home Carp Where to treat gout. Gout

Where to treat gout. Gout

Gout, known as the “disease of kings,” was described in the time of Hippocrates. In the 1st century AD Seneca described gouty attacks as “the gout makes itself felt at a certain time.” Even then, chronographs noticed a connection between the degree of development and prosperity of cities and even states and the spread of gout among the population. At the beginning of the 20th century. this assumption was confirmed by the work of G. Ellis, “The History of the English Genius,” which not only showed a very high frequency of gout among prominent people in England, but also gave a clear definition of gouty genius. The answer to the increased incidence of gout among geniuses was found in 1955 in another remarkable work by E. Oruan, “The Descent of Man,” who showed that uric acid is structurally very similar to caffeine and theobromine, known stimulants of mental activity.

Relevance

Gout affects 1–2% of the population, mostly men. Overproduction of uric acid is caused by a genetically determined deficiency of hypoxanthine-guanine phosphoribosyltransferase. By the end of the 20th century, gout began to be considered as a disease of accumulation of urate crystals in the joint structure, subcutaneous tissue and bones, kidneys in the form of urolithiasis or tubular nephropathy. Hyperuricemia is detected in all patients with gout, but the vast majority of people with hyperuricemia have never had an attack of acute arthritis. This means that the development of gout is due to pathophysiological features that determine the deposition of urate crystals in tissues, accompanied by inflammation and subsequent degenerative changes.

Hyperuricemia is a necessary but not sufficient antecedent for the development of urate microcrystalline disease. If early asymptomatic disorders of purine metabolism are potentially reversible with timely diagnosis and correction, then at the stage of tophi gout with damage to blood vessels and target organs (heart, brain, kidneys), the prognosis of the disease is unfavorable.

Complex spa treatment, aimed primarily at eliminating hyperuricemia, is a method of preventing the development and progression of gout in all its clinical manifestations.

Gout in literature

Here is a rhyme for me Vasily Lvovich*!
What can I tell you about him?
He sits with gout alone;
But your reverend Turgenev -
He has the most vicious gout
A hundred times more murderous:
P. A. Vyazemsky
*[ V.L. Pushkin, the poet's uncle]

The clinical picture and treatment methods for gout are described in detail in many outstanding literary works. “The poet Publius Porphyry Optatian looked with sad thoughtfulness at his legs, disfigured by gout,” wrote D.S. Merezhkovsky in the novel Death of the Gods. Julian the Apostate. Another hero of this novel, the famous theurgist and sophist, Iamblik from Chalcis, the Greek philosopher, whom everyone called the divine Iamblik, liked to complain about gout.

Michel Montaigne believed that gout spares neither kings nor their subjects: “at the first attack of gouty pain, no matter what sovereign or majesty dressed in gold he may be, does he not forget about his palaces and his greatness?” However, in fairness it should be noted that he did not consider gout a disease at all, since it is not fatal. Five centuries after M. Montaigne I.S. Turgenev described his illness in a letter to L.N. Tolstoy:

“My illness... is not at all dangerous, although quite painful; The main problem is that, being difficult to respond to medications, it can last for a long time and deprives me of the ability to move.”

Turgenev was repeatedly treated at the waters in Baden-Baden. S. Maugham does not agree with their opinion, describing Eliot’s urekemia in the novel “The Razor’s Edge”, so the doctor considered his condition to be serious, since the kidneys were seriously affected and a complete recovery was impossible. That is why Eliot drank only Vichy when treating his friends to the best wines. This case probably describes gouty nephropathy, which includes various forms of kidney damage caused by disorders of purine metabolism. Tophi lesions of internal organs are especially dangerous. So in the play “Uncle Vanya” by A.P. Chekhov, Serbryakov, after an attack of gout, complains of difficulty breathing and remarks: “They say Turgenev got angina pectoris from gout.”

Gout: history of spa treatment

Since ancient times, healing waters have been used to treat gout. We owe much of the development of balneology to the gouty geniuses of humanity. As Seneca wrote in his Philosophical Writings, “in water lies the hope of the future world, and the beneficial properties of water are no less varied than the taste.” The baths, built on healing springs, served one purpose: to restore the health of the august persons. The main resort of ancient Rome was the hot sulfide springs of Baia near Naples, where the procurator of Judea Pontius Pilate treated gout. Septimius Severus was treated for gout and urolithiasis with the radon waters of the Bulgarian resort of Hisar, and Marcus Agrippa with the sulfide waters of Acque Albule in the ancient city of Tivoli in the Italian province of Lazio. Michelangelo, who suffered from gout and urolithiasis, was treated for many years by the waters of the Italian resort of Fiuggi.

Gout: treatment in a resort

The main goal of gout treatment is to reduce the level of uric acid in the blood, which is a fundamental factor in the basic treatment of the disease and should be carried out over a long period of time (sometimes permanently). The impact on hyperuricemia includes reducing the intake of purines into the body by prescribing a special diet, using drugs that inhibit the synthesis of uric acid (uricodepressors), increasing the excretion of uric acid compounds (uricosuric drugs) and ensuring their chemical breakdown (uricodepressants).

The main method of spa therapy for gout is drinking treatment with alkaline mineral waters of predominantly hydrocarbonate or sulfate-bicarbonate composition.

Complex spa therapy in the form of drinking treatment, mud therapy and balneotherapy twice a year makes it possible to achieve stable remission during gouty arthropathy and prevent damage to internal organs.

Indications for spa treatment and choice of spa for gout:

ICD-10 code

Codes ICD-10

Name of the disease

Title

E79.0

Hyperuricemia without signs of inflammatory arthritis and gouty nodes

Hyperuricaemia without signs of inflammatory arthritis and tophaceous disease

M10.0

Idiopathic gout*

Idiopathic gout

* In endocrinology, a disorder of purine metabolism without damage to the kidneys and joints is considered.

