Gout : types, causes, symptoms , diagnosis, treatment
Gastroenterology / / August 12, 2017
Gout is a painful inflammatory condition of acute arthritis, which is characterized by the deposition of uric acid crystals in the joints and soft tissues.Pain often starts at night and can last for weeks.
If gout is diagnosed correctly, the treatment of this disease is relatively mild for both doctors and patients.The main recommendations for reducing chronic symptoms of gout are adherence and lifestyle.However, asymptomatic disease between painful sensations contributes to the fact that not all patients seek care in a timely manner.
People with gout are at increased risk of having metabolic syndrome.Metabolic syndrome is a collection of such manifestations as abdominal obesity, high blood pressure and lower cholesterol levels.This syndrome increases the risk for a person to get heart disease and stroke.Thus, lifestyle changes is an important aspect of prevention of gout and improve overall health.
gout disease occurs in humans as a result of the following events:
- The metabolism of purines .The process leading to hyperuricemia and gout, begins with purine metabolism, nitrogen-containing compounds that are important in energy production.Purines can be divided into two types:
1.Endogennye purines, which are produced in human cells.
2. exogenous purines - obtained from the products.
process of destruction of purines leads to the formation of uric acid in the body.In most mammals there the uricase enzyme, which breaks down uric acid, so it can be easily removed from the body.Users do not have the enzyme uricase, which due to uric acid is not so easily that entails its accumulation in body tissues.
- Uric acid and hyperuricemia. purines in the liver produce uric acid.Uric acid enters the bloodstream, most of it will eventually go through the kidneys and excreted in the urine.The rest of the uric acid passes through the intestine, where bacteria help her to disunite.
Typically these processes allow to maintain healthy levels of uric acid in the blood plasma (the liquid part of blood), in a healthy person index below 6.8 mg / dL.Under certain circumstances, the body produces too much uric acid, or too few outputs.In this case there is an increase in the concentration of uric acid in the blood.This condition is called hyperuricemia.
If the concentration of uric acid in the blood reaches a level above 7 mg / dL, begin to form needle-like crystals of salt, monosodium urate called (Moscow State University).The higher the level of uric acid in the blood, the greater the risk for the formation of crystals.The process of crystal growth in the joints causing inflammation and pain - typical symptoms of gout.
Causes of gout
Gout is classified as primary or secondary, depending on exactly what causes produce high levels of uric acid in the blood (hyperuricemia).
More than 99% of primary gout is called idiopathic, meaning that hyperuricemia cause can not be determined.Primary gout likely results from a combination of genetic, hormonal and dietary factors.Secondary gout is caused by medication or other factors that have caused the violation of metabolism in the body.
Risk factors for gout
The risk of gout increased by the following factors:
- Age . Gout usually occurs in middle-aged men, peaking at the age of 40 years.For this age group is most often the appearance of diseases associated with obesity, high blood pressure, low cholesterol, and alcohol abuse.
Gout can also develop in older people, this disease occurs equally in men and women.In this group, gout is most often associated with kidney problems and the use of diuretics.It is less frequently associated with alcohol consumption.
In rare hereditary genetic disorders that cause hyperuricemia, gout occurs in children.
- Paul. Men.Males had a significantly higher risk of developing gout.They, uric acid levels increase significantly during puberty.Approximately 5 - 8% of Americans uric acid level greater than 7 mg / dL (indicating a diagnosis of hyperuricemia).As a rule, their first attack of men experience at the age of 30 to 50 years.
Women.Before menopause, women have a significantly low chances of getting gout than men, perhaps it happens because of the action of estrogen.This is a female hormone that facilitates the excretion of uric acid by the kidneys.(Only 15% of women occur cases of gout before menopause.) After menopause, the risk of gout in women is increasing.At the age of 60 years and for men and women is equal to the incidence, and after 80, even gout is more common in women.
- genetic inheritance family. Genetic gout is present in approximately 20% of patients who have rodstvnnikov suffering from this disease.Often, these people have a defective protein (enzyme) that affects the breakdown of purines.
