The main morphological manifestations of changes in gout. Rheumatology gout

Second stagegout called intermittent, or "interval" gout. There is already a gradual deposition of urates in the area of ​​​​the joints and in the tubules of the kidneys. The disease proceeds in the form of exacerbations ( acute gouty attacks) and periods of remission. During an exacerbation, joint symptoms are usually observed, which will be detailed below. The formation of kidney stones in intermittent gout is rare.

Exacerbations and acute joint symptoms are usually caused by the following reasons:

• injury;
• excessive alcohol consumption ( even disposable in large quantities);
• surgical intervention;
• acute infectious disease usually acute respiratory infections - acute respiratory disease, or ARVI - an acute respiratory viral infection).

The attack lasts 3-7 days, after which it comes complete remission, and patients do not experience any pain or any discomfort even with a load on the affected joint.

Third stage of gout called chronic. It occurs when the patient actually forms tophi with uric acid crystals. Outwardly, they look like bumps that are hard to the touch, which can reach large sizes and severely deform the joint. It should be noted that tophi are externally determined only in 50-60% of patients, and they are not the main criterion for the onset of the third stage. For orientation in the diagnosis, the frequency of acute gouty attacks and their duration are taken in comparison with periods of remission. Also in the third stage, urolithiasis develops with a corresponding clinical picture.

The main symptoms of gout on the part of the joints are:

• pain;
• joint redness;
• formation of tophi;
• inflammation of the periarticular tissues;
• limitation of mobility in the joint;
• local rise in temperature.

Pain

Gout pain can be very severe. The attack begins, as a rule, at night, often under the influence external factors. The pain radiates spreads) throughout the limb. Increased pain can be caused by even light pressure on the affected joint. Conventional painkillers are ineffective during an attack.

As noted above, the small joints of the feet and hands are usually affected. In more than 55% of patients, the first attack of gout is localized in the region of the I metatarsophalangeal joint ( base of the big toe). As a rule, the joint on only one limb is affected, the symmetrical development of the inflammatory process on both limbs is not typical for gout.

The frequency of damage to various joints in gout early stages

Joint or anatomical region	Damage frequency
I metatarsophalangeal joint	56%
Phalanges of fingers	18%
Wrist joints	11%
elbow joint	4%
Spine, hip and knee joints	less than 3%
Ankle joint and Achilles tendon	5%
Damage to 2 - 5 joints at the same time (oligoarthritis)	17 - 34% (more common in women)

Gout pain is caused by deposits of urate in the soft tissues and the presence of crystals in the joint fluid. Solid particles directly injure tissues and cartilaginous surfaces inside the joint, leading to severe pain. To a lesser extent, the pain is due to inflammatory edema.

Joint redness

Redness of the joint develops quickly, in parallel with the increase in pain. It is more characteristic during the period of exacerbation, while during remission it may disappear. Redness is due to a rush of blood to the affected area. Due to microtraumas of soft tissues, cellular elements of blood migrate to the focus ( mostly neutrophils). These cells are able to secrete biologically active substances that increase the permeability of the walls of blood vessels and the expansion of capillaries. Under the influence of these substances, the blood supply to the affected area increases, which causes redness and swelling.

Formation of tophi

Tophi is a symptom specific to gout. As mentioned above, they are an accumulation of uric acid salts located subcutaneously or intradermally. Usually from the first symptoms of the disease ( first attack) before the formation of tophi takes at least 3 - 5 years ( in rare cases 1 - 1.5 years). These formations increase slowly, but in advanced cases, gout can reach several centimeters in diameter. Trophic ulcers may appear due to impaired blood supply to the skin over tophi. A white paste-like mass is released from them, or even just urates in the form of a white powder.

The predominant places for the formation of tophi are:

• phalangeal joints on the fingers and toes;
• metacarpophalangeal and metatarsophalangeal joints ( base of the finger);
• region knee joints;
• area of ​​elbow joints;
• ankle joint;
• auricles;
• superciliary arches.

With atypical forms of gout, early formation of tophi can also be observed ( one year after the first attack of the disease).

The early appearance of tophi is typical for the following categories of patients:

• patients with juvenile gout cases of gout in children and adolescents);
• elderly women who developed gout while taking diuretics ( diuretics);
• patients with severe diseases of the hematopoietic system;
• in chronic renal diseases accompanied by hyperuricemia.

Inflammation of the periarticular tissues

The inflammatory process can affect not only the joint area, but also other anatomical structures located nearby. Against the background of gout, diseases such as tendinitis are often observed ( tendon inflammation), tendovaginitis ( inflammation of the tendon sheath), bursitis ( inflammation of the joint capsule, characteristic mainly of large joints).

Limitation of mobility in the joint

The main cause of limited mobility of a joint affected by gout is a sharp pain. It appears mainly in the acute period of the disease and does not allow you to make any movements, or even give an insignificant load on the entire limb.

During remission, when the pain subsides, joint stiffness can still be observed. It is partly due to inflammatory edema, partly due to concomitant inflammatory processes in the tendons and other periarticular anatomical structures.

Local temperature increase

Local temperature increase is explained by increased blood supply to the affected joint and acute inflammatory processes. By touch, the patient can easily determine that the reddened area of ​​\u200b\u200bthe skin is much hotter than the surrounding surface tissues. Above the tophi, the skin temperature is also almost always 1 - 2 degrees higher, regardless of their location.

Depending on the causes of gout, concomitant diseases and individual characteristics the patient's body for gout can take several clinical forms. Each of them is characterized by some features and a set of symptoms typical of it. Often, it is the clinical form of gout that becomes the main criterion for choosing a treatment.

Currently, the following clinical forms of gout are distinguished:

• typical acute attack;
• subacute form;
• rheumatoid-like form;
• pseudophlegmonous form;
• infectious-allergic polyarthritis;
• asymptomatic form.

Typical acute attack

This clinical form occurs in 60 - 80% of patients with gout. In fact, it includes symptoms that are not observed constantly, but during the exacerbation phase. With an intermittent course of gout, exacerbations are observed quite rarely. In the chronic stage, most symptoms are observed constantly. The duration of attacks, depending on the severity of the disease and the nature of the treatment, varies from several days to several weeks.

