ointment is used to combat gout

Further treatment of a gout attack is carried out with anti-inflammatory drugs. The dosage is selected by the attending physician in accordance with the course of the disease. The following means are used:

• Allopurinol.
• Thiopurinol.
• Hepatocatasal.
• Milurite.
• Orotic acid.

As an anti-inflammatory treatment use:

• Metindol.
• Indomethacin.
• Butadion.

The course of therapy lasts 1-2 weeks. Possible use of steroids long-acting(triamcinolone hexacetonide). It is also shown blood purification, physiotherapy.

To prevent an exacerbation of the disease, it is necessary:

• Not to accept alcoholic drinks.
• Completely eliminate foods rich in purines (fish, fatty meats, chocolate, legumes, tomatoes, spinach, sorrel, tea).
• Introduce lemon, dairy products, honey, sugar, bread, juices (from berries, vegetables and fruits), soups into the diet.
• Drink mineral water("Borjomi").
• If you are overweight, remove high-calorie foods from the diet, reduce the amount of carbohydrates, increase the proportion of protein and unsaturated fatty acids. Overweight and health problems are interrelated.

Being overweight is one of the main causes of gout.

Therapy with folk remedies

To quickly calm a gouty attack will help some folk recipes.

It is useful to drink herbal tea based on yarrow, rosehip, peppermint and aralia. You need to drink a drink often and a lot. It removes uric acid from the body pain.

Decoction works well bay leaf. Cooking scheme:

1. Bay leaf (5 g) pour 1.5 cups of boiling water.
2. Cook in a saucepan with the lid open for 10 minutes.
3. Close with a thick cloth and infuse for three hours.
4. Drink for the day.

Helps with gout. Cooking scheme:

1. Pour the cereal with water and leave overnight.
2. Rinse in the morning and bring to a boil.
3. Drain the first water and put back on the boil.
4. Repeat the procedure twice.

Eat rice without oil and salt twice a day. After rice, you can not drink and eat for 4 hours. The course is 45 days.

On benefit will go ointment based on camphor. Cooking scheme:

1. Melt unsalted butter (200 g) in a saucepan until foam forms, which must be skimmed off.
2. Slowly pour in 70 ml of beer.
3. Add camphor (50 g) to the mixture.
4. Cool and apply to affected areas of the body before going to bed.

Baths with chamomile effectively help in the treatment of gout

The root tincture of the wrestler has a strong effect. To prepare the medicine you need:

1. Pour 100 g of plant root with a liter of vodka.
2. Insist in a warm place for 3-4 days.

The liquid is used for grinding. One teaspoon is enough for one rubbing.

Possible Complications

The onset of the disease is associated with a high content of uric acid, which, even during the first attacks of gout, is able to form crystals (tophi). If a person abuses food rich in purines, alcohol, then the synthesis of nodules is accelerated. The progression of gout leads to the development of diabetes mellitus, atherosclerosis and other diseases.

Gout- a disease associated with an excess of uric acid in the body and the deposition of its salts in tissues (mainly in the kidneys and joints).

There is currently no cure for gout. This disease forces to carry out a constant intake of medicines throughout life. Long-term use of drugs that normalize the level of uric acid in the blood is the main principle of the treatment of gout, because the abolition of drugs leads to the resumption of attacks of the disease.

There are two types of treatment for gout:

• treatment of an acute attack of gout;
• permanent anti-gout treatment.

Treatment of acute gout

Treatment of an acute attack of gout is carried out with non-steroidal anti-inflammatory drugs, glucocorticoids, colchicine.

The choice of drugs for the treatment of an acute attack of gout depends on the severity of the disease, on the presence of concomitant pathology, the presence of complications of chronic diseases, allergies and individual tolerability of drugs.

During an acute attack of gout, it is necessary to provide the sore leg (arm) with an elevated position and complete rest.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs in the treatment of gout are Reopirin, Butadion, Pirabuton, Vofapirin, Indomethacin, Diclofenac sodium, Movalis, etc. Institute of Rheumatology Academy medical sciences Russia recommended the appointment of Nimesil (Nimesulide) for the treatment of acute gouty arthritis, as a highly effective and well-tolerated drug. The drug has a less pronounced, compared with other drugs in this group, toxic effects on the liver and kidneys. Nimesil (Nimesulide) can be used orally and intramuscularly, and is the drug of choice for the treatment of gout. A more pronounced anti-inflammatory and analgesic effect is observed when prescribing the granular form of Nimesulide compared to the tablet form.

Colchicine

Colchicine is widely used in Europe. The drug is an extract of the bulb of meadow saffron. Formerly appointed high doses colchicine, but this method of treatment had a number of complications (renal failure, reactive hepatitis, and others). Now an alternative treatment regimen with colchicine is used (small doses of it), they get a good effect and good tolerability of the drug even in the presence of renal pathology in the patient.

With the ineffectiveness of non-steroidal anti-inflammatory drugs and colchicine or existing contraindications, glucocorticoids are used for their appointment.

Glucocorticosteroid hormones

Hormonal preparations (glucocorticosteroids) are recommended to be used in the form of 1 or 2 times intravenous administration(depending on the severity of the process and the number of affected joints) Methylprednisolone (Metipred). Can also be used Prednisolone, Dexamethasone, Prednisone, Reosolone ( combination drug Prednisolone and Butadion). In addition to a quick, pronounced and persistent anti-inflammatory effect, the drug also has a uricosuric effect (promotes the excretion of uric acid salts).

Given the likelihood of re-exacerbation during treatment with corticosteroid drugs and their side effects, the use of glucocorticoids is carried out in a hospital setting.

Local cryotherapy

It is also reasonable to use acute attack gouty arthritis local cryotherapy(cold treatment) simultaneously with non-steroidal anti-inflammatory drugs.

iotherapy - short-term exposure to low temperatures. It allows you to improve blood microcirculation in tissues, enhance metabolic processes. Cryotherapy has anti-inflammatory and analgesic effects. With local cryotherapy, the affected joint is treated with ice (temperature minus 180 o C) gas. Can be used and stay for 2-3 minutes in the cryosauna. In the absence of conditions for cryotherapy at home, you can apply a plastic ice pack to the diseased joint.

Painkillers

For severe pain, painkillers are prescribed.

A patient with gout should have home first aid kit any anti-inflammatory and pain medications, because a gout attack can start suddenly at any time.

Anti-gout treatment

Long-term anti-gout treatment and maintenance therapy in an individually selected dosage prevents the progression of gout and promotes the regression of tophi (deposits of uric acid crystals in the tissues in the form of dense nodes). Knots can soften and even disappear.

You should start taking anti-gout drugs only in the interictal period. If a gout attack has developed against the background of ongoing treatment, then it is not necessary to cancel the drugs. When taking anti-gout drugs, it is necessary to consume at least 2-2.5 liters of fluid daily.

For the correct treatment of gout, it is necessary to determine its type (metabolic, renal or mixed).

In the metabolic type, gout develops due to excessive production of uric acid in the body. In the renal type, the disease is associated with insufficient excretion of uric acid compounds by the kidneys. At mixed type both of these reasons are present; this type of gout is the most severe.

To determine the type of gout, the patient is prescribed special diet and complete exclusion of alcohol for 7 days. On the 6th and 7th day, it is necessary to collect separately the urine allocated per day. In each serving, the amount of excreted uric acid is determined, as well as its average daily excretion. If 600 mg or more (3.6 mmol) is excreted per day - metabolic type, if 300 mg or less (1.8 mmol) - renal type.

