Gout of the big toe

Among all diseases associated with the disorder of purine metabolism, gout of the big toe is most common. Pathology is characterized by the deposition of sodium urate in the joint tissues of the thumb - the urate precipitates into crystals that provoke the appearance of microcrystalline arthritis, with all the relevant symptoms.

[1], [2], [3], [4], [5]

Causes of the gout of the big toe

The cause of the disease lies in the increased and persistent content of sodium urate (uric acid) in the bloodstream. In the initial stage of the development of the disease in the joint of the thumb, crystallization takes place, which contributes to the gradual destruction of the joint tissues.

Excess urate can occur for various reasons:

• with insufficient function of the kidney filtration system;
• with excessive production of uric acid in the body.

It is possible to single out a common number of possible causes of the development of the disease:

• failure of renal function;
• trauma and hypothermia of the joints;
• alcoholism;
• persistent and severe stress;
• treatment with diuretics and other drugs that affect kidney function or purine metabolism;
• wearing unsuitable and uncomfortable shoes that can promote deformation of the joint of the thumb.

[6], [7]

Pathogenesis

The trigger mechanism in the development of gout is a persistent increase in the level of urate sodium. Excess uric acid leads to its deposition in the form of crystals in the joint tissues. The crystals have sharp edges and damage tissues, resulting in an inflammatory reaction with joint deformation and severe pain.

Also characteristic is the formation of so-called gouty nodules - tofusov. Without proper treatment tofus gradually increase and deform the joint.

The disease often occurs against the background of other pathologies that are related to metabolic processes. It can be obesity, diabetes, calculous cholecystitis and pyelonephritis. The disorder of renal function is often the cause of the development of hypertension, and the failure of the metabolic processes leads, in turn, to the destruction of blood vessels, including coronary vessels.

The course of gout alternates with periods of attacks and remission. In this acute period can last 7-14 days, and the period of remission of the disease is determined by the severity of the disease, and may differ.

[8], [9], [10]

Symptoms of the gout of the big toe

The defeat of the gout is determined by the presence of characteristic symptoms that the patient himself can detect. The first signs of the disease manifest sharp sharp soreness of the joint. The attack can be accompanied by a feeling of general fatigue, headache, the appearance of edema on the affected foot, hyperemia of the skin at the site of inflammation, and an increase in local and general temperature.

To the doctor, patients usually turn, complaining of a sharp pain in the first metatarsophalangeal joint - that is, at the junction of the big toe with the first metatarsal bone. Pain can increase with support on the forefoot, both at rest and during walking. Often deterioration occurs at night, especially after a plentiful feast or drinking. The joint of the thumb to the touch becomes hot, increases in size. Skin covers get a purple-red color.

As a rule, the first time the disease is easily healed. Subsequent seizures are already longer and more difficult to treat.

[11]

Forms

• M 00-M 99 - diseases affecting the musculoskeletal system and connective tissue.
• M 00-M 25 - arthropathy.
• M 05-M 14 - inflammatory polyarthropathies.
• M 10 is gout.
  • M 10.07 - idiopathic gout with lesion of ankle and foot.
  • M 10.17 - lead gout with ankle and foot damage.
  • M 10.27 - drug gout with lesion of the ankle and foot.
  • M 10.37 - gout caused by a disorder of kidney function, with ankle and foot damage.
  • M 10.47 - other gout secondary nature with lesion of the ankle and foot.
  • M 10.97 - gout, unspecified with ankle and foot injury.

[12]

Complications and consequences

Gout is a complex chronic pathology, so complications of this disease are not uncommon. The most frequent and formidable complication of gout is the development of gouty arthritis, which is accompanied by signs of general intoxication and an acute inflammatory process.

In addition, urolithiasis can occur with the formation of urate stones (crystals of uric acid).

Tofusi - the second name of gouty nodes - are aggregates of urate sodium. They are able to accumulate in any part of the body. With the deposition of tofusos inside the joints, immune defense works, in view of the fact that these clusters are a kind of foreign body. Activation of leukocytes occurs, an inflammatory reaction occurs, which is the beginning of the development of arthritis.

The formation of kidney stones can lead to insufficient kidney function, which can also have corresponding complications and adverse effects on the body.

[13], [14]

Diagnostics of the gout of the big toe

The main number of diagnoses is established on the basis of available patient complaints and external examination. If the case is complicated, then other diagnostic methods may be needed.

• Lab tests:
  • increased content of leukocytes in the general blood test accelerated by ESR;
  • high level of sodium urate in the blood;
  • the content of leukocytes in the joint fluid from 10 to 60;
  • In the study of tofus, urate crystals are found.

• Instrumental diagnostics:
  • when carrying out X-rays, erosive changes are found in the subchondral bone area, and first the first metatarsophalangeal joint is affected;
  • X-ray, CT and MRI do not determine the presence of periarticular osteoporosis.

