Review of methods for treating gout

Gout - a chronic disease of the joints with periodic exacerbations of inflammation and severe pain caused by the deposition of a salt of uric acid or its crystals in the articular cartilage - affects at least 1% of the population of different countries: in Germany -1,4%, in the US and Japan - almost 4% .

Why does gout treatment remain an urgent problem in modern clinical medicine? Because the pathogenesis of this disease is metabolic, and physicians mark its spread and "rejuvenation". Thus, the British Society of Rheumatology (BSR) reports that over the past 10 years, the diagnosis of gout among middle-aged Englishmen has doubled, increasing the level of locomotor disability. And there are fears that an increasing number of people will be affected by gout.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Methods for treating gout

There is a protocol for the treatment of this pathology, approved by the League of Europe against rheumatism (EULAR), the American College of Rheumatology (ARC) and other international and national medical organizations of this profile.

Standardized clinical therapies include both pharmacological agents for relieving inflammation, pain and lowering the level of uric acid in the blood, and non-medications.

Recall that the etiology of this disease is associated with a violation of the exchange of nitrogenous substances (purines) and an abnormally high concentration of uric acid in the blood (hyperuricemia). This provokes the yield of monosodium urate salt not only in the joints, but also in soft tissues (in the form of tofusov). The disease develops either due to an increase in the synthesis of uric acid, or because of its insufficient excretion by the kidneys.

The recommendations on the treatment of gout included in the protocol include non-pharmacological measures:

• taking into account endogenous factors in the development of pathology, patients are recommended Diet for gout or Diet for gouty arthritis;
• recommendations are given on lifestyle changes, including weight loss, the need for physical exercise, smoking cessation, the use of a sufficient amount of liquid;
• a survey is being conducted to identify the metabolic syndrome aggravating hyperuricemia (adipositosis, hypertriglyceridemia, hypercholesterolemia, type 2 diabetes) and renal failure.

The protocol also provides for drug treatment of gout. Since the disease manifests itself with arthritis with episodes of acute inflammation in the synovial membrane of the joints, accompanied by their swelling and pain, the treatment for gout (acute gouty arthritis) is aimed at removing these symptoms and fighting hyperuricemia.

Surgical treatment of gout, practiced today, consists in the removal of tofus, as well as the restoration of the destroyed articular cartilage. Physiotherapy and sanatorium-resort treatment of gout are used.

Gout remedies: recommended medications

Leading experts recommend the following medicines for gout treatment:

• NSAIDs (non-steroidal anti-inflammatory drugs): Ibuprofen (Ibuprom, Ibuprof, Ibusan, etc.), Diclofenac (Naklofen, Olfen), Indomethacin (Indocin), Naproxen, Celecoxib and others;
• corticosteroids (Prednisolone, Methylprednisolone, Dexamethasone, Triamcinolone, etc.);
• Colchicine (Kolkrys);
• Allopurinol (Ziloprim, Aloprim, Allozim, Allogexal, Purinol, Sanipiprol, Milurit and other trade names);
• Probenecid (Benefemade, Benefits, Balanced).

The use of these drugs and represents a modern treatment for gout.

Adherent to the NSAID group, acetylsalicylic acid (Aspirin) can relieve pain and reduce temperature, acts against inflammation and dilutes blood. However, for anti-inflammatory efficacy, Aspirin is much inferior to NSAIDs. In addition, the treatment of gout Aspirin is not included in modern medical standards for anti-gout therapy, since taking this medication at a low dosage reduces the excretion of uric acid by the kidneys and raises its level in serum.

Inflammation, pain and treatment of swelling with gout is performed by modern non-steroidal anti-inflammatory drugs (listed above). In acute gouty attacks, they are taken orally for 2-7 days (daily dose to 0.2 g); The most effective are Indomethacin, Ibuprofen and Diclofenac. It should be remembered that regular use of NSAIDs can cause bronchospasm, ulcers in the stomach and gastrointestinal bleeding. Therefore, patients should accurately observe the dosage prescribed by the doctor and the duration of taking the drugs of this group.

Taking oral corticosteroids is an alternative for contraindications or intolerance to NSAIDs. Steroids are considered more appropriate in the case of multiple joint damage. Injections of Methylprednisolone into the affected joint relieve pain and relieve inflammation. However, their long-term use gives serious side effects, including osteoporosis, increased blood pressure and the development of cataracts.

Treatment for gout Fullflex clinical standards are not provided, in addition, Fullflex is not a cure, but supplements.

Treatment of gout with colchicine

Colchicine - a preparation based on the toxic alkaloid colchicum autumnale (Colchicum autumnale); Since 2009, the only colchicine brand that has been approved by the FDA for the treatment of gout is Colcrys.

