Tophi, polyarthritis or repeated gout pain, … are all manifestations of chronic gout. The reason for the development of chronic disease is that it is not treated or properly treated, resulting in complications and serious health effects.
Table of Contents
What is chronic gout?
Chronic gout is a form of arthritis caused by a buildup of uric acid crystals in the joint. Abnormal excretion of uric acid along with crystallization of compounds in the joint. In the long run, there appear painful episodes of arthritis, kidney stones and blockage of the kidney filters with uric acid crystals leading to kidney failure.
If acute gout causes pain intermittent 12-24 months to occur a few times, chronic gout will appear repetitive pain or relapse continuously from 2-3 times in within a year. In rare cases, chronic gout can also occur in people with gout for 1-2 years.
Causes of chronic gout
The increase in uric acid accumulation in the joints is the cause of gout. However, some of the following factors that trigger chronic gout include:
- The subjectivity: Many people with gout in the early stages often underestimate, subjective and not early treatment. Others find that the disease is gradually improving and immediately discontinue treatment, making the disease not only do not get better, but also relapse worse.
- No timely treatment: Early detection of the disease, but not proactive treatment or treatment is not finished, incorrect method has made the disease develop into chronic.
- Unhealthy activities: The abuse of alcohol, stimulants and foods rich in purines (red meat, seafood, animal organs, …) along with sedentary habits has made the disease unintentionally turn into chronic. count.
- Other causes: Inherited genes or diseases of the urinary tract, arthritis, diabetes … are also the indirect cause of the disease.
The warning signs of gout turn to chronic stage
The following warning signs indicate that a patient with gout has entered a chronic stage:
- Tophi: This is the urate phenomenon around joints, in synovial membrane, bone head, cartilage. The size of the tophi is not uniform depending on the precipitated urate, a little firm or soft, painless when pressed, covered in a thin layer of skin or sore skin, easily yellowish watery and white matter like chalk.
- Polyarthritis: This inflammation mainly occurs in the fingers, toes, wrists, knees, elbows, … but does not cause much pain and progress slowly. However, over time, if tophi is broken, it will create conditions for bacteria to invade, causing ulcers and destroying joints.
- The deposition of urate salt crystals in the kidneys: The deposition in the kidney parenchyma is scattered with no symptoms, but only detected during kidney surgery.
- Urat is deposited in the external organs: Urat is deposited in plaques on the skin and nails and toenails, easily confused with skin diseases such as psoriasis , fungus. In addition, urate can also be deposited in the pericardium, myocardium and the heart valves, but this is very rare.
- Restriction of movement: When moving or exercising vigorously, the pain will become more severe. Since then, the mobility of the patient is clearly limited.
- Inflamed, swollen joints : Inflammation and swelling of the limbs causes intense pain as often as many times a month or to come back again and again throughout the year.
Is chronic gout dangerous?
When it turns to a chronic stage, gout is not only difficult to treat, but it also has potential complications that are dangerous for patients such as:
1. Kidney damage
The kidneys are the organs that help to remove uric acid from the body. In chronic gout, high uric acid levels cause urate salt crystals to be deposited in the kidneys and cause kidney damage. Besides, chronic gout also causes a number of kidney diseases such as kidney stones, glomerulonephritis, chronic kidney failure, …
In addition, using drugs to treat chronic gout also has a risk of side effects and leads to impaired renal function or arising problems of poisoning, kidney failure, …
2. Broken joints, polio
If the disease is not treated in time, tophi will grow rapidly. At that time, the skin cells and cartilage tissue around the joint will gradually be eroded.
In the long run, the joint will be deformed due to prolonged pain condition, even at the risk of complete destruction. Motor function will be threatened and the patient may face the risk of being paralyzed or disabled affecting life, living and work.
3. Heart disease
Chronic gout is also the risk of cardiovascular diseases, myocardial infarction, … The reason is due to the imbalance between the formation of oxygen free radicals and the mechanism against free radicals. of body.
Not only that, gout also causes inflammatory factors in the joints to form blood clots in the capillaries and cause serious cardiovascular diseases.
4. Stroke
According to recent studies, people with gout and diabetes have a 1.4 times higher risk of stroke and heart attack than people with diabetes alone. Gout has been shown to significantly increase the risk of stroke in these patients.