[15], [16]

Differential diagnosis

Differential diagnosis is carried out with such pathologies:

• Infectious inflammation of the joint;
• amyloid damage of the joint tissues;
• chondrocalcinosis (the so-called "pseudogout");
• rheumatoid arthritis.

Treatment of the gout of the big toe

Gout can not be cured completely: treatment is only used symptomatic, to ease the condition during attacks. Typically, prescribed analgesics and anti-inflammatory drugs, as well as drugs that lower the level of urate sodium in the bloodstream.

• Drugs designed to control the level of uric acid:
  • Allopurinol is a remedy that interferes with the production of urate sodium. The average dosage of the drug per day is 200 mg. The scheme of therapy is determined by the doctor individually;
  • Phoebusostat is a drug-inhibitor of xanthine oxidase, which suppresses and reduces the amount of uric acid. The average dosage of Phoebusostat is 80 mg / day;
  • Peglotisis (recombinant uricase) is a new drug, an enzyme that causes the splitting of uric acid to a neutral substance. Single dose of the drug - 8 mg;
  • Santuril is a medication that blocks the formation of uric acid stones and promotes their excretion from the body.
• Medications for symptomatic treatment of gout:
  • Colchicine - a remedy for the elimination of a gouty attack. The effect occurs within 12 hours after taking the drug. It is used in accordance with the scheme of treatment agreed with the doctor, from 1 to 3 tablets up to 3 times a day;
  • Prednisolone - anti-inflammatory, anti-edematous, antitoxic drug, analogue of hormones of the adrenal cortex. Apply up to 4-6 tablets per day, depending on the situation;
  • nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen) - drugs that reduce the signs of inflammation and intoxication. Dosage - from 400 to 800 mg three times a day.

During the exacerbation of the disease, it is necessary to follow such rules:

• it is necessary to ensure the rest of the affected limb and joint;
• You should drink a large amount of liquid to reduce the concentration of urate in the blood (except soda and alcohol);
• it is recommended to revise its principles of nutrition, abandon animal fats and limit the number of animal proteins. Preference should be given to vegetables, fruits and cereals. Especially recommended diet table number 6.

Alternative treatment can be used along with traditional doctor appointments. In many cases, it helps to improve the patient's condition and accelerate the onset of remission.

Herbal treatment usually includes the use of compresses, infusions, decoctions, and other remedies that can alleviate pain and soothe inflammation.

1. The steamed turnip rubs off to a gruel-like condition and is applied to the affected joint in the form of a compress.
2. To receive a mixture of 100 g of pressed garlic, 150 g of grated onions and 250 g of cranberry mint is prepared. The mixture is placed in a dark place for 1 day, after which 500 g of honey is added and mixed. The scheme of reception - 1 tsp. Three times a day for 30 minutes before meals.
3. If you drink a glass of celery juice daily on an empty stomach, you can accelerate the excretion of uric acid from the bloodstream.
4. To make foot baths, 150 grams of chamomile color are brewed in 1.5 liters of water and infused for 2 hours. The temperature of the water for the procedure is about 37 ° C. Duration - 20-30 minutes.
5. It is also useful to make baths with the addition of root aira.

For adherents of nontraditional types of treatment, homeopathy is offered - it is the use of special homeopathic herbal remedies that restore their own immunity, and eliminate the adverse signs of gout. Such drugs do not cause harm and are not toxic to patients. The dose of the remedy is calculated by the homeopathic physician, based on the reaction of the patient's body.

Among the most popular homeopathic remedies for gout are:

• Berberis vulgaris - used in the formation of deposits in the kidneys, as well as with pain in the joints when walking.
• Calcium fluoride - is used when increasing the joint of the thumb, which is accompanied by acute pain.
• Colchicum - helps with a painful edematous joint, as well as with night pain.
• Rhododendron - helps to eliminate swelling and morning pain in the joints.

Operative treatment is prescribed only in cases of severe gout, during the formation of tophi against the background of infectious inflammation and deformation of the joint. The operation can be the only method of treatment when the medications no longer have the expected effect.

Prevention

• Try to wear only comfortable shoes, the size of which corresponds to the length of the foot. If the shoes cause discomfort when wearing, then it is better to refuse it. If possible, for example, at home, it is preferable to walk barefoot.
• Massage of the toes is an excellent measure for the prevention of joint diseases of the lower extremities.
• Do not forget about proper nutrition and healthy lifestyle. Let this sound trite, but it is the rejection of bad habits and a well thought-out diet that can prevent and relieve gout.

Methods of prevention are especially relevant for those people whose relatives already have the disease, since genetic predisposition is one of the possible causes of gout.

[17], [18], [19], [20]

Forecast

The prognosis of pathology is unambiguous - gout is considered an incurable disease. However, every patient can control the frequency and force of attacks. To do this, it is necessary to carefully follow all recommendations for taking medication, nutrition and lifestyle, and regularly give tests for the level of uric acid in the body. This will help prevent a relapse of the illness in time.

Gout of the big toe brings a lot of inconvenience to the sick person. But it is very important not to allow further spread of the disease.

[21],