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What is gout? Gout is a type of arthritis caused by having too much uric acid in your body. The uric acid may not cause symptoms for years, but after a time too much of it can cause painful joint inflammation (arthritis). Usually gout first affects the joint between the foot and the big toe. Later attacks may affect other joints of the foot and leg. Less often, the arms and hands have gout. In addition to the arthritis, gout causes tophi. Tophi are lumps of uric acid crystals just under the skin. Common places to have tophi are the outer edge of the ear, on or near the elbow, the fingers and toes, and around the Achilles tendon near the ankle. Gout can also cause kidney stones made of uric acid. Most people who have gout are middle-aged men, but it can occur at any age. It is less common in women. How does it occur? Gout usually happens because too much uric acid is in your blood. Uric acid is a chemical your body makes when it breaks down substances called purines. Purines are found in all of your body's tissues. They are also in many foods. Normally, uric acid dissolves in the blood and passes through the kidneys and out of the body in the urine. If the level of uric acid builds up in the blood, sharp uric acid crystals may form in the joints. The crystals cause pain and swelling. Most cases of gout happen because your kidneys do not get rid of enough uric acid. The specific problem with the kidneys is usually not found. Gout may also happen because your body is making too much uric acid. There are different reasons this may happen: - You may eat a lot of purine-rich foods, such as seafood and meat, especially red meat and organ meats like liver. - You may drink a lot of alcohol. - You may have inherited a tendency to make too much uric acid. - You may have a disease such as cancer or a red blood cell problem. Some conditions, such as dehydration, can cause high levels of uric acid. Diuretic medicine (also called water pills), which is often used to treat high blood pressure, can increase the level of uric acid. Other medicines can also affect the level of uric acid in the blood. Uric acid levels in men start to go up after puberty. Women's uric acid levels usually do not go up until after menopause. For this reason women are protected from gout until several years after menopause. Usually the uric acid levels have to be high for many years before you start having gout. People who have recently had a serious illness or surgery have an increased chance of having an attack of gout. Some people have gout even though they have normal uric acid levels. What are the symptoms? Many people have high uric acid blood levels for years and never have any symptoms. Only 10 to 20% of people with high levels of uric acid develop symptoms in their joints. Symptoms may include: - sudden, severe pain, especially of just 1 joint at a time - redness of a joint - swelling of a joint. Sudden attacks sometimes happen with illness, injury, or drinking too much alcohol. The symptoms may last for days to weeks. The symptoms of pain, redness, and swelling usually happen months or years before either tophi or kidney stones develop. The tophi do not cause any symptoms unless they open and drain. They are usually not painful. Depending on where they are on the body, they may limit movement of a joint. The symptoms of uric acid kidney stones are like those of other kidney stones. They can cause severe abdominal pain and sometimes nausea, vomiting, fever, or blood in the urine. The stones may block urine flow, which can damage the kidneys if it is not treated. How is it diagnosed? Your healthcare provider will ask about your symptoms and your family and personal medical history. He or she will examine you and ask about all of the medicines you are taking. Your provider will suspect that you have gout if: - Your first toe joint is inflamed. - You have a blood test that shows a high level of uric acid in your blood. - You have tophi. - You start taking the drug colchicine and your arthritis symptoms get better. (Colchicine, an anti-inflammatory drug, is effective only for gouty arthritis.) To confirm the diagnosis, your provider may take a sample of fluid from an affected joint for lab tests. If there are uric acid crystals in the fluid, you have gout. How is it treated? Usually, if you have high uric acid levels but no symptoms, you will not need treatment. In special cases (for example, if you have a family history of gout or kidney stones), you may be treated for gout even though you do not have any symptoms. If you have symptoms of gout, the goals of treatment are: - Stop the pain. - Try to keep the problem from coming back by controlling uric acid levels. - Prevent serious problems such as kidney damage. Anti-inflammatory medicines are used to treat the arthritis, such as: - ibuprofen or naproxen - steroid drugs, such as prednisone - colchicine. Anti-inflammatory medicines are sometimes taken daily to prevent recurrent attacks of gouty arthritis. - Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen and naproxen, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason. - Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it. Aspirin