E79.0 Hyperuricemia without signs of inflammatory arthritis and gouty nodes

M10 Gout

M10.0 Idiopathic gout

Idiopathic (primary gout), chronic gouty monopolyarthritis, oligopolyarthritis, without visceritis, mild to moderate course, not higher than I degree of inflammatory process activity, insufficiency of joint function not higher than II degree

*No. 227 (arthropathy, infectious arthropathy, inflammatory arthropathy, arthrosis, other joint lesions

When treating gout, resorts with two therapeutic factors are preferable - with drinking water (treatment of uric acid metabolism disorders) and mud or balneotherapeutic waters (treatment of gouty arthritis).

For gout, balneotherapeutic resorts are indicated:

For latent and urolithiasis types of kidney damage, drinking resorts are indicated, and for proteinuric types, climatic resorts are indicated.

Yalta (the southern coast of Crimea), Yangan-Tau (Bashkiria), and Tinaki (Astrakhan region) are rightfully considered the resorts of choice for those suffering from the proteinuric type of gouty nephropathy.

Contraindications and restrictions for spa treatment for gout:

Chronic renal failure and poorly corrected arterial hypertension.
If the kidneys are damaged, resorts with sulfide waters are excluded.
With the urolithiasis type of nephropathy, patients should be sent to drinking resorts without obstruction of urine passage from stones, as well as persons after lithotomy and lithotripsy.

Drinking treatment for gout

The drinking regime, even in a non-resort environment, requires at least 2-3 liters of liquid per day. Insufficient fluid levels impair kidney function and lead to increased concentrations of uric acid in the blood plasma. However, all standards must be individualized.

For drinking treatment, low-mineralized alkaline mineral waters of predominantly hydrocarbonate or sulfate-bicarbonate composition are used. Hypotonic waters taken orally are quickly absorbed, increase the volume of extracellular fluid, mobilize metabolic processes and are quickly eliminated from the body, providing a kind of “washing” of the intercellular space and urinary tract.

Increasing diuresis due to drinking treatment with mineral waters helps to reduce hyperurecemia, and alkalinization of urine increases the solubility of uric acid and thereby prevents the occurrence or progression of tophi lesions of target organs and gouty nephrolithiasis.

The effects of drinking treatment for gout are due to the mineral composition of the waters, since many of the trace elements act as catalysts for enzymatic reactions of important biochemical processes.

Rn Radon waters when treated with drinking water, they have anti-inflammatory, diuretic, desensitizing, sedative and analgesic effects. The low content of minerals in radon waters used for drinking treatment contributes to an increase in diuresis and the elimination of urate. Some authors explain this by an increase in the permeability of basement membranes, as well as the transition of extracellular uric acid to a soluble state. . In addition, radon has a normalizing effect on basal (protein), carbohydrate, mineral, cholesterol and water metabolism in the body. When drinking radon water, there is an improvement in the metabolism of uric acid in patients with gout, which is associated with the normalization of liver function under the influence of radon procedures.

HCO 3 Hydrocarbonate ions Mineral waters, alkalizing urine, promote the dissolution of urates and their excretion in the urine, dissolving mucus in the urinary tract, and contribute to the proliferation of the inflammatory process.

SO 4 Sulfur-containing sulfate and sulfide H 2 S mineral waters have diuretic, anti-inflammatory, choleretic effects. Thiosulfates act as coenzymes for many biochemical processes. Sulfate and low-sulfide waters have a pronounced choleretic effect, regulating stool, improving elimination function, and helping to reduce hyperurecemia.

Mg Magnesium ion in mineral waters is useful for patients with concomitant nephrolithiasis, which about 25% of patients with gout have. Urinary stones most often have a urate core with an oxalate shell. Magnesium ions bind up to 40% of oxalic acid in the urine, and their deficiency is manifested by the formation of calcium oxalate crystals. In addition, magnesium sulfates have antispasmodic and atyspastic effects.

Ca Calcium ion in mineral waters for drinking treatment of gout, it increases the solubility of uric acid in urine, which explains the effectiveness of treatment with calcium-containing waters for gout. In addition, Ca ions have desensitizing and anti-inflammatory effects due to their astringent and compacting effect on the cell membrane. In combination with silicon, Ca has an antioxidant and membrane protective effect.

Si Silicon, which has the property of restoring the colloid-crystalloid state of urine and has a membrane-protective effect. Drinking treatment with siliceous water enhances the diuretic effect, reduces the degree of crystallization of mineral salts, and affects metabolic processes. The high silicon content in water increases the solubility of oxalic acid crystals, preventing the growth of urate stones, the shell of which most often consists of oxalates.

Balneotherapy for gout

Balneotherapy for patients with gout is carried out in the inter-attack period. Balneotherapy helps improve microcirculation, improves blood supply and trophism of tissues and the synovium of the affected joints. Under the influence of radon and sodium chloride baths, kidney function significantly improves, uric acid clearance increases, diuresis increases, which leads to increased excretion of urates from the body. This in turn helps remove uric acid salts from the synovial membranes and tissue depots. Under the influence of balneotherapy, inflammation in the joints decreases, the activity of lysosomal enzymes decreases, the functionality of the liver and kidneys increases, and the indicators of purine and lipid metabolism improve.