Colchicine (Colchicum-dispersant) is not a specific preparation and can be used for familial Mediterranean fever, pericarditis, Behcet's disease and atrial fibrillation. Its use in gout is associated with the effect of this alkaloid on the formation of urate crystals in the body. The withdrawal of the pain syndrome and the treatment of edema with gout are also included in the list of indications of this medication.

Treatment of gout Colchicine assumes its ingestion (1.2 mg) no later than a day after the onset of symptoms of gouty attacks, and an hour after the first dose should take another 0.6 mg. Long-term treatment with colchicine (within 1-2 months) - 0.6 mg 1-2 times a day - can prevent the next attack of gout.

It should be borne in mind that the treatment of gout with colchicine is strictly contraindicated in diseases of the liver or kidneys, heart pathologies, stomach ulcers, ulcerative colitis, Crohn's disease. As side effects of Colchicine, severe vomiting and diarrhea, muscle pain and weakness, numbness of the fingers, flu symptoms, the appearance of blood in the urine and a decrease in diuresis are noted. In addition, it must be remembered that the simultaneous administration of this drug with non-steroidal anti-inflammatory drugs increases the risk of reducing the number of platelets and leukocytes in the blood.

Colchicine causes a lot of criticism because of the high risk of accumulative toxicity, which can lead not only to irreversible neuromyopathy, but also to hypercapnia respiratory failure and death.

In domestic clinical practice, alternative medicines such as Butadion, Phenylbutazone and Reopirin are considered as an alternative to colchicine, which help to remove inflammation and stimulate the excretion of urate salts.

Treatment of gout with Allopurinol

If too much uric acid is formed in the body (and this is confirmed by appropriate assays), therapy should be used to reduce the intensity of this process by treating allogurinol gout.

Attention: drugs to reduce the level of uric acid do not take during gouty attacks! Also, simultaneous intake with NSAIDs should be avoided.

Treatment of gout with allopurinol leads to a decrease in the synthesis of uric acid by blocking the enzyme xanthine oxidase, which provides the process of recycling purines and the formation of uric acid in the body. Allopupinol is most commonly used in the long-term treatment of gout in elderly patients: its standard daily dosage is 0.2-0.3 g, and in severe cases it can be increased to 0.8 g (FDA recommendation). But after the normalization of uric acid in the blood plasma (<360 μmol / l), the daily dose of the drug should not exceed 0.1 g.

The drug is used with regular monitoring of the level of uric acid in the blood and the mandatory use of a sufficient amount of fluid to ensure the optimal level of excreted urine (within two liters per day).

If the kidneys do not cope with the release of the body from excess uric acid (with hyperuricemia), the appointment of alternative means of uricosuric: Probenecid, Sulfapirazone, Benzbromarone, etc. Is prescribed. Preference is given to Probenecid, prescribed in a daily dose of 0.5-2 g.

Treatment of tofus with gout is also performed by Allopupinol or Probenecid, long-term use of which (six months and longer) contributes to the fact that tofusi can gradually soften and disappear.

New in the treatment of gout

To date, new in the treatment of gout - a drug that expands the therapeutic possibilities in the fight against excess uric acid. The agent Uloric (Febuxostat), manufactured by Takeda Pharmaceuticals (USA), as well as Allopurinol inhibits xanthine oxidase and is prescribed at elevated urate levels in the blood (40-80 mg per day, at one time, the course of treatment - up to 14 days). According to clinical randomized trials (involving 2757 patients with hyperuricemia and gout), this drug has a higher efficacy (a decrease in serum urate in 53% of patients) than Allopurinol (a decrease in uric acid in 21% of patients).

Another novelty for the treatment of gout in Europe - the drug Kristexa (Krystexxa, Pegloticase) for intravenous infusion (every two weeks); approved in the United States in 2010, and in early 2013 permission for its use issued by the European Medicines Agency (EMA). This is an option for patients who do not respond to or tolerate other medications. Pegloticase is a recombinant porcine uricase (a specific uric acid enzyme) that promotes the oxidation of uric acid to a highly soluble allantoin and thereby reduces its serum level. This is certainly useful for gouty nodes, but there are too many side effects in the novelty, including the threat of anaphylactic shock and infusion reactions when the drug is administered.

A clarification of the role of an increased level of inflammatory mediator interleukin IL-1β in inflammation of joints with gout and rheumatoid arthritis led to the creation of the drug Anakinra (Anakinra, Kineret), which affects the inflammatory process by blocking the cellular receptors of this immune cytokine.

Treatment of gout by Bolotov

Among the various alternative treatments for gout - with the help of kerosene, laundry soap, bee venom, hot foot trays with herbal decoctions - many are interested in the treatment of gout by Bolotov.

