«Allopurinol» in gout and effective as other medications
Among the many diseases that occur in humans, occupy a special place of metabolic disorders. Normal metabolism for optimal performance of all organs and systems of the human body. Currently very widespread such a disease as gout. It is characterized by the deposition of uric acid salts in various organs, including bones. A sick person seeking medical assistance needs as early as possible to start treatment of gout. «Allopurinol» this is a major drug.
According to current data, in our country, gout affects about one in a thousand people. Men suffer more often than women. The prevalence of gout is much higher in the elderly.
This pathology is dangerous for its possible complications, which include the deposition of kidney stones and kidney failure, severe deformation of the joints and impaired motor activity. All of this can lead to disability. Let us consider in more detail what is the etiology and clinic of the given disease, when is drug therapy and other treatments.
The etiology and pathogenesis of the disease
To properly diagnose and prescribe appropriate treatment, the doctor needs to know the main causes for development of gout. This pathology is known for a very long time. In the past, gout was described by Hippocrates. What is the feature of this pathology? Gout is a disease resulting from metabolic disorders of purine bases, characterized by deposition of urate in tissues and hyperuricemia. The mechanism of this process is quite simple. In the course of metabolic disorders of the renal function suffers, resulting in difficulty excretion of uric acid from the body. This leads to an increase in the content of it in the bloodstream.
Under normal conditions in a healthy person is the degradation of purines to uric acid and dispose of the last of the body. Gout this process is disrupted. The urate crystals are able to be deposited in body tissues. They are often found in the joints and bones. Against the background of such a metabolic shift occurring inflammatory process (arthritis). Very often it affects several joints and developing arthritis. Often salts contribute to the formation of kidney stones. In this case, developing urolithiasis.
Gout may have a different etiology, the main causes of the disease include:
- poor nutrition (drinking large amount of purines from food);
- autoimmune diseases;
- violation of the synthesis and excretion of uric acid from the body;
- some medications (anticancer drugs, diuretics, cyclosporine);
- some somatic diseases (obesity, diabetes, hypertension, blood diseases, psoriasis).
The most common cause is poor nutrition. Often it is combined with the violation of metabolism in the body. The excess in the diet red meat, spinach, tea, coffee, chocolate can lead to gout.
You need to consider that the precursors of uric acid in large quantities contained in beer, so the abuse of this drink is a risk factor.
The clinical manifestations of gout
Gout has specific clinical features that facilitate diagnosis. This pathology occurs in several stages. The first in the blood increased concentration of uric acid, but patients do not show any complaints. During the inspection also not detected any changes.
The second stage is called acute gouty arthritis. It is the most important, as it was in this period largely affects the joints and other organs. The third stage is inter-critical period. The fourth is characterized by a chronic course, the symptoms are less pronounced.
The emergence of kidney stones can be second, third or fourth stage. As for the defeat of the joints, the acute phase very often this disease affects the toes. This raises sharp pain, swelling and redness of the joint. On palpation determined sharp pain.
Patients have can increase the body temperature. In addition, there is weakness, malaise. The important thing is that pain is able to fade in a few days. Specific feature of gout is the formation of tophi. They are small nodules. Tophi and bony growths are the cause of deformation of the joints.
Gout treatment should be complex. Not only drug therapy. Treatment is determined by the stage of the disease. The physician must pursue the following main objectives: reducing the concentration of uric acid in the body and the normalization of metabolism, treatment of arthritis, cure of the patient from the pain syndrome and other acute manifestations of the disease, prevention of possible complications. In the presence of acute arthritis caused by gout, used anti-inflammatory drugs. The main and most effective representative of this group is colchicine.
It is an alkaloid and is assigned to until the patient gets better. In case of adverse reactions the treatment you want to stop. This drug should be undertaken at an early stage of the disease when the first symptoms. The optimal way of drug administration is intravenous. It faster active substance enters the bloodstream. In addition, the intravenous method eliminates the risk of lesions of the gastrointestinal tract, which is very often observed when administered orally.
Various anti-inflammatory drugs
To take in this ailment can not only colchicine. Pronounced anti-inflammatory effect have NPRC is a non — steroidal anti-inflammatory drugs. Most often for the treatment of gout used drugs such as indomethacin, naproxen and several others.
Every drug has side effects, this should be considered when assigning treatment. To side effects of indomethacin include depression of the Central nervous system, sodium retention in the body, impaired function of the digestive tract. By treatment of gout, the physician must remember that allopurinol and means, which improve the excretion of uric acid during an acute attack of arthritis is not used.
In a situation when NSAIDs and colchicine do not bring the desired therapeutic effect, it is possible to use glucocorticoids. They are administered intravenously or directly into the cavity of the affected joint. Glucocorticoids have powerful anti-inflammatory effect.
Below the therapeutic effect was highest in the joint cavity enter the preparations with prolonged action. In such a situation it is advisable to use triamcinolone.
When applied «Allopurinol»
Allopurinol used in the treatment of gout to prevent acute attack of the disease. Treatment should begin with small doses, then gradually increase. The drug is recommended after a meal with a large glass of water. Allopurinol not used in acute gout, when there is severe dysfunction of joints. Allopurinol is protivopodagricakih drug with which it is possible to decrease the synthesis of uric acid. Allopurinol inhibits the production of the enzyme xanthine oxidase, which is directly involved in the formation of uric acid.
This drug is in most cases very well tolerated. Despite this, some patients may experience the following side effects: nausea, vomiting, violation of the chair-type diarrhea, allergic reactions, depression, sleep disturbance, changes in the blood.
«Allopurinol» is contraindicated if patient has renal insufficiency, in the period of nurturing of the child and hypersensitive. We must remember that renal failure is one of the complications of gout. In the case of its development «Allopurinol» can not be used. Of great importance is the fact that the drug can be combined with other medications with uricosuric action.
Treatment of gout involves the use of uricosuric drugs. These include phenylbutazone, aspirin, Keaton, anturan and some others. They are used when excessive blood levels of uric acid without an increase in daily excretion. In addition, these medications should be used only for persons younger than 60 years with normal renal function. Urikozuricescie means you cannot assign the presence of kidney stones. This is because they increase the load on the kidneys. The main mechanism of action is reducing the absorption of urate in the renal tubules.
If colchicine is used in acute gout then all the above uricosuric drugs are effective in chronic course of the disease. All of them, like allopurinol, is used long course. In some cases, treatment can last for years. When choosing the most safe and effective drug, the physician must take into account the age of the sick person, the presence of complications and contraindications. In a situation when there are multiple tophi, this group of drugs is not able to eliminate them.
If the tophi are large in size or have serious skin defects (ulcers), surgical intervention is performed.
The need for dieting
An important aspect in the treatment of gout — proper nutrition. You want to exclude the use of products containing purine bases: liver, red meat, kidney, chicken, coffee, black tea. Important is the fact that patients denied alcohol consumption because it impairs the excretion of uric acid from the body.
Some products can not be fully excluded from your diet, but you must limit their use. These products include spinach, sorrel, eggplant, fish, mushrooms, eggs. It is recommended to enter into the diet of cherries, currants, strawberries, as they reduce blood levels of uric acid.
Thus, treatment of gout depends on the stage of the disease. It should include not only medication, but also nutrition, physiotherapy. If you have difficulty moving the joints, the doctor may prescribe physiotherapy.