Arthritis of Gout

Reason:

Because uric acid salts are deposited in the joint SAC, synovial sac, cartilage, bone and other tissues resulting in disease damage and inflammatory reaction,

Symptoms

There are many genetic factors, good hair in men over 40 years of age, more commonly seen in the first toe joint, can also occur in other large joints, especially the ankle and foot joints, the knee can also appear symptoms. Blood uric acid examination should be done, the erythrocyte sedimentation rate and C-reactive protein were also elevated in acute attack period, and the differential diagnosis was needed.

Gout :

Gout (gout; Scientific name: Metabolic arthritis) is a form of purine ("Pu lin") metabolic disorders, so that the accumulation of uric acid caused by disease, belongs to arthritis, also known as metabolic arthritis . Women generally do not develop gout until they are 50 years old, because estrogen inhibits the formation of uric acid, but increases the rate of seizures after menopause. Because the concentration of uric acid in the human blood is too high, in the soft tissue such as the joint membrane or tendon formation needle-like crystallization, causing the body immune system over-reaction (sensitive) and cause painful inflammation. The general attack site is big toe joint (this condition is called Podagra), ankle joint, knee joint and so on. Long-term gout patients have seizures in the finger joints, and even the auricle contains soft tissue parts of the case. Acute gout attack site appears red, swollen, hot, severe pain, usually more in the midnight attack, can make people from sleep awakened. In the early stages of gout, seizures are seen in the lower limbs.

Gout, known as "The King's Disease", "King of Diseases", "affluenza", because this disease good hair in the dignitaries, such as yuan-shi, the ancestors of Kublai Khan in his later years due to excessive drinking and suffering from gout, so that he can not walk and riding the soldiers to battle. It is interesting to note that in history, gout was once thought to be a socially desirable disease, because only dignitaries, powerful upper-class people, had the opportunity to develop gout (a high-uric acid diet is only affordable for the wealthy). [1] There is also a belief that the onset of gout is a more serious disease that can prevent paralysis and stroke ^.

The word "gout" first appeared in the Northern and Southern dynasties of the medical code, because its pain came fast as wind, so named. Ancient also known as "Pain Bi", the Ming Dynasty 虞抟 Medicine Cloud: "The husband of the so-called pain arthralgia, that is, the gout also." The book also called the White Tiger Festival wind, with its pain in the limbs condyles, such as the tiger Bite, and the name of the ear.

The rest of the world also has an ancient record of gout disease, such as the 2640, when Egyptians had been found to have gout induced to the great toe joint lesions. Ancient Greek doctors of Hippocrates called gout "can not walk the disease", and pointed out that gout is the rich arthritis, and rheumatism is the poor people's arthritis. In his motto (aphorisms), he made the following conclusions about gout: "The eunuch will not get gout, women will get gout after menopause, the inflammation of gout will subside within 40 days, and gout will occur more in the spring and autumn." "^[2].

In Third century, the Roman physician Galen first described the gout stone (uric acid salt). Gout English word "gout" was about 12th century A.D. by a monk named Randolphus of Bocking. This word is from the Latin gutta, is a drop of meaning. At the time of the medieval medical concept of "four bodily fluids," gout is thought to be a more virulent part of the joint ^[2].

Causes of high uric acid
Uric acid crystals under the microscope

When the concentration of uric acid in the blood is longer than 7.8 mg/100c. C, medically known as "hyperuricemia". Uric acid in the blood will rise because of excessive production of uric acid and decrease in excretion, which leads to excessive production of uric acid, including congenital metabolic abnormalities, lymphatic hyperplasia disease, which accounts for about ten of hyperuricemia. The reason for the decrease in excretion of uric acid includes renal dysfunction and poor uric acid excretion caused by drugs. These medications include the pyrazine diuretics, cyclosporine A, pyrazine, Ethylamine butanol, niacin and the new ^[3].

Although about three of the two people with Hyperuricemia do not have any symptoms on their bodies, the concentration of uric acid in the blood continues to rise, eventually forming a "uric acid sodium" (monosodium urate) needle crystals, commonly called "uric acid salts", which accumulate in soft tissues, especially in the lower extremity of the foot joint. When white blood cells swallow crystals in the joint cavity, they release an inflammatory substance that causes a series of inflammatory reactions, causing joint pain and swelling and deformation of the joints. If uric acid salt is deposited in the kidneys, it will cause kidney stones and urinary calculi, causing severe lumbago.

