What does a seizure look like?
- Sudden onset, usually at night or early in the morning
- The first metatarsophalangeal joint of the big toe is most often affected.
- The pain reaches its maximum within 6–12 hours and is extremely intense
- The joint is red, hot, swollen, intolerable to touch
- Without treatment, the attack goes away in 7-14 days, with treatment - in 2-3 days
- Between attacks the joint looks and functions normally
Уровень мочевой кислоты во время приступа может быть нормальным или даже сниженным — это частая ловушка. Нормальный анализ в момент боли не исключает подагру; его повторяют через 2 недели после стихания приступа.
What provokes
- Alcohol, especially beer and spirits
- Rich meat foods, offal, seafood
- Sweet drinks with fructose
- Dehydration, sauna, intense exercise
- Diuretics are a common and underappreciated cause.
- Fasting and sudden weight loss
- Joint injury, surgery, acute illness
Treatment of an attack
- Начать лечение как можно раньше — в первые часы эффект максимален.
- НПВС в полной дозе, или колхицин, или глюкокортикостероид — выбор делает врач с учётом почек, сердца и желудка.
- Покой и возвышенное положение конечности, холод на сустав.
- Обильное питьё.
- НЕ начинать и НЕ отменять препараты, снижающие мочевую кислоту, во время приступа: резкое изменение её уровня продлевает воспаление.
If the patient is already taking allopurinol constantly, it is not discontinued during an attack - it is continued at the same dose.
The main thing is therapy between attacks
The point of treating gout is not to suppress attacks, but to prevent them from happening. To do this, you need to steadily reduce uric acid, and this is achieved with drugs.
- The target uric acid level is usually below 360 µmol/l, and in the presence of tophi below 300
- Allopurinol is the basic drug; the dose is selected gradually under the control of the analysis
- Febuxostat - in case of intolerance or insufficient effect of allopurinol
- Therapy STARTS outside of an attack and continues CONSTANTLY, for years
- In the first months, frequent attacks are possible - this is a normal reaction to the dissolution of deposits, and therapy is not canceled; doctor adds prophylactic cover
- Monitor uric acid every 2–4 weeks while adjusting the dose, then 1–2 times a year
Самая частая ошибка — принимать аллопуринол «курсами» или только когда болит. Это не обезболивающее: препарат работает, только пока принимается, и его задача — постепенно растворить накопленные кристаллы.
Nutrition and lifestyle
- Limit: alcohol (especially beer), organ meats, red meat, seafood, sodas and juices with fructose.
- You can and should: low-fat dairy products, vegetables, cereals, eggs, coffee, cherries
- Vegetables rich in purines (legumes, spinach, tomatoes) do not need to be limited - they do not increase the risk
- Drink enough water - at least 2 liters if there are no contraindications
- Gradual weight loss; sudden fasting provokes an attack
- Talk to your doctor about changing diuretics if prescribed.
- Control blood pressure, sugar and lipids: gout is closely associated with cardiovascular risk