Rn Radon stimulates the activity of tissue lipolytic enzymes, reduces the level of uric acid in the blood. In gouty atropathy, the leading role is given to the restoration of the adaptive-trophic function of the sympathetic-adrenal system, local mechanisms of regulation of cellular metabolism and microcirculation in the synovial membrane (transport of plastic and energetic substances, hormones, electrolytes, activation of enzymes, increased evacuation of metabolites). Essential in the mechanism of therapeutic and physiological action of radon baths is their effect on the terminal link of blood circulation - microcirculation in the skin. Radon baths improve the hemodynamics of the kidneys and liver, normalize the metabolism of uric acid, improve liver function, have a beneficial effect on lipid metabolism, have an anti-inflammatory effect, have a hypotensive effect, stimulate the glucocorticoid function of the adrenal glands, improve the urodynamics of the lower urinary tract, and have a uricosuric effect. The main sanogenetic effects of radon therapy for atropathy: desensitizing, anti-inflammatory, trophic, analgesic, restoring impaired joint functions, preventing the progression of the process determine its effectiveness when used in the form of baths, including “dry” air-radon baths - Reabox-VRV.

H 2 S Sulfide or hydrogen sulfide baths. The specific effect of sulfide baths is due to hydrogen sulfide, which enters mainly through the skin. Hydrogen sulfide has a positive effect on the liver, which affects the state of purine and other types of metabolism. In addition, sulfide (hydrogen sulfide) baths enhance microcirculation, trophic processes in joint tissues, improve cartilage nutrition, reduce the level of uric acid in the blood, and have a uricosuric effect. Contraindications to hydrogen sulfide baths are: an acute attack of gout and a phase of incomplete remission, impaired renal function, liver function, chronic hepatitis, cholelithiasis and urolithiasis.

CO 2 Carbon dioxide baths indicated for patients with concomitant diseases: coronary heart disease, hypertension, lipid metabolism disorders. Nonspecific reactions of the body to carbon dioxide baths are generally similar to those to hydrogen sulfide baths, but their specific effect is different. Thus, if hydrogen sulfide baths mainly affect the course of metabolic processes, increasing their reduction phases, then carbon dioxide baths stimulate the cardiac mechanisms of self-healing and compensation through the autonomic apparatus for regulating the activity of the heart and the state of the vascular system, helping to improve the function of redox systems due to the utilization of oxygen.

ClNa Sodium chloride baths have a tonic and regulating effect on the central nervous system, improve renal blood flow, acting more gently on the body than other mineral baths.

I Br Iodine-bromine baths have a vasodilator, diuretic and hypotensive effect, and have a sedative effect. The microelements iodine and bromine, forming a depot in the skin, partially penetrate into the humoral environment of the body. As part of various enzyme systems, they affect metabolic processes, improve kidney function, increase urate excretion, reduce the level of urate in the blood, and normalize lipid metabolism. The effect on the kidneys and urinary tract is due to the improvement of renal blood flow, the functional state of the kidneys, and the normalization of metabolic processes in the kidneys. The anti-inflammatory, antitoxic, bactericidal effect of iodine-bromine baths allows them to be used by patients with gout with fistulas in the tophi, promoting their rapid cleansing and scarring. Iodine-bromine baths are well tolerated by patients. They are indicated when gout is combined with stage I-II hypertension, obesity, urolithiasis, coronary artery disease no higher than class II without heart rhythm disturbances.

Hydrotherapy in a complex resort treatment of patients with gout has a therapeutic effect due to a combination of irritations of thermal, chemical, and mechanical factors. Widely used: jet, rain, underwater shower-massage; baths (common, two-, four-chamber). As a result of the action of hydrotherapy, blood and lymph circulation, tissue trophism improves, muscle tone decreases, pain decreases, and range of motion in the joints increases. Under the influence of thermal irritation, metabolic processes in the body intensify, the rate of biochemical reactions and microcirculation increase. In addition, when adding various herbal decoctions or active substances to fresh baths, an additional desired effect is obtained, which helps improve joint movements and reduce pain due to the active substance.

For gout, complex spa treatment widely uses various methods of massage, exercise therapy, hardware physiotherapy, and extracorporeal treatment methods.

Diet therapy for gout in a sanatorium

An indispensable component of the treatment of gout in a resort setting is the organization of proper nutrition. Despite the fact that diet as a part of complex therapy has been known for a long time, many patients neglect it or use it incorrectly in practice. The characters in O’Henry’s short story “Kindred Spirits” believed that “only one thing in the world helps with joint pain.” Good, old, intoxicating, heart-melting drink.” They were wrong.

The effect of alcohol on gout: Scientists from Boston University (USA) examined 179 patients who had suffered at least one attack of gout in a year. Even small and medium doses of alcohol can cause an exacerbation of gout, since alcohol reduces the excretion of uric acid by the kidneys.

A diet for gout involves limiting foods that contain large amounts of purines. These include liver, kidneys, brains, meat, mushrooms, meat broths, jelly, sausages, ham, fish, beans, beans, lentils, cocoa, strong tea and coffee, chocolate. Lingonberries and eggplants have a uriconormalizing effect (mainly uricosuric).

Table No. 6 according to Pevzner

Indications:

gout with articular and extra-articular manifestations, idiopathic and symptomatic hyperuricemia (with the exception of secondary hyperuricemia in chronic renal failure), urolithiasis, uric acid diathesis, erythremia and other diseases for which limiting the consumption of animal proteins is indicated

Excluded:

foods rich in purine compounds;

Table salt is moderately limited.

For overweight patients, limit the amount of carbohydrates.

meat, fish and mushroom broths;

liver, kidneys, tongue, brains;

sausages, smoked meats, salted fish, caviar, canned food;

spinach, sorrel, legumes, mushrooms, cauliflower;

salty and spicy cheeses;

pepper, horseradish, mustard;

chocolate;

raspberries, cranberries;

cocoa, strong tea and coffee;

fats of animal origin.

Allowed:

products containing alkaline radicals:

vegetables,

fruits,

berries,

milk, dairy products

General characteristics of the diet:

physiologically complete nutrition.

The usual protein intake, but with a limitation of animal proteins; normal content of fats and carbohydrates.

Dried fruits.