The main symptoms during an acute attack are:

• acute pain in the joints;
• general weakness;
• headaches;
• a sharp rise in temperature from subfebrile level ( 37 - 38 degrees) up to 38.5 - 39 degrees;
• the skin over the affected joint quickly turns red, and then acquires a bluish tint.

During an acute attack in the data laboratory tests characteristic changes are observed, which will be described in detail below ( increased ESR - erythrocyte sedimentation rate, increased levels of sialic acids in the blood, fibrin, seromucoid, and the appearance of C-reactive protein).

Subacute form

The subacute form differs from the attack in less intense symptoms. In particular, the inflammatory process is usually limited to one joint ( monoarthritis), the pain is moderate, and the swelling is not so strong. Subacute involvement of several joints can occur in the early stages in young people. Gradually, the subacute form passes to more severe variants of the course with frequent acute attacks.

Rheumatoid-like form

The rheumatoid-like form is called so because gout in this course is difficult to distinguish from some rheumatic diseases. Features of this form is the defeat of small joints ( finger and toe joints, wrist joint) at the onset of the disease, as well as prolonged attacks of moderate intensity. The duration of attacks in rheumatoid-like form can be up to several months. It creates serious problems doctors with correct diagnosis.

Pseudophlegmonous form

The pseudophlegmonous form is characterized by an acute inflammatory process around the joint, while the symptoms typical of gout fade into the background. The leading symptom in this course of the disease will be a temperature of 39 - 39.5 degrees, chills, an increase in the level of leukocytes in the blood up to 12 - 15 million / ml, an increase in ESR. All these symptoms are more like phlegmon - acute diffuse purulent inflammation soft tissues. However, tissue necrosis and pus formation usually do not occur with this form of gout.

Infectious-allergic polyarthritis

Infectious-allergic polyarthritis is an independent disease in which one or more joints become inflamed one by one. In rare cases ( up to 5%) gout can mimic such a clinical picture. In this case, the defeat of new joints appears quickly ( during the day), however, the inflammatory process is not as intense as with a typical exacerbation of gout.

oligosymptomatic form

The oligosymptomatic form of gout also presents serious difficulties for diagnosis. With it, patients complain of moderate pain, usually in one joint. On examination, there may be no signs of inflammation such as swelling or redness of the skin.

It should be remembered that these six clinical forms of gout are mainly characteristic of the initial stages of the disease. Gradually, the disease progresses with the formation of tophi and an increase in typical attacks. However, the above forms can be observed for several years, until the disease takes a more characteristic course.

In addition to damage to the joints with gout, damage to the urinary system often occurs. This occurs in the later stages of the disease and is characterized by the deposition of urate in the tissues of the kidneys ( tubules, renal pelvis). gouty nephropathy ( kidney damage due to gout) occurs according to various data in 30-50% of patients with this pathology.

The main symptoms of gouty nephropathy are:

• Sharp pains in the back. Pain is a consequence of the movement of stones in the renal pelvis. Crystals damage the epithelium of the renal pelvis, leading to the development of inflammation.
• Hematuria ( detection of blood in the urine). Hematuria is manifested by reddening of urine or the detection of blood elements in it during laboratory research. The cause of hematuria is minor bleeding that occurs as a result of the movement of stones.
• Renal colic. This syndrome involves the sudden onset severe pain in the lower back without apparent reason. Renal colic in gout is caused by blockage of the ureter by a large stone, or by its getting stuck directly at the mouth of the pelvis. Colic may be accompanied by vomiting, urination disorders, moderate fever.
• The appearance of tofus-like formations in the kidneys. Sometimes, against the background of gout, urates are not formed in the pelvis, but directly in the brain tissue of the kidneys. In this case, it gradually leads to overgrowth of the renal tubules. connective tissue and chronic renal failure.

Diagnosis of gout

As mentioned above, the diagnosis of gout often presents serious difficulties even for experienced doctors. The fact is that when contacting a doctor, patients most often complain of pain in the joints, which can be caused by a variety of diseases. To significantly increase the chance of making a correct diagnosis, it is best to contact the rheumatology department. Rheumatologists have more experience with arthritis than other specialists and will be able to recognize gout more quickly.

The diagnosis is made directly on the basis of clinical and paraclinical ( laboratory and instrumental) surveys. For some patients, the diagnosis does not take much time, while others have to undergo a series of tests and examinations. First of all, it depends on the cause of the disease, and on the severity of the symptoms.

In the diagnosis of gout, the following stages can be distinguished:

• anamnesis ( patient interview);
• grade clinical picture the course of the disease;
• instrumental research;
• laboratory research.

Anamnesis

History taking plays important role in the diagnosis, as it allows you to immediately exclude several diseases of the joints with similar symptoms. During the interview of the patient, the doctor necessarily specifies what the first symptoms of the disease were and in what order they appeared. Most patients manage to recall joint pain in the past. They are usually sharp pain in the small joints of the feet and hands. large joints ( knee, elbow, hip) and the spine are rarely affected first.

Another important point in the collection of anamnesis are cases of gout in the family. As mentioned above, hereditary factors play an important role in the pathogenesis this disease, That's why similar cases facilitate diagnosis.

An indispensable issue that the doctor will try to clarify during the examination is the patient's nutrition and some bad habits. In particular, the abundance of meat food, alcohol abuse, smoking and significant physical exercise suggest gout. Another dietary pattern that plays a role in the onset of gout is inadequate fluid intake throughout the day.

Often the doctor also asks about illnesses that have occurred in the past. In gout, the most important are serious surgical interventions, kidney disease with reduced filtration and long-term use some medicines (cytostatics, thiazide diuretics).

Assessment of the clinical picture of the course of the disease

The clinical picture of the course of the disease is a set of symptoms of a disease and a change in the patient's condition over time. An experienced doctor, carefully observing the patient, can a high degree probabilities to put correct diagnosis even without paraclinical studies.