is not usually recommended because it may keep the kidneys from getting rid of the uric acid. Your healthcare provider may prescribe narcotic medicine, such as hydrocodone, to help relieve the pain. If the gouty arthritis becomes a frequent problem, other medicines may also be prescribed to lower the amount of uric acid in your body. Examples of these medicines are allopurinol, febuxostat, and probenecid. The medicines can help keep uric acid crystals from forming in the joints. This can help prevent painful attacks of gouty arthritis and damage to the joints. How long will the effects last? The sooner treatment is started, the sooner the symptoms stop. You may start feeling better 1 to 2 days after you start treatment. If gout is not treated, it could last a few days to several weeks. You could have another attack of gout, but usually not for at least 6 months to 2 years. It could be years before you have gout again, or you may never have another attack. How can I take care of myself and help prevent gout? To treat symptoms of gout: - Make the changes in your diet, the fluids you drink, and alcohol use as recommended by your healthcare provider. - Take medicine as prescribed by your provider. - A warm washcloth or heating pad set on the lowest setting may help lessen pain. You can put heat on the painful joint for 15 to 30 minutes 3 to 4 times a day. Be careful not to fall asleep with a heating pad on. It could cause a burn. - Acetaminophen or nonprescription anti-inflammatory medicine such as ibuprofen or naproxen may help lessen your pain. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason. There is no sure way to prevent gout. However, you can take these steps to lessen the chance that you will have high uric acid levels: - Eat a diet low in purines. Purine-containing foods that you should avoid include meat—especially red meat and organ meats such as sweetbreads, liver, and kidney—shrimp, anchovies, sardines, and dried legumes (beans). - Don’t drink a lot of alcohol. Don’t drink more than 2 ounces of alcohol a day. It’s best not to drink any alcohol. - Unless your healthcare provider has restricted how much fluid you can have, drink lots of nonalcoholic fluids. Call your healthcare provider right away if during a gout attack: - You start to have pain in your belly or back. - Your pain is not controlled with pain medicine. - You have nausea and vomiting. - You start to have pain in other joints also. - Your urine looks bloody or is the color of tea. - You have bloody, black, or tarry looking bowel movements. This can happen when your stomach or intestines are irritated by medicines used to treat gout. - You have a fever higher than 101.5° F (38.6° C). - You have any other symptoms that worry you. Developed by RelayHealth. Adult Advisor 2012.1 published by RelayHealth. Last modified: 2011-06-26 Last reviewed: 2011-05-03 This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. © 2012 RelayHealth and/or its affiliates. All rights reserved.
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Urični artritis ili giht je reumatska bolest uzrokovana poremećajem prometa mokraćne kiseline u tijelu. Bolest karakterizira povećana količina mokraćne kiseline te njezino smanjeno izlučivanje iz tijela, a zbog čega dolazi do zadržavanja mokraćne kiseline u krvi te taloženja u obliku soli na različitim mjestima u tijelu. Urični artritis je najčešće nasljedna bolest, a nasljeđuje se sklonost prema stvaranju povećane količine mokraćne kiseline te njezinom smanjenom izlučivanju iz tijela. Recepte za liječenje gihta možete pronaći u Magazinu Ljekovite biljke Povremeno povećana količina mokraćne kiseline u krvi ne znači istovremeno i bolest. Mala i prolazna povećanja količine mokraćne kiseline u krvi najčešće su uzrokovana neprimjerenom hranom ili uzimanjem nekih lijekova, a tek u oko 5% slučajeva dolazi do razvoja bolesti. Osim toga, nalaz povećane količine mokraćne kiseline u krvi tijekom djetinjstva ne mora istovremeno značiti da će kasnije doći do razvoja bolesti. Jer, osim nasljednih sklonosti te nekih drugih bolesti zbog kojih je došlo do oštećenja funkcije bubrega, način prehrane i života uopće povezan je također s nastankom i razvojem uričnog artritisa. Često se urični artritis kao bolest dugo vremena ne zamjećuje, iako već postoji povećano stvaranje mokraćne kiseline i njezino zadržavanje u tijelu. Najčešće se prvi znakovi uričnog artritisa javljaju tek nakon četrdesete godine života, a bolest se vrlo rijetko javlja kod djece i prije 25. godine života. Mokraćna kiselina Mokraćna kiselina je organski sastojak mokraće te konačan proizvod razgradnje purinskih tvari, a koje su sastavni dio bjelančevine u jezgri ljudskih i životinjskih stanica. Najveći dio mokraćne kiseline izlučuje se u bubrege te putem bubrega u mokraću, a manji dio se izlučuje putem crijeva, lako je mokraćna kiselina otpadni proizvod, normalno se u krvi nalazi 34 mg mokraćne kiseline. Kad dođe do poremećaja razgradnje purinskih tvari vlastitih stanica ili onih hranom unesenih u organizam, povećava se količina mokraćne kiseline. Kako se zbog bolesti mokraćna kiselina ne izlučuje u normalnoj količini iz organizma, dolazi do njezinog zadržavanja u krvi. Taloženje kristala mokraćne kiseline u bubrezima