In addition to the complications outlined above, people with chronic gout are at risk for other complications such as:
- Sensory disturbances
- Cataract
- Stomach ulcers
- Poor vision, dry eyes
- Increased risk of infection
Treatment of chronic gout
When it goes into the chronic stage, the treatment for gout becomes extremely difficult. In order not to face with dangerous complications, the patient needs to seriously coordinate according to the treatment regimen set by the doctor.
Usually, before an appropriate treatment regimen is offered, the patient will be assigned to perform the following diagnostic tests :
- Supersonic
- Blood tests
- Joint fluid test
- X-ray
- CT scan
1. Principle of treatment
- Treatment of arthritis during a chronic gout attack: Give anti-inflammatory drugs.
- Lower blood uric acid: To prevent gout attacks from recurring as well as complications of gout.
- Treatment of comorbidities: Including diabetes, obesity, hypertension, …
2. Treatment of chronic gout with medication
This is considered the most common treatment for chronic gout. Medicines for the treatment of chronic gout are divided into the following groups:
2.1. Group of drugs that inhibit the synthesis of uric acid in the blood
This group of drugs is created by inhibiting the enzyme xanthinoxydase to convert hypoxanthin into xanthin. Also specify the following objects:
- Gout patients have an increase in renal excretion of uric acid.
- Patients who have used a group of drugs that increase uric acid excretion but are ineffective.
- The uric acid content causes kidney problems such as kidney stones or impaired kidney function.
To inhibit the synthesis of uric acid, the doctor will prescribe mainly drugs such as:
- Allopurinol: This drug is quite commonly used. However, care should be taken in patients with a history of renal failure and not for acute gout attacks.
- Febuxostat: This is a prescription drug that is widely used only after Allopurinol. Note, the drug can cause some side effects such as liver irritation, nausea, joint pain, rash.
- Topiroxostat: A drug used to inhibit selective and non-purine XOs.
2.2. The group of drugs that increases uric acid excretion
The mechanism of this group of drugs is increased glomerular uric acid excretion and inhibition of tubular reabsorption. Indicated for use when the patient is intolerant to the side effects of Allopurinol or the ineffective group of drugs that inhibit uric acid synthesis.
Some of the drugs in this group include:
- Probenencid: This is a URAT1 inhibitor. It is not selective and interactive, so it should be noted when using this drug group.
- Benzbromarone: This drug has uric acid-lowering effects and can be used in patients with impaired renal function.
- Lesinurad: Patients with chronic gout with tophi can use this drug in combination with allopurinol or febuxostat. The drug is contraindicated in patients with impaired renal function, kidney transplantation, dialysis, …
2.3. Uric destroyers
The urate destroyers work to convert auric into soluble allantoine, helping to lower uric acid levels. This drug is indicated for use in the case of acute hyperuricemia in blood diseases.
Some urate destroyers are indicated:
- Pegloticase: This is an injectable drug used in the treatment of gout resistant to the above groups of drugs, gout containing tophi seed causes joint destruction and serious complications.
- Rasburicase: This drug is rarely used in Vietnam. Side effects include shortness of breath, hot flashes, chest pain and, more serious, possible hemolysis or anaphylaxis.
3. Treatment of chronic gout by surgical methods
Surgery is hardly recommended. But during the use of the drug, the disease is still not in remission due to the large amount of tophi around the joint and for a long time, tophi seed removal surgery will be indicated to avoid affecting motor function.
How to prevent chronic gout
When gout turns chronic, the disease is much worse than acute. Therefore, the treatment regimen is also more difficult, takes more time and effort of the patient. In order to control dangerous complications, patients need to pay close attention to the following:
- Treatment of chronic diseases with drugs must be extremely cautious and absolutely not used without permission from a doctor.
- During the treatment process, patients need to persevere and strictly follow the doctor’s protocol.
- Limit your intake of foods high in purines (red meat, seafood, animal offal) or acidic foods such as fermented foods or highly acidic fruits.
- Absolutely do not use alcohol, stimulants or alcoholic beverages that will inhibit the renal excretion of uric acid.
- Increase drinking water every day from 2-3 liters will help eliminate uric acid from the body.
- Avoid strenuous exercise or overwork. It’s also important to have a balance between work and rest, even if the pain doesn’t trigger.
- Exercising appropriate exercises every day will help improve joint mobility, limit complications arising from paralysis and joint damage.
Chronic gout can appear more serious if the patient does not have treatment to control the disease. When realizing an abnormal body, the patient needs to proactively visit and strictly follow the doctor’s treatment regimen to promptly prevent complications that may arise.