Honey, non-chocolate candies, jam, marmalade, marshmallows, marshmallows.

Tea, coffee (weak, limited), juices

With concomitant arterial hypertension, you should limit the consumption of table salt and liquid, and in cases of decreased kidney function, protein products.

Excess weight, as well as debilitating diets, lead to an increase in the concentration of uric acid in the blood.

Treatment of gout, as well as other diseases of the endocrine system and metabolic disorders, largely depends on the active position of the patient. Translated from Latin " Patiens" - patient. Following doctor's recommendations, changing eating behavior, and an active lifestyle are the main factors for gout, which determines lifestyle.

The combination of medicinal methods, diet therapy and spa treatment allows achieving good results in more than 2/3 of patients with gout. Gout is one of those “thankful diseases”, the early recognition of which and the correct therapeutic tactics help preserve the health and ability of patients to work for many years.

Resorts for gout patients

Famous resorts indicated for gout with various types of medicinal natural factors are given.

Resorts with drinking water of low mineralization

Resort Truskavets, Ukraine known for Naftusa - low-mineralized (M 0.63-0.85 g/l) hydrocarbonate magnesium-calcium water, the healing properties of which are associated with the presence of organic substances of petroleum origin in it.

Fiuggi resort, Italy. The mineral waters of Fiuggi's two springs contain organic substances belonging to the family of fulvic and humic acids and are characterized by low mineralization - 0.133 g/l.

Resort Chianciano Terme, Italy. The waters of the spring of St. Helena Chianciano Terme, Italy: low-mineralized (0.49 g/l) hydrocarbonate-sulfate sodium-calcium are used for drinking treatment for gout. The waters of three other springs are indicated for drinking treatment for diseases of the liver and biliary tract and balneotherapy. The Chianciano Terme resort is indicated for patients with combined pathologies: gout and diseases of the digestive system.

Romania. The “300 steps” spring is distinguished by low mineralization – 0.197 g/l. It has long been used for drinking treatment for kidney diseases and gout. The waters of the resort’s 20 springs are used “for all diseases of the digestive tract.” In addition, the resort has mofettas (natural release of carbon dioxide), which are considered one of the effective methods of treating diseases of the cardiovascular system. The largest speleological clinic in Europe is located in the Târgu Ocna salt grottoes. Treatment at the Slanic Moldova resort should be recommended for patients with combined pathologies: gout and concomitant diseases of the circulatory system, digestive system, respiratory system (especially speleotherapy is indicated for patients with bronchial asthma).

Resorts with radon waters for balneotherapy for gout

In the resort of Teplice, Czech Republic patients with gout have been treated since the 18th century. The main natural factors of the resort: radon thermal fluorine-containing hydrocarbonate-sulfate sodium-calcium waters of mineral springs, peat mud.

In Baden-Baden, Germany For balneotherapy, thermal (up to 68.8 °C) radon (35.7-44.7 nK/l) waters are used, and for drinking treatment, hydrocarbonate-sulfate sodium-calcium-magnesium waters are used.

Spas with sulfur-containing waters for balneotherapy for gout

In Baden near Vienna, Austria Peter I was treated, who, as is known, suffered from urolithiasis, and, according to many historians, the emperor’s “rheumatism” was most likely caused by tophi lesions of the joints - gout. Low-mineralized (up to 2 g/l) sulfur-containing waters from 14 springs are used for balneotherapy and swimming in pools.

Resort Baden, Switzerland. Thermal mineral waters (46.5 °C) sulfate-chloride sodium-calcium are used for balneotherapy and swimming in the pool. Spa treatment was described by G. Hesse in the novel “Spa Party”.

Resorts with several types of water: for drinking treatment and balneotherapy for gout

Siberian resort Belokurikha known for its sources of radon-nitrogen siliceous thermals (42 °C). For drinking treatment, low-mineralized sulfate-chloride magnesium-calcium-sodium waters - “Belokurikha Eastern” - are used.

In Pyatigorsk For balneological procedures, radon waters from the springs of Goryachaya Mountain are used (from 5 to 274 nCi/l). Sulfurous waters are characterized by high temperature (42-47 °C), relatively low mineralization (5 g/l), therapeutically active concentrations of hydrogen sulfide (10 mg/l) and silicon (50 mg/l). These waters are used mainly for balneological procedures (Pirogovsky, Lermontovsky, Pushkinsky, Ermolovsky and People's baths), and some of them are taken to the drinking pump rooms of the Academic and Drinking Galleries. Pyatigorsk narzans (Cold and Teply narzans, Krasnoarmeyskie springs) are also used for drinking treatment.

Vichy resort, France(from lat. Vicus calidus, literally - a warm village). Mineral waters of 15 Vichy springs, subthermal and thermal (17-66 °C) - carbon dioxide bicarbonate-sulfate sodium (M - 3.3-8.9 g / l) are used for drinking treatment, baths, inhalations, balneotherapy, among which the famous and Vichy massage four hands under the shower.

Noboribetsu Onsen Resort on Hokkaido Island, Japan: according to Japanese balneologists, 3 out of 11 springs of water are effective in treating patients with gout. Sulfate sodium: improves the elimination function of the intestines. The calcium sulfate spring, Sekkoh-sen, is called the gout hot spring, Tsufu no Yu. These waters have an analgesic and antispasmodic effect. In addition, calcium ions increase the solubility of uric acid in urine. Radon waters from other sources of the resort, increasing diuresis, help reduce hyperurecemia.

Bibliography
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© Nadezhda Manshina 2008—2015
Manshina, N.V. Gout. Sanatorium-resort treatment at resorts around the world //
Medical Council, Scientific and practical journal for doctors. No. 7-8, 2008

Treatment of gout in a sanatorium is one of the most effective measures. It is held both in Russia and abroad. Moreover, therapeutic techniques are the same almost everywhere. Treatment in a sanatorium will allow you to quickly get rid of pain, as well as put the disease into remission.

