Urinary gout

Gout in Latin sounds like arthritis urica. This disease is caused by a failure in the process of metabolism and removal of purine in the body, which leads to an increase in the level of uric acid in the intercellular fluid and blood flow. It is due to this that this disease has another name - urinary gout, the essence of which, as well as methods of its relief, we will try to consider in this article.

Causes of Urinary Gout

The disease mainly considered in this article is a disease of the strong half of humanity, although women are not immune from it. In most cases, it is diagnosed after forty to fifty years, but there are cases of earlier diagnosis. The causes of urinary gout are quite numerous, we will name only the main ones.

• During this period, the amount of estrogen in the body decreases, which leads to disruption of metabolic processes, including purines.
• Hereditary predisposition to this disease.
• Joint injuries.
• Addiction to alcoholic beverages.
• Obesity. The more extra kilos, the more complex the problem and the higher the risk of developing pathology.
• Unhealthy diet.
• Organ transplantation.
• Hypodynamia.
• Hypothermia.
• Long-term use of certain medications.
• Frequent diets with abrupt changes in diet.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Pathogenesis

In order to effectively combat the problem that has arisen, it is necessary to know the pathogenesis of the disease that you have encountered. This is the only way to expect a complete cure or transfer of the disease to the remission stage. If the pathogenesis is not clear, the specialist can only influence the symptom, which will improve the patient's condition, but not solve the problem as a whole.

The basis of the problem is the growth of uric acid levels in the patient's body. As studies show, it is often impossible to establish the catalyst that provoked the development of this disease.

But the mechanism of disease progression itself can be traced. Uric acid is produced by liver purines. Then it is carried throughout the body through the bloodstream. The main organ for its removal from the body is the kidneys, which remove the substance of interest to us along with urine.

Less uric acid is absorbed into the intestines, where it is processed by intestinal bacteria.

The uric acid levels in the blood of a healthy person are no more than 6.8 mg/dl. If this level is higher, the doctor calls this condition of the body hyperuricemia.

With an increased content of this element in human blood, the formation of needle-shaped salt crystals, called monosodium urates (MSU), begins. The higher the level of uric acid, the higher the risk of forming such conglomerates.

When deposited in the joints, these compounds cause an inflammatory process, accompanied by the appearance of other pathological symptoms.

Symptoms of Urinary Gout

Manifestations of the disease in question may result in the following pathological deviation:

• Pain localized in the area of joints and adjacent tissues.
• Pain symptoms increase with any movement in the problem area. This discomfort mainly increases at night and in the morning.
• Swelling of the affected area.
• An increase in temperature readings locally at the site of the lesion.
• Hyperemia of the skin at the site of the diseased joint. The dermis becomes smooth and glossy.
• Chills may appear and a slight increase in body temperature may be observed.
• Deterioration of the general condition of the body and appetite.
• If the pathology is advanced, growths appear and continue to grow, localized in the affected joint.
• It is possible that an element of the musculoskeletal system may become immobilized.

In most cases, urinary gout symptoms affect one joint, but variations are possible.

First signs

Usually, the first signs of the disease that begin to bother a person are the formation, manifestation and growth of nodular formations (tophi), the appearance of discomfort in the joint, and swelling.

Consequences and complications

If you do not maintain the level of uric acid within the norm, allowing its long-term excess, you can get the formation of needle-shaped salt crystals. The consequences of their growth are the formation of conglomerates, which contribute to the manifestation of the inflammatory process and the pathological symptoms described above.

Uncontrolled excess uric acid leads to a worsening of the patient's situation. Complications of such pathology can be described as follows:

• Tophi deposits that cause unbearable pain, which intensifies with any, even slight, touch.
• Transition of the disease to a chronic form.
• Damage to blood vessels. Primarily this concerns the heart and kidneys.
• Destruction of the tissue structure of the diseased area.
• Hyperemia, appearance of the “glass surface” effect.
• Deformation of the articular apparatus.
• Gradually, the joint's motor activity is reduced to zero.
• Increase in the size of tophi.
• Proliferation of connective tissue fibers.
• Sclerotic changes in the human body.
• Increased blood pressure.
• Changes in kidney function.
• This process also influences the development of diabetes, cataracts, and dry eye syndrome in the patient.