Anti-gout drugs are divided into 3 groups:

• uricodepressive (reduce the formation of uric acid);
• uricosuric (increase the excretion of uric acid);
• mixed action (reduce the formation and increase the release of uric acid compounds).

In the metabolic type of gout, uricosuppressive agents are prescribed, and in the renal type, uricosuric agents are prescribed. If, according to the results of the examination, there is a normal release of uric acid (300-600 mg or 1.8-3.6 mmol), then the disease may be due to a combination of increased formation and insufficient excretion of urates (uric acid salts). In this case, if less than 450 mg (2.7 mmol) of uric acid is excreted per day, uricosuric agents are prescribed, and if 450 mg or more is released, uricodepressive agents are prescribed.

Uricodepressive agents

Uricodepressive agents include Allopurinol, Thiopurinol, Hepatocatalase, Orotic acid.

Indications for their appointment are:

• gout with damage to large joints and large nodes;
• gout (primary or secondary) in blood diseases;
• nephropathy (kidney disease) with increased excretion of uric acid;
• urolithiasis with urate stones;
• chemotherapy for blood diseases (leukemia), lymphomas, malignant neoplasms in order to prevent increased excretion of uric acid and manifestations of gout.

Allopurinol- tablet preparation. Doses of Allopurinol depend on the severity of the course of gout, the content of uric acid in the blood and kidney function. Therefore, only a doctor can choose the dose of the medicine. Normalization of indicators of the level of uric acid in the blood is achieved after taking the medicine for 4-6 months, and a decrease in the frequency and severity of attacks, resorption of nodes - after 6-12 months.

Treatment with Allopurinol has been carried out for many years with short breaks (for 2-3 weeks), because. with each exacerbation of gout, the severity of the course of the disease increases and the possibility of developing complications with a threat to life increases. Tolerability of the drug is good.

In the first 10 days of the start of treatment with Allopurinol, articular crises may occur (this is due to the removal of urates from the tissues and their crystallization). To prevent their occurrence, Colchicine or non-steroidal anti-inflammatory drugs are prescribed until the normalization of uric acid levels in the blood.

Uricosuric drugs should not be taken simultaneously with Allopurinol, because they reduce the effectiveness of the first. Allopurinol is contraindicated in pregnancy and in violation of liver function.

Thiopurinol(also a tablet preparation) has the same activity as Allopurinol, but the drug is better tolerated by patients.

Hepatocatalase(preparation from beef liver) is less active compared to Allopurinol, it is administered intramuscularly 2-3 times a week.

Orotic acid, as well as Allopurinol, reduces the synthesis of uric acid and at the same time enhances its excretion, but less active agent compared to allopurinol. It is used before meals in the form of granules or tablets. The drug is taken for 20 days, then take a break for 20 days and repeat the course. Tolerability of the drug is good, but the effectiveness is weak. Orotic acid also lowers blood cholesterol levels. The drug is usually prescribed when Allopurinol is contraindicated or if it is poorly tolerated.

Uricosuric agents

Uricosuric agents reduce the reabsorption of urate in the tubules of the kidneys and, as a result, increase the excretion of uric acid by the kidneys.

Indications for the appointment of uricosuric drugs:

• renal type of gout (in the absence of pronounced manifestations gouty nephropathy);
• mixed type of gout (with daily excretion of uric acid less than 450 mg or 2.7 mmol;
• intolerance to Allopurinol.

Doses of uricosuric agents are selected individually by the doctor. When taking uricosuric drugs, it is imperative to consume 2-2.5 liters of fluid per day. In addition, you need to alkalize the urine by drinking 1 teaspoon of baking soda every morning and alkaline mineral waters. These measures are necessary to prevent the formation of kidney stones.

Uricosuric drugs include salicylates in large doses(Aspirin, Butadion), Anturan, Ketazon, Benemid (Probenecid), Flexin, Atofan, Urodan.

Application salicylates, and even more so in large dosages, is limited due to the severity side effects from the gastrointestinal tract. In small doses, they, on the contrary, increase the level of purine compounds in the urine and increase their content in the blood.

In the initial period of treatment, articular crises may develop, to prevent their occurrence, it is recommended to take Colchicine or Colbenide (contains both Colchicine and Benemide in 1 tablet).

It is advisable to combine the appointment of Butadion and Benemid. Benemide is generally well tolerated, but may also have digestive and allergic reactions. The appointment of Benemid is contraindicated in case of frequent joint crises, pregnancy, chronic renal failure and high levels of uric acid in the blood (above 800 mg per day).

Allopurinol slows down the breakdown of Benemid in the body and therefore enhances the effect of their combined use.

Anturan(sulfinpyrazone) should be taken after meals with milk, but it also has side effects on gastrointestinal tract. Therefore, peptic ulcer duodenum or stomach is a contraindication for its administration. He is not assigned severe lesions kidneys and liver.

The combined use of Anturan and Benemid has a more pronounced effect than with their isolated appointment.

Etamid also helps to reduce the content of uric acid in the blood and its excretion in the urine. It is prescribed for 10-12 days, then a break for 5-7 days and a second dose of the drug. During the year, such treatment is carried out 3-4 times. The drug is well tolerated.

Dezurik(Benzobromarone) has a strong uricosuric effect by reducing reverse suction uric acid in the renal tubules and, in addition, blocks the enzymes involved in the synthesis of uric acid. The drug also promotes the release of uric acid compounds through the intestines. In the first days of treatment, there may be an increase in pain in the joints. In this case, non-steroidal anti-inflammatory drugs should be taken. The drug is well tolerated, but there may be adverse reactions from the gastrointestinal tract or allergies. Benzobromarone is contraindicated in renal and hepatic insufficiency.

Urodan(easily soluble granules) promotes the excretion of uric acid and alkalinization of urine. The course of treatment is 30-40 days (repeated if necessary).

Ketazon enhances the excretion of purines in the urine and has an anti-inflammatory effect.

Improvement in well-being occurs after 3-4 weeks from the start of taking uricosuric drugs.

Mixed action anti-gout agents

A mixed action anti-gout agent is Allomaron(combined preparation containing Benzobromarone and Allopurinol).

The effect of the drug is twofold: it reduces the synthesis of uric acid compounds and increases their excretion in the urine. This combination of two drugs eliminates the formation of kidney stones and reduces the risk of side effects of Allopurinol. Taking this drug does not require mandatory heavy drinking and alkalinization of urine. Only if patients have urolithiasis they need to drink 2.5 liters of fluid and alkalize the urine in the first 2 weeks. Allomaron is more effective than Allopurinol or Benzobromarone monotherapy. In 3-4 weeks they reach normal performance uric acid levels in the blood. The duration of the course is determined by the doctor individually (3-6 months or more).

Allomaron is used for any origin of gout. The drug is contraindicated in pregnancy, lactation, chronic renal failure, individual intolerance and under the age of 14 years. The drug is well tolerated, adverse reactions are rare. At the beginning of treatment, joint pain may increase due to the consumption of uric acid salts from gouty nodes (tophi). In these cases, Indomethacin or Colchicine is used.

Alternative treatments for gout

Of the non-traditional methods of treating gout, one should name acupuncture, herbal medicine, spa treatment.

Acupuncture with gout, it helps to eliminate the inflammatory process in the diseased joint, which means it reduces the pain experienced by the patient. Under the influence of this type of treatment, the metabolism in the affected joint is normalized. But acupuncture can be used only outside the exacerbation of gout.