Mokraćom se izlučuje najveći dio mokraćne kiseline, a normalno se dnevno izlučuje oko 0,51 g mokraćne kiseline. Kod povećane količine mokraćne kiseline u tijelu, bubrezi u početku pojačano izlučuju mokraćnu kiselinu. Zbog toga u početku bolesti najčešće ne dolazi odmah i do znakova bolesti, iako ona već postoji. Ali, kako je mokraćna kiselina teško topiva, dolazi do taloženja njezinih soli u obliku kristala. Ako se kristali mokraćne kiseline počnu taložiti u bubrezima, njihovo taloženje uzrokuje oštećenje bubrega. Oštećeni bubrezi više ne mogu održavati ravnotežu između povećanog stvaranja mokraćne kiseline i njezinog izlučivanja, a što uzrokuje daljnje taloženje kristala mokraćne kiseline te nastanak bubrežnog pijeska i kamenaca. Kad je količina mokraćne kiseline u bubrezima jako povećana, a bubrezi već oštećeni, bubrežni kamenci se brže razvijaju. Bolesnici često izmokre pijesak i malene kamence koji su nastali od mokraćne kiseline, a stoje najčešće jedan od prvih znakova uričnog artritisa ili gihta. Taloženje kristala mokraćne kiseline na zglobovima Kod više od 50% oboljelih, a kod kojih još uvijek ne postoje nikakvi znakovi bolesti, kristali mokraćne kiseline već se talože na nekim dijelovima tijela. Osim u bubrezima, kristali mokraćne kiseline talože se pod kožom te na zglobovima na različitim mjestima u tijelu. Kako se kristali mokraćne kiseline vrlo sporo talože na jednom mjestu, naslage polako rastu i često postaju vidljive i bolne tek nakon 10 i više godina. Koliko je proces taloženja kristala mokraćne kiseline spor vidi se po tome što ukupna količina tih kristala, koji se talože godinama, najčešće ne iznosi više od 35 g. Samo kod jako povećane količine mokraćne kiseline u krvi, a koja je već uzrokovala i oštećenje bubrega, naslage kristala na zglobovima stvaraju se brže. Upala zglobova Najčešće mjesto taloženja kristala mokraćne kiseline su hrskavice zglobova. Naslage kristala mogu se nalaziti na zglobovima, a da ne uzrokuju gotovo nikakve smetnje. Tek kad se naslaga kristala poveća i ošteti stanice sinovijske membrane, koja se nalazi između hrskavica zglobnih kostiju, dolazi do upale zglobova. Prvi znak upale najčešće je iznenadna, jaka bol u jednom zglobu, a obično se to događa noću ili ujutro, odmah nakon ustajanja. Zglob vrlo brzo i jako otekne, vrlo je bolan, crven i topao, a bolesnik često ima povišenu temperaturu. Kod prvog napadaja gihta, koji se najčešće javlja poslije četrdesete godine života, uvijek boli samo jedan zglob. Gotovo uvijek je to zglob korijena nožnog palca, a vrlo rijetko su mjesto prvog napadaja zglobovi stopala, gležnjevi ili pete. Poslije može upalom biti zahvaćen svaki zglob: zglob koljena ili lakta, ili zglobovi prstiju na rukama. Važno je znati da ne postoji neka druga upala zglobova kod koje je početak bolesti tako iznenadan i jak kao kod gihta. Prvi napadaj uričkog artritisa ili gihta najčešće prolazi, čak i ako se ne liječi, za desetak dana, iako otekline i osjetljivost mogu još potrajati. Kad se upala smiri, bolesnik se opet osjeća potpuno zdrav, oboljeli zglob je bezbolan i potpuno pokretljiv, sve do novog napadaja. Često se sljedeći napadaj javlja tek nakon nekoliko mjeseci, ili čak nakon nekoliko godina, ali kasnije se napadaji javljaju sve češće. Vrlo rijetki su slučajevi da više nikada ne dolazi do napadaja, već trajanjem bolesti oni postaju sve učestaliji. Kod sljedećeg napadaja može boljeti isti zglob, ili neki drugi, ali istovremeno i više zglobova. Upala najčešće zahvaća neki drugi zglob, a svaki novi napadaj sve je teži i bolniji, i traje dulje vremena. Osim toga, svaka sljedeća upala sve više oštećuje zglobove. Malopomalo dolazi do teškog gihta: otečenih, ukočenih i izobličenih zglobova. Zbog stvorenih naslaga kristala mokraćne kiseline, zglobovi su trajno zadebljani, a zadebljanja su vidljiva kao čvrste potkožne, manje ili veće kvrge. Takve kvrge na zglobovima nazivamo tofima, a najčešće se javljaju na zglobovima prstiju ruku, petama, koljenima i laktovima. Nakon 10 i više godina učestalih napadaja artritisa razvija se kronični urični artritis, a koji karakterizira nepostojanje razdoblja bez bolova. Liječenje uričnog artritisa ili gihta Budući da je urični artritis ili giht najčešće nasljedna bolest, on se ne može izliječiti. Urični artritis može se samo liječiti kako bi se usporilo ili spriječilo napredovanje bolesti te ublažile njezine popratne tegobe. Li ječenje uričnog artritisa sastoji se ponajprije u smirivanju upalnog procesa u zglobovima te ublažavanju boli. Osim toga, liječenjem se smanjuje proizvodnja mokraćne kiseline, sprječeva taloženje njezinih soli u obliku kristala te pospješuje izlučivanje u bubrege, a kako bi se količina mokraćne kiseline u krvi zadržala u granicama normale. lako se kod uričnog artritisa preporuča dijetalna prehrana s malo purina, mnogo djelotvornije je smanjiti uzimanje ili uopće ne uzimati hranu koja sadrži veće količine purina, masti i kolesterola. Ne preporuča se uzimanje mesne hrane, jer purinske tvari su sastavni dio bjelančevine u jezgri životinjskih stanica, a njihovom razgradnjom nastaje mokraćna kiselina. Osim što se ne preporuča uzimanje alkohola, ne preporuča se uzimanje kave, kakaoa i čokolade. Recepte za liječenje gihta možete pronaći u Magazinu Ljekovite biljke