There are frequent cases when concomitant diseases of this pathology are nephrosclerosis, glomerulonephritis, pyelonephritis, as well as renal dysfunction. Less frequently, but still, complications affecting the respiratory organs, radiculitis, pharyngitis, allergies, lumbago can be observed.

However, with timely and correct therapeutic treatment, one can count on a fairly high quality of life.

[ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]

Diagnosis of urinary gout

It is possible to correctly diagnose the disease if you have a complete picture of the pathology, which is obtained after a general examination of the patient. Directly, the diagnosis of urinary gout consists of a number of studies:

1. Finding out the patient's medical history.
2. Visual examination of the patient. Presence of tophi.
3. Laboratory tests.
   • Synovial fluid analysis.
   • Urine tests.
   • Blood test to determine uric acid levels.
4. Instrumental diagnostics.
   • Radiography.
   • Ultrasound examination.
   • Magnetic resonance imaging (MRI) and/or computed tomography (CT).
5. Differential diagnosis is the exclusion of other diseases that have similar symptoms.

[ 10 ], [ 11 ], [ 12 ]

Tests

When establishing a diagnosis, laboratory tests are essential to assess the level of uric acid in the patient's organs and systems and the severity of the damage to the body caused by the pathology. The following tests are required:

• General and biochemical blood tests will allow you to evaluate the blood formula, its quantitative components, including uric acid levels. The presence of an inflammatory process in the body.
• General and biochemical urine tests.
• Conducting an analysis of synovial joint fluid and the contents of tophi (if uric acid crystals are found, then the diagnosis of gout is confirmed).

Laboratory studies are quite informative. They allow us to recognize, evaluate and track the process of formation and utilization of uric acid substance.

[ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ]

Instrumental diagnostics

Modern medicine cannot do without the help of medical equipment. Instrumental diagnostics of the disease we are interested in can be recognized by a number of medical methods. The most popular are:

• X-ray, which allows to assess the condition of bones, connective tissues and other components of the joint, as well as the degree of destruction and their deformation. X-ray allows to detect tophi, ranging in size from 0.5 mm to 3 cm in diameter, and other associated diseases.
• Ultrasound Dopplerography is an examination conducted to study the state of blood flow in the vessels invaded in the area of interest. Such a study is especially informative during the period of exacerbation of the disease.
• Computer tomography. This technique visualizes the processes occurring in the area of interest.
• Magnetic resonance imaging (MRI). The method is similar to the previous one. It allows to examine the joint in 3D dimension. At the same time, the produced photo frame package allows to use the obtained examination results more than once.
• If the clinical picture of the disease is blurred, the patient is prescribed scintigraphy with technetium pyrophosphate. A special substance is injected into the patient's blood - a marker, which selectively settles in places where urates are concentrated, which allows, by subsequent scanning, to confirm or refute the diagnosis.

Instrumental diagnostics is prescribed to almost all patients who have complaints of joint pathologies.

Differential diagnostics

Diagnosis of gout is sometimes difficult even for an experienced qualified doctor. Therefore, differential diagnosis is the analysis of as many different examinations and test results as possible. This is the only way to get a complete picture of the pathology and differentiate the disease in question from other pathologies with similar symptoms.

An analysis of the patient's medical history and examination results makes it possible to diagnose not only gout itself, but also the stage of destruction it is at. After all, it is based on this that we can talk about adequate, effective treatment or preventive measures that can maintain the patient's body in remission.

A specialist must be able to evaluate the clinical picture of a disease. The main criterion in this is the stage of the pathology. Mostly, if a patient has already consulted a doctor with complaints, the patient is diagnosed with one of three stages of the disease:

• Hyperuricemia, deposition of urates in the elements of the musculoskeletal system. At this stage of the pathology, the patient's body can be for more than one year without showing symptoms. But in medicine, there are cases when the disease still manifested itself even without an increase in the level of uric acid substances in the body.
• Accumulation of urates in tissue structures. Urates are crystalline neoplasms that, even in small quantities, can cause discomfort to a person. It is with their appearance that pathological symptoms begin to gradually manifest and increase.
• An exacerbation of the process caused by an inflammatory process occurring in the tissues. The patient reaches this level only if the accumulation conglomerates become significant. They not only injure the adjacent tissues, but also cause resistance from the affected organism.