Spa treatment also carried out only in the interictal period. In sanatoriums, mineral water treatment and mud therapy are used. Radon, iodine-bromine and sodium chloride baths are prescribed (general, 4-chamber, 2-chamber). Under the influence of these procedures, blood supply and tissue nutrition in the joints improves, kidney function improves, uric acid excretion increases, movements in the joints improve. Showers are widely used (Charcot, underwater, jet). Physiotherapeutic methods, physiotherapy exercises, massage are widely used.

Patients with gout are shown such resorts: Pyatigorsk, Tinaki ( Astrakhan region), Yalta, Odessa, Evpatoria, Yangan-Tau (Bashkiria) and others. Sankur treatment is contraindicated in chronic renal failure and difficult to correct high blood pressure.

Phytotherapy: traditional medicine recommends using mountain ash, lingonberries, wild rosemary, St. Traditional medicine recommends a lot of recipes for herbal preparations.

Herbal teas should not be consumed during treatment with Colchicine.

In case of an acute attack of gout, the following collection is used (1 glass of decoction every 2 hours): calendula flowers, blue cornflower and peony - 5 g each, juniper fruits and buckthorn bark - 5 g each, black elderberry flowers and dioica nettle leaves - 10 g each , willow bark, horsetail grass and birch leaves - 20 g each.

Favorable psycho-emotional climate in the family and at work, adequate sleep and physical activity also contribute to the normalization of metabolic processes in the body.

Diet therapy for gout

Exclusively important role diet plays a role in the treatment of gout. Often, strict adherence to the diet can even save the patient from attacks of gout.

Complete abstinence from alcohol is extremely important. This necessary condition must also be observed in the treatment with Allopurinol. If there is no effect from the treatment, then the patient is drinking alcohol.

Eliminate from food fatty meat, beef, offal (lungs, liver, kidneys, brains), meat, fish and mushroom broths, porcini mushrooms, peas, asparagus, fatty fish, sardines and sprats are recommended, smoked fish, herring, pork and cooking oil, cauliflower, spinach and sorrel.

Restrict desirable: drinking coffee, strong tea, cocoa, chocolate, pastry and puff pastry products, sauces, ketchups, figs, fresh tomatoes, tomato paste and salt. The amount of fat consumed should be reduced, because. they reduce the excretion of uric acid. From fats, vegetable oil and butter are allowed. Not fatty varieties meat and fish are allowed to be consumed boiled and lightly fried (1-2 times a week).

Allowed in food various cereals, chicken eggs(1 per day), Swiss cheese, caviar, white and black bread, milk, sour cream, kefir, cottage cheese, walnuts and hazelnuts, potatoes, onions, radishes, eggplants, beans. Very useful is the use of berries and fruits, such as: oranges, grapes, lemon, cherries, dogwood, blueberries, apples, strawberries, plums, pears, watermelon. Fruits can be consumed both fresh and in the form of compotes, jelly, fruit drinks. Seasonings allowed lemon juice, bay leaf, vinegar, cinnamon, vanillin.

Food should be taken fractionally, in small portions, 5-6 times a day. Alkaline mineral water, rosehip decoction - drink between meals.

Patients suffering from gout are encouraged to control their weight. If you are overweight, it is advisable to use fasting days 1-2 times a week. You can spend fruit and vegetable (1.5 kg), kefir (1-2 l) or curd-kefir (low-fat cottage cheese 400 g and kefir 500 ml) days. Complete fasting is not recommended.

Conclusion

Summing up, it should be noted that the main principle of the treatment of gout is the long-term use of funds to normalize the level of uric acid in the blood. Delay in contacting a doctor when gout occurs should not be. Properly selected treatment will save the patient from articular crises, subject to strict adherence to the doctor's recommendations and an appropriate diet.

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Gout is a joint disease caused by the deposition of uric acid salts (urates).

Approximately three out of a thousand people suffer from gout. And men make up the vast majority.

The disease usually appears after the age of 40 in men and after menopause in women.

Gout affects any joint: fingers, hands, elbows, knees, feet. The joints most commonly affected by gout are the toes.

Risk factors also include arterial hypertension, diabetes, hereditary predisposition, malnutrition.

As a rule, a gout attack develops against the background of drinking alcohol (especially beer) or overeating.

Causes of gout:

The disease is manifested by sudden and intense pain, redness and "heat" in the joint.

Attacks of gout usually occur at night. Sharp pain in the affected joint can be caused even by the weight of the sheet.

A second attack of gout is usually preceded by a tingling sensation in the affected joint.

If gout is not treated, attacks become more frequent and periods of exacerbation are longer.

Arthritis settles in all new joints, kidneys and urinary tract are often affected.

First classic description gouty arthritis "Treatise on gout" belongs to the largest English clinician of the XVII century Th. Sydenham, who compared the pain of gout with pain "from clamping the limb with the press." Later, Yarrod (1883), using a thread dipped into the blood of a patient with gout, discovered the fact of an increase in the content of uric acid in the blood. In 1899, urate crystals were discovered in joint fluid during an attack of gouty arthritis, but only in 1961 MacCarty and Hollander established the role of urate crystals in the development of gouty inflammation. It is customary to count the onset of gout from the first attack of arthritis, which marks the onset of intermittent gout.

It is characterized by alternation of acute attacks and remissions; during the latter, a person feels completely healthy. Several years may pass between the first and repeated attacks, but more often they recur 1-2 times a year. With the course of the disease light gaps» between attacks are reduced. In typical cases (50-65%), the I metatarsophalangeal joint is affected with the development of acute monoarthritis. The characteristic localization of gout may be due to the fact that it is in these joints that degenerative-dystrophic changes in the cartilage occur earlier and most often, which predisposes to the deposition of urates. In 15-20%, gout debuts with damage to other joints of the legs: II-IV metatarsophalangeal, ankle, knee and, as an exception, the joints of the hands (hence the name of the disease, which in Greek means "foot trap" - podos - foot, leg; argo - trap). In 5% of cases, a polyarticular onset of the disease is observed.

Gout is classified into different forms.

Depending on one form or another, different clinical pictures are observed.

1. Acute attack:

Usually begins at night; Weakness in the body; Headache; Elevated temperature- about 39 degrees; Pain in the big toe, accompanied by redness skin, the functions of the joint are violated; The patient is unable to move.

2. Subacute form:

Slight pain in the big toe, exudative manifestations sometimes occur; If a person is young, then oligoarthritis may occur, which covers medium and large joints.

3. Rheumatoid gout:

The small joints of the hands are affected; If the attack lasts long enough, then oligoarthritis is diagnosed.

4. Pseudophlegmonous gout:

Any joints can be affected by monoarthritis; The affected joint is characterized by an inflammatory process; The patient's condition can be characterized as close to fever; Increased erythrocyte sedimentation rate.

Symptoms of gout:

The most striking symptom of gout is acute inflammation joints. It is characterized by sudden onset, pronounced inflammation, usually of one joint (attack, attack of gout). The basis of gouty arthritis is the periodic “falling out” of crystals of uric acid salts from the tissues of the joint into its cavity. Any joint can be affected, but joints are most commonly affected lower extremities, especially stop, and ankle joint. During the first attack of gout, inflammation of the joint of the big toe is noted in half of the cases. A gouty attack usually starts at night.

Provoking factors can be:

*alcohol intake,

* joint overload (for example, long walking),

*surgical operations,

* taking medications, especially diuretics.