The main criterion in assessing changes in the state over time is the staging of gout. In almost any of the patients who undergo regular medical examinations and tests, it is possible to identify the following three stages of the development of the disease:

1. Hyperuricemia and accumulation of urates in the body. This stage can last for years without causing serious inconvenience to the patient. Nevertheless, it is she who sooner or later leads to the second stage. Occasionally, in medical practice, there are cases when gout appears without a preliminary increase in the level of uric acid.
2. Deposition of urates in tissues. Urates, as mentioned above, are small crystals that begin to make themselves felt as soon as the first of them are deposited in soft tissues. It is at this stage that the first obvious symptoms of gout appear, which usually lead the patient to a doctor.
3. Acute gouty inflammation. This stage occurs only with the accumulation of a significant amount of urates. In addition to multiple microtraumas caused by crystals in soft tissues, there is also a response of the body to foreign substances. The main role is played by neutrophils and tissue phagocytes, which capture ( phagocytize) crystals.

Kidney damage, as noted above, occurs after several years of the course of the disease.

Instrumental Research

Instrumental studies are assigned to almost all patients who have applied for pain in the joints. With gout, most instrumental methods are uninformative in the early stages, since morphological ( structural) changes in the tissues are practically not observed. However, this type of diagnosis makes it possible to exclude a number of other rheumatological pathologies. The appointment of one or another method of instrumental diagnostics is done by the attending physician if necessary. With a pronounced clinical picture with typical manifestations of gout, instrumental diagnosis may not be necessary.

In the diagnosis of gout, the following are used: instrumental methods research:

1. ultrasound ( ultrasound examination of the joints);
2. scintigraphy with technetium pyrophosphate;
3. x-ray of the affected joints.

ultrasound
With an intermittent course of gout, changes in ultrasound will be noticeable only during an exacerbation of the disease. In the first 3-4 days of an acute attack, there is an expansion of the joint space, swelling and hardening of the soft tissues around the affected joint. Already 5-7 days after an acute attack, the above changes are hardly noticeable, and after 10-12 days, ultrasound of the joint may not reveal any abnormalities.

In the chronic form of gout in the later stages, ultrasound of the joint can reveal moderate deformation of the articular surfaces and deeply located tophi. In addition, ultrasound can detect stones ( clusters) urates in the kidneys and bladder with urolithiasis.

Scintigraphy with technetium pyrophosphate
This study is prescribed mainly to patients with a blurred clinical picture of the disease, when the doctor has problems with an accurate diagnosis. Scintigraphy involves the introduction of a specific substance into the blood ( technetium pyrophosphate), which selectively accumulates in places where urates are deposited. Subsequent scanning of the body allows you to accurately determine the localization pathological process. Scintigraphy can indicate gout even in the early stages, when tophi have not yet begun to form. In addition, it can be used to quickly identify urate accumulations in atypical places ( spine, sternoclavicular region). The disadvantages of this study include its high cost.

CT scan
Computed tomography provides a series of high-precision x-ray images. With its help, it is possible to determine the degree of deformation of the joints in the later stages of the disease and the exact localization of tophi. In the early stages, the pictures will show only the thickening of the soft tissues around the joint during the period of exacerbation.

X-ray of affected joints
Single X-ray images at an early stage of the disease are prescribed in order to differential diagnosis with other arthropathies ( joint diseases). With gout, they do not reveal significant changes. Only in the chronic course of the disease, an X-ray image can suggest a diagnosis.

X-ray signs of gout

Tissue under study	Characteristic changes
Soft periarticular tissues	diffuse ( spilled) compaction due to the inflammatory process, dark areas with blurred contours ( tophi).
Bones and joints	The articular surface of the bone is clearly visible, no signs of osteoporosis are observed, with chronic gout, signs of erosion are observed. Dark areas against the background of a light image of the bone may indicate an intraosseous accumulation of urates ( intraosseous tophi). In radiology this sign also referred to as a "punch". Symptom of the "hanging edge" of the joint.

Laboratory research

Laboratory studies of peri gout are very informative, as they allow us to trace the process of formation and excretion of uric acid on various levels. Changes in the analysis of blood and urine are also valuable from the point of view of differential diagnosis, as they make it possible to distinguish gout from other inflammatory diseases of the joints with similar symptoms.

Laboratory studies for gout include the following tests:

1. blood chemistry;
2. biochemical analysis of urine;
3. examination of the synovial fluid of the joints;
4. study of the contents of tophi.

General blood analysis
In the general analysis of blood at first, no changes may be observed. During periods of exacerbation against the background of the inflammatory process, leukocytosis appears ( an increase in the number of leukocytes in the blood) with a shift of the leukocyte formula to the left. This means that the percentage of immature stab forms is increasing. Adult segmented leukocytes migrate to the focus of inflammation and are destroyed there. In addition to leukocytosis, an intense inflammatory process leads to increase in ESR (erythrocyte sedimentation rate). Other changes in the general blood test are observed only with concomitant severe defeat kidneys or when the patient has secondary form gout on the background of severe diseases of the hematopoietic system.

Blood chemistry
A biochemical blood test is the most important laboratory test for gout. It is within the framework of this study that the level of uric acid in the blood is determined and hyperuricemia is detected.

Possible changes in the biochemical blood test for gout are:

• increased levels of C-reactive protein;
• hyperglycemia ( increase in sugar levels) occurs in 15-25% of patients with hyperuricemia and is often due to hereditary fermentopathies;
• an increase in the level of creatinine and urea is observed mainly with kidney damage;
• the amount of lipids and lipoproteins in the blood is usually increased;
• elevated calcium levels.

In addition, with a biochemical blood test, it is recommended to check the level of prothrombin, fibrinogen, liver enzymes ( AlAT and AsAT) and bilirubin. These substances indicate the work of other internal organs and can help to make a correct diagnosis in case of secondary gout.

Separately, it should be said about the determination of uric acid in the blood. In gout, in most cases, there is an increase in its content ( hyperuricemia). Normally, the content of uric acid in the urine varies from 0.18 to 0.38 mmol/l in women and from 0.27 to 0.48 mmol/l in men. The determination of the serum level of uric acid is carried out before the start of treatment to clarify the diagnosis and after the start of treatment to monitor its effectiveness. Hyperuricemia has been proven to be a risk factor for gout. But, despite this, the serum level of uric acid cannot serve as an indicator that excludes or confirms gout. During the period of an acute attack, the determination of the serum level of uric acid is not informative, since almost half of the patients during this period have increased excretion ( selection) uric acid by the kidneys, due to which the level of uric acid in the serum can reach normal levels.