The main burden of this disease, in addition to the musculoskeletal system, falls on the kidneys. But this fact is discovered after several years of the disease.

[ 20 ], [ 21 ], [ 22 ], [ 23 ]

Treatment of urinary gout

Modern possibilities allow a patient with gout to be offered a number of diverse methods of relieving the problem. At the same time, they can relate to both traditional classical medicine and non-traditional methods. Treatment of urinary gout can be carried out using the following methods:

• Drug therapy.
• Physiotherapy treatment.
• Surgical treatment.
• Homeopathy.
• Massages and therapeutic exercises.
• Aromatherapy.
• Use of traditional medicine recipes.

It is only necessary to remember that any therapy should be agreed with the attending physician. Otherwise, the patient risks only aggravating the situation, which will be much more difficult to stop. And the consequences of self-medication can lead the patient's body to irreversible processes.

Medicines for gout and high uric acid

Once the diagnosis is established, the doctor can begin to prescribe a treatment protocol for the disease. Medicines for gout and high uric acid are conventionally divided into two main stages of relief. Initially, drugs are prescribed that reduce the intensity of pathological symptoms. The second point is when the attending physician begins therapy for the pathology or preventive measures that will help bring the disease in question into the remission stage, which will help avoid a relapse.

The treatment protocol prescribes medications from several pharmacological groups.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed mainly during the period of exacerbation to relieve the severity of the process. The following drugs can be used: butadion, motrin, ketoprofen, dexibuprofen, reopyrin, sulindac, indomethacin, naproxen, diclofenac, voltaren, and a number of others

Indomethacin is a very strong inhibitor of prostaglandin biosynthesis, which has antipyretic and analgesic properties. It is usually taken after meals in the amount of 25 mg two to three times a day. If the therapeutic effectiveness of the treatment is not observed, this dosage can be increased to 100-150 mg daily, divided into three to four doses.

Contraindications for this pharmacological agent include hypersensitivity to the components of the drug, ulcerative disease of the mucous membrane of the digestive organs, renal failure, bronchial asthma, pregnancy and breastfeeding.

Glucocorticosteroid (hormonal) drugs, steroid hormones synthesized by the adrenal cortex. Powerful anti-shock, anti-allergic and anti-inflammatory properties. But they must be prescribed very carefully, since these drugs also show immunosuppressive properties that reduce the body's defenses, increasing the likelihood of infectious lesions of the patient's body, and worsen blood clotting.

The most commonly used drugs are prednisolone, hydrocortisone, methylprednisolone, dexamethasone, betamethasone and others.

Prednisolone ointment is recommended to be applied to the damaged joint in a small amount, rubbing it into the skin with light movements one to three times during the day. The duration of therapy is determined by the doctor, based on the effectiveness of the result.

Contraindications to this pharmacological agent include individual intolerance to the components of the drug, herpes, ulcerative disease of the mucous membrane of the digestive organs, renal failure, Cushing's syndrome, bronchial asthma, bacterial, fungal or viral skin pathologies, acne vulgaris or rosacea, pregnancy and lactation.

Anti-gout medications are mandatory: allopurinol, urodan, colchicum-dispert, allomaron, colchicine and others.

Drugs that remove uric acid

It is also worth noting that the treatment protocol also includes drugs that remove uric acid from the body. They help reduce its level, which helps speed up the treatment process and improve the patient's condition as quickly as possible. Such drugs include: probenecid, allopurinol, blemaren, sulfinpyrazone and their analogues.

Allopurinol, an active anti-gout drug, effectively reduces the level of uric acid in the patient’s blood.

It is prescribed in an amount directly dependent on the level of uric acid environment. The minimum dosage of the drug is 100 mg, the maximum is 800 mg. Usually, on average, this level is 200 - 400 mg per day, divided into one or two doses.