Since therapeutic muds are natural substances rich in mineral elements, they are extremely effective in treating joints, due to the ability to saturate human cartilage tissue with missing organic substances

Treatment of gout in sanatoriums is carried out through complex treatment. The following procedures are used:

Mud baths.
Mineral water.
Balneotherapy.

At the same time, there are many recipes for various baths. In sanatorium conditions, radon baths, mineral, nitrogenous and sodium-based, are used to get rid of gout. The combination of different types allows you to influence the problem comprehensively: reduce pain, relieve swelling and redness, and also stop the inflammatory process.

Sanatorium treatment is carried out only as prescribed by a doctor, as it has a number of contraindications. For example, it is prohibited for people with high blood pressure, as well as for chronic renal failure. Moreover, it is worth considering that therapy in sanatoriums is not always advisable. Advanced stages of gout are treated with medications, and in some cases surgery may be required.

Therapy in a sanatorium is aimed at eliminating the root cause of the development of pathology - reducing the level of uric acid in the joints. In most cases, a single course of treatment is not enough, since the disease goes into remission, but does not disappear completely. Therefore, patients need to undergo sanatorium treatment on average once a year.

In addition to external procedures, spa treatment involves drinking mineral water. These waters are aimed at accelerating the metabolic process; they are quickly eliminated from the body, cleansing it of toxic substances. The alkali included in the product helps break down uric acid and accelerate its removal from the body.

Mineral water has a positive effect on the condition of the entire body, since its constituent elements act as catalysts for all biochemical processes in the body.

The best sanatoriums for gout therapy

A timely prescribed course of treatment is the key to successful therapy, relief of well-being and partial restoration of the body.

There are many sanatoriums for the treatment of gout. Since the treatment regimens in them are approximately the same, when choosing, you should rely on the climate where the sanatorium is located, as well as personal preferences.

Belarus

Among the sanatoriums in Belarus, the following are the most popular:

“Energetic”.
"Golden Sands".
"Vesta".
"Alpha Radon".
“Krinitsa”.
“Ruzhansky”.
“Nadzeya”.

The basis of treatment in Belarusian sanatoriums is also the use of mineral water and taking special baths. They actively use healing mud, which quickly relieves the inflammatory process.

The listed sanatoriums are distinguished not only by their favorable natural location, but also by the presence of modern equipment. Almost every sanatorium has a spa or wellness center where massages, wraps and other useful procedures are performed. In addition, these institutions pay special attention to special physical exercises that have a positive effect on the condition of the joints.

In each sanatorium it is possible to create an individual menu in accordance with the type of disease. A suitable diet will speed up the process of relieving the inflammatory process, as well as improve the health of the body as a whole.

The average cost of treatment is 1500-2000 rubles per day. This price includes a comfortable room and basic treatments for gout treatment. The spa and wellness center is subject to an additional charge.

The following documents will be required for check-in:

Passport (can be a general civil passport or a foreign passport).
Sanatorium-resort card.
Health insurance policy.
Certificate of vaccinations.

Belarusian sanatoriums are considered one of the best among resort institutions, so you need to worry about booking a room in advance.

Ukraine

Treatment of patients with gout depends on the severity and form of the disease; in the Pirogov sanatorium it is carried out comprehensively

Among the sanatoriums in Ukraine, the most popular are the following:

"Greenhouse".
“Mountain Tisa”.
“Golden Niva”.
“Sanatorium named after. Pirogov."
"Miner".
“Crystal Palace”.

Treatment of gout includes following a special diet, drinking plenty of mineral water, thermal baths, thermal procedures, as well as measures to normalize metabolism. The diet is selected individually, taking into account the patient’s disease and personal preferences.

The average cost is 1000-1500 rubles per day per room. The cost depends on the location of the sanatorium, the time of year and the procedures offered. Meals and basic treatments are included in the price, some spa activities are optionally paid for separately.

The course of treatment averages 10-12 days, after which the pathology goes into remission. Upon check-in you must present your passport. For treatment you will need a sanatorium-resort card, as well as a health insurance policy.

Russia

The largest number of sanatoriums in Russia for the treatment of gout are concentrated in the Moscow region, Krasnodar Territory and the Crimean Peninsula.

Many people are interested in where to treat gout in Russia. The most popular are the following institutions:

“Lenin Sanatorium”.
“Staraya Russa”.
“Vorovsky Sanatorium”.
“Oak trees.”
“Uvildy”.
"Kyiv".

Sanatoriums located in the south of Russia allow you to treat gout not only with procedures and special nutrition, but also with climatic influences. The effect of climate is especially noticeable in spring and summer, which is why the highest cost occurs during this period. The price per room per night varies on average from 1,500 to 2,500 rubles. Moreover, in some institutions the cost can reach up to 10,000 rubles, but this implies an all-inclusive program.

Almost every sanatorium has a spa and wellness center, where in addition to standard procedures in the form of medicinal baths, the patient is offered all kinds of wraps, massages, floating or pool sessions. Such an integrated approach allows not only to transfer the gouty disease into remission, but also has a beneficial effect on the condition of the whole organism.

Particular attention is paid to nutrition, since with gout the diet must be balanced, but with some restrictions. Almost every sanatorium has instructors who help patients engage in physical activity. Special gymnastics allows you to restore the motor function of the joints and reduce pain.

The following documents will be required for check-in:

Passport.
Sanatorium-resort card.
Medical insurance.

The effect of spa treatment

Complex spa treatment for gout in the form of drinking treatment, mud therapy and balneotherapy allows you to achieve stable remission and prevent damage to internal organs

Spa therapy can cure gout or put it into remission. Improvements during sanatorium treatment come quite quickly - from the first days the pain syndrome decreases and swelling disappears. Properly selected procedures allow the patient to feel comfortable and forget about the disease for a long time after the course of treatment.