There is a rapidly growing pain, swelling of the joint and surrounding tissues, often there is reddening of the skin over the joint. Body temperature may rise. Acute gout arthritis usually resolves (even without treatment) in a few days, and if severe, in a few weeks. A second attack of gout develops in most patients 6-24 months after the first, but in a number of patients this period of time is much longer (sometimes up to 10-20 years). Over time, the frequency of acute attacks of gout increases in the absence of treatment. Gouty tophi are painless nodules ranging in size from a few millimeters to 1-2 cm, located mainly under the skin near elbow joints, cartilage of the auricles, Achilles tendons.

Tophi are painless, although inflammation may gradually occur in adjacent periarticular bags (bursitis) or tendons (tendovaginitis), which causes pain. Sometimes tophi are opened to the outside, while the white content is released, resembling cottage cheese in consistency. Tophi can also be located in internal organs(for example, heart valves).

Diagnosis of gout:

The diagnosis of gout is established on the basis of the presence of two of the following criteria: the content of uric acid in the blood is above 416.4 µmol/l in men and above 356.9 µmol/l in women; the presence of tophi; detection of uric acid crystals in synovial fluid or tissues; acute transient arthritis In addition to examining the level of uric acid in the blood, it is necessary to determine its daily excretion in the urine, to examine the condition of the kidneys ( general analysis urine, the level of creatinine and urea in the blood, Rehberg's test, preferably also ultrasonography kidneys and urinary tract).

Diet for gout:

Treatment of patients with gout is aimed primarily at reducing the content of uric acid compounds, including uric acid in the patient's body.

Much of this can be achieved through diet.

From the diet it is necessary to exclude foods rich in purine bases.

These include all by-products (liver, kidneys, brains, tongue), meat of young animals, fatty meats and fish, canned food, smoked meats, herring, sprats, sardines. Only 200-300 grams of lean boiled meat per week is allowed.

Since, when cooking meat and fish, up to 50% of the purine bases contained in them pass into the broth, the patient should not eat meat and fish broths.

Limit table salt(up to 6-7 grams per day). This means that you need to cook food without salt and only add salt to ready-made dishes at the rate of: half a teaspoon of salt per day.

Eliminate refractory fats (mutton, pork) from the diet, as they slow down the excretion of uric acid by the kidneys.

You can eat butter, ghee (fat limited to 10 grams per day), vegetable oil. Although the vast majority of the source of purines are animal products, they are found in many herbal products. These are fresh legume pods (peas, beans, lentils), mushrooms, spinach, cauliflower as well as coffee, tea, cocoa, chocolate.

They should also be limited. And vice versa, it is necessary to widely use in the diet poor in purines milk, dairy and lactic acid products, eggs, potatoes, bread, cereals. Eat more raw vegetables from those that are allowed to you, as well as berries and fruits.

From fruits, citrus fruits are preferable due to their pronounced alkalizing effect.

Berries and fruits can be eaten both raw and cooked. For a long time many doctors, and after them patients, were very wary of tomatoes.

Even now there is an opinion that the benefits from them are much less than the harm, and this is associated with great content organic acids in tomatoes.

However, recent studies have shown that for negative attitude there is no reason for tomatoes. They really have a lot of organic acids, but first of all, such as citric and malic, which the body certainly needs.

There are many options for unloading: vegetable (1.5 kilograms of vegetables in any culinary treatment), fruit (1.5 kilograms of apples or oranges without peel), curd (400 grams of cottage cheese and 0.5 liters of kefir), dairy or kefir (1.5 liters of kefir or milk).

Unloading diet contains very few food purines and thus has a very beneficial effect on metabolic processes in the body.

On any fasting day, the amount of fluid you drink should not be less than 1.5 liters. Drink the same amount of liquid on ordinary days.

On the day of unloading, drink only tea and mineral water.

In no case should patients with gout be given even short-term courses of complete fasting, which are so fashionable now.

And here's why: already in the first days of fasting, the level of uric acid in the blood increases, which can contribute to the development of a pain attack.

If gout is combined with obesity, which is observed very often, it is necessary to follow a reduced (with reduced calorie content) diet.

At the same time, the foods that I mentioned above, and sugar, sweets, cakes, pastries, flour dishes, as well as all fatty foods, are also limited in the diet.

Diet for gout, as you already hopefully understood - essential part treatment. Complex therapy This disease also includes drugs and physiotherapy. They are prescribed by the doctor individually for each patient, taking into account the severity of gout, the presence of concomitant diseases.

The treatment of gout consists of the following areas:

1) a decrease in the content of uric acid compounds in the body (anti-gout therapy);

2) treatment of acute attacks of gout;

3) treatment of chronic polyarthritis;

4) treatment of complications and concomitant diseases.

Reducing the content of uric acid compounds in the body is considered the main, most important direction in the treatment of gout. It is desirable to carry out it with a recurrent form of gout with frequent (more than 1 time per year) repeated attacks of arthritis. Therapy is carried out constantly (for life), only then it can lead not only to a suspension of the development of the disease, but also to its regression, and in some cases to the practical recovery of the patient.

Reducing the content of uric acid compounds is achieved in the following ways:

a) measures are taken to increase the excretion of uric acid from the body, such drugs are called uricosuric;

b) the synthesis of uric acid is suppressed, drugs directed to this are called uricodepressors;

c) limit the intake of exogenous purines with food.

The appointment of uricosuric drugs is advisable for hyperuricemia without an increase in daily excretion of uric acid (that is, less than 366 mmol / l per day), age not more than 60 years, satisfactory kidney function (creatinine clearance of at least 50 ml / min), the absence of urolithiasis. This is necessary to prevent side effects, since the mechanism of action of this group of drugs is due to inhibition of urate reabsorption in the renal tubules, which is accompanied by an increase in urate excretion in the urine - that is, the mechanism is associated with an additional burden on the kidneys.

The drugs in this group include:

1. Aspirin. An increase in the excretion of uric acid and a decrease in tophi in the treatment of gout with salicylates was established in the second half of the 19th century. But, unfortunately, the best effect of the excretion of uric acid compounds in the urine is achieved at doses that are close to the border of intolerance - 5-6 g per day. Some authors believe that aspirin can be used in small doses to prevent gout flare-ups. Others believe that small doses of salicylates suppress the secretion of uric acid.

2. Butadio n. The uricosuric properties of the drug were established using an isotope study. The action is quite moderate and is effectively manifested only when prescribing "super-high" doses: more than 0.6 g per day. Various side effects are not uncommon.

3. Anturan. Currently, it is one of the most effective drugs. The mechanism of action is associated not only with a significant inhibition of tubular reabsorption of uric acid compounds, but also, possibly, with an increase in tubular secretion of uric acid. The drug is prescribed orally at 400-500 mg per day (with insufficient increase in uricosuria - up to 600-800 mg per day). The content of uric acid in the blood is significantly reduced or even normalized within 2-3 weeks.

4. Ketazon. Also pronounced uricosuric effect. At the same time, it also has anti-inflammatory and analgesic properties. Daily dose: 0.25-1 grams. It is administered orally and parenterally.

5. Benemides. Very effective drug, which received wide recognition. Uricosuria can increase up to 200% in relation to baseline. A valuable addition is the concomitant diuretic effect (by reducing the tubular reabsorption of water, sodium and chlorides). Therapeutic doses are from 0.5 to 2 grams per day (sometimes up to 3 g / day). During the first week, 0.5 g per day is prescribed, then each subsequent week is increased by 0.5 g until uricemia normalizes (usually this occurs at a dosage of 1.5-2 g per day). It is characteristic that when long-term treatment benemid reduces (or even disappears) tophi, including bone ones. Treatment continues throughout the life of the patient, almost continuously, only with long-term stabilization of normal uricemia, interruptions in treatment can be prescribed for no more than 4-5 months.

