Types and treatment of articular syndrome in gout

In astrologie is determined by following kinds of damage to the articular joints in gouty:

Acute gouty arthritis

Observed in most of the cases. Pathology has sudden onset, the initial manifestation occurs at night with intense pain. Aggravating factors can result in personal injury, alcoholic beverages, excess food consumption, emotional distress, surgery, vespertinus.

Algicheskom syndrome and symptoms of the inflammatory process occur and culminate in a few minutes or hours. In some cases, precede the manifestation may be minor pain attack in the damaged area, and in rare cases, there is a gradual increase in pain.

Characterized by predominant involvement of the metatarsophalangeal of artaudian toe (90% affected). Not uncommon in postprocess involved ankle joints of the arch of the foot, knee articulation, but the joints of the hands are damaged seldom. Characteristic stands for the upper extremities inflammation in the Bursa (especially the elbow).

TBS, the vertebral column is affected in extremely rare cases. Gouty inflammation goes on paryushana tissue and skin. Develops redness and swelling, increased local temperature, pain during polerowania joint and periarticular region. The dermis is stretched and shiny, at the end of the attack period occurs desquamation. In parallel with the intensification of the pain and transformation of developing febrile condition and chills on the background of leukocytosis and elevated ESR.

Synovia microscopy shows the presence of urate crystals with sharp corners. They are freely located or the type of inclusions in elongated neutrophil cells.

This picture is typical of acute gouty arthritis, detected in 95% of case patients. Rentgenissledovany joint compounds are not essential for diagnosis. It is necessary to determine the patient’s hyperuricemia and other gout cleanprofile. Test is the truncation attack period colchicine 12 hours (typical for 75% of cases).

In the absence of remedial measures, this form lasts from days to a few weeks, however, tends to regress gradually over a two week period. In some cases, during convalescence there is a relapse. In remission patients articular manifestations are mostly absent.

Treatment involves NSAIDs. Quite effective colchicine appointed on 1 mg and then 0.5 mg every two hours. Criteria for discontinuation of therapy are:

  • the relief of an attack;
  • the development of side-effects from the digestive organs (diarrhea);
  • more than 6 mg per day.

In some cases, prescribe glucocorticosteroid drugs, and after their abolition in some cases, there is recurrence of acute gouty arthritis.

After the first demonstrations at one-tenth of cases over many years, the relapses do not occur, although in the blood increased content of urate. But most undergo a repetition of the attack in the first year of the disease (over 60 %). For 5 years from the start of demonstrations recurrence occurs in 90% of patients. Most with the time frequency of repeated cases increases, exacerbations become much harder and longer and to engage partprocess more articular joints. The part of cases the frequency of repetitions is maintained or reduced to complete cessation. And sometimes you can find permanent course of disease, i.e. aggravation of the constant in the absence of periods of remission and rapidly lead to deformirovaniya and functional articular disorders.

Prevention of exacerbations ensures protivodiabeticescoy therapy and exclusion of precipitating factors (alcohol, use pornstargames food, the dramatic weight reduction). Failure to comply with the recommendations demonstrated the use of colchicine 1-2 mg per day. In most of the affected by gout it is possible to minimize exacerbations and prevent deformation and breakdown of the articular motor abilities.

Joint and periarticular tophi

This form presents a dense painless subcutaneous nodules, which are formed by the deposition of urate crystals in the cartilage layer, the fibers of the tendon, synovial membranes, epiphyseal and diaphyseal ends of the bones, soft tissues parsontown.

Damage to the articular joints in this case are visualized radiographically dense subcutaneous periarticular foci, large erosions in the cortex of the bone structure, localized chaotic intra – and accountno, thickening the dense connected with bone structure, tissue, and articular gap.

Such education must be differentiated from similar when deforming osteoarthritis, rheumatism, etc. Intra – or juxta-articular placement of tophi often lead to gross lesions of the articular joints:

  • rupture tendon-ligament fibers on the background of developing subluxations;
  • extensive erosive lesions;
  • focal bone destruction.

Such transformations are the reason for arthralgic syndrome, chronic reactive inflammation of a joint in combination with repetitions of acute gouty arthritis. All this leads to the development of persistent gross deformation of the articular joints and disability of the sick.

Protivogerpeticescoe therapy significantly reduces the frequency of recurrence of gout and may lead to reversible formation of tophi.