Causes of Gout [edit ]

Hyperuricemia is the main cause of gout. The study pointed out that in men, the higher the blood uric acid concentration, the higher the chance of gout symptoms, the blood uric acid concentration exceeds 9 mg per person, 4.9% will appear gout ^{[4]. Recent large-scale epidemiological studies have found that gout is associated with alcohol consumption (especially beer), excess meat (especially offal and shelled seafood), and recent studies suggest that high sugars (such as carbonated drinks and fructose) can cause gout. On the other hand, vitamin C, coffee and dairy products may help prevent the occurrence of gout [5][6].}

Alcohol causes gout because alcohol in the liver tissue metabolism, a large amount of water absorption, so that the blood concentration, so that the original has been close to saturated uric acid, accelerated into soft tissue formation crystallization, causing the body immune system over-reaction (sensitive) and cause inflammation. Some foods after metabolism, some of the derivatives can cause the original savings in the soft tissue of uric acid crystallization re-dissolution, which can induce and aggravate arthritis. [7] In addition, strenuous exercise, obesity and stress can lead to an increase in uric acid concentration and induce gout ^.

Gout mostly in the middle of the night is because of sleep, the body's anti-inflammatory hormone in the middle of the night secretion of the least, plus sleep when the ph value due to the accumulation of carbon dioxide in the body to the acidity, and the toe of the temperature is lower, plus the liquid near the toe will be absorbed by the body to increase uric acid concentration, Therefore, gout is easiest to appear at the foot of the toe in the middle of the night.

Diagnosing Gout

1. According to the history and clinical manifestations.
2. Ultrasound, X-ray and other imaging examinations of pain joints.
3. Detection of the concentration of uric acid in the blood may be misdiagnosed, because many people in the gout attack in the blood uric acid is normal, so after the seizure still need to check the blood uric acid.

Prevention of Gout [edit ]

40 years of age and above should be regular health check, to receive blood uric acid value check, prevention of gout. In the case of hyperuricemia, in addition to taking uric acid drugs under the instruction of a physician, the uric acid value is controlled outside the normal range, and the cause of all gout must be eliminated from life and diet. Reduce the consumption of high-purine foods (such as seafood, offal, non-vegetarian stock, plant-like high-purine foods) and avoid excessive alcoholic beverages, especially beer, which is a taboo for patients with gout. In the long term more effective diet is able to prevent cardiovascular disease, diabetes and kidney disease diet (low saturated fat, low sodium, low sugar index, low sugar, protein not too much or too little, the loss of kidney function to a certain degree of patients with potassium and phosphorus can also not too much), it is also easy to maintain the ideal weight, reduce obesity problems. Do not overeat (including as often as possible drinking water, not to thirst to drink water, with a small amount of water to achieve adequate water), starvation, exercise and vigorous exercise will also increase the risk of gout.

If the gout has already occurred, it is necessary to immediately detect uric acid concentration, kidney function, blood pressure and blood sugar and receive treatment, and begin to prevent cardiovascular disease and diabetes (first gout is to start to prevent these diseases signal), so as to avoid the complications such as myocardial infarction, cerebral embolism and gout nephropathy.

Gout Treatment [edit ] weight Loss [edit ]

For patients with excessive gout, healthy weight loss can also reduce uric acid. However, excessive weight loss and lactic acid accumulation (high-intensity aerobic exercise and anaerobic games caused by lactic acid accumulation, but can be avoided after exercise, low-intensity aerobic exercise is not easy to cause accumulation of lactic acid) will also increase uric acid, increase the likelihood of gout attack.

Healthy weight loss can also make fatty liver, cardiovascular disease and diabetes change slightly, mild patients even have a chance to cured.

The goal of weight loss is to make the waistline less than half of height, safe weight loss rate is one months less than one kilogram.

vegetarian [edit ]

If you can accept vegetarian food, the change of vegetarian diet can reduce the blood uric acid content, the milk is better, and the use of plant protein to replace some of the animal protein intake is also helpful; the traditional plant foods, which are considered to be high in purine, actually reduce the incidence of gout . Just still avoid high sugar, high salt, high protein, high calorie, saturated fat, and eliminate the trans fat intake as much as possible.

Diabetes Treatment and Prevention [edit ]

Some studies have suggested that insulin resistance is responsible for the inability of the kidneys to excrete uric acid, while statistics have pointed out that high fructose intake can lead to high uric acid, so for patients with gout who have not yet suffered from diabetes, the uric acid will naturally drop.

drugs for controlling uric acid [edit ]

Because it is a metabolic disorder, if the control of the diet is not effective, must be long-term drug control. Commonly used drugs are divided into two categories:

reduction of uric acid synthesis [edit ]

Do not Allopurinola alcohol tablets (Allopurinol 100mg), but also the purine alcohol.

increased excretion of uric acid [edit ]

Acute gout patients in the use of such drugs, often with the physiological salt water or glucose drip use, to accelerate the discharge of uric acid.