General urine analysis
In the general analysis of urine, pathological changes appear after kidney damage. The definition of urate crystals in the urinary sediment is characteristic. Possible albuminuria ( urinary excretion of albumin fraction of blood proteins), moderate hematuria ( detection of blood in the urine), cylindruria ( cell detection columnar epithelium in the urine). The reason for the appearance of these changes is direct damage to the epithelium of the renal pelvis with stones.

Biochemical analysis of urine
First of all, this analysis is necessary to determine the level of uric acid in the urine. Usually determine the clearance of uric acid - the amount of excreted substances during the day. Normally, it is 250 - 750 mg. Depending on the reasons that led to the appearance of gout, this figure varies. If the kidneys are not affected by the pathological process, then filtration occurs normally, and the level of uric acid in the urine will rise in parallel with the level of uric acid in the blood. With increased intake of purines in the diet, the amount of uric acid increases. If the gout in the patient developed a second time, against the background of chronic kidney disease, then less than 250 mg of uric acid will be excreted in the urine during the day due to insufficiently effective filtration.

Examination of the synovial fluid of the joints
In the synovial fluid obtained by puncture of the joint, an increased content of leukocytes, mainly neutrophils, is found ( 10 - 16*10 9 /l). Polarizing microscopy is performed, which reveals a precipitate of needle-like crystals of uric acid salts ( size 3 - 30 microns), which have the property of negative birefringence. Individual neutrophils are also visible, containing crystals of sodium urate in the cytoplasm. This analysis is the most reliable for confirming the diagnosis of gouty arthritis.

Examination of the content of tophi
When puncturing or opening tophi, a white pasty mass or even a white crystalline powder is found. This symptom is also characteristic only for gout, but it can be detected only in the later stages of the disease.

In addition to the classical stages of diagnosing gout, there are a number of criteria recommended by WHO ( world health organization). According to WHO, there are 12 key points that a doctor should pay attention to during an examination. If at least 6 out of 12 points are confirmed, the doctor can reasonably make a preliminary diagnosis of gout without conducting additional research. The advantage of diagnosis according to WHO criteria is the speed and high accuracy of diagnosis, the disadvantage is the ability to confuse an asymptomatic form of gout with some rheumatic diseases.

• More than one acute attack of arthritis in history. If the patient recalls at least two episodes with similar joint pain, this criterion is considered positive. Information is taken from the words of the patient during the survey.
• The maximum inflammation of the joint is already in the first day. With gout, inflammation develops quickly, which is not so typical for arthritis in other diseases. If the patient turned on the 2nd - 3rd day of the attack, then information about the inflammation on the first day is taken from his words. If he arrived on the first day, the doctor independently assesses such signs of inflammation as the intensity of redness, swelling of the joint, and local temperature increase.
• Monoarticular nature of arthritis. Gout almost always affects only 1 joint at first. Parallel inflammation of several joints is characteristic of other rheumatic diseases.
• Hyperemia of the skin over the affected joint. The criterion is considered positive if the skin over the inflamed joint is bright red and differs sharply in color from the surrounding healthy tissues.
• Swelling or pain localized in the I metatarsophalangeal joint. As noted above, it is this joint that is most often affected during the first attack of gout.
• Unilateral damage to the joints of the arch of the foot. Inflammation and pain appear only on one leg. Bilateral lesion is more characteristic of rheumatic diseases.
• Nodular formations resembling tophi. For positive evaluation of this criterion, the doctor may prescribe a puncture of the nodule.
• Hyperuricemia. For a positive assessment of this criterion, the doctor prescribes a biochemical blood test.
• Unilateral lesion of the I metatarsophalangeal joint. The joint is affected in the first attack on one side only. Only in advanced cases with chronic gout are both first metatarsophalangeal joints inflamed in parallel. However, even then the intensity of inflammation is different.
• Asymmetric swelling of the affected joint. Even within one joint there is asymmetry of swelling. This is due to the uneven deposition of urates in soft tissues.
• Detection on radiographs of subcortical cysts without erosion. These cysts look like dark spots against the background of the epiphysis ( extreme thickened part) bones. Most often, cysts are an intraosseous accumulation of urates.
• Absence of flora in joint fluid. To confirm this criterion, bacteriological seeding of the joint fluid taken during puncture is carried out on nutrient media. If, after a day, colonies of pathogenic microbes appear on the medium, then they are considered to be the cause of inflammation, and the criterion is assessed as negative.

As noted above, some rheumatic diseases have similar symptoms and manifestations, so it can be difficult to distinguish them from gout. These diseases are rheumatoid arthritis, psoriatic arthritis, and chondrocalcinosis ( also called pseudogout). To facilitate the diagnosis, special criteria for the differential diagnosis between these diseases have been developed.

Criteria for the differential diagnosis of gout and some rheumatic diseases

Diagnostic criteria	Gout	Rheumatoid arthritis	Psoriatic arthritis	Chondrocalcinosis ( pseudogout)
Floor	97% men	75% women	-	M:W - 4:1
Provoking factors	Alcohol, malnutrition, stress	-	Stress	-
Predominant joint damage	I metatarsophalangeal, joints of the arch of the foot	Small joints of the hand	Distal interphalangeal joints	Knee-joint
hyperuricemia	+	-	-	-
Radiogram ( calcifications, erosion)	As a rule, calcifications are absent, erosions are characteristic	-	-	Chondrocalcinosis and degenerative changes observed
Crystals: the form birefringence	+	-	-	+
	Sodium monourate	-	-	calcium pyrophosphate
	Acicular	-	-	rod-shaped
	negative	-	-	Weakly positive
Damage to internal organs	kidneys	Heart, lungs	Kidneys, CCC ( the cardiovascular system )	-

Gout treatment requires integrated approach with an impact on the pathological chain at various levels. Whenever possible, doctors try to determine the underlying cause of the disease and eliminate it. However, with hereditary enzymopathies, even an accurate determination of the missing enzyme does not allow to eliminate the root cause, so one has to limit oneself symptomatic treatment (aimed at eliminating the symptoms and manifestations of the disease and improving the quality of life of the patient).