6. Zoxazolamine (flexin). Also a good uricosuric effect. It is used in individuals resistant to Anturan or Benemide. The therapeutic dose is 300-600 mg per day. However, there are more frequent and serious side effects (toxic hepatitis, nephropathy). Application is limited.

7. Atofan. Uricosuria to a lesser extent than that of Anturan and Benemid, but has the ability to stop an acute gouty attack. It has a number of side effects (may cause the development of nephrosis, gastritis, cystitis, jaundice, etc.). Therefore, treatment is carried out with great care. Daily doses - from 0.75 mg to 3 g, divided into 3-4 doses.

8. Urodan. An agent that increases the solubility of tissue uric acid precipitates. Interacting with uric acid, urodan is able to form its soluble salts, increasing uricosuria. Use 1 teaspoon in 1/2 cup of water. 3-4 times a day. The course of treatment is a month; repeats periodically.

Uricodepressive agents are used in the treatment of chronic gout. Daily urinary excretion is allowed more than 3.6 mmol/day; age after 60 years, renal failure, urolithiasis are not a contraindication for their appointment. The main uricodepressive agent, allopurinol (milurite), inhibits the enzyme xanthine oxidase, which is involved in the metabolism of uric acid, and therefore its synthesis is suppressed. A positive clinical effect was noted in most patients. After a few weeks of treatment, there is a decrease in the number and intensity of attacks, pain and stiffness in the affected joints decrease, and their mobility increases. A few months later, a decrease in joint deformity is detected, and the dynamics of the reverse development of tophi is underway.

Some researchers even noted the restoration of the structure of previously destroyed parts of the bone. According to a number of authors, the combined use of uricosuric and urodepressive agents is most favorable. Thus, the high efficiency of the use of small daily doses of anturan and allopurinol is indicated. The initial dose of the drug is usually 0.3-0.6 g per day, maintenance - 0.1-0.3 g per day. Allopurinol is generally well tolerated. The drug is contraindicated in pregnant women. When treating with all anti-gout agents, it is necessary to increase the amount of fluid you drink (especially in the first days of the appointment) to such doses that the daily diuresis is at least 2 liters per day.

Treatment of gout folk remedies:

In order for the body to get rid of excess uric acid, when treating gout with folk remedies, you need to drink infusions and decoctions.

Infusion of lingonberry leaves: brew 20 g in a glass of boiling water, leave for half an hour and drink a tablespoon several times a day.

Dioecious nettle juice is taken in a teaspoon 3 times a day.

A decoction of birch leaves: pour 2 tablespoons of crushed leaves with 2 cups of boiling water and boil for 10 minutes, leave for 30 minutes, strain, drink 1/4 cup 3 times a day with meals.

With gout, for pain relief, lotions and poultices can be applied to sore spots, as well as rubbing.

Grind a handful of calendula flowers into gruel, pour 1 tablespoon of vinegar, add 10 teaspoon of iodine. First, grease the cones with chicken or duck bile (alternating between them), and then wipe with acetic-iodine rubbing.

Before going to bed, steam your legs and, after rubbing it well, lubricate the bumps with Butadion ointment. Place and secure cellophane on top. After a few procedures, the pain disappears.

If necessary, the treatment can be repeated.

Pour one part of red fly agaric with five parts of vodka and keep for 5 days. Apply for rubbing, before that, having previously filtered.
Pour one glass of dry dead bees with 1 liter of vodka and insist in a dark place for 12 days. Apply for rubbing, before that, having previously filtered.

Lubricate the diseased joints with any animal fat, apply a linen cloth soaked in bee infusion, cover with cellophane and wrap it with a downy scarf on top.
Good results are obtained by treating gout with herbal baths.

Pour 200 g of sage leaves with 1.5 liters of boiling water and leave for two hours. Strain the infusion and pour into a bath with a temperature of 34 degrees, gradually reducing it to 26 degrees.

Pour 300 g of flowers and stems of pharmaceutical chamomile with 5 liters of boiling water and leave for two hours, then strain and pour into the bath.

Boil oatmeal for 30 minutes. Keep your feet in the decoction for 20-30 minutes.

In two liters of hot water (about 40 degrees), dissolve half of the grated piece laundry soap and add half a pack of salt to the solution. Steam in the foot solution for half an hour, adding hot water as it cools.

General recommendations for taking baths. The course of treatment depends on how long you have been sick. Some will feel relief after 3-5 treatments, others need 20-40 foot baths. After every 20 baths, you need to take a break for 20 days.

Gout on the legs:

Gout on legs gouty arthritis) - This chronic illness inflammatory nature joints thumbs stop, which develops due to the retention of uric acid in the blood, leading to the deposition of uric acid salts on the joint. Leg gout is formed primarily in men over 40 years of age, with increased body weight and metabolic disorders.

The most common method of treating gout on the legs is medication, in which the patient is prescribed anti-inflammatory drugs. For acute attacks, the doctor may inject into the joint. If gout of the legs affects several joints at once, the attending physician prescribes non-steroidal antibiotics for a course of treatment of 7-10 days. Since the cause of gout is the deposition of uric acid salts, the doctor may prescribe drugs that reduce the level of uric acid in the blood.

In addition, in the treatment of gout on the legs, physiotherapy is used, in which the diseased joint is subjected to electrophoresis or electromagnetic effects. At severe forms diseases, growths of the affected joint are removed surgically. The treatment of gout on the legs is accompanied by work with the patient, which is aimed at reducing body weight and restoring normal metabolism. Application of funds traditional medicine without consultation with the attending physician is highly undesirable, since self-medication can lead to a deterioration in the patient's condition and complications.

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With acute pain in the joint, it is necessary to ensure complete rest for the affected limb. It is desirable that the leg or arm be on a raised platform. With severe inflammation, ice is applied to the sore spot, and after relieving acute pain, a warming compress is applied. During this period, you need to drink more fluids (2-2.5 liters per day). Alkaline mineral waters, jelly, compotes, diluted lemon juice, milk, oat broth are recommended.

From medications in exacerbation, colchicine is used. It has antikinin, antihistamine and mild anti-inflammatory effects. After the cessation of the attack, colchicine is continued to be taken for 3-5 days, gradually reducing the dose. This drug is contraindicated in peptic ulcer heart failure and pregnancy.

Locally, to stop a gouty attack, compresses with a solution of dimexide (50%) can be used. It has a pronounced analgesic and anti-inflammatory effect. Applications of this solution with novocaine, analgin, indomethacin also help.

If you have acute pain, take any of the non-steroidal anti-inflammatory drugs: butadione, ketoprofen, diclofenac, movalis, ibuprofen. These medicines act quickly and reduce inflammation and pain.

Diet for gout

When symptoms of gout appear, the first step is to adjust your diet. The patient needs to give up heavy, fatty, coarse food. Exclude from the menu smoked and canned food, various offal (kidneys, brains, liver, etc.). Eat less fish, do not drink alcohol-containing drinks, especially beer.

Treatment of gout may also fail if significant amounts of mushrooms, spinach, coffee, cocoa, beans, and cauliflower are consumed. These foods and drinks also contain high amounts of purines, so you should limit your intake to a minimum. In this disease, tomatoes and citrus fruits are most preferred due to their low content of purines.

Salts of uric acid are well removed from the joints and tissues of eggplant, as well as compotes from currants, blueberries, lingonberries and cherries. Useful lime and Mint tea. Alkalization of tissues is promoted by mineral water - Borjomi, Smirnovskaya, Slavyanskaya, Esentuki No. 17.

