Gout on hand: causes, symptoms and treatment

Metabolic diseases in recent years are beginning to meet more and more often. The reason for this is improper diet, lack of exercise, bad habits. In the result of violation in one or another branch of the metabolic reactions that lead to involvement in the metabolism and other substances, which further worsens the situation. One of such frequently encountered diseases include gout. It relates to rheumatic diseases because it affects the joints.

The reasons for the defeat of the joints of the hands

Подагра на руке: причины, симптомы и лечение

Classic gout affecting the joints in the hands begins with the destruction of the first metatarsophalangeal joint (suffers finger), and then, as chronic diseases involves in the pathological process and other joints. In rare cases, the disease can occur as an isolated monoartrit with periodic inflammation of the metatarsophalangeal joint only. However, there is another variant of development of a gouty arthritis, which primarily affects the joints of the hands.

Gout is starting to hit the joints of the hands only in two cases: if the illness is atypical or if the process has gone quite far and it became involved all joints. Gout is a systemic inflammatory disease associated with impaired metabolism of purine bases, which are nucleotides that form DNA and RNA. They appear in the body in two ways: by doing with food and obrazujas in some cells.

As a result of violations of metabolism in the blood, there is increased formation of uric acid. It normally present in plasma in dissolved form. Once in the joint cavity or the surrounding tissue, it is deposited in the form of crystals. These deposits are called “tophi”.

The normal amount of uric acid in serum (defined by calorimetric method) should not exceed 0,36 (360 µmol/l). Exceeding of this value (according to the criteria of EULAR — the European Association of rheumatology) allows the diagnosis hyperuricemia.

Depending on how much uric acid in the blood, and the rate of increase in this index is determined by the risk of developing gout.

Violation of metabolism in this disease

Подагра на руке: причины, симптомы и лечение

X-ray picture of hands of a patient with gout

Gout develops when certain changes of purine metabolism.

  • Excessive synthesis of purine bases (metabolic or metabolic type of gout). Found in the result of hereditary pathology. Most often this type of gout lead fermentopathy, the lack of the enzyme gipoksantin-guanine-phosphoribosyltransferase, for example. In addition, the increased production of purine bases influenced some hematological diseases: polycythemia Vera, leukemia, lymphoma, pernicious anemia, tumors, psoriasis, Gaucher disease. Also may impair the use of such drugs as nicotinic acid, warfarin, ethanol. Other factors — diet, foods rich with purine bases: fatty meats, red wine, juices, fruit.
  • Violation of the allocation of purines from plasma (renal gout). Basically the removal of uric acid occurs via the kidneys, although a small proportion is excreted through the skin. Any violation of the kidney (nephropathy, renal failure, dehydration), pathology of endocrine system (hypothyroidism, hyperparathyroidism), taking certain drugs (diuretics, cyclosporine, TB) influence the filtration ability of the kidneys and reduces uric acid excretion from the body.
  • The combination of the above attributes (hybrid or mixed type of gout).
  • The development of gout can trigger bad habits (particularly alcohol abuse), some medications (aspirin, intravenous heparin, some antibiotics), disease (chronic renal failure), and such adverse factors as the effects of lead on the body.

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    What happens when the development of the disease

    Подагра на руке: причины, симптомы и лечение

    Urate (uric acid crystals) contribute to the development of gout

    Urate (uric acid) from the blood are carried throughout the body where it is deposited in various tissues and organs. The greatest sensitivity to it has skin, cartilage and synovial fluid, the kidneys. Urate are deposited mainly in areas where there are a large number of proteoglycans. In this case, more likely to suffer cartilage. Through the defects of cartilage urate penetrate deep into the joint, reaches the bone.

    The result of accumulation of crystals in this region begin to migrate giant cells. Along the way, in the place of deposits of crystals formed granulomas. Antivirus, macrophages begin to destroy the subchondral bone, which in this place form the so-called «defect of the punch» x — ray symptom, characterized by the formation of rounded shadows caused by the area of destruction.

    The destruction of bone tissue activates the process of inflammation.