Of all the variety of ways to improve and prolong life, generated by 85-year-old electrical engineer Boris Bolotov, it is worth, for example, his original recipe for removing salts from the body. To do this, at least two months each day, eat about 100 grams of leaves of a medicinal plant mother-and-stepmother - chopping them and mixing with table salt. The same mixture must be lubricated with inflamed joints and warm them with a heating pad. In this case, you need to consume more sauerkraut and salted vegetables.

As you know, the decoction of the mother-and-stepmother is an expectorant, and is also used for inflammatory processes in the digestive tract. Maybe it's all about the inulin that is contained in the leaves of this plant, which activates the intestinal microflora and thereby improves the general state of the body?

These recommendations for the treatment of gout "according to Bolotov" are not limited: you should drink decoctions of mother-and-stepmother, sabelnik, bird mountaineer, field horsetail (the last two diuretics). And the body oxidize, using as much as possible fermented drinks from the leaves of bearberry (a well-known diuretic), berries of watermelon, watermelon and birch juice, horseradish roots and parsley. In addition, the elimination of salts contributes to the release of sweat during a weekly steam bath, after which the body should be wiped off with vinegar, infused on the leaves of sage.

Local remedies for gout

The means of treatment of gout for external use - ointments and gels - are intended for anesthetizing and removing hyperemia and edema of joints. Most often, the effect is based on Diclofenac, Ibuprofen, Pyroxicam, and Dimexid (Capsicum and Remisid) ointments. For more details, see - Ointment for pain in the joints.

Treatment with Dimexide gives an analgesic and anti-inflammatory effect in gouty attacks. Apply this dermatotropic agent in the form of compresses, diluted with water in a ratio of 1: 1. Compress (top coated p / e) is kept on the joint for 15-20 minutes; course of procedures - every day for one to two weeks. Dimexide has contraindications, and such compresses can not be done if there are problems with the heart, kidneys or liver.

You can do compresses with a warm bishofit or medical bile; applications from a mixture of clay, table salt and water with the addition of iodine (10 drops). Inflamed joints should be lubricated with alcohol tincture of lilac flowers or aconite roots. Also these tinctures are home treatment of swelling with gout - by applying them to the skin over swollen joints with subsequent easy rubbing.

Surgical treatment of gout

With gout surgical treatment is carried out in the following cases:

• development of destructive arthritis associated with chronic gout;
• for tofus of considerable size (nodules of uric acid are removed, as they can be opened and cause ulceration and inflammation of surrounding tissues);
• with the destruction of joints and the "fusion" of their synovial membranes;
• with complete and irreversible destruction of all joint structures and damage to hyaline cartilage; replacing with artificial materials - endoprosthetics, arthrodesis of arthroplasty.

According to experts from the American Academy of Orthopedic Surgery (AAOS), 10% of patients with gout have tofuys, which are best removed before they damage the skin, tendons, ligaments and skeletal structures. And orthopedists consider surgical treatment of gout to be justified, when: tofusi disfigure limbs, they are painful, urate deposits limit the functions of the tendon, the presence of tofus threatens with skin necrosis, tofusi compress the nerve endings and disrupt innervation.

Other possible surgical interventions for gout: joint resection, curettage or partial resection of tendons (may help to preserve the function of the joint), amputation of the fingers.

Physiotherapy for gout

Hardware physiotherapeutic procedures that can be used for gout during an exacerbation include infrared and ultraviolet irradiation of joints, UHF and iontophoresis with corticosteroids.

After relief of acute pain - to improve microcirculation and metabolism in the joint tissues - is practiced by ultrasound and laser therapy (laser with a power of not more than 20 mW). There is also a system of cold laser therapy BioFlex.

Treatment of gout with the laser is used in the manifestation of the disease in the form of microcrystalline arthropathies, common among elderly patients who are more vulnerable to the side effects of medications. The effectiveness of laser therapy for pain relief is combined with the complete absence of side effects.

In many countries, including us, various "home" physical instruments for the treatment of gout are offered. As a rule, these are compact devices, the principle of which is based on the effect of an alternating magnetic field on tissue or on microvibration. The latter include the device Vitafon and its analogue Fonovit (Russian-made).

According to the developers and manufacturers of this device, in the presence of pathology, tissue cells experience a lack of natural "biological vibrations" generated by contraction of muscle cells. The method of alternative physiotherapy of joint diseases - microvibration therapy or phonotherapy, as indicated in the manual, helps reduce pain in the spine and joints after trauma, surgical treatment, etc. However, the treatment of gout by Vitafon in the list of diseases in which this device should be used is not indicated.