Salt intake should also be limited. In the treatment of gout, its daily norm is 1 gram. Animal fats should be replaced with vegetable fats, but also in limited quantities. You should also refuse products that acidify urine (kvass, wine, sour juices).

It is necessary to adhere to a diet even when acute attacks pass. Enter into the diet more fruits, cereals, dairy products, juices. Poultry and fish can be eaten no more than twice a week. With the permission of the attending physician, you can eat 200-400 g of boiled meat per week, but you can not use the broth obtained as a result of its cooking. Most purine compounds leave meat in boiling water. By adhering to this diet, you can avoid gouty attacks (acute attacks).

Infusions and decoctions of herbs can be very effective in the treatment. Contribute to the normalization of metabolism and the removal of uric acid from the body leaves of strawberries, birches, lingonberries, buckwheat roots, succession, fragrant violet, sage. In pharmacies, you can buy herbs and herbal teas for gout.

as an additional remedy apply hot baths with the addition of a decoction of sage, chamomile, sea ​​salt. Even one bath can bring significant relief. But it is desirable to conduct a course of 20 baths, then take a break for a month and repeat the procedures.

Used to treat gout and iodine. In mild cases, application helps iodine nets on gouty nodes. Baths are used with a solution of 2 tablespoons of sea salt and 10 drops of iodine per liter of water. Lubricate sore spots with an ointment from a mixture of iodine and aspirin.

Lotions, ointments and compresses from rather unexpected components help many. Compresses are made from fresh river fish, raw potatoes. Lotions are used from decoctions of sweet clover flowers, steamed nettles. Ointments are made by mixing honey and lard or flax-seed with crushed activated carbon and water.

It is not possible to completely cure gout, but it is quite feasible to significantly improve the condition and prevent relapses of the disease. To do this, you must use proven folk recipes, after consulting with your doctor.

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Treatment of an acute attack (acute gouty arthritis)

It often happens that the first manifestation of the disease is precisely an acute attack of gouty arthritis. Often this happens at night after a hearty meal with a lot of eaten meat and drunk alcoholic beverages, when there are sharp and sharp pains in the area of ​​the affected joint (most often it is thumb legs, but other joints may be affected).

This attack, if not started treatment, can last for days and even weeks, causing severe suffering to the patient. Therefore, if such pain occurs, it is necessary to consult a doctor as soon as possible.

Non-pharmacological help

First of all, it is necessary to provide the affected joint with maximum rest and avoid any movements in it. It is best for the patient to take lying position, giving the leg a slightly elevated position (for example, resting the leg on a small pillow).

If the pain is especially strong, then before the doctor arrives, ice can be applied to the sore joint (but make sure that frostbite does not occur).

Since drugs that clear excess uric acid salts (urates) do not help during an acute attack, it is important to use other methods to do so. These include the intake of a relatively large amount of liquid, preferably an alkaline composition (milk, compote, jelly), in the amount of 2-3 liters per day.

Medical treatment of an acute attack

If this is the first attack of acute gouty arthritis, then usually its treatment is carried out in a hospital in the rheumatology department. This is necessary not only to ensure that the patient receives assistance as quickly as possible, but also in order to spend all necessary examinations and analyzes and make an accurate diagnosis.

After all, acute pain in the joint can be a symptom not only of gout, but also of many other diseases - infectious and non-infectious arthritis, reactive arthritis and other diseases.

Simultaneously with the examination, the patient is prescribed medication to interrupt an acute gouty attack: for these purposes, non-steroidal anti-inflammatory drugs, colchicine, steroid (hormonal) drugs that reduce inflammation are used.

Non-steroidal anti-inflammatory drugs

In order to reduce pain in the affected joint and reduce the level of inflammation, the doctor prescribes various non-steroidal (non-hormonal) anti-inflammatory drugs (NSAIDs), based on his experience or on the basis of the treatment protocols that are accepted in this hospital.

It can be both the well-known diclofenac, ibuprofen, indomethacin, as well as newer and more expensive drugs, but sometimes more effective and giving fewer side effects - for example, celecoxib or nimesulide.

NSAIDs in the treatment of this disease are purely symptomatic: they do not treat gout directly, but help reduce the symptoms that an acute attack gives - pain and inflammation in the joint. For this reason, an acute attack is almost never treated with these drugs alone - other drugs are used for this.

Colchicine

Colchicine is a drug that directly affects inflammation in gout and restores normal work the affected joint. This remedy is prescribed almost immediately after the start of gout treatment and is taken according to a certain scheme every one and a half to two hours for 1-1.5 days - until the attack subsides or it becomes clear that this medicine Does not help.

Since all people are different, it happens that drugs, including colchicine, help one person, but do not work at all on another. If this happens, colchicine is canceled and treatment with other drugs is started.

Hormonal anti-inflammatory drugs

In cases where colchicine does not have the desired effect on an attack of gouty arthritis, the doctor prescribes another group of drugs - hormones that reduce inflammation in the affected joint. For these purposes, so-called glucocorticoids are usually prescribed - derivatives of prednisolone: ​​betamethasone and methylprednisolone.

These are very powerful drugs, but they have a lot of side effects on the body as a whole when taken in pill form. Therefore, to stop an attack, these drugs are usually prescribed once or in a very short course in the form of injections, including injecting the drug directly into the area of ​​\u200b\u200bthe diseased joint. As a rule, thanks to such a powerful treatment, an acute attack of the disease can be stopped, and the inflammatory process in the joint begins to subside.

Treatment of gouty arthritis in the interictal period

Treatment of this disease during an attack and after it is quite different. This is due to the fact that drugs that help the patient outside of attacks do not work during acute gouty arthritis. However, when the attack is over, they do an excellent job. What are these medicines?

Since gouty arthritis is a metabolic disease in which an excess of uric acid salts (urates) accumulate in the body, the action of drugs that are taken between attacks of gout is aimed at either reducing the formation of uric acid salts in the body or increasing their excretion.

The fact is that in some diseases (such as kidney disease), the amount of uric acid entering the body may be within the normal range, but urates may not be excreted due to problems with the kidneys. Therefore, the doctor prescribes medications that help the body to dump excess uric acid salts. For these purposes, a medicine such as allopurinol is prescribed.

Since all excess urates cannot be removed from the body in one day, such drugs are usually prescribed for a long time, for a period of several months. But taking them in combination with a diet can guarantee with a high degree of probability that the attack will recur more, and this is worth a lot!

Medical nutrition and diet

It is difficult to name any other joint disease in which dieting is as important for maintaining health and preventing relapses as gout.

Since gouty arthritis is a metabolic disease, the mere observance of simple rules for eating healthy food gives more than half the success in treating this disease! So, if you are taking drugs that increase the excretion of urates, and you are on a diet, then after a few months you can count on the fact that the drugs may be able to be stopped, and you will be able to control the disease with diet alone.

Forbidden foods: what not to eat with gouty arthritis

What can and what can not be eaten with gout? First of all, it is necessary to exclude from the diet foods rich in nucleotide bases, during the exchange of which purines are formed. These products include red meat (pork, beef, lamb), as well as organ meats (liver, kidneys, heart).

In addition, it is important to limit the consumption of seafood (fatty fish, shellfish, shrimp), as well as foods plant origin, rich in proteins - in the first place - legumes(peas, beans, beans).

In addition, it has long been known that one of the worst enemies for health with gout is alcohol. Therefore, its use is just as important to limit as the intake of red meat. This is especially true for red (including dessert) wine, champagne, and cognac.

