Acute gout

In rheumatology, attacks of acute gouty arthritis, which in 70-75% of cases is localized in the first metatarsophalangeal articulation of the toes, is defined as acute gout.

Pathology is attributed to diseases of the musculoskeletal system and connective tissue (class XIII), the ICD code is 10 M10.

[1], [2], [3], [4], [5], [6], [7]

Causes of acute gout

Given the pathogenesis of gout, including acute, the disease can be attributed to metabolic syndromes. After all, gout, known since ancient times, was not without reason called "the disease of the rich", who ate more meat than less well-off people, and suffered a violation of protein metabolism. And the fact that the key causes of acute gout are associated with an increase in the blood uric acid content (the protein metabolism product) was discovered in the middle of the XIX century thanks to the research of the British doctor Alfred Baring Garrod, who discovered this fact in his patients suffering from this disease.

Today, listing the causes of acute gout, in addition to hyperuricemia and the deposition of uric acid crystals in the joints, tendons and surrounding tissues, doctors are most often called:

• food with a high intake of protein (meat), alcohol abuse;
• urate nephropathy (formation of stones consisting of uric acid salts);
• hyperuricuria (urine acid diathesis);
• renal insufficiency;
• abdominal obesity and abnormal lipid levels;
• hypertension;
• hemolytic anemia;
• insulin resistance of the body (diabetes mellitus type II);
• polycythemia (increase in the level of erythrocytes in the blood);
• lead poisoning.

And genetic studies confirm the connection of almost 60% of abnormalities of uric acid in the blood and the occurrence of acute and chronic gout with mutations of three genes (SLC2A9, SLC22A12 and ABCG2), which are also involved in familial hyperuricemic nephropathy, medullary cystic kidney disease and a number of congenital fermentopathies, violating the metabolism of proteins in the body.

[8], [9], [10]

Symptoms of acute gout

Acute gout can affect not only the metatarsophalangeal joints of the big toes, but also other joints (ankles, knees), as well as fingers and wrists (in rare cases - elbow joints).

When the first signs of an attack of acute gout appear, a person has a strong burning pain in the joint in the middle of the night (against a background of physiological decrease in body temperature), the soft tissues surrounding the joint swell (edema often spreads all over the foot); the affected area becomes extremely sensitive to touch, and the skin on it turns red and becomes hot. The mobility of the joint is blocked. In addition, there may be a low-grade fever.

These unmistakable symptoms of acute gout occur within 3-10 days, and then permanently subsided. But the pathology does not disappear, but simply does not express itself clearly, acquiring a chronic form and spreading to other joints. And from time to time there is another acute attack of gout - gouty attack.

Acute pain in gout is explained by the fact that the presence of uric acid crystals in the synovial (intraarticular) fluid causes a protective reaction from the endothelial cells of the synovial membrane (Synovial membrane), which is covered inside the articular bag. One of the main functions of this shell is the defense of the joint, and it performs it: the macrophage cells activate the enzyme cyclooxygenase (COX-2) and the synthesis of anti-inflammatory mediator molecules - prostaglandins begins. This is how the local immune-mediated inflammation starts.

A prolonged increase in the level of uric acid (hyperuricemia) can cause complications in the form of its extensive crystallized clusters, known as tofusi. In themselves they do not cause pain, but their proliferation becomes the cause of chronic arthritis due to bone erosion. In some people, the acute form of gout turns into chronic - with constant inflammation and deformation of the joints by accumulated crystals. Gout can lead to a serious form of bursitis (inflammation of the joint bag). Excess uric acid can also cause effects such as the precipitation of its crystals in the kidneys, and as a result, urate nephropathy develops.

Diagnosis of acute gout

At first glance, the diagnosis of acute gout does not cause difficulties: it is enough to examine the joint and listen to the patient's complaints.

To confirm the diagnosis, the doctor prescribes tests: a general blood test, a biochemical blood test (for the amount of uric acid in the plasma), urine analysis (diurnal), synovial fluid analysis (taken by intra-articular aspiration).

Instrumental diagnostics includes x-ray examination of affected joints, as well as polarization microscopy of the synovial cavity and intraarticular fluid, through which the crystals of monosodium salt of uric acid or salt deposits are identified and visualized. If necessary, doctors perform ultrasound examination of the affected joint.

The most important differential diagnosis for distinguishing acute gout and joint diseases such as traumatic or septic arthritis, rheumatoid arthritis, pseudo-dog, osteoarthritis, ankylosing spondylitis, calcifying periarthritis, pyrophosphate arthropathy, sarcoidosis.

[11], [12], [13]

Treatment of acute gout

The first question is how to relieve acute pain with gout? Alternation of hot and cold compresses on the joint: cold for half a minute, and then hot - for three minutes, and so several times.

Among the drugs used to relieve pain and reduce the duration of gouty attacks, the first place in the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs): Naproxen, Indomethacin, Diclofenac, Aspirin, Ibuprofen, etc.

These medications relieve pain, swelling and inflammation. For example, Naproxen (Naxxen, Anaprox, Inaprol, Methoxypropylocin, Artagen and other trade names) is used to remove an acute attack of gout with an initial dose of 0.8 g, after which it is recommended to take 0.25 g every 8 hours.

Medication for acute gout - to cure gouty attacks - includes corticosteroids: inside - Prednisolone in tablets (20-30 mg per day), for the introduction into the joint - Methylprednisolone (Depo-medrol), Dexamethasone, etc.

It should be borne in mind that with gouty attacks, surgical treatment is excluded. However, with acute gout it is recommended to try alternative treatment, among the recipes of which are:

• lubrication of affected joints with iodine alcohol solution;
• rubbing of sick joints with tincture of mushroom on vodka;
• compresses from a mixture of alcohol tincture valerian with triple cologne;
• ointment from iodized salt and pork smalt or melted laundry soap with turpentine.

But, it is not difficult to guess, the guaranteed relief of pain, which is provided by NSAIDs, is not achieved by these means.

Treatment with herbs - in the form of foot baths with decoctions of chamomile or sage, as well as hot compresses from infusions of starch, thyme, horseradish or sabelnik - is also not designed for rapid relief from pain and cessation of the inflammatory process in the joints.

Medicinal plants also use homeopathy, offering such remedies for gout as Colchicum (based on Colchicum autumnale colchicum extract), Ledum Pal (based on Ledum), Benzoic Acid (benzoic acid), Aconitum (from the poisonous aconite plant), Nux vomica is produced from the seeds of the plant Strychnos - chilibuha, containing the alkaloid strychnine).

Prophylaxis and prognosis of acute gout

An important part of managing gout is prevention, which can help to minimize the attack of the disease. It consists in combating obesity and reducing the consumption of food products such as meat and seafood, more about nutrition, see - Diet for gout and Diet for gouty arthritis.

According to Nature Reviews Rheumatology, a low-calorie diet can reduce uric acid levels in obese patients to 100 μmol / L, and consumption of 1.5 grams of vitamin C per day reduces the risk of gout by 45%.

Early diagnosis and treatment aimed at the causes of the disease, help prevent damage to the joints and allow you to live a normal life, so the outlook is optimistic.

However, without treatment, acute gout will become chronic with the destruction of articular surfaces and deformation of the joints.