Treatment of gout in sanatoriums

Experts say that the treatment of gout in the sanatoriums - balneology, peloidotherapy (mud cure), thalassotherapy - is recommended only a few months after the exacerbation of the disease.

An important factor in the effectiveness of treatment procedures during the period of sanatorium treatment is general relaxation and a positive attitude of patients. Although it is still impossible to cure completely of gout, balneological procedures such as carbonic mineral, sulfide-hydrogen sulfide, radon, sodium chloride baths help to improve the blood lymph flow in the affected tissues and to activate metabolic processes, which has a positive effect on the mobility of the joints.

Contribute to this and the use of therapeutic mud and sea water. The technique of spa therapy is numerous, and the doctors, combining them, choose the most suitable for each patient: hydrothermal therapy, magnetotherapy, diadynamic therapy, therapeutic massage, kinesitherapy, etc.

Perhaps the treatment of gout in the sanatoriums and spa clinics in Berdyansk, where the therapeutic mud are in the estuary on the Berdyansk spit; near Odessa - in the Kulnitsky estuary, in the Kherson region - in Sivash. In Transcarpathia, they treat gout "Sanayak", "Berehove", "Bozhava" and at least two dozen other resorts.

Treatment of gout in the Crimea is a sanatorium on Kalamitsky Bay in Evpatoria, and also in Saki on a salt lake, where peloidotherapy is performed with the help of sulphide silt mud and brine.

Treatment of gout with sulphide muds can be obtained in Pomorie near Burgas (Bulgaria), and the Polanica-Zdrój resort in Poland is famous for its peat mud.

Treatment of gout abroad

Judging by the recent publications of the "Ukrainian Rheumatology Journal", domestic specialists adhere to the protocol and conduct modern gout treatment, prescribing all necessary examinations and preparations.

However, many people consider gout treatment abroad to be more effective ...

Treatment of gout in Israel can be attractive, since doctors in this country own almost all modern methods, and Israeli clinics are equipped with the latest technology.

As part of the gout treatment protocol, drug treatment, diet therapy, exercise therapy, ultrasonic and shock wave therapy are used. Purification of the blood from uric acid is carried out by means of plasmaphoresogemosorption. It also carries out the varying complexity of the surgical treatment of gout in Israel.

And, of course, water and Dead Sea mud are used - see more details: Treatment of joints in Israel.

The treatment of gout in Germany for centuries was carried out with rosemary oil, and the locals widely use it to this day. And still there they drink nettle tea, which, as recent studies have shown, really helps to cleanse the body of excess uric acid.

Modern treatment of gout in Germany since 2008 is also conducted according to the recommendations of EULAR and BSR, using appropriate pharmacological drugs. Although, according to rheumatologists Klinik der Gegenwart (Munich), which reduces urate therapy with Allopurinol, they have been prescribed to their patients since 1964. But recently more and more doctors prefer not to prescribe Allopurinol (which only reduces the uric acid level in 24% of patients), and Benzbromarone (92%, respectively) or Probenecid (65%).

Attitude towards patients who treat gout in Germany, professionally in everything: there will never be prescribed any medication without mandatory check of glomerular filtration of the kidneys.

Germany is known for its homeopathic school, and for the treatment of gout in the arsenal of homeopathic doctors more than 200 means.

When choosing gout treatment abroad, you can change the direction and refer to oriental medicine - traditional Chinese medicine.

Treatment of gout in China includes acupuncture, medicinal plants and ... Bloodletting. If a Chinese has gout, it means something is wrong with his chinjee or ching (body fluid), because this liquid "absorbed too much waste from food and drink".

Of the plants in special esteem for gout are the Ci Miao San medication: the rhizome Atractylodes lancea (atractylodes lanceolate), the cortex of Phellodendron amurense (Amur velvet wood), Colchicum autumnale (saffron meadow or colchicum - see earlier Allopurinol!).

Usual dandelion is also used in the treatment of gout in China. Decoction of dandelion leaves is drunk to remove uric acid, and fresh leaves are applied to the joints to reduce swelling and pain. And as for the bleeding, then, as reported by the Journal of Traditional Chinese Medicine, this method went out of fashion in the West over a hundred years ago, but in China it is again used to relieve severe pain in gouty attacks - in conjunction with Chinese herbs. The results showed that in almost 62% of cases, the condition of patients quickly improved.

Specialists have long been illusions about the reversibility of nitrogen metabolism disorders in the body. Seven years ago, researchers at the MRC Human Genetics Unit of the University of Edinburgh found that people with a SLC2A gene mutation tend to delay uric acid and accumulate in the body. And very likely that they - sooner or later - will need treatment for gout.