There is a protocol for the treatment of this pathology, approved by the European League against Rheumatism (EULAR), the American College of Rheumatology (ARC) and other international and national medical organizations of this profile.

Standardized clinical treatments include both pharmacologic agents to relieve inflammation, pain, and lower blood uric acid levels, as well as non-drug agents.

Let us recall that the etiology of this disease is associated with metabolic disorders of nitrogenous substances (purines) and an abnormally high concentration of uric acid in the blood (hyperuricemia). This provokes the release of monosodium urate salt not only into the joints, but also into the soft tissues (in the form of tophi). The disease develops either due to an increase in the synthesis of uric acid, or due to its insufficient excretion by the kidneys.

taking into account endogenous factors in the development of pathology, patients are recommended to gout diet or gouty arthritis diet;
Recommendations are given for lifestyle changes, including weight loss, the need for exercise, quitting smoking, and drinking enough fluids;
An examination is proposed to identify metabolic syndrome aggravating hyperuricemia (adipositosis, hypertriglyceridemia, hypercholesterolemia, type 2 diabetes mellitus) and renal failure.

The protocol also provides for drug treatment of gout. Since this disease manifests itself as arthritis with episodes of acute inflammation in the synovium of the joints, accompanied by swelling and pain, treatments for gout (acute gouty arthritis) are aimed at relieving these symptoms and combating hyperuricemia.

Surgical treatment of gout, practiced today, consists of removing tophi, as well as restoring destroyed articular cartilage. Physiotherapy and spa treatment of gout are used.

NSAIDs (nonsteroidal anti-inflammatory drugs): Ibuprofen (Ibuprom, Ibuprof, Ibusan, etc.), Diclofenac (Naklofen, Olfen), Indomethacin (Indocin), Naproxen, Celecoxib, etc.;
corticosteroids (Prednisolone, Methylprednisolone, Dexamethasone, Triamcinolone, etc.);
Colchicine (Colcris);
Allopurinol (Zyloprim, Aloprim, Allozym, Allohexal, Purinol, Sanfipurol, Milurit and other trade names);
Probenecid (Benemid, Benecid, Probalan).

The use of these drugs represents the modern treatment of gout.

Acetylsalicylic acid (Aspirin), which belongs to the NSAID group, can relieve pain and reduce fever, acts against inflammation and thins the blood. However, in terms of anti-inflammatory effectiveness, Aspirin is much inferior to NSAIDs. In addition, treatment of gout with Aspirin is not included in modern medical standards of anti-gout therapy, since taking this medication in a low dosage reduces the excretion of uric acid by the kidneys and increases its level in the blood serum.

Inflammation, pain and treatment of swelling in gout is carried out with modern non-steroidal anti-inflammatory drugs (listed above). In case of an acute attack of gout, they are taken orally for 2-7 days (daily dose up to 0.2 g); Indomethacin, Ibuprofen and Diclofenac are considered the most effective. It should be remembered that regular use of NSAIDs can cause bronchospasm, stomach ulcers and gastrointestinal bleeding. Therefore, patients must strictly adhere to the dosage and duration of taking medications from this group prescribed by the doctor.

Oral corticosteroids are an alternative if NSAIDs are contraindicated or intolerant. Steroids are considered a more appropriate treatment in cases of multiple joint damage. Injections of Methylprednisolone into the affected joint relieve pain and reduce inflammation. However, their long-term use has serious side effects, including osteoporosis, increased blood pressure and the development of cataracts.

Treatment of gout with Fulflex is not provided for by clinical standards; moreover, Fulflex is not a medicine, but a dietary supplement.

Treatment of gout with Colchicine

Colchicine is a drug based on the poisonous alkaloid of the autumn crocus (Colchicum autumnale); as of 2009, the only brand of colchicine that has been approved by the FDA for the treatment of gout is Colcrys.

Colchicine (Colchicum dispert) is not a specific drug and can be used for familial Mediterranean fever, pericarditis, Behçet's disease and atrial fibrillation. Its use for gout is associated with the influence of this alkaloid on the formation of urate crystals in the body. Relief of pain and treatment of swelling due to gout are also included in the list of indications for this medicine.

Treatment of gout with Colchicine involves taking it orally (1.2 mg) no later than 24 hours after the onset of symptoms of a gout attack, and an hour after the first dose, another 0.6 mg should be taken. A long-term regimen of Colchicine (for 1-2 months) - 0.6 mg 1-2 times a day - can prevent the next gout attack.

It should be borne in mind that treatment of gout with Colchicine is strictly contraindicated in case of liver or kidney diseases, heart pathologies, stomach ulcers, ulcerative colitis, Crohn's disease. Side effects of Colchicine include severe vomiting and diarrhea, muscle pain and weakness, numbness in the fingers, flu symptoms, blood in the urine and decreased urine output. In addition, it must be remembered that simultaneous use of this medicine with non-steroidal anti-inflammatory drugs increases the risk of a decrease in the number of platelets and white blood cells in the blood.

Colchicine has been widely criticized due to its high risk of cumulative toxicity, which can lead not only to irreversible neuromyopathy, but also to hypercapnic respiratory failure and death.

In domestic clinical practice, alternatives to Colchicine are drugs such as Butadione, Phenylbutazone and Reopirin, which help relieve inflammation and stimulate the excretion of urate salts.

Treatment of gout with Allopurinol

If too much uric acid is formed in the body (and this is confirmed by appropriate tests), therapy should be carried out to reduce the intensity of this process (treatment of gout with Allopurinol).

Attention: drugs to reduce uric acid levels are not taken during a gout attack! You should also avoid taking them simultaneously with NSAIDs.