It is also highly undesirable to use drinks such as tea and coffee for gout, as they increase the amount of urates. Therefore, in order to quench thirst and provide the amount of urine excreted necessary for the release of urates, it is better to use other drinks - compotes, herbal infusions and finally plain water. You can read more about what can and what is undesirable to use for gout in the article. Health food with gout.

Proper nutrition and foods for gouty arthritis

What, then, remains to be eaten? Foods that are relatively low in protein but rich in carbohydrates. These are, first of all, dairy products, as well as various cereals, bread, pasta, nuts, fresh vegetables and fruits.

Milk is especially beneficial for the health of a person with gout: it not only contains proteins that do not give during the breakdown of urates, but it additionally increases the excretion of uric acid salts from the body by increasing the amount of fluid excreted in the urine.

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Symptoms

Gout is a disease that occurs as a result of a metabolic disorder in the body. Because of this, uric acid salts accumulate in the tissues (the kidneys cannot cope with removing them from the body). Most often they are debugged in the joints of a person. Men are more affected by this disease.

Signs of gout are:

• In places where acid is deposited, inflamed gouty nodes are formed - tophi;
• In the area of ​​\u200b\u200bthe focus of inflammation, the skin turns red and edema appears;
• There is a feverish state;
• Malaise;
• Difficulty moving;
• Joint hypersensitivity.

All manifestations of the disease can last for several days in a row. Therefore, at the first signs of inflammation, it is necessary to consult a doctor to clarify the diagnosis and begin treatment of the problem.

Gout can provoke the development of urolithiasis, as well as nephrolithiasis (kidney stones) and pyelonephritis (inflammation of the kidneys).

Joint pain is one of the symptoms of gout.

Causes

There are a number adverse factors, which affect the excess in the body of unnecessary urates:

• Synthesis of such an amount of acid that cannot be fully excreted by healthy kidneys;
• Kidney disease, due to which even a normal amount of acid is not excreted in the urine, but accumulates in the body;
• Food rich in purines;
• Urinary retention due to kidney failure;
• Autoimmune disorders (destruction of purine nucleotides);
• High blood pressure;
• An excess of lipids in the blood;
• hereditary predisposition.

How to reduce pain?

What to do during acute manifestation disease? If the attack caught the patient at home, then first aid should be given:

1. A prerequisite is the location of the diseased joint in an elevated state. It is important to provide the patient with complete rest.
2. Ice should be applied to the inflamed area. This will reduce pain and alleviate the condition of the person.
3. After removing the first painful sensations, it is necessary to make a compress from Vishnevsky Ointment or Dimexide. They relieve inflammation.
4. It should be understood that various painkillers injections and drugs have absolutely no effect. To relieve joint pain, glucocorticoids (non-steroidal anti-inflammatory drugs) must be injected into it. They can be taken intravenously and orally.

Vishnevsky ointment is used to combat gout

Further treatment of a gout attack is carried out with anti-inflammatory drugs. Colchicines help reduce the production of uric acid. The dosage is selected by the attending physician in accordance with the neglect and complexity of the disease. To quickly reduce the amount of acid, use the following tools:

• "Allopurinol";
• "Thiopurinol";
• "Hepatocatazal";
• "Milurit";
• "Orotic acid".

As an anti-inflammatory (non-steroidal) treatment, Metindol, Indomethacin, Butadion are used. The course takes 1-2 weeks. In some cases, steroid drugs are prescribed for a long-term effect (triamcinolone hexacetonide). Doctors recommend, in addition to taking medications, to use blood purification, as well as physiotherapy.

With a strong pain syndrome, it is recommended to use Ibuprofen, Diclofenac (intramuscularly). To stop an acute attack of gout, you can use some pharmaceutical ointments("Vishnevsky", "Fuflex"). To enhance the effectiveness of treatment, it is necessary to adhere to the recommendations of the doctor:

• Exclude alcoholic drinks (especially of low quality);
• Completely eliminate foods that are high in purines. These include fish, fatty meats, chocolate, legumes, tomatoes, spinach, sorrel, tea;
• Introduce lemon, dairy products, honey, sugar, bread, juices (from berries, vegetables and fruits), soups into the diet;
• Drink mineral water (Borjomi) more often;
• If there are problems with overweight, then it is important to remove high-calorie foods from the diet, reduce the amount of carbohydrates, increase protein and unsaturated fatty acids. High weight and health problems are interrelated.

Being overweight is one of the main causes of gout.

Therapy with folk remedies

Some folk recipes will help to quickly calm a gouty attack.

It is useful to drink herbal tea based on yarrow, rosehip, peppermint and aralia. You need to drink this drink often and a lot. It helps to remove unnecessary acid from the body, relieving pain. A remedy made from bay leaf works well. It is prepared as follows:

1. Bay leaf (5 gr) pour 1.5 cups of boiling water.
2. Cook in a saucepan with the lid open for 10 minutes.
3. Close with a thick cloth and infuse for three hours.
4. Drink for the day.

Helps with a similar disease rice. It is necessary to fill the cereal with water and leave it overnight. Rinse in the morning and bring to a boil. Be sure to drain the first water and put back on the boil. Repeat this procedure two more times. You need to eat rice without oil and salt twice a day. After rice, you can not drink, and also eat, for 4 hours. The course is 45 days.

1. Melt unsalted butter (200 g) in a saucepan until foam forms, which must be skimmed off.
2. Slowly pour in 70 ml of beer.
3. Add camphor (50 gr.) to the mixture.
4. Cool the product and apply to diseased areas of the body. It is advisable to do this before bed.

Baths with chamomile effectively help in the treatment of gout

The root tincture of the wrestler has a strong effect. To prepare the medicine you need:

1. Pour one hundred grams of root with a liter of vodka.
2. Infuse the remedy in a warm place for 3-4 days.
3. After the appearance of a dark color, the liquid is used for grinding. One teaspoon is enough for one rubbing.

Gout is a condition that occurs when elevated level uric acid in the blood and excessive deposition of salts in body tissues. Often, the development of this disease can be accompanied by sharp and sudden sharp pains, especially at night.

The affected area turns red, swells and becomes too sensitive to the slightest touch. Almost every movement of the patient causes severe pain in the leg.

If an attack has begun, then the person's body temperature will rise significantly. As the morning approaches, the excruciating discomfort decreases or disappears altogether, but every evening the pain returns again.

Such pathological condition may last for several weeks in a row, and then the attacks go away for several months.

After the disease begins to torment the patient even more, rapidly worsening his condition.

Acute attack, how to help?

As with any other disease, the sooner treatment is started, the sooner pain and other symptoms will subside. Moreover, each patient should know how to relieve an attack of gout, because his well-being and the outcome of the disease will directly depend on this.

To begin with, it is important to ensure the absolute rest of the diseased limb by placing it on a raised platform (you can use a pillow). You can quickly remove redness and swelling by applying ice packs.

There are times when the cold further exacerbates the manifestations of pain in the leg and an attack of gout. Therefore, it may be necessary to apply a warm compress to the affected area or begin treatment with Vishnevsky's ointment.

In addition, it is important to consume a lot of alkaline drink:

• mineral water;
• rice water;
• tea from mint, rose hips with lemon;
• compote based on dried cherries and black currants.

If an acute attack of gout has begun, then it will be good to adhere to a strict diet, which provides for the rejection of the use of such foods:

1. fresh bread and pastries;
2. confectionery;
3. any type of cabbage, except white cabbage;
4. legumes;
5. seafood;
6. steep meat broths;
7. fatty, spicy, spicy culinary dishes;
8. sausage products;
9. natural coffee, strong black tea;
10. alcoholic drinks.