- Obesity. researchers report that there is a clear link between body weight and uric acid levels.In one Japanese study, people with overweight cases of hyperuricemia have met three times more likely than those with a healthy weight.Children who are obese have a higher risk of gout in adulthood.
- Medicines. thiazide diuretics are "diuretics", used for hypertension control.Preparations are closely associated with the development of gout.A large percentage of patients with gout who meet later in life, according to the use of diuretics.
general, many medications can raise uric acid levels and increase the risk of gout.These include:
- Aspirin - low-dose aspirin reduces the excretion of uric acid and increase the likelihood of hyperuricemia.This can be a problem for elderly people who take aspirin (81 mg) in heart disease.
- Nicotinic acid - used to treat cholesterol problems.
- Pyrazinamide - is needed to treat tuberculosis.
- Alcohol. Drinking excessive amounts of alcohol can increase the risk of gout.Beer is most closely associated with the development of gout.Moderate consumption of wine does not increase the risk of developing gout.
Alcohol increases the level of uric acid by the following three ways:
- Provides an additional food source of purines (the compounds of which is formed by uric acid);
- Enhances the body's production of uric acid;
- affects the kidneys' ability to excrete uric acid.
- organ transplantation. Kidney transplantation is a high risk for vozniknoaeniya renal failure which can lead to the development of gout.In addition, other transplants, transplants such as heart, liver, increase the risk of gout.Not only is the procedure itself is at risk of developing gout, but drug (cyclosporine) used to prevent rejection of the transplanted organ.
- other diseases. treatment of other diseases may result in a significant increase of uric acid in the blood and hence gout.Such diseases include:
Symptoms of gout
Obvious symptoms of gout depending on the stage of her disease.Gout is often divided into four stages:
- asymptomatic hyperuricemia. Asymptomatic hyperuricemia is considered the first stage of gout, which occurs without any symptoms.The level of urate in the body gradually increases.This stage can last for 30 years or more.
worth knowing that hyperuricemia does not always lead to gout.In fact, only 20% of full scale end hyperuricemia gout.
- Acute gouty arthritis. Acute gouty arthritis occurs when the first symptoms of gout.Sometimes the first signs of gout are limited to short episodes of pain in the affected joint.
Symptoms of acute gouty arthritis include:
- severe pain in the joints and around it;
- physical activity, or even the weight of the sheet can be unbearable;
- pain occur late at night or early in the morning;
- swelling, which may extend beyond the joint;
- a local rise in temperature;
- red, shiny skin on the affected area;
- chills and low-grade fever, loss of appetite and malaise;
- most symptoms begin in one joint.
Monoartikulyarnaya gout. Gout, which is formed in one joint, called monoartikulyarnoy gout.About 60% of first attacks of gout in adults and middle-aged people are found in the big toe.Symptoms may also occur in other places, such as the ankle or knee.
polyarticular gout.If the pain is felt in more than one joint, a condition called polyarticular gout.Only 10 - 20% of cases, the first manifestations of the symptoms of gout affects several joints.Older people are more likely to have polyarticular gout.The most commonly affected joints of the feet, ankles, knees, wrists, elbow and hand.Pain is mainly felt on one side of the body, and it is usually, though not always, lower leg and foot.People with polyarticular gout, often have a slower onset of pain and a longer delay between the discomfort.They are also more likely to experience low-grade temperature, loss of appetite and a general poor condition.
treat seizures, it is usually necessary for 24 - 48 hours after the first symptoms.Nevertheless, some pain lasts only a few hours, while others continue to exist for several weeks.Although the symptoms may subside, the crystals are still present in the body and soon the pain can emerge with renewed vigor.
- intercritical gout. intercritical gout term used to describe a period between seizures.The first pain is usually accompanied by a feeling of complete remission of symptoms, but if left untreated, gout almost always returns.More than two-thirds of patients will have at least one attack within 2 years from the first discomfort.