Treatment of gout with Allopurinol leads to a decrease in the synthesis of uric acid by blocking the enzyme xanthine oxidase, which ensures the process of utilization of purines and the formation of uric acid in the body. Allopupinol is most often used in the long-term treatment of gout in elderly patients: its standard daily dosage is 0.2-0.3 g, and in severe cases it can be increased to 0.8 g (FDA recommendation). But after normalization of the uric acid content in the blood plasma (

The drug is used with regular monitoring of the level of uric acid in the blood and mandatory consumption of a sufficient amount of fluid to ensure an optimal level of urine excretion (within two liters per day).

If the kidneys cannot cope with releasing the body from excess uric acid (with hyperuricemia), alternative uricosuric drugs are prescribed: Probenecid, Sulfapyrazone, Benzbromarone, etc. Preference is given to Probenecid, prescribed in a daily dose of 0.5-2 g.

Treatment of tophi in case of gout is also carried out with Allopupinol or Probenecid, long-term use of which (six months or longer) helps tophi can gradually soften and disappear.

New in the treatment of gout

Today, what is new in the treatment of gout are drugs that expand therapeutic options in the fight against excess uric acid. The drug Uloric (Febuxostat), manufactured by Takeda Pharmaceuticals (USA), like Allopurinol, inhibits xanthine oxidase and is prescribed for elevated levels of urate in the blood (40-80 mg per day, in one dose, course of treatment - up to 14 days). According to clinical randomized trials (in which 2757 patients with hyperuricemia and gout participated), this drug is more effective (reducing serum urate concentration in 53% of patients) than Allopurinol (reducing uric acid in 21% of patients).

Another new product for the treatment of gout in Europeans is the drug Krystexxa (Pegloticase) for intravenous infusion (every two weeks); approved in the USA in 2010, and in early 2013 permission for its use was granted by the European Medicines Agency (EMA). This is an option for patients who do not respond to or cannot tolerate other medications. Pegloticase is a recombinant porcine uricase (a specific uric acid enzyme) that promotes the oxidation of uric acid into highly soluble allantoin and thereby reduces its serum levels. This is certainly useful for gouty nodes, but the new product has too many side effects, including the threat of anaphylactic shock and infusion reactions when administering the drug.

And elucidation of the role of increased levels of the inflammatory mediator interleukin IL-1β in joint inflammation in gout and rheumatoid arthritis led to the creation of the drug Anakinra (Anakinra, Kineret), which affects the inflammatory process by blocking the cellular receptors of this immune cytokine.

Treatment of gout according to Bolotov

Among the various folk remedies for treating gout - using kerosene, laundry soap, bee venom, hot foot baths with herbal decoctions - many are interested in the treatment of gout according to Bolotov.

Of all the variety of ways to improve health and prolong life generated by 85-year-old electrical engineer Boris Bolotov, it is worth citing, for example, his original recipe for removing salts from the body. To do this, you need to eat about 100 g of leaves of the medicinal plant coltsfoot every day for at least two months - crushing them and mixing them with table salt. It is necessary to lubricate the inflamed joints with the same mixture and warm them with a heating pad. At the same time, you need to eat more pickled and salted vegetables.

As you know, coltsfoot decoction is an expectorant and is also used for inflammatory processes in the gastrointestinal tract. Maybe it’s all about the inulin contained in the leaves of this plant, which activates the intestinal microflora and thereby improves the general condition of the body?

Recommendations for the treatment of gout “according to Bolotov” are not limited to this: you should drink decoctions of coltsfoot, cinquefoil, bird knotweed, horsetail (the last two are diuretic). And oxidize the body by consuming as many fermented drinks as possible from bearberry leaves (a known diuretic), viburnum berries, watermelon and birch sap, horseradish roots and parsley. In addition, the removal of salts is facilitated by the release of sweat during a weekly steam bath, after which the body should be wiped with vinegar infused with sage leaves.

Local treatments for gout

Treatment with Dimexide gives an analgesic and anti-inflammatory effect in gout attacks. This dermatotropic agent is used in the form of compresses, diluted with water in a 1:1 ratio. The compress (covered with plastic on top) is kept on the joint for 15-20 minutes; course of procedures – daily for one to two weeks. Dimexide has contraindications, and such compresses should not be used if there are problems with the heart, kidneys or liver.

You can make compresses with warm bischofite or medical bile; applications from a mixture of clay, table salt and water with the addition of iodine (10 drops). It is recommended to lubricate inflamed joints with an alcohol tincture of lilac flowers or aconite roots. Also, these tinctures are used for home treatment of edema due to gout - by applying them to the skin over the swollen joints, followed by light rubbing.

Surgical treatment of gout

For gout, surgical treatment is performed in the following cases:

development of destructive arthritis associated with chronic gout;
for tophi of significant size (uric acid nodules are removed, as they can open and cause ulceration and inflammation of surrounding tissues);
with the destruction of joints and the “fusion” of their synovial membranes;
with complete and irreversible destruction of all joint structures and damage to hyaline cartilage; replacement with artificial materials is carried out - endoprosthetics, arthrodesis, arthroplasty.

According to the American Academy of Orthopedic Surgery (AAOS), 10% of patients with gout have tophi, which are best removed before they damage the skin, tendons, ligaments and skeletal structures. And orthopedists consider surgical treatment of gout justified when: tophi disfigure the limbs, they are painful, urate deposits limit the functions of the tendon, the presence of tophi threatens skin necrosis, tophi compress nerve endings and disrupt innervation.

Other possible surgical interventions for gout: joint resection, curettage or partial resection of tendons (can help preserve joint function), finger amputation.

Physiotherapy for gout

Hardware physiotherapeutic procedures that can be used for gout during an exacerbation include infrared and ultraviolet irradiation of joints, UHF and iontophoresis with corticosteroids.

