'Disease of Kings' Affects Young People

Russian doctors began to identify gout more often in young people who are not yet thirty years old. If fifteen to twenty years ago, patients older than fifty years were treated with characteristic joint pain, now, according to the Ministry of Health of Russia, even students face the disease. What is this disease, which is popularly called the "disease of kings", how to treat it, and most importantly - to prevent, "Moscow Komsomolets in the Kuban" told the doctor-rheumatologist candidate of medical Sciences Zhanna Otarova.

The disease changed age

Zhanna Zalkufovna, what is gout, what functions of the body affects?

- To put it very simply and briefly, gout is a disease associated with a violation of the exchange of purine bases. Purines are substances that as a result of metabolism in our body lead to the formation of uric acid. The higher the concentration of uric acid in the blood, the greater the likelihood of formation of uric acid crystals. These are so-called urates.

These urates can be deposited in the synovial membrane of the joints, in the kidneys, thereby causing such pathological changes, which are popularly and medically called gout.

- What are these changes? What should alert us?

- They are primarily associated with the chemical, physical structure of urate salts. If you look at them under a microscope, they look like miniature needles. When deposited inside the joint cavity, salts cause a violent immune reaction from the body. The body tries to neutralize them as much as possible and bring them out.

This process is accompanied by very strong inflammation, which is clinically manifested by swelling and severe pain inside the joint. Therefore, if you focus on the patient's complaints, this is primarily classic arthritis, that is, inflammation of the joint.

- How often does this disease occur in the Krasnodar Territory?

- Gout is becoming more common in recent years, and the scientific community believes that this is primarily due to the fact that we have an increasing number of cases of obesity. There is a direct correlation of gout with obesity. The higher the body weight of the patient, the higher the risk that this patient will have gout.

When I was in medical school, the textbooks said that the peak incidence of gout was forty to fifty years, but now in clinical practice I increasingly encounter young patients - twenty-five years and younger. The fact that gout is getting younger is primarily due to the fact that the nature of our diet is changing very much towards ultraprocessed foods and easily digestible carbohydrates.

Not just a man's story

- Is there any predisposition to gout?

- If a person has relatives with gout, this is such a red flag that he is also at risk. But this does not mean that a person necessarily gets sick.

In order for such hereditary potential to be realized, we must, on our part, invest some negative factors: this is a violation of nutrition, a decrease in physical activity, and so on, which ultimately can really lead to the development of gout.

- What diseases can provoke it?

- Gout can be secondary, some primary diseases lead to its development. First of all, these are kidney diseases, chronic renal failure, as a result of which the excretion of uric acid from the body is disturbed and it begins to concentrate in the blood and cause negative effects.

In addition, arterial hypertension syndrome is often combined with gout. But here we must understand that this is not the cause of gout. There are many risk factors for these diseases and they are often duplicated. For example, obesity, inactivity are a risk factor for both gout and arterial hypertension.

If the patient has these risk factors, he may develop several diseases at once. There is a nuance: patients with hypertension very often use diuretics to reduce pressure, which, removing excess fluid from the body, can cause an increase in the concentration of uric acid in the blood, and this increases the risk of gout.

Therefore, if a patient with gouty arthritis has concomitant arterial hypertension or chronic heart failure, due to which the patient is forced to take diuretics, we give recommendations with which he goes to the cardiologist or therapist to adjust therapy to minimize the risk of exacerbation of gout.

- Who gets sick more often, men or women?

There is certainly a gender difference, but there is a caveat: men are more likely to get sick before the age of fifty than women. Women before that have a kind of estrogen shield, which allows you to be protected from gout. But after menopause, women equalize the frequency of gout and get sick almost as often as men.

Woke up and didn't step

- How not to miss the onset of the disease? What's the first bell?

Gout is a disease that is simply impossible to miss. She has a very bright debut. It usually occurs in the early morning hours, that is, the patient can go to bed in the evening absolutely healthy, and in the morning wake up from very pronounced pain, with reddened, with a swollen joint.

