Gout
Gout is a type of arthritis that occurs in some people who have a high proportion of uric acid in the blood, as uric acid crystals like needles inside the joints, causing the symptoms of the disease. Uric acid is naturally formed when the body breaks down purines, which are found in human body cells and in multiple foods, and uric acid is transported through the blood to get it out through the kidneys and put into the urine. The increase in uric acid in the blood due to excess uric acid secretion in some people, in other cases, the secretion of the normal but can not be treated properly kidneys, and therefore some people to get gout.
Symptoms of gout
Gout may affect the joints of the foot, ankle, knee, fingers, and elbow. Gout may appear in the beginning as a contract on the hands, elbows, and ears. In some cases, the symptoms may be continuous and persistent, almost all the time, not in the form of painful seizures. In this case, chronic gout is called, and this is similar in older adults with gout with other types of arthritis : Arthritis), it is worth noting that chronic gout is less painful. Gout is likely to cause inflammation in fluid-filled and tissue-filled bags, especially in the elbow and knee. It is important to know that the symptoms of gout similar to the symptoms of other health conditions, and symptoms may begin to occur after exposure to a disease or surgery, and the symptoms of this disease are as follows:
- Feel pain with heat and swelling in the joint. Usually, these symptoms occur in the big toe. The pain usually begins at night. It can get so fast that there is little pressure, even if it is light.
- Skin appears red or purple in the area around the affected joint, where it appears to have inflammation.
- Limitations in the movement of the injured joint.
- The feeling of itching and peeling in the skin surrounding the injured joint as the disease improves.
Causes of gout
The following may cause gout or make a person vulnerable:
- Some factors that can not be changed, such as a family history of gout, some rare cases of birth, which cause an increase in uric acid in the blood, such as Kelley-Seegmiller Syndrome, Lesch-Nyhan syndrome. Males are more likely to be infected.
- Some medications may increase the uric acid content in the blood, such as the regular and permanent use of aspirin or niacin, urine medications, chemotherapy treatments commonly used to treat cancer, and immunosuppressive drugs such as cyclosporine To prevent rejection of the body after transplantation.
- Some diet and weight-related reasons, such as obesity, moderate or severe drinking regularly, eating high-purine foods such as seafood and meat, frequent dehydration, and low-calorie diets.
Tests for gout diagnosis
The following tests are among the tests used to help diagnose gout:
- Examination of the joint fluid: A needle is used to pull the fluid around the injured joint to be examined under the microscope, where the liquid may show crystals of urate crystals.
- Blood test: The percentage of uric acid and creatinine in the blood can be examined. However, this test may give misleading results. The percentage of uric acid may be high in some people without showing any symptoms. In contrast, the symptoms of gout may appear in some people, The ratio of uric acid within the normal level.
- X-ray: A joint image is taken to exclude other causes of arthritis.
- Ultrasound examination: where the examination of the musculoskeletal system to observe the presence of crystals of urate in the joints, for example.
- CT scan: This test can detect the presence of crystals of urates in the joints, although not acute inflammation, but this examination is not widely available and is not usually used because of high cost.
Treatment of gout
This disease is controlled by three basic stages: acute seizure, prevention of seizures, reduction of urinary stock increase to prevent gout-related arthritis attacks and reduction of the deposition of urate crystals in tissues. In general, the high uric acid, which does not cause symptoms in the person does not need to be treated, but if the increase of uric acid and increase the proportion of uric acid in the blood of 11 mg / dL will increase the chances of kidney stones and kidney disease, so it is necessary to examine Kidney function in these people. Drugs that reduce the proportion of urates in the blood reduce the risk of kidney damage in gout patients.
