Gout treatment: the main methods and their effectiveness
Gout is a metabolic disease, the main feature of which is the elevated levels of uric acid in the blood, leading to the development of gouty arthritis. The treatment of this disease involves suppression of hyperuricemia, the main pathogenetic link of the disease.
Gout is known since ancient times. There is a theory that this disease affects men of genius, as many famous writers and scientists have suffered from this disease. How to cure gout is mentioned in many literary works of the XIX and XX centuries.
Gout most often affects men and women aged 40-60 years old, before that age may have latent course of the disease with asymptomatic hyperuricemia. The first attack of the disease can happen in old age and have pronounced the clinic, so they often have to carry out differential diagnosis of infectious lesions.
Many people are interested in the doctor which speciality treating gout. To answer this question you must know what exactly is gouty lesions in the patient. If gout is complicated by gouty nephropathy, such patients involved the nephrologist. If expressed articular manifestations of the disease, the treatment makes a rheumatologist. On dispensary registration of patients takes doctor-therapist. In Russia, this disease occurs among the population older than 40 years. Gout is very important to start treatment in time, it will help to prevent the development of tophi which are causing a lot of suffering patients. Gout and its treatment are frequently discussed topic in modern medical conferences, due to the high relevance of the problem.
The treatment of the disease
Previously for the treatment of gout widely used traditional methods, allowing to improve the quality of life of patients. Mostly used pain ointment plant-based, they are allowed to relieve the inflammation and dull the pain. Many folk methods are used today, for example, the collection of hop cones, calendula, chestnut and parsley.
So, how to cure gout? How to defeat the insidious disease? To get rid of the disease is not possible, however, with timely treatment for medical help is possible to achieve control of the disease and reduce the frequency of exacerbations. To understand what is gout and how to treat it, you need to understand the mechanism of development of symptoms.
When the concentration of blood uric acid, its crystals can be deposited in tissues, causing inflammation and pain. Given the mechanism of development of symptoms, the approach to gout treatment is different in acute attack and during remission where there are no clinical manifestations.
Treatment during an acute attack of gout
Acute gouty attack is manifested by arthritis of the first metatarsophalangeal joint of the foot. The attack occurs suddenly, often at night. A sharp pain in the joint, redness and swelling, the skin in this area becomes hot. Motion of the thumb cause such severe pain that becomes almost impossible. The pain gradually increases and becomes unbearable. Perhaps the rise in body temperature to febrile.
The development of the first acute attack may include the following factors: restriction of fluid intake, intense physical activity, previous infection, alcohol intake and food that contains a lot of purines, taking certain medicines.
Drugs that can cause hyperuricemia:
For the treatment of gout the first step is to establish the drinking mode (to use about 2-3 l of fluid per day). With the aim of pain relief and relieve inflammation prescribe NSAIDs (ibuprofen, diclofenac, indometacin). Good effect of colchicine, its effect begins within 12-48 hours. The effectiveness of treatment with colchicine increased if the drug was approved immediately after the first signs of an acute attack.
When taking colchicine it is necessary to monitor renal function, especially in elderly patients. In the presence of contraindications to nonsteroidal anti-inflammatory drugs and colchicine (renal failure, gastric ulcer or duodenal ulcer, hypersensitivity) may be administered corticosteroids to suppress inflammation. Drug of choice is prednisone, the dose is adjusted depending on the severity of gouty arthritis.
Purpose gout is a steroid hormone allows in the short term to reduce inflammation and return the affected joint lost functions.
Treatment of gout in between attacks
The period between attacks is characterized by the absence of clinical manifestations of the disease, the only symptom is the high blood levels of uric acid. For the treatment of gout in this period used two main groups of drugs: reduces the formation of uric acid and improve its excretion from the body. To cure gout you can, if you strictly adhere to proper behavior.
Patients with gout should adhere to the principles of proper nutrition. Exclude or significantly limit the foods that contain a lot of purines: fatty meats, especially smoked, fatty fish, legumes. It is strictly forbidden to consume alcohol, strong tea and coffee. It is highly recommended to limit the use of salt and sugar. Gout treatment with drugs that affect the metabolism of uric acid, loses its effectiveness if not observed diet.
It is also important to keep drinking regime. Berry fruit drinks and fruit drinks will help to fill the shortage of vitamins and reduce the level of uric acid. You can drink mineral water, only a low degree of mineralization. Proper drinking regime allows to improve the metabolism of purines that contributes to uric acid excretion, reducing hyperuricemia.
In Russia the gold standard for the treatment of gout outside the acute manifestations is the use of allopurinol. This drug reduces the formation of uric acid in the body.
To start the allopurinol during an attack of gout is undesirable, it can worsen arthritis and increase pain. The drug must be included in the treatment after disappearance of symptoms of inflammation of the joint. If the attack had developed on a background of reception of preparation it is possible not to abolish it, and to reduce the daily dose medications.
To beat gout will also help the use of drugs that increase uric acid excretion of urine and thereby reducing its concentration in the blood. Such drugs probenecid belongs. If the patient has a complication of gouty nephrolithiasis (formation of stones), the use of probenecid as a treatment for gout is not advisable, since this drug promotes stone formation.
Probenecid dose selected individually to achieve the desired therapeutic effect requires a gradual increase.
The use of physiotherapy
The role of physiotherapy treatment for gout in the interictal period – the achievement of stable remission. Application of electro — and phonophoresis with corticosteroids has good anti-inflammatory effect. Paraffin baths and heat treatments help the joint regain mobility. It should be noted that the application of heat in the acute period of the disease is prohibited. In the presence of tophi (subcutaneous deposits of uric acid crystals) the decision on need of physical therapy takes the doctor.
For the use of medicines for gout there are special indications: frequent, 3-4 times per year worsening of the disease, presence of tophi (subcutaneous located crystals of uric acid), arthritis, kidney failure gouty origin, nephrolithiasis. The attending physician selects the optimal treatment of gout based on the presence of symptoms and complications of the disease, the individual characteristics of the patient.
Timeliness of treatment for gout improves the quality of life of patients and prevent disability.Correctly chosen scheme of treatment of gout does not get rid of symptoms forever, but will significantly reduce the frequency of acute attacks of gout, allowing patients to keep their usual lifestyle, to continue working.