• Huang Shu (probenecid)

the mechanism of uric acid excretion is to inhibit the re-absorption of uric acid in the renal tubules, increase the excretion of uric acid from urine, reduce the concentration of uric acid in the blood, and eventually reduce the uric acid salt deposition in soft tissue and reduce the occurrence of gouty inflammation. The following patients should not be used; urinary calculus, blood loss, chemotherapy and uric acid caused by cancer.

• Phenyl bromide Malone (Benzbromarone).

The benzene bromide Malone is also called this supplementary Malon. Phenyl bromide is a type of benzene and furan derivatives, the main pharmacological action to suppress the renal tubules to the heavy absorption of uric acid, thereby reducing the concentration of uric acid in the blood. Phenyl bromide was developed and used in clinical trials in Germany in 1978 and has been applied in Europe for many years, with more than 10 years of treatment experience, and the tolerability and efficacy of phenyl bromide are higher than that of Allopurinol and propanol. (100mg-Bromo-Malone is equivalent to 300mg allopurinol, while the side effects of C-L-shu are larger, patients with poor tolerance and efficacy is not as good as benzene bromide Malone) and the half-life of phenyl bromide is long, one oral once a day, each 50-100mg can not only control the uric acid in the safe range. It should be noted that at the beginning of the use of bromine Malone, drinking at least 2L per day, the urine ph value is maintained between 6.0-6.8 (with sodium bicarbonate), such as joint pain, combined with non-steroidal anti-inflammatory drugs. Regular review of liver and kidney function.

common anti-inflammatory drugs [edit ]

Acute gout can be taken

• Lesang, also known as lovastatin sodium tablets (loxoprofen Sodium Tablets), non-steroidal anti-inflammatory pain medication

  usually occurs one to two tablets each time, as directed by the physician.

• Diclofenac sodium, also known as two grams of sodium chloride (Diclofenac Sodium) non-steroidal anti-inflammatory analgesics 25mg

  daily after two to three meals, one to two tablets each time. The stomach is taken according to the doctor's instructions.

• Nozomi Celebrex (celecoxib) 200mg

  daily one to two times after meal, one pill at a time. People with heart disease and stomach problems must follow the instructions of their doctor.

• Etoricoxib;arcoxia is a non-steroidal anti-inflammatory pain reliever or non-steroidal anti-inflammatory drug (NSAID) that selectively inhibits -2 (COX-2) to block the synthesis of prostaglandins, which can relieve pain and inflammation. It has anti-inflammatory, analgesic and antipyretic effects. 120mgArcoxia per day (etoricoxib) relieves pain in patients. If not necessary, you should not take etoricoxib for a long time. This medicine belongs to the Orthopaedic pain medicine, the weight should be decided by the doctor.

  side effects: dizziness, nausea, headache, drowsiness and high blood pressure are common. But the gastrointestinal toxicity is low, also does not affect the platelet function.

  Arcoxia is currently in the study of many orthopedic pain and neurological pain disorders, including arthritis, rheumatoid arthritis, acute and chronic pain, dysmenorrhea and ankylosing spondylitis, etc.

• Colchicine for obsolete drugs, the liver damage is relatively large, the liver function of the defective person use cautiously.

During acute gout, the weight of the controlled purine drug should not be increased, or the body's immune system will overreact.

Supplemental Agents [Edit ]

Goose Carnosine, aka amine (Ammonia) carnosine (anserine) is a human peptide histamine, metabolized in the kidneys, more than 90% converted to three methyl histamine (3-methyl-histidine) excreted in vitro. can help excretion of uric acid.

surgery [Edit ]

Gout stone can be surgical treatment, surgery to take, but must be based on the patient's own condition and the guidance of the doctor, can not blindly choose. ^[9]

Cold compress and hot compress [edit ]

Hot compresses and cold compresses are inappropriate in the case of pain, which may aggravate the condition or inflammation; the best way to do this is to stay in bed (sideways), to elevate the limb appropriately and when feeling safe, and to take colchicine or UPM immediately. ^[Ten]

symbiotic disease [edit ]

• In the case of patients with hereditary gout, most of them have essential hypertension because of metabolic insufficiency.
• Metabolic syndrome: The long-term high uric acid diet is not a high purine food, but will cause diabetes, high blood pressure, heart disease, stroke, fatty liver and other dietary habits, and uric acid crystallization may also cause arterial obstruction.
• Chronic renal failure: The reason is that uric acid may also be in the kidney crystallization, long-term use of pain medication to the liver and kidney damage, and may even be due to kidney dysfunction caused by high uric acid.

Arthritis of Gout