Treatment of acute seizures
Attention should not be paid to the treatment of cases whose diagnosis has not been definitively confirmed. For example, the symptoms of septic arthritis are similar to gout or pseudogut. The lack of knowledge of septic arthritis may result in the loss of the injured limb or even Loss of life. Treatment of acute gout seizures is about removing pain and inflammation, and appropriate treatment is chosen according to the person’s health status, depending on the presence of problems such as kidney problems or ulcers in the digestive system. The medicines used include:
- Nonsteroidal Anti-Inflammatory Drugs: The first option for acute gout cases in people who do not have other health problems, these drugs should be avoided for patients with a history of gastric ulcer or hemorrhage, kidney failure, dysfunction In liver function, in patients taking Warfarin, and in intensive care patients exposed to gastritis. These include Indomethacin and other non-steroidal anti-inflammatory drugs, but it is important to avoid aspirin as it affects the level of uric acid and may increase the severity and duration of the seizure.
- Colchicine: The use of this treatment has recently been reduced due to the narrowing of its therapeutic window and the possibility of toxicity. It should be noted that it should be used within thirty-six hours of the seizure in order to obtain the effect and effectiveness and should be avoided in cases of imbalance. Liver function, bile duct obstruction, and in cases where the rate of glomerular filtration rate is less than ten milliliters / min, and in patients who can not tolerate the diarrhea caused by it as a side effect.
- Corticosteroids are used for patients who can not use non-steroidal anti-inflammatory drugs or colchicine. These drugs can be given orally, intravenously injected, injected into the muscles or injected into the joint, where the latter is used in cases that occur In which the seizures are in a single joint, by giving a long-acting injection to reduce the effects on the entire body when taking oral corticosteroids, but be sure there is no inflammation before giving it. It is important to take action to prevent osteoporosis in corticosteroid therapy that lasts for more than two weeks.
- Adrenocorticotropic Hormone.
Treatment of chronic gout
In many cases when the first bout of gout is recommended to start taking the drugs reduced for uric acid, but if the first bout is not severe advised some specialists of rheumatism and joints to wait until the second bout to start treatment. It is worth mentioning that the probability of a second seizure is 62% after the first year, 78% after two years, and 93% after ten years. The decision to start treatment depends on the uric acid in the blood. It is important to know that long-term treatment is aimed at reducing the proportion of uric acid in the blood, and should avoid the use of drugs and treatments that increase the proportion of uric acid, but in cases where it is necessary to control the dosage of allopurinol (Allopurinol) Propenecid, which is used to treat chronic gout. People with a diet are advised to be overweight, stop drinking beer, and stay away from foods rich in purine.
Chronic gout can be treated with the following medications:
- Allopurinol: Decreases the production of uric acid by inhibiting Xanthine Oxidase. In many patients it may cause dyspepsia, headaches, diarrhea, etc. Very severe drug sensitivity may occur in very few people and is more likely to occur in people with kidney failure. It should be noted that the dose should be reset every two to five weeks, depending on the level of uric acid in the blood.
- Febuxostat is an effective alternative to alopurinol, and is mainly taken out of the body by the liver, so it can be given to patients with kidney problems without having to modify the dose.
- Lesinurad: Inhibits the urinary carrier responsible for the reabsorption of uric acid from the kidneys. It is given with Xanthine Oxidase inhibitors. In cases where the treatment has not been met with Zanithin Oxidase inhibitors alone, the renal function must be ascertained before it can be used. Period of treatment periodically.
- Uricase (Uricase): Used to treat high uric acid-induced high levels of chemotherapy in patients with malignant tumors or gout-resistant treatment.
- Propenecid: It can be used in cases where the use of alopurinol or fiboxoestate is inconsistent or intolerable in patients with kidney disease and can be used with Xanthine oxidase inhibitors in cases that do not respond to enzyme inhibitor therapy alone, or Cases that may cause the use of enzyme inhibitors a significant risk.
Preventive treatment
Preventive gout is treated with colchicine or non-steroidal anti-inflammatory drugs for a period of six months or by a low dose of prednisone in patients who can not take colchicine or non-steroidal anti-inflammatory drugs. These options in prevention are important to reduce the incidence of acute seizures that may occur due to the use of alopurinol, fibroxestate, and propecid.