    In this area begin to migrate leukocytes (particularly neutrophils and eosinophils), macrophages. They start the process of synthesis of anti-inflammatory cytokines, TNF — tumor necrosis factor. Their joint effect on the joint only enhances the process of inflammation. In the end, a failure occurs in the immune cells: lysoamidase cells (neutrophils and eosinophils) are broken, and the contents of their lysosomes (aggressive proteolytic enzymes) out in the joint cavity, exacerbating the already serious condition and re-starting the migration of immune cells and synthesis of mediators of inflammation.

    Symptoms of gout in the hands

    For gouty arthritis does not differ from classical gout. There are several stages. It is asymptomatic hyperuricemia, acute gouty arthritis, interictal period.

    Подагра на руке: причины, симптомы и лечение

    The deposition of uric acid crystals in the soft tissues

    Asymptomatic, long-existing hyperuricemia — a condition does not manifest itself and is revealed only during prophylactic examinations in the biochemical study of blood. If it is not transient, then eventually flows into the acute or chronic form of gout. To confirm the diagnosis of gout it is recommended to make repeated biochemical blood test for uric acid, simultaneously with the definition of it in the urine.

    Acute gouty arthritis — its development proyavlenii at the metacarpophalangeal joints is observed in approximately 40% of patients. For aggravation is characterized by intense pain, swelling, violation of the range of motion (in particular, because of the pain). The affected joint is warmer to the touch, when palpation revealed tenderness, in some cases, positive symptom of crepitate — the sensation of crunching under your fingers moving. Active movement practically not occur, passive painful. Progression of disease there is a decrease in the volume of active movements in the joint stiffness and deformation.

    Gradually acute arthritis tousou flows into the chronic form. Tophi on hands localized in the region of the tendons of the back of the hand, sometimes the affected elbow joint. Themselves represent tophi painless, raised above the skin formation.

    Interictal period — in acute gout is characterized by the subsidence of the symptoms of the acute phase, recovery of motion in the affected joint. With the development of the disease the period of remission becomes shorter and the symptoms begin to accumulate. As a result, the flows into chronic arthritis.

    Rare, but atypical gout in the joints of the hands may occur without significant pain syndrome, however with numerous formation of tophi and severe deformity of the joints. Because of this, it is sometimes confused with osteoarthritis, and growths — osteophytes.

    With time, almost in 90% of cases, gout affects, and kidney tissue. Developing tubulointerstitial nephritis, nephrolithiasis, and urate nephropathy.

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    Criteria for the diagnosis

    Diagnosis of gout is based on certain criteria. To them, refers the two main criteria (detection of uric acid in the synovial fluid and determination of uric acid in the biopsy of a tophus) and at least six additional characteristics.

    Подагра на руке: причины, симптомы и лечение

    The formation of crystals of lactic acid

    The list of small, or additional signs of illness:

    • the peak of the inflammatory process in the first days of exacerbation;
    • a history of at least one similar attack in the joint;
    • monoartrit;
    • redness of the joint;
    • the pain and inflammation of the metacarpophalangeal joints, during the classical period — in the first metatarsophalangeal joint;
    • asymmetric joint damage of the hands;
    • lose the heel (tarzali) joints (one side) — for classic gout;
    • hyperuricemia;
    • the discovery of “punch”;
    • a negative result for culture of synovial fluid;
    • with the development of arthritis — asymmetric joint involvement;
    • identification of tophi (or tophousebeton formations).

    For gouty arthritis can be divided into mild, moderate and severe.

    Mild course characterized by occasional bouts of relapse, low intensity of symptoms of inflammation, quick and easy relief of the attack. Moderate for 3-5 is characterized by attacks of arthritis in the year, the defeat of several (usually 4) joints, moderately severe symptoms and formation of tophi. Severe course is observed in the case of increased frequency of seizures, formation of large amounts of of tophi, kidney damage and significant deformation of multiple joints.