The main directions in the treatment of gout are:

• dieting;
• anti-inflammatory drugs;
• anti-gout drugs;
• local treatment;
• folk remedies.

Dieting

In the prevention of gout, the main role is given to dietary nutrition. The main goal of the diet is to reduce the content of uric acid compounds in the body. If the diet is observed, purine bases practically do not enter the body from the outside. Thus, the diagnostic process is also facilitated. If on the 5th - 7th day of the diet the level of uric acid in the blood does not decrease, then we are most likely talking about secondary gout caused by a strong decrease in filtration in the kidneys or a massive breakdown of the body's own tissues.

Diet for gout implies several rules:

• Exclusion or limitation of the amount of foods rich in purine bases. It is these foods that in most cases are responsible for the increase in the level of uric acid in the blood. With their limited consumption, exacerbations of the disease are observed much less frequently and proceed more easily.
• The introduction of products that do not contain purine bases or with a low content of them. These products also need to be selected by a nutritionist. It is on them that the main emphasis is placed in the diet, and they must fully cover the body's needs for calories and nutrients ( proteins fats carbohydrates).
• The introduction of a sufficient amount of liquid. When consuming large amounts of liquid ( at least 2 liters of water per day, not counting liquid meals) increases the amount of circulating blood and accelerates filtration in the kidneys. Due to the increased blood volume, the concentration of uric acid falls, and its deposition in the form of salts in the soft tissues does not occur. Intensive filtration in the kidneys flushes the urinary system, does not allow urine to stagnate. This prevents the deposition of urate in the renal pelvis and bladder. In the presence of chronic kidney disease, it is necessary to clarify the need plentiful drink at the attending physician, as in this case it can lead to a sharp rise blood pressure.
• Weight loss. In most cases, getting rid of excess weight improves the functioning of internal organs, so that uric acid is better excreted from the body. In addition, the amount of lipids and lipoproteins circulating in the blood and contributing to the accumulation of uric acid is reduced. Most effective method weight loss for patients with gout is selected individually by the attending physician.

Foods that are high in purines(more than 150 mg per 100 g of product), are :

• beef internal organs brains, kidneys, liver, tongue, pancreas);
• sardines;
• anchovies;
• small shrimp;
• mackerel;
• legume crops.

Moderate Purine Foods (50 - 150 mg per 100 g of product):

• most types of meat beef, lamb, chicken);
• fish;
• crustaceans.

Products with low level purine content(0 - 15 mg per 100 g of product):

• milk;
• eggs;
• fish caviar;
• cereals;
• nuts;
• vegetables and fruits.

The meat of young animals contains more purine bases than the meat of older animals, so its consumption should be avoided or at least limited. It is also recommended to limit the intake of saturated fats ( sunflower oil, butter ), since in conditions of hyperlipidemia, excretion becomes difficult ( selection) uric acid by the kidneys.

Gout is a disease in which uric acid salts are deposited in the joints. The most common method for diagnosing deviations is x-rays. With its help, it is possible to identify a destructive process in the cartilage, for example, a “punch” symptom, characterized by the formation of a number of nodular formations (tophi), and other bone defects. Most of the symptoms of gout appear on x-rays.

Gouty arthritis of the upper limbs similar symptoms with rheumatoid arthritis, so these diseases are difficult to distinguish.

Gout: what are the causes and what are the symptoms?

Gouty arthritis occurs when:

• violations of the metabolism of purine bases, which is associated with excessive consumption of products containing purine;
• genetic predisposition to the disease;
• the patient has heart failure, hemoblastosis, hormonal pathologies;
• malfunction of the excretory system.

It manifests itself in the form of sudden acute attacks that occur for 3-10 days, and then suddenly disappear. Their occurrence is provoked:

• joint injuries;
• infections;
• drinking alcohol, fatty and fried;
• hypothermia.

With gout, the temperature mainly rises at night.

More often the disease makes itself felt at night. With a deviation, the following symptoms occur:

• pain in the injured joint;
• high temperature: 38-39 degrees Celsius;
• swelling at the site of the joint acquires a blue tint.

X-ray as one of the diagnostic methods

X-rays help to accurately determine the type of disease. This type of diagnosis is one of the most accurate, since no other method is able to give a specific classification of the disease. For example, during an exacerbation, the level of urates sharply decreases - they all go to the diseased joint, so a blood test can no longer determine gout.

X-ray signs of gout

The main sign that helps to confirm gouty arthritis- “symptom of a puncher”. On x-ray, such a pathology looks like a cystic formation located on the edge of the bone with clear boundaries. The more calcium inclusions in neoplasms, the better they are visible on the pictures. This diagnostic technique highlights other radiological signs:

• expansion of the joint due to the deposition of uric acid;
• changes in the end sections of the bones.

For citation: Svetlova M.S. X-ray method in the diagnosis of diseases of the joints // BC. Medical review. 2014. No. 27. S. 1994

Joint diseases are widespread among the population throughout the world. Diagnosis of most of them involves not only an assessment clinical manifestations, laboratory test data, but also the use of imaging techniques, primarily radiography. Despite the rapid development in recent years of such modern methods of medical imaging as magnetic resonance imaging, X-ray CT scan, expanding the possibilities of ultrasound diagnostics, radiography remains the most common method for diagnosing and monitoring the effectiveness of treatment of joint diseases. This is due to the availability of this method, ease of research, cost-effectiveness and sufficient information content.

X-ray examination is essential for establishing the diagnosis of the disease and should be used whenever possible in every patient with joint involvement. In this case, several radiological techniques (methods) can be applied: radiography, tomography, X-ray pneumography. X-ray of the joints allows you to determine the state of not only the bone and cartilage elements that make up the joint, but also the soft periarticular tissues, which is sometimes important for the diagnosis. When performing radiographs of the joints, a snapshot of the joint in at least 2 projections (in front and side) and a comparison of the affected and healthy paired joints are mandatory. Only under these conditions, on the basis of the radiograph, it is possible to judge the state of the joint with certainty.

