(Jrt)
Gouty arthritis
Gout is a disease linked to the metabolism of uric acid. This disease progresses according uricémie rate (rate of uric acid in the blood).
The adjective referring to them is gout.
History
Gout is an ancient disease, described as from the Roman era. The confirmation diagnosis is made, however, found that when crystals of urates characteristics in tissues preserved until today. This is particularly true on a mummified finger of Charles V retained the monastery Royal San Lorenzo de El Escorial and examined under a microscope.
Pathophysiology
Gout is more common among men. It is due to a crystallization of uric acid. Its origins are multiple. On the one hand, it is the waste formed by the breakdown of purines. In normal times, they are synthesized from ribose-5-phosphate, which is transformed after several reactions acid inosinique, carrying a kernel purique. This acid then enter into a long cycle that leads to the synthesis of adenine and guanine, components of DNA. The latter may be degraded later in xanthine and then, through xanthine oxidase, uric acid, that the kidney removed in urine. As the synthesis of acid inosinique far exceeds the needs of the body, there is also a short cycle where this molecule is degraded directly to xanthine. The drop may come from a runaway short cycle that leads to an excess of uric acid in the blood.
On the other hand, it may come from the degradation of purine nucleotide (adenine and guanine) present in the cells. This explains why a drop may be triggered when many cells are destroyed, for example during treatment for cancer. Finally, nucleotides present in purine diet suffer the same fate as those of the body. That is why gout is more common among bons vivants, which consume lots of foods rich in purines (meat, seafood, etc.)..
There is a rare genetic disease, Lesch-Nyhan syndrome, where the lack of an enzyme, hypoxanthine-guanine-phosphoribosyltransferase, also leads to a runaway short cycle, but more severe. The syndrome appears in childhood and is characterized by a gouty illness and mental retardation and a tendency to self.
However, drops by excess uric acid production represents only a minority. Most of the time, the high level of this substance in the blood (hyperuricemia) is due to renal failure, kidney no longer able to dispose properly of the waste. Often, gout is triggered by taking a drug (including a diuretic). It competes with uric acid: The kidneys can not eliminate the two substances both because they have similar chemical properties. As a result the amount of uric acid reduces eliminated and it accumulates in the blood.
When hyperuricemia becomes important, uric acid may precipitate in the form of crystals. This occurs at the joints, especially the coldest and most subject to trauma microscopic, ie mainly the big toe.
Terrain
Gout is more common in men and increases in frequency with age. It affects about 1% of the population.
Even if it is closely linked with hyperuricemia, the presence of the latter does not make it compulsory to gout.
It is more common among obese people or with an excessive consumption of alcohol (mainly among beer drinkers, probably by the richness of purines drink) and sometimes a diet rich in tripe (red kidney). It is also more prevalent among consumers of fructose that it is in the form of sugar or fruit.
Clinic
The gout
The fluxion gouty presents itself by a sudden sharp pain and swelling of a joint. It usually does articulation by a crisis and first toes, but sometimes the ankles, heels, knees and wrists. The pain which often triggers the night, is insomniante and prevents any contact with the articulation (even with the bed sheets). The crisis inaugural disease usually affects the big toe.
Without treatment, it heals in a week but with a high probability of recidivism in the year following (62%). Among the elderly, the damage can be done on several joints at once.
Tophus
The tophi (a tophus, tophi) are deposits of urates sodium in the subcutaneous tissue. It is formed aggregations of urates giving whitish hard nodules in the skin, these deposits are insensitive and not very symptomatic. They typically sit next to joints that have suffered from gouty arthritis and also on the flag of the ear, faces post elbows, fingers and so on.
Diagnosis
The diagnosis is often evident on the description of the damage and it is not then require further explorations.
In case of doubt, the analysis of liquid crystals in the puncture of the joint attack is the diagnosis.
The blood levels of uric acid (uricemie) can reduce or even normalize during the crisis and a normal dosage does not have the diagnosis.
Complications
When the cause of gout, hyperuricemia is not treated, the disease becomes chronic. The deposits of uric acid crystals are becoming more numerous. Then we can see the presence of tophus. However, the crystals are deposited also at the joints, causing destruction of cartilage and bone pain with every movement, especially in the kidneys, where they are responsible for a shift to renal failure, which makes all the seriousness of the disease. Uric acid can also precipitate in the urine in the form of calculations (urolithiasis), which block the urinary tract and trigger spasms very painful (renal colic).
Prevention
A team of researchers from the University of BC (Vancouver) and the School of Public Health at Harvard (Boston) has highlighted the beginning of 2007 than those who drink the most coffee were less likely than Other crises have gout. The risk of gout is less than 40% in people drinking 4 to 5 cups of coffee per day and 61% beyond. The effect is even more marked among men not taking diuretics, another risk factor for developing this disease. Among the latter, consumption of 6 cups of coffee or more is associated with a decrease of 70% of the risk of gout.
Another study showed that those who drink 4 to 5 cups of coffee per day had an average rate of uric acid below 0.26 mg / dl on average compared to those who do not drink at all.
Treatment
There are two means of treatment for gout:
* Reduce the rate of uric acid in the blood,
* Relieve pain crises arthritis gout.
Dealing with the crisis fluxionnaire
Most of the time, the pain which is the main treatment. It then uses nonsteroidal anti-inflammatory drug (as indomethacin), and simple analgesics (paracetamol). Drinking plenty of water can obviously help reduce uric acid. Apply ice locally (30 minutes 4 times a day) also relieves pain.
The colchicine is used frequently in France but much less in the Anglo-Saxon countries because of its side effects (diarrhée. ..)
Other treatments, though not medically checked, can relieve the patient during a crisis:
* Baking soda: 1 / 2 teaspoon in a glass of water every 2-4 hours
* Cherries: thanks to its anti-oxidant properties and its high content of anthocyanin, a natural anti-inflammatory
* Vinegar apple cider: 2 teaspoons vinegar and 2 teaspoons honey in a glass of water seem to help during a crisis by changing the pH of blood.
Treating the disease gouty
The diet is encouraged with a diet low in purines:
* Avoid offal, anchovies, consumed, seafood, asparagus, spinach, legumes.
* Consume preference: cherries, celery, strawberries, blueberries, milk products low in fat, bread (without white flour), tuna, salmon.
A weight loss is desirable and a significant decrease in the taking of alcohol.
When crises are too frequent, then reduce the rate of uric acid in the blood. The most prescribed medication is then allopurinol. Since 2005, it also has the febuxostat. Other treatments may be indicated, including corticosteroids.
Read also Gout
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