    Non-drug methods of dealing with illness

    Подагра на руке: причины, симптомы и лечение

    Therapy of gout should be comprehensive and include not only medication, but also the normalization of all metabolic processes. The complex care for a given ailment that includes diet for gout. The first thing to reasonably explain to the patient that the treatment of gout, including diet, will now be lifelong. Full recovery will never come, you only arrest the symptoms.

    Among non-pharmacological methods of treatment of this disease can identify a lifestyle change.

    Doctors recommend to follow certain rules.

  • Complete rejection of alcohol. Even with a carefully followed diet a small amount of alcohol can provoke an acute attack of arthritis, to arrest which would be pretty hard. An unfavorable outcome as a result of violations of the “dry mode” may develop this disease as acute toxic kidney with outcome in ARF.
  • Diet for gout on hand. Excluded from the diet of fatty meats, artificial juices, various pastries and sweets. Allowed to eat low-carb foods to Supplement their unsaturated fats: milk and dairy products (yogurt, cottage cheese, yogurt, cheeses), nuts (walnut, hazelnut), vegetables (cabbage, beets, cucumbers, carrots, onions), fruits (grapes, plums, cherries, oranges).
  • The decrease in body mass. This factor has virtually no effect on joint damage of the hands with gouty arthritis, and realizes himself in the classical period.
  • For the most effective treatment of acute form of the disease, it is recommended to ensure that the patient rest, to give inflamed joints elevated position. It is recommended to put cold on the area of the affected joints. During the attack should give the patient more fluid.
  • Подагра на руке: причины, симптомы и лечение

    How to treat gout with medicines

    Medical treatment for gouty attacks should provide relief of acute symptoms. Of the drugs used NSAIDs, glucocorticoids, colchicine. These funds affect the pathogenesis of.

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    So non-steroidal anti-inflammatory drugs (NSAIDs) block the formation of cyclooxygenase, the enzyme responsible for the synthesis of inflammatory prostaglandins. Their use reduces the symptoms of inflammation, due to what is happening and the relief of acute gouty attacks. Glucocorticoids are used in case of ineffectiveness of NSAIDs. Introduced mainly in the joint cavity, so that the glucocorticoids have less side effects on the body as a whole.

    Colchicine belongs to the alkaloids of plant origin. It has anti-inflammatory effect by stabilizing cell membranes, participates in the development of inflammation in the joint. In addition, it stabilizes the pH of the synovial fluid than prevents further deposition of salt crystals in the joints.

    During prolonged attacks of gout, the increase in their frequency throughout the year, the deterioration of the General condition begin antipodagriceski therapy. For this purpose use allopurinol (excessive formation of uric acid), probenecid, arisan (with decreased excretion through the kidneys). These drugs, like any other, must appoint a physician.

    What to pay attention to in the treatment and prevention of

    When you use a medication subject to the following principles.

  • In acute gouty attack should not begin therapy with allopurinol reception.
  • Allopurinol assigned to and used by the method of titration of dose is assigned to the starting dose (50 mg), then increase the dose to achieve normal numbers of uric acid.
  • The first month of treatment is recommended to be guided by the principle of progressive treatment: the slower, the better.
  • With decline of renal parameters (clearance and glomerular filtration rate) is better to use low doses of the drug.
  • For the prevention of exacerbation you need to carefully adjust the daily diet.
  • Diet for gout should include foods rich in purines. You should use enough water: at least 2-2. 5 liters per day. The liquid is used for diluting blood plasma, and to improve excretion of uric acid via the kidneys by increasing urine output.

    With advanced renal failure it is recommended to get rid of it, and then assign the fluid intake. You can use alkaline mineral water, as they promote dissolution of the urate crystals. It is not necessary to eat salt. On the contrary, it is recommended to reduce the daily dose of salt to 3 g, as it contributes to fluid retention in the tissues and prevents the leaching of urate in the joints and tissues.

    Gout called disease people of the upper class, illness of lords, as it develops on the background of eating red wine, fatty meats, alcohol. However, simple normalization of the diet not be able to completely prevent the development of gout. Should be done annually preventive examinations for timely diagnosis of possible diseases.