Monthly monitoring of serum uric acid levels is necessary here.

Contraindications for this drug include hypersensitivity to the components of the drug, renal failure, pregnancy and breastfeeding.

[ 24 ], [ 25 ], [ 26 ], [ 27 ], [ 28 ]

Folk remedies

The experience of our ancestors allows us to use folk medicine to rid the patient of many pathologies. This judgment also applies to our problem.

Numerous folk recipes can relieve such a patient from pain, lead to regression of the inflammatory process and effectively combat the accumulation of uric acid in the blood. But it is worth noting that treatment with alternative medicine methods does not lead to complete recovery. They can reduce the severity of symptoms or maintain the patient's body in a state of remission.

However, they can only be used with the permission of a doctor, since some of them can negatively affect the action of a number of drugs, reducing their effectiveness. Traditional medicine is a secondary, supportive, auxiliary treatment of the disease.

Here are a number of recipes that will help you achieve positive treatment dynamics.

• Turnip compresses. Boil or bake this root vegetable until soft. Mash. You can add a couple of tablespoons of sunflower or any other vegetable oil to the resulting consistency. The "medicine" is placed on the sore area of the skin. Secure it with a cloth on top. If the integrity of the skin is damaged at the site of the joint, such applications are prohibited.

• Bee products are a wonderful medicine for the pathology in question. Both ointments based on bee venom and bee stings themselves, which are applied to the affected joint, are used. But this method is only suitable for a patient who is not allergic to bee products.
• Ten-minute baths with the following composition have proven themselves well: add drop by drop such essential oils as rosemary (or pine), juniper, tea tree (or niaouli tree), cajeput into hot water. After the bath, use one of these same oils to do a light massage of the heated area.
• Similar baths can be taken with a combination of grape and lavender oils, taking one drop each.
• In such a situation, you can drink apple broth. Peel and core the apple, chop it and pour boiling water over it. Let it sit for half an hour, strain it and drink a couple of cups between meals. Before each use, warm up the broth in a water bath. Take it warm.

[ 29 ], [ 30 ]

Herbal treatment

Nature has gifted us with a great variety of plants with medicinal properties. Herbal treatment helps to solve the problem discussed in this article. But the only difference is that they will not be able to bring the therapy to a complete recovery of the patient, but will be able to improve his condition, especially during an exacerbation. We are ready to voice only a few recipes from a large list of treatments.

• Poplar buds, crushed and combined with Vaseline (ratio 1:4), show a high stopping effect. The resulting ointment should be applied to the sore joint once or twice a day. This will ease the pain and relieve the exacerbation.
• An excellent anti-inflammatory remedy is ginger root tea. One or two teaspoons of grated product per cup of boiling water, taken three times a day, are enough to feel a surge of strength and prevent the development of the disease.
• A couple of teaspoons of St. John's wort, steam with a liter of just boiled water. Wrap up and leave to brew for two to three hours. To reduce the level of uric acid in the blood and as a pain reliever, this medicine should be taken three times a day, 50 ml. The duration of such therapy can be several months.
• Celery root is also effective, which is taken in the amount of one tablespoon and placed in half a liter of boiling water. Two hours of infusion and the decoction is ready. It should be drunk three to four times a day 30 minutes before meals. The properties are similar to the previous recipe.
• Baths with chamomile infusion are also suitable.

Homeopathy

Modern homeopathy is not “fortune telling on coffee grounds”, but the research and production of alternative medicine drugs, put on an industrial basis.

In relation to the treatment of the disease discussed in this article, homeopathic doctors are ready to offer a whole list of medicines that, if they do not allow a person to achieve complete recovery, will help eliminate pathological symptoms, improving the patient's condition.