- Chronic gout. After several years of constant manifestation of symptoms of gout can develop a condition called chronic gout.This long-term condition is often also called tophi, which are crystals of solid deposits that form in the joints, cartilage, bones and other body parts.In some cases, tophi break through the skin and appear as white or yellowish-white, chalky nodules.
tophi usually are formed in the following locations:
- in curved ridges along the outer edge of the ear;
- the elbow or the knee;
- arm or leg - in elderly patients, especially women, gout is often seen in the small joints of the fingers;
- around the heart and spine (appears infrequently).
tophi are usually painless.However, they can cause pain and stiffness in the affected joint.In rare cases, they may even break a bone or cartilage, which ultimately lead to joint destruction.Large tophi under the skin of the hands and feet can lead to extreme deformation of bone.
The main symptoms of chronic gout may be considered:
- tophi gout in his arms.Without treatment, tophi can develop about 10 years after the initial symptoms of gout, although their appearance can range from 3 - 42 years.Tophi, most likely, almost immediately appear in elderly people at the beginning of the disease.In old age, women are at a higher risk of the formation of tophi than men.Some people, such as those receiving cyclosporine after organ transplantation are also at high risk for tophi.
- The development of chronic pain.If gout is left untreated, it intercritical periods, while they themselves pain may last longer tend to become shorter and shorter.In the long term (about 10 - 20 years) Gout becomes a chronic disease characterized by persistent pain in the joints or acute inflammation.Ultimately Gout can affect even those joints which have not been affected by the appearance of the first symptoms of the disorder.In rare cases, may suffer shoulder, hip or spine.
diagnosis of gout
Studies have shown that family physicians can diagnose gout quite correctly, using simple diagnostic information based on specific symptoms, history and way of life of the patient.However, there are a number of methods and means of diagnosing gout, these include:
- analysis of synovial fluid. Zkspertiza synovial fluid is the most accurate method of diagnosing gout.Synovial fluid is a lubricant, it fills the synovial membrane (membrane around the joints, creating a protective bag).This analysis allows us to detect gout even between periods of pain.
procedure called joint puncture.Medical practice uses a needle attached to a syringe to draw fluid from the affected joint.Local anesthesia is used because it can reduce the effectiveness of the procedure.After analysis may be some discomfort in the area where the needle has been inserted, but it usually takes place quickly.
liquid sample sent to the laboratory for analysis.Testing can reveal the presence of crystals of monosodium urate (Moscow State University), which are almost always confirm the diagnosis of gout.
- Urine. This assay is sometimes useful to determine the amount of uric acid in the urine of the patient, especially if the patient is young and has pronounced symptoms of hyperuricemia which can be associated with metabolic disorders.If the level of uric acid in urine is greater than a certain value, to be performed further tests to identify defects of the enzyme or other identifiable causes of gout.A significant amount of uric acid in the urine also indicates that the patient is likely to form uric acid stones in the kidney.
Urine was collected between the attacks, after the patient has been placed on the purine diet.The patient is also asked to temporarily stop using alcohol or any drugs, as it may adversely affect the reliability of the analysis.
- blood test to determine the level of uric acid. blood test is usually done to measure the level of uric acid and detect the presence of hyperuricemia.Low levels of uric acid makes the diagnosis of gout is much less likely to occur in the blood, and a very high level increases the possibility of gout, especially if the patient has symptoms of the disease.Nevertheless, the level of uric acid in the blood during an attack of gout can be within or below the norm, and the presence of hyperuricemia is not necessarily indicative of gout.82% of patients with high levels of uric acid and acute onset of joint pain are diagnosed gout.
- X-rays. For the most part, the X-rays do not reveal any problems during the early stages of gout.Their usefulness is to assess progress in the chronic phase of the disorder and identify other diseases with symptoms similar to gout.On the X-ray can be seen tophi, before they become apparent on physical examination.
- CT and MRI.