After relieving acute pain, in order to improve microcirculation and metabolism in joint tissues, ultrasound treatment and laser therapy (laser with a power not exceeding 20 mW) are practiced. There is also a BioFlex cold laser therapy system.

Laser treatment for gout is used when the disease manifests itself in the form of microcrystalline arthropathy, which is common among older patients who are more vulnerable to the side effects of medications. The effectiveness of laser therapy for pain relief is combined with a complete absence of side effects.

In many countries, including ours, various “home” physiotherapy devices are offered for the treatment of gout. As a rule, these are compact devices whose operating principle is based on the effect of an alternating magnetic field on tissue or microvibrations. The latter include the Vitafon device and its analog Fonovit (Russian production).

According to the developers and manufacturers of this device, in the presence of pathology, tissue cells experience a deficiency of natural “biological vibrations” generated by the contraction of muscle cells. A method of alternative physiotherapy for joint diseases - microvibration therapy or phonotherapy, as indicated in the instructions, helps reduce pain in the spine and joints after injuries, surgical treatment, etc. However, treatment of gout with Vitafon is not included in the list of diseases for which this device should be used.

Treatment of gout in sanatoriums

Experts note that treatment of gout in sanatoriums - balneology, peloid therapy (mud therapy), thalassotherapy - is recommended only a few months after an exacerbation of the disease.

An important factor in the effectiveness of treatment procedures during the period of spa treatment is the general relaxation and positive attitude of the patients. And although it is not yet possible to completely cure gout, balneological procedures such as carbon dioxide mineral, hydrogen sulfide, radon, sodium chloride baths help improve blood and lymph flow in the affected tissues and activate metabolic processes, which has a positive effect on joint mobility.

The use of medicinal mud and sea water also contributes to this. There are many spa therapy methods, and doctors, combining them, choose the most suitable for each patient: hydro and thermotherapy, magnetic therapy, diadynamic therapy, therapeutic massage, kinesitherapy, etc.

It is possible to treat gout in sanatoriums and health resorts in Berdyansk, where therapeutic mud is located in the estuary on the Berdyansk Spit; near Odessa - on the Kulnitsky estuary, in the Kherson region - on Sivash. In Transcarpathia, gout is treated in the sanatoriums “Sinyak”, “Beregovo”, “Bozhava” and at least two dozen other resort institutions.

Treatment of gout in Crimea is in sanatoriums on the Kalamitsky Bay in Evpatoria, as well as in Saki on the salt lake, where peloid therapy is carried out using sulfide silt mud and brine.

Treatment of gout with sulfide mud can be obtained in Pomorie near Burgas (Bulgaria), and the Polanica-Zdroj resort in Poland is famous for its peat mud.

Treatment of gout abroad

Judging by the latest publications of the Ukrainian Rheumatology Journal, domestic specialists adhere to the protocol and carry out modern treatment for gout, prescribing all the necessary examinations and medications.

However, treatment of gout abroad is considered by many to be more effective...

Treatment of gout in Israel can be attractive, since doctors in this country know almost all modern methods, and Israeli clinics are equipped with the latest medical technology.

As part of the gout treatment protocol, drug treatment, diet therapy, exercise therapy, ultrasound and shock wave therapy are used. Blood is purified from uric acid by plasmaphoresohemosorption. Surgical treatment of gout of varying complexity is also carried out in Israel.

Rosemary oil has been used to treat gout in Germany for centuries, and is still widely used by locals to this day. They also drink nettle tea, which, as recent studies have shown, really helps cleanse the body of excess uric acid.

Modern treatment of gout in Germany since 2008 has also been carried out according to the recommendations of EULAR and BSR, using appropriate pharmacological drugs. Although, according to rheumatologists at Klinik der Gegenwart (Munich), they have been prescribing urate-lowering therapy with Allopurinol to their patients since 1964. But recently, more and more doctors prefer to prescribe not Allopurinol (which reduces uric acid levels in only 24% of patients), but Benzbromarone (92%, respectively) or Probenecid (65%).

The attitude towards patients who are treated for gout in Germany is professional in everything: they will never prescribe any drug treatment without a mandatory check of the glomerular filtration of the kidneys.

Germany is known for its homeopathic school, and homeopathic doctors have more than 200 remedies for the treatment of gout.

When choosing treatment for gout abroad, you can change direction and turn to oriental medicine – traditional Chinese medicine.

Treatment for gout in China includes acupuncture, herbal remedies and... bloodletting. If a Chinese man has gout, there is something wrong with his zhinye or jingye (body fluid) because the fluid has “absorbed too much waste from eating and drinking.”

Among the plants that are especially held in high esteem for gout are those included in the well-known remedy Xi Miao San in the West: the rhizome of Atractylodes lancea (Atractylodes lanceata), the bark of Phellodendron amurense (Amur velvet tree), Colchicum autumnale (meadow saffron or colchicum - see earlier Allopurinol!).

The familiar dandelion is also used in the treatment of gout in China. A decoction of dandelion leaves is drunk to remove uric acid, and fresh leaves are applied to the joints to reduce swelling and pain. As for bloodletting, as the Journal of Traditional Chinese Medicine reported, this method fell out of fashion in the West more than a hundred years ago, but in China it is being used again to relieve severe pain from gout attacks - in combination with Chinese herbs. The results showed that in almost 62% of cases the patients' condition improved quickly.

Experts have long had no illusions regarding the reversibility of disorders of nitrogen metabolism in the body. Seven years ago, MRC Human Genetics Unit researchers from the University of Edinburgh discovered that people with the SLC2A gene mutation tend to retain uric acid and accumulate it in the body. And there is a very high probability that they will - sooner or later - need treatment for gout.