Gout - Symptoms, treatment and prevention

The article is written by Master, Doctor Tran Thi Tuyet Nhung, Doctor of Musculoskeletal - Joints, Department of General Internal Medicine - Vinmec Times City International General Hospital

To prevent and control the disease in the most effective way, patients must adhere to a reasonable diet, have regular checkups, and adhere to a long-term treatment regimen.
Along with other metabolic disorders such as diabetes, lipid metabolism disorders and obesity, gout is increasing in developed countries as well as in Vietnam. However, if we know how to apply a reasonable diet, adhere to a treatment regimen and closely monitor the disease, we can completely prevent and control the disease.
The mechanism of the disease is due to increased uric acid in the blood (> 420mmol/l for men and >360mmol/l for women, when increased it will be deposited in organs and organizations of the body in the form of urate crystals. (in the synovial membrane, it causes arthritis; in the kidney, it causes interstitial nephritis, urinary stones gradually lead to kidney failure; in bone cartilage: joint cartilage, ear cartilage; in subcutaneous tissues: elbows, ankles, knees); This increase may be primary or secondary, in which the cause of the increase is associated with genetic and local factors, the synthesis of endogenous purine is greatly increased, causing increased uric acid plus other factors. Caused by eating a lot of foods containing a lot of purines (liver, intestines, beef, dogs, shrimps, crabs...), drinking a lot of alcohol is the main cause of gout. : there are two types, acute and chronic. Acute form: Sudden swelling, pain, heat, intense redness in the joint of the big toe or other joints (lesser) such as knees, ankles, elbows, wrists , fingers. The pain can be after a hearty meal, an injury After surgery, infection, after taking drugs (aspirin, diuretics...) or after cancer treatment (chemotherapy, radiation), pain lasts 5 to 7 days, can go away on its own or go away. more rapidly when treated with colchicine or other non-steroidal anti-inflammatory drugs. The whole body has mild fever, fatigue. The test can show that the blood uric acid is elevated but there are also cases that do not increase, which makes it easy for many clinicians to ignore the disease. Chronic form: Due to not being treated, the prolonged increase in uric acid causes deposition in organs, causing lumps (tophi granules; chronic arthritis gradually causes joint deformities, urinary stones, nephritis) interstitial, renal failure, hypertension, tendinitis, bursitis...). Blood uric acid test is always increased, there is bone and joint damage on X-ray image. Treatment has two equally important parts, which are: Diet: Avoid foods high in purines: animal organs (heart, liver, oval); seafood (shrimp, crab, salmon, sardines); beans, asparagus, spinach; red meat (buffalo, cow, dog); sour foods (sour fruits, pickled foods) Avoid drinking alcohol and beer. Avoid taking diuretics and corticosteroids. Should drink a lot of water: about 2 liters / day (alkaline mineral water) Should eat a lot of green vegetables, carrots, cabbage, tofu Can drink milk, eat eggs, eat white meat (poultry without skin, copper fish) . Do not wear shoes that are too tight. In general, an energy-restricted diet because gout is often associated with other metabolic disorders.
Medicines: Anti-inflammatory drugs: Colchicine or diarrhea; other non-steroidal anti-inflammatory drugs (Voltazen, Piroxicam, Meloxicam, Etoricoxib...) in the absence of peptic ulcer; Use corticosteroids as prescribed by your doctor.
Drugs that reduce uric acid include: drugs to reduce uric acid production (Allopurinol - Zyloric), Febuxostat (currently in Vietnam there is a combination form with Tam ventricular and ginseng extract named: Forgout), pay attention to drugs. or cause allergies. Probenecid (Probenecid) These drugs are only used when the patient has recovered from acute arthritis.
Drugs that alkalinize the blood and urine, increase uric acid excretion: Sodium bicarbonate solution, Foncitril...
Patients usually stop treatment when the acute attack is over, so the uric acid in the blood increases, the disease progresses gradually. become chronic leaving serious complications in joints, kidneys and other organs. Therefore, in order to prevent and control the disease in the most effective way, the patient must adhere to a reasonable diet, have regular checkups, and adhere to a long-term treatment regimen.

SOME PICTURES OF ARTISTIC JOINTS AND TOPHI granules in Gout
Tophi in the joints of the fingers, fingers on both sides

Arthritis left 1 toe

Arthritis of the wrist, the joints of the right hand

References:
Prof. Dr. Tran Ngoc An. Gout. Rheumatism. Medical Publishing House, 1998, 278-296.
Assoc. Prof. Dr. Vo Tam. Gout. Diagnosing and treating common musculoskeletal diseases. 2012, 117-123.
Michael A Becker, MD. Clinical manifestations and diagnosis of gout, Treatement of acute gout, Prevention of recurrent gout. Upto date Jan 25,2011.
Terkeltaub RA. Clinical practice. Gout. N Engl J Med 2003; 349: 1647.
Colcrys(colchicin USP) Medication Guide. Revision 02, September 2009. Mutual Pharmaceutical Company, Inc. Philadelphia, PA 19124 USA. (Approved by the U.S. Food and Drug Administration)