It must be borne in mind that on initial stage disease X-ray does not reveal any pathological symptoms. The earliest radiological sign in inflammatory diseases of the joints is osteoporosis of the epiphyses of the bones that make up the joint. In the presence of osteoporosis, the spongy substance of the epiphyses looks more transparent on the radiograph, and against its background, the contours of the bone are sharply distinguished, formed by a denser cortical layer, which in the future can also be subjected to thinning. Osteoporosis (both diffuse and focal) develops most often in acute and chronic inflammatory diseases of the joints. With degenerative-dystrophic lesions of the joints, osteoporosis is not observed in the early stages, so this symptom may have differential diagnostic significance in such cases. In the later stages of arthrosis, moderate osteoporosis can be observed, combined with cystic restructuring of the bone.

For degenerative-dystrophic forms of diseases of the joints, compaction of the bone substance of the subchondral layer of the epiphyses (the trailing plates of the articular surfaces) is characteristic. This seal develops as the articular cartilage degenerates and its buffering function decreases (as a compensatory phenomenon). With the complete disappearance of cartilage, but while maintaining mobility in the joint, which usually occurs with arthrosis, a more pronounced and more widespread bone sclerosis is determined on the x-ray. On the contrary, with the loss of joint function, thinning of the subchondral layer of the epiphyses is observed even with preserved cartilage.
An important radiological sign is a change in the x-ray joint space, reflecting mainly the state of the articular cartilage. Expansion of the joint space can be observed with large effusions in the joint cavity or with thickening of the articular cartilage, which occurs, for example, in Perthes disease. Much more often there is a narrowing of the joint space due to degenerative changes, destruction or even complete disappearance of cartilage. Narrowing of the x-ray joint space always indicates pathology of the articular cartilage. It can occur both with long-term inflammatory and dystrophic lesions of the joints, progressing with the course of the disease, and thus has no differential diagnostic value. The complete disappearance of the joint space is observed in inflammatory diseases in the case of the development of bone ankylosis. With degenerative processes, the joint space never completely disappears.

The state of the articular surfaces of the epiphyses has a much greater differential diagnostic value. Inflammatory diseases of the joints are characterized by destructive changes in the articular surfaces and, above all, the presence of marginal bone defects - the so-called usurs. Usurs are located most often on the lateral parts of the articular surfaces, from where pannus (granulation tissue) “creeps” onto the articular cartilage.
In recent years, in the diagnosis of joint lesions, they began to attach importance to cystic restructuring of bone tissue, which can be observed both in inflammatory and degenerative processes.
Despite some common radiological signs, each joint disease has its own radiological picture. There is a lot of data in the literature about the possibilities of radiological diagnosis of osteoarthritis, rheumatoid arthritis(RA) and much less information about the features of the X-ray picture of ankylosing spondylitis (AS), psoriatic arthritis (PA), gout, i.e. those diseases that practitioners often encounter in their daily work.

So, AS, or Bechterew's disease, - inflammatory disease affecting the spine, sacroiliac joints and peripheral joints. X-ray examination of patients with suspected AS requires x-rays of the sacroiliac joint and spine. When examining the sacroiliac joint, it is recommended to take 3 images: 1 - in direct projection and 2 - in oblique (right and left, at an angle of 45o). When examining the spine, x-rays are needed in frontal and lateral, and sometimes in oblique projections.
Radiological symptoms are the most important and early sign of 2-sided sacroiliitis. At first, one joint can be changed, after a few months the second joint is also involved in the process. The first sign of sacroiliitis is the fuzziness of the bone edges that form the joint, the joint space seems wider. Later, marginal erosions occur, the contours of the articular surfaces look “corroded”, uneven, and the joint space narrows. In parallel, periarticular sclerosis develops, further - ankylosis and obliteration of the joint. In most cases, a characteristic x-ray picture develops only after 2 years from the onset of the disease, but sometimes after 3-4 months. manages to find early signs sacroiliitis.

Another important feature- a characteristic lesion of the intervertebral joints - blurring of the articular plates, and then narrowing of the joint space. As a result, ankylosis is formed, the joint space is not visible. At the same time, there are no marginal osteophytes, the joint space does not change, and neoarthrosis does not form. This feature, in combination with 2-sided symmetrical sacroiliitis, allows a confident diagnosis of AS.
Characteristic of AS is the formation of bone bridges (syndesmophytes) between adjacent vertebrae due to ossification peripheral departments intervertebral discs. First of all, they occur at the border of the chest and lumbar spine on the lateral surface. With the widespread formation of syndesmophytes in all parts of the spine, a symptom of a “bamboo stick” appears.
Less specific radiological signs of spinal lesions in AS include:
- the formation of erosion at the junction of the fibrous ring with the vertebra, especially in the anterior sections;
- square shape of the vertebra (on the lateral radiograph);
- ossification of the longitudinal ligaments, which appears on the radiograph in the frontal projection in the form of longitudinal ribbons, and in the lateral projection, ossification of the anterior longitudinal ligament is clearly visible;
- ankylosis of the vertebrae, which, as a rule, is formed first in the anterior sections of the spine (Fig. 1).
Involvement of the hip and knee joints in the process is manifested by narrowing of the joint space, erosions are rarely found. The joints of the hands and feet are rarely affected. Radiological erosions are very similar to those in RA, however, osteoporosis is mild, changes are often asymmetric. In the sternocostal and sternoclavicular joints, erosions and sclerosis can be detected, and ankylosis can sometimes be noted in the pubic symphysis. At long course in the area of ​​the wings of the pelvic bones and on the ischial tubercles, small exostoses can be detected - a “spiny pelvis”.
Thus, during AS, the following radiological stages can be distinguished:
a) radiographic signs of the disease are not visible on a traditional radiograph;
b) signs of sacroiliitis are revealed, i.e. lubrication of the subchondral layer of the joints is noted; not at first significant expansion, and then the narrowing of the joint space; there are signs of the formation of erosions and osteophytes in the joints of the spine;
c) ankylosis of the sacroiliac joints and the symptom of "bamboo stick"; joint spaces in the intervertebral joints are not visible; signs of osteoporosis;
d) the spine looks like tubular bone, discs and all ligaments ossify, bone atrophy occurs.
PA is a fairly common disease of the musculoskeletal system, combined with psoriasis skin lesions. The X-ray picture of PA has a number of features. Thus, osteoporosis, which is characteristic of many diseases of the joints, is clearly observed in PA only at the onset of the disease and in the mutilating form.
Radiological manifestations of arthritis of the distal interphalangeal joints are quite typical. This is an erosive asymmetric process, in which proliferative changes are simultaneously detected in the form of bone growths at the bases and tips of the phalanges, periostitis.