As a rule, these are the joints of the lower limb, the first toe of the foot. Occasionally this is the debut of the ankle joint. That is, the joint screams about gout - it is simply impossible to miss this bright first attack.

- How not to confuse gout with joint pain, for example, from intensive training or hard work?

- You asked the right question. Indeed, this happens, because very often the first attack is associated with some physical exertion, with an overload of the joint. Patients tend to think that they have either damaged the joint or not, they first go to orthopedic traumatologists.

Only then in the direction of orthopedic traumatologists, after excluding injury, the patient comes to us. The foot looks visually in such a way that you can think, of course, about some serious injury and injury.

Sentence overturned

- Can gout be cured?

- This is a chronic disease – we cannot completely cure it, unfortunately, because the disorders I mentioned remain with the patient. But gout is not a sentence. With the right treatment and cardinal lifestyle modification, we minimize periods of exacerbation - in this case, we can talk about remission of the disease.

But we must understand that the recommendations that we give to the patient, he must follow all his life. First of all, it is a long-term intake of drugs. But if the patient seriously changes his lifestyle and significantly reduces body weight, then sometimes we cancel the drugs, because the level of uric acid comes to the target values.

- Which specialist should you go to if a person suspects any symptoms? Or do you want to get tested right away?

- No, you do not need to take tests immediately, because the patient may go the wrong way. And this path must be corrected by a specialist. First of all, this is, of course, a rheumatologist. Gout is a rheumatic disease. Today, routing is built so that a patient with joint pain should first consult a physician in the clinic.

Clinical examination is very helpful in this regard, because in the absence of symptoms of gout, we can detect hyperuricemia in the early stages, that is, an increase in uric acid, and already at this stage make recommendations so that the patient prevents the development of gout and other conditions that are associated with increased uric acid levels.

The correct lifestyle of a patient who wants to prevent gout is primarily a properly balanced diet. It's an increase in motor activity. This is compliance with the drinking regime: the less a person consumes liquids, water, the higher the concentration of uric acid salts.

If there is already obesity, you can not very sharply reduce body weight, because with rapid weight loss in the body a large amount of urate is formed, which can lead to the first attack. Do not starve, because during fasting, our body begins to metabolize its own tissues, resulting in uric acid.

It is also necessary to correct the drugs that have already been prescribed by the doctor so that the prescribed therapy does not lead to the risk of gout.

Risk factors

1. Immutable factors

Gender and age: men get sick much more often, and the main peak of the incidence falls on the age of over forty years. In women, the risk increases after menopause due to a decrease in estrogen levels.

Genetic predisposition: hereditary predisposition to impaired metabolism of purines or features of the renal, intestinal transporters of uric acid.

2. Disease and health status

- Obesity and Metabolic Syndrome: Being overweight increases stress on the joints and promotes uric acid levels.

- Arterial hypertension - high blood pressure.

- Diabetes mellitus and disorders of carbohydrate metabolism.

- Chronic kidney disease - a decrease in the ability of the kidneys to effectively remove uric acid.

- Other pathologies: blood diseases, psoriasis, frequent infections.

3. Nutrition and lifestyle

Abuse of alcohol, especially beer, including non-alcoholic, and spirits.

Diet with excess purines: frequent consumption of red meat, offal, fish of some species and seafood.

High fructose drinks: sugary carbonated drinks and foods with corn syrup.

Sharp fluctuations in weight or starvation can provoke a sharp release of uric acid.

4. Medications

Diuretics are diuretics, often prescribed for pressure.

Low-dose aspirin and some other medications.

5. Triggers of acute attacks

A sharp pain in the joint, most often in the area of the big toe, can start:

trauma or excessive physical overload of the joint;

severe stress or surgery;

- hypothermia or overheating;

abrupt cancellation or violation of taking drugs that reduce the level of uric acid.

A patient with joint pain should first consult a therapist in the clinic. There are contraindications. Consultation of a specialist is required