When diagnosing gout, homeopaths may recommend the following homeopathic remedies:

• Bryonia Alba has proven itself to be effective in relieving inflammation in joint tissues, as well as in cases of limited mobility.
• Colchicum - relieves swelling and stops the inflammatory process. The basis of the drug is the medicinal plant colchicum.
• Formic acid – perfectly relieves pain in rheumatism and gout, has a warming effect on joint tissues, and normalizes blood pressure.
• Potassium carbonate is an effective pain reliever.
• Lithium Carb – perfectly relieves joint pain and burning sensation.
• Urea pura – relief of acute manifestations of gout and gouty eczema. The drug is made on the basis of urea.

Alternative medicine preparations are designed to stimulate the patient's own healing powers.

Surgical treatment

But in a number of clinical pictures, doctors cannot do without more radical measures. If the size of the tophi is significant and it interferes with the movement of the joint, causing unbearable pain to a person, or the disease has gone so far that there is a deformation of the element of the musculoskeletal system and destruction of tissues, doctors come to the decision to perform surgical intervention.

In such a situation, surgical treatment may involve excision of the pathological formation or its removal along with the affected joint, followed by prosthetics.

Prevention

It is better to prevent any disease or attack than to deal with the problem that has arisen. To prevent a relapse of gout, it is necessary to prevent this disease. Specialists studying this problem recommend:

• It is necessary to carefully review your diet. On the table of such a patient there should be a minimum amount of products rich in purine.
• Minor sports activities: morning warm-up, light jogging or walking. The set of exercises should form a muscular corset. It will help reduce the pressure on the joints, taking over some of the stress.
• If the patient has a sedentary job, it should be compensated for by regular exercise.
• It is necessary to take a sufficient amount of liquid, which will ensure the normal removal of uric acid from the patient's body. This is about 2.5 - 3 liters of liquid per day.
• Reduce heavy loads and intense twisting.
• It is necessary to normalize your weight, not allowing extra kilos. After all, this is an additional load on the support system.
• Avoid injury.
• You shouldn't wear narrow and uncomfortable shoes. They injure the joints of the foot.
• The same applies to clothing.
• If the patient has undergone chemotherapy, then to prevent uric acid deposits in the body, he is prescribed antihyperuricemic therapy. This is mainly the use of the drug allopurinol.
• You should massage all joints regularly for several minutes.
• It is necessary to avoid long-term use of a number of drugs, especially those belonging to the pharmacological group of thiazide diuretics and cytostatics.
• Reduce alcohol and nicotine intake to a minimum. This especially applies to beer and wine.
• Avoid overcooling the body.
• Try to lead a calm, stress-free lifestyle.
• Avoid acute infections.

Forecast

Medical statistics show that the prognosis for gout is quite favorable. The vast majority of people with this diagnosis suffer mainly from the pathological symptoms of accompanying diseases, rather than from gout itself. The exception is the period of exacerbation. But the sooner effective measures are taken, the easier the patient tolerates attacks, and the sooner the period of remission will come.

As the same statistics show, many patients diagnosed with gout also suffer from urolithiasis (a metabolic disorder leading to the formation of urinary stones) and/or nephrolithiasis (stones and sand in the kidneys). In more severe cases, renal failure can be observed, and it is this that can cause death, and not the disease discussed in this article.

"Take care of your health from a young age!" This catchphrase, perhaps, like no other characterizes the essence of the problem. If a person leads a healthy lifestyle since childhood, monitoring proper nutrition, then the probability of developing the disease discussed in this article is minimal. And even if it so happens that urinary gout is still diagnosed, it is much easier for such a person to stop an attack and keep the disease in a state of remission. But another category of patients should not give up. If the disease is diagnosed, then with the correct implementation of the specialist's recommendations, you can live to a ripe old age, leading a quite high-quality active life, without feeling inferior. We wish you good health and a full, rich life!

[ 31 ], [ 32 ], [ 33 ]

ICD-10 code

According to the International Classification of Diseases, Tenth Revision (ICD code 10), microcrystalline types of arthritis, which include urinary gout, have their own individual code - M10. At the same time, this category was described in more detail:

• Idiopathic gout is coded M10.0.
• Lead type of pathology – coding M10.1.
• Drug-induced gout - coding M10.2.
• Disease associated with kidney failure - code M10.3.
• Secondary pathology - coding M10.4.
• Disease of unspecified genesis - coding M10.9.