Erosions, having arisen along the edges of the joint, further spread to its center. In this case, the tops of the terminal and middle phalanges are grinded off with simultaneous thinning of the diaphysis of the middle phalanges, and the second articular surface is deformed in the form of a concavity, which creates an x-ray symptom of “pencils in a glass”, or “a cup and a saucer”.
The growth of bone tissue around erosions, osteolysis of the distal phalanges are characteristic. One bone often slides into another like spyglass("telescopic" finger).
In case of polyarthritis that occurs without damage to the end joints, the radiographic picture may resemble RA with marginal erosions of the epiphyses and bone ankylosis of the joints, however, the development of an ankylosing process in several joints of the same finger is considered pathognomonic for PA.

The mutilating form of PA, as mentioned above, is manifested by severe osteolytic changes in the constituent bones of the joints. Not only the epiphyses are resorbed, but also the diaphyses of the bones of the joints involved in the pathological process. Sometimes the lesion affects not only all joints of the hands and feet, but also the diaphysis of the bones of the forearm (Fig. 2).
X-ray changes in the spine in patients with PA include:
- osteoporosis of the vertebrae;
- paraspinal ossifications;
- ankylosis and erosion of the intervertebral joints;
- deformation of the vertebrae;
- syndesmophytes;
- decrease in the height of the intervertebral discs;
- multiple osteophytosis (lateral, anterior, posterior corners of the vertebrae);
- sharpening and elongation of the edges of the uncovertebral joints;
- Schmorl's hernia.
The defeat of the spine and sacroiliac joints during X-ray examination can be detected in 57% of patients, most of whom Clinical signs sacroiliitis and spondyloarthritis are absent. In other words, spondyloarthritis proceeds hidden, which must be borne in mind when examining a patient. Sacroiliitis is most often 1-sided, although there is also a 2-sided symmetrical process with ankylosing of the sacroiliac joints, as in true AS.
Thus, radiographic features that help distinguish PA from other inflammatory rheumatic joint diseases are as follows:
- asymmetry of damage to the joints of the hands;
- arthritis on radiographs may be without periarticular osteoporosis;
- isolated lesion of the distal interphalangeal joints of the hands with no changes or minor changes in other small joints of the hands;
- axial lesion of 3 joints of one finger;
- transverse lesion of the joints of the hands of the same level (1- or 2-sided);
- destruction of terminal phalanges (acroosteolysis);
- terminal narrowing (atrophy) of the distal epiphyses of the phalanges of the fingers and metacarpal bones;
- bowl-shaped deformation of the proximal part of the phalanges of the fingers together with the terminal narrowing of the distal epiphyses - a symptom of "pencil in a glass";
- bone ankylosis, especially proximal and distal interphalangeal joints of the hands;
- multiple intra-articular osteolysis and destruction of the epiphyses of bones with multidirectional joint deformities (mutilating arthritis);
- inflammatory changes in the sacroiliac joints - sacroiliitis (usually unilateral asymmetric or bilateral, possibly no sacroiliitis);
- changes in the spine (asymmetric syndesmophytes, paravertebral ossifications).
Gout is a systemic disease associated with a violation of purine metabolism, deposition of urates in the articular and / or periarticular tissues and inflammation that develops in connection with this.
In acute arthritis, specific changes on radiographs are not detected. X-ray changes characteristic of gout usually develop no earlier than 3 years from the onset of the disease. At the same time, signs of destruction, degeneration and regeneration can be observed.

For gout, intraosseous cystic formations of various sizes are typical, caused by tophi, which can be located inside the joint, but, which is especially noteworthy, next to it and even at some distance. Chronic gouty arthritis may be accompanied by cartilage destruction (narrowing of the joint gap) and the development of marginal bone erosions. The so-called "punch symptom" - marginal bone erosions or cystic formations correct form with clear, sometimes sclerosed contours - observed in gout infrequently and is nonspecific for it. For this disease, a pronounced destruction of not only the subchondral bone area, but also the entire epiphysis and even part of the diaphysis (intra-articular osteolysis) that occurs over time, is more characteristic. In this case, a significant expansion of the “corroded” articular sections of the bones and sharpening of their edges can be observed. Bone ankylosis in gout has been described but is extremely rare (Fig. 3).

Localization of radiographic changes is always peculiar in gout. Usually the most pronounced pathology is found in the joints of the feet (primarily in the joints thumbs) and brushes. A rare but known localization of radiological changes in gout are the shoulder, hip, sacroiliac joints and spine. It is important to note that destructive changes in the joints or intraosseous cysts are considered as a sign of "tofus" gout.

Bone changes in gout rarely decrease on the background specific therapy over time, they may even increase slightly. Tophi located in soft tissues may also be detected by radiography, especially if they are calcified, which is noted infrequently.

Thus, in the diagnosis of joint diseases, no doubt, the X-ray method should be used, especially in the daily practice of a doctor. primary care, since each of the diseases has its own characteristic radiological signs only for it. Knowledge of the features of the X-ray picture of arthritis, of course, can help the practitioner in making the correct diagnosis.

Literature
1. Nasonov E.L. Clinical guidelines. Rheumatology. M.: GEOTAR-Media, 2008.
2. Kishkovsky A.N., Tyutin L.A., Esinovskaya G.N. Atlas of laying in X-ray studies. L .: Medicine, 1987.
3. Lindenbraten L.D., Korolyuk I.P. Medical radiology (basics radiodiagnosis and radiotherapy). 2nd ed., revised. and additional M.: Medicine, 2000.
4. Agababova E.R. Differential diagnosis of seronegative arthritis // Ter. archive. 1986. V. 58. No. 7. S. 149.
5. Zedgenidze G.A. Clinical radiology. M., 1984.
6. Nasonova V.A., Astapenko M.G. Clinical rheumatology. M., 1989.
7. Sidelnikova S.M. Issues of pathogenesis, diagnosis and differential diagnosis seronegative spondyloarthritis // Ter. archive. 1986. V. 58. No. 6. S. 148.
8. Badokin V.V. Rheumatology. M.: Litterra, 2012.
9. V. A. Molochkov, V. V. Badokin, and V. I. Albanova, Russ. and others. Psoriasis and psoriatic arthritis. M.: Association of Scientific Publications KMK; Author's Academy, 2007.

The disease inevitably progresses, causes pathological changes in internal organs and threatens with disability. Proper examination helps to avoid a false diagnosis, slow down the progression of the disease.

Criteria for diagnosing gout

Joint diseases have similar symptoms, have a latent course and inevitably become chronic. This significantly complicates the differentiation of ailments, prevents timely treatment. In 1961, the global medical community defined general diagnostic criteria for gout:

• increased concentration of uric acid in the blood, urine, joint fluid;
• having a history sudden attacks acute arthritis lasting up to 1-2 days;
• detection of uric acid crystals, urates in soft tissues, articular cavity;
• visual detection of salt deposits - .

The detection of two or more criteria from the above list is a strong basis for the diagnosis of gout. American scientists have expanded this list to 12 items:

• excess content of uric acid and salts;
• pathological absence of microflora in the synovial fluid;
• the presence of non-erosive subcortical cysts on x-rays;
• the presence in the history of the disease 2 or more attacks of gouty arthritis;
• the acute phase during attacks is observed on the first day;
• prolonged inflammation in the metatarsophalangeal joint on the legs;
• unilateral form of damage to the joints on the foot;
• asymmetric type of joint damage;
• signs of arthritis in one joint of the foot;
• hyperemia (redness) of the skin in the joint area;
• confirmed presence of tophi;
• damage to one metatarsophalangeal joint.

On a note!

The diagnosis of gout is made by the presence of six of these criteria or by the presence of uric acid and urate crystals in tophi (or synovial fluid).

Clinical picture and external examination

When making a diagnosis, the collection of data for anamnesis plays an important role. Studying the medical history, the doctor receives valuable information for identifying the disease. To diagnose gout, it is necessary to distinguish it from similar diseases (, rheumatism,). An external examination establishes the following facts:

• the time of onset and duration of the first symptoms;
• change appearance joint - swelling, redness, deformity;
• the presence of surgical operations, injuries, pathologies;
• burdened heredity and predisposition;
• the patient's lifestyle, habits.

On a note!

The clinical picture of a chronic, long-term disease often has a pronounced, clearly defined character. An experienced specialist is able to determine gout without analysis, guided by his own experience, skills and knowledge. However, most often a preliminary diagnosis is made, which requires confirmation and justification by an appropriate examination.

Features of differential diagnosis

At the first signs of damage to the joints on the legs, a rheumatologist, surgeon, traumatologist is required. After studying the clinical picture, the doctor decides what tests to take for gout. Differential diagnosis allows you to accurately determine the causes of the disease according to the results of laboratory tests of blood, urine, and instrumental examination.

Laboratory tests

The first stage in the diagnosis of any disease is a laboratory study of blood and urine. The results of the analysis indicate changes in the composition, rheological properties of liquids. These data allow us to suggest the cause, patterns of development of the disease. To identify gout you will need:

• results of a general blood test, urine;
• data of their biochemical research;
• the results of studying the composition of the joint fluid;
• study of the contents of tophi.

Results of a general blood test

A constant excess of uric acid and crystallization of urates is accompanied by metabolic disorders, inflammatory processes in the joints. These factors inevitably lead to a change in the chemical composition of fluids in the body. Indicators of a blood test for gout by general parameters:

• increase in the proportion of neutrophils;
• change in the leukocyte formula;
• decrease in the number of lymphocytes;
• an increase in the erythrocyte sedimentation rate (ESR).

On a note!

At the initial stage of gout in the general blood test, deviations from the norm may not be observed.

Features of a biochemical blood test

At full biochemical research blood is set to the value of different indicators. Them certain change, the ratio suggests the presence of gout and determine the degree of neglect.

Established and generally accepted norms of blood parameters:

Tests for gout (indicator)	Children (1-14 years old)	Men	Among women
The amount of total protein	48-82 g/l	64-83 g/l
Albumin content	33-55 mg/l	33-50 mg/l
Content of C-reactive protein	Missing	up to 0.5 g/l
Creatinine value	35-110 µm/l	63-115 µm/l	54-97 µm/l
Importance of uric acid	0.15-0.28 µmol/l	0.13-0.21 µmol/l	0.16-0.41 µmol/l
Importance of calcium	0.94-1.16 mmol/l	1.04-1.27 mmol/l	2.14-2.5 mmol/l
The value of total bilirubin	17- 67 µmol/l	3.5-20.7 µmol/l	3.41-17.0 µmol/l
Importance of high density lipoprotein cholesterol	0.9-1.9 mmol/l	0.7-1.83 mmol/l	0.9-2.2 mmol/l
The Importance of Low Density Lipoprotein Cholesterol	1.6-3.5 mmol/l	2.1-4.7 mmol/l	1.91-4.5 mmol/l

results biochemical analysis blood tests for uric acid in gout are overestimated. For self-diagnosis and the establishment of hyperuricemia, increased levels of C-reactive protein, sialic acids, and fibrin are taken into account. If there is a suspicion of dysfunction of the kidneys, the urinary system, the value of bilirubin, prothrombin, and liver enzymes is studied.

The results of a general urine test

With hyperuricemia, there is an increase in the level of uric acid, urates in the urine, crystallization of salts in urinary tract, kidneys, bladder. General analysis is effective with concomitant. According to the results of a urine test for gout, it is established:

• increased concentration of uric acid;
• alkaline pH>7 per late stage gout;
• deviation in color due to changes in the composition;
• the presence of urate crystals in the dry residue of urine;
• detection of protein molecules (albumin);
• small amounts of blood, epithelium.

The study of synovial fluid

An important step in the differential diagnosis of gout on the legs is the study of the articular (synovial) fluid. Its composition is close to blood plasma, it differs in the content of hyaluronic acid. The norm is the presence of cholesterol, cells (synovocytes, lymphocytes, monocytes, neutrophils). Synovial fluid is removed from the joint cavity by puncture for bacteriological, bacterioscopic examination. Changes in its indicