It used to be known as “gout” due to its frequent location on the big toe. The term, however, is no longer used as this joint (1st metatarsophalangeal) is not the only one affected by the disease.
Where is it due?
Its appearance is due to the inability of the body to regulate the levels of production or elimination of uric acid. Uric acid is a substance produced by the body as the end product of the metabolism of purines, some of the proteins contained in various foods. Normally, it is excreted from the body through the kidneys and gastrointestinal tract in a ratio of 2/3 -1/3.
“When the body can not regulate the levels of production or elimination of uric acid or both then a condition called hyperuricemia is caused. “Hyperuricemia, which means a uric acid level above> 6.8mg / dl, causes the deposition of monosodium crystals in the joints and surrounding tissues, resulting in their inflammation, gout”, points out Mr. Dimos Patrikos, Director of Rheumatos Metropolitan Hospital.
However, when the symptoms of the disease appear, it is preceded by a long period of usually “silent” hyperuricaemia, a period of elevated levels of asymptomatic uric acid. A large percentage of these people with hyperuricaemia will not develop gout, while a percentage of 10-15% will develop it at some point. The time when this will happen is not specified as well as the reason why the majority of people with hyperuricaemia do not develop the disease. However, it seems that some factors such as the frequent minor injuries of the joint, the high consumption of alcohol, the diet rich in purines and the taking of some drugs (aspirin, diuretics, allopurinol) favor its appearance.
Which people are affected by the disease?
Gout usually occurs after the age of 50 and affects men more often than women (in a ratio of 5: 1). It is related to the way of life in the so-called western world (1-2% of the population will experience it at some point in their lives). Evidence suggests that rates doubled between 1990 and 2010, and this increase in the disease is thought to be due to increased life expectancy, dietary changes and an increase in patients with gout-related diseases such as metabolic syndrome and high blood pressure.
Which joints are affected?
In the lower extremities, except for the first metatarsophalangeal joint (the big toe) which is the reason for the older name of the disease, the tarsus, ankles and knees are affected, while in the upper extremities the wrists, elbows and toes are affected. hands.
Symptoms
As an inflammatory disease, gout exhibits all the symptoms of acute inflammation:
• Pain, which can be from moderate to very strong, sharp and intense to prevent walking or waking the patient during the night. There are patients who due to the pain can not even bear the weight of the cover on the affected joint.
Swelling of the affected joints.
• Heat and redness.
• Restriction of the mobility of the affected joints.
“These symptoms last up to 2 weeks and then subside even without any treatment. However, after a few weeks, months or even years, the inflammation reappears in the same joint but also in others. Then it subsides again, reappears in the same way, and so on, with the duration of the episodes increasing, the distance between them shortening, and medication becoming necessary to treat it.
If this pattern of relapsing flares is not treated with proper medication, after a period of about 10 years, acute recurrent gout passes into years. During chronic gout several joints are permanently painful, swollen and with limited mobility. “These lesions are now irreversible, while the increased uric acid is ‘stored’ in the form of monosodium urea crystals in the joints and other parts of the body, creating swellings called tombs,” the doctor explains.
Diagnosis
The diagnosis is made by taking a history, the clinical examination of the patient and the examination of synovial fluid or a sample from an existing urinary tract. If typical fluid monosodium crystals are found on examination of the fluid or sample, then it is gout. It should be noted that if a culture of synovial fluid obtained during inflammation is cultured, it should be sterile for germs, in order to rule out septic arthritis (caused by germs), which requires different treatments.
Complications
Gout, without proper medication, leads to permanent deformity and destruction of the affected joints. In addition to these permanent damage to the joints, however, elevated uric acid levels can lead to kidney problems such as lithiasis and kidney failure, cardiovascular problems such as high blood pressure and be associated with hyperlipidemia (high cholesterol and triglycerides). Usually people with gout are obese and suffer from the so-called metabolic syndrome.
Treatment
Gout requires long-term medication for elevated urinary levels as well as non-pharmacological treatment with close monitoring. The choice of medication is made by the rheumatologist and is adapted to the coexisting diseases and the particularities of each patient, aiming at the seizures and their prevention. The drugs used are: colchicine, non-steroidal anti-inflammatory drugs, glucocorticosteroids (cortisone) and, in persistent cases, interleukin inhibitors 1.
For the treatment of hyperuricaemia, mainly drugs that reduce the production of uric acid or drugs that increase its elimination from the body where they are available are administered.
Non-pharmacological treatment of patients includes:
• Control for congenital or acquired conditions that favor hyperuricaemia.
• If possible, replace any medications that promote hyperuricemia with others that do not.
• Diet & lifestyle recommendations: Foods to avoid, foods that are allowed, diet and controlled weight loss, mild (to avoid minor injuries) and daily exercise.
Diet
“The following must be avoided:
• Foods that are rich in purines such as: offal, meat broth, “small meats” such as lamb and goat, shellfish such as mussels, oysters, etc., small fish such as sardines, mackerel, anchovies, herring.
• Alcohol and especially beer, as well as soft drinks with sweeteners.
Allowed: Low fat dairy products, eggs, pasta, rice, potatoes (non-fried) fruits, fruit juices, vegetables (except peas, beans, spinach, lentils, asparagus, mushrooms, tomatoes, cauliflower, cauliflower) “Cereals and white or corn bread, and drinks such as coffee, tea and cocoa”, concludes Mr. Patrikos.
Writes:
K. Dimos Patrikos, Rheumatologist Director at the Metropolitan Hospital
Follow Skai.gr on Google News
and be the first to know all the news