We can say that the complex - works great, and this combination is quite effective in a gout attack.

If the pain in the leg is too severe, and the attack of gout is extremely painful, then doctors recommend the use of medications to stop it:

• non-steroidal anti-inflammatory. This may be Diclofenac (100-200 mg per day), Indomethacin (150-200 mg), Butadione (400-600 mg), Ortofen (150-200 mg). Aspirin is strictly prohibited from this group of drugs. It is a strong acid that can only aggravate the pain;
• glucocorticosteroids. The following have shown their high efficiency: Triamcinolone, Betamethasone, Prednisolone, Dexamethasone. However, these drugs can have an effect on the body Negative influence and side effects. Therefore, they should be taken with extreme care and caution. Only a doctor prescribes glucocorticosteroids;
• specific drugs. The most famous is Colchicine. It should be used at 0.5-0.6 mg 8 times a day at intervals of 30-60 minutes. This scheme is repeated the next day, and then the daily dosage is gradually reduced. Treatment with Colchicine is completed 3-4 days after the symptoms of gout have completely disappeared. Even despite the obvious advantages, the drug is too toxic and therefore its intake is always coordinated with the doctor;
• local preparations. You can make compresses based on Dimexide with the addition of Novocaine, Analgin or Indomethacin.

Treating an attack at home?

Not every patient during an attack of gout is able to seek medical help or he may not have the necessary medicines at hand. In this case, the relief of a gout attack can be carried out using traditional medicine recipes. There are generation-tested remedies that allow treatment at home:

• the use of decoctions from elder flowers, chamomile and birch buds;
• baths with pharmaceutical chamomile and sage.

If a gout attack is mild, then you can help yourself by making iodine nets on the affected joint.

No less effective will be baths with the addition of natural sea salt. The treatment of gout with the help of lotions from raw potatoes, carefully chopped on a grater or steamed nettle leaves proved to be good.

In addition, at home, you can make applications from a mixture of honey and animal fat. A compress from the root of horseradish or radish will reduce joint pain. It is applied to a burdock leaf and applied to a gouty joint.

An excellent result was shown by the use of an ointment based on butter and alcohol (taken in equal parts).

To cook it, you need to melt the butter, combine it with alcohol and set it on fire. As soon as the alcohol is completely burned out, the ointment should be cooled and rubbed into the affected joint twice a day.

It should always be remembered that the proposed remedies will help relieve the pain and symptoms of gout, but will not save the patient from the true cause of the disease. Therefore it is important to pass comprehensive examination body and initiate appropriate treatment.

Usually the attack overtakes the patient at night or some time after a heavy dinner. Also, the joint attack can begin early in the morning.

In an acute attack, there is a very strong, intense pain in the affected joint, which is almost unbearable to touch. Even touching the sheet causes discomfort.

How to relieve an attack - treatment, first aid

There is redness and swelling on the affected area. Inflammation affects the carpal, knee, ankle and other joints, less often the hip and shoulder. The disease causes malaise, fever, and difficulty moving in the affected area. The amount of time it takes for complete symptomatic regression (how long a spontaneous attack of gout lasts) is 3-7-10 days.

by the most simple action there will be an increase in the amount of fluid consumed. Best suited for this: milk, jelly and various compotes (preference is given to drinks with an alkaline composition). Drink at least 3 liters per day.

You can relieve an attack with non-steroidal anti-inflammatory drugs, such as Diclofenac or Indomethacin (you need to take it regularly, the dose is from 25 to 50 mg, the number of doses per day is 4).

To reduce the risk of side effects of non-steroidal anti-inflammatory drugs (NSAIDs), which can adversely affect the kidneys, liver and gastrointestinal tract, a highly effective drug called Colchicine is used. It affects the metabolic processes associated with the excretion of uric acid from the body.

After the pain has been relieved, the medication should be stopped.

In the worst case (provided there are no contraindications), internal administration of glucocorticosteroids (GCS) is performed.

Relieve pain with ice

After the person has been provided with complete rest and provided first aid, ice is applied to the affected area.

However, you need to watch the time so that cooling does not lead to frostbite, thereby greatly complicating the patient's condition.

Ice is a good way to reduce pain, but it must be used carefully. For cold treatment, special soft rubber containers with a tight-fitting lid are used.

Injections - one of the ways to anesthetize an acute attack

Injections are used when the disease is especially difficult.

Performs an anti-inflammatory function Diclofenac". Ampoules this drug help to fight high temperature. The dosage and duration of administration are indicated on the package - 1-2 pcs. in the early stages of the disease and when he reached his maximum strength, respectively, from 1 to 5 days.

If desired effect has not been achieved, a similar type of medicine is used, only a different form - capsule.

Relieve pain, as well as block the development of inflammation, will help " Movalis”, the main component of which is meloxicam. Injections are given only in the first days (daily dose - 7.5 mg), then they switch to tablets and medicinal ointments. The doctor may increase the dose if necessary.

Usually, all of the above drugs are contraindicated in pregnant and breastfeeding women, and hormonal drugs are also included in them. Dexamethasone», « Prednisolone" And " Reozolone”, often prescribed by a doctor in the case when NSAIDs have not helped.

The tablet or injection may cause flatulence, nausea, and colitis. You can not drive, as one of the negative effects is dizziness and drowsiness, as well as excessive irritability. Caution should be exercised in people suffering from pressure.

Ointment

You can treat an exacerbation with pharmacy and home-cooked ointments. Pharmacies belong to " Fuflex" And " Vishnevsky ointment". The first option is able to eliminate the original cause of the disease and, importantly, has no contraindications and side effects. The composition is based on birch extract and fragrant martini.

Also in the pharmacy you can find ointments prepared according to folk recipes, for example, a mixture for lotion from 20 ml of castor oil and 40 ml of alcohol.

"Homemade" ointment recipes are widely known and easy to prepare.

To make one of them you will need: unsalted butter (200 g), beer (70 ml) and camphor (50 g). The first ingredient is laid out in a saucepan and brought to a boil, after which the foam is removed and beer is poured in a thin stream and camphor is added. The diseased joint is lubricated with an already cooled remedy before going to bed.

Risk groups and prevention

You can get gout if someone close to you has already had such a disease. IN such a case healthy family members should begin to regularly monitor the level of sUA in the blood plasma and try to keep healthy lifestyle life.

To avoid seizures, the diet should be fractional, portions should be small, and the number of meals per day should be from 5 to 6 times. Be sure to drink between them.

As a preventive measure for everyone, doctors recommend eliminating purine-rich foods from the diet:

• meat;
• offal;
• sardines;
• fish caviar;
• sweet drinks, incl. coffee.

Instead, increase the dose plain water(at least not less than half of all the liquid you drink per day).

At risk are people with high blood pressure and obesity.

To avoid gout, in addition to the above tips, you can add one more - diet (as an additional "plus" - support good condition bodies).

You should also do "fasting days" (no more than 2 times a week). To do this, stock up on cottage cheese and kefir (daily intake is 400 and 500 grams, respectively), vegetables (any kind, except for prohibited ones - 1.5 kg) or fruits (apples and oranges - also 1.5 kg).

Fruits and vegetables are best eaten raw, the rest of the food - whole (not crushed) form. For variety, they can be baked or steamed.

Healthy drinks are tea and cranberry juice, almost any juice, alkaline mineral water.

Sports, gymnastics or walking will increase the amount of UA excreted from the body, which means it will help to avoid the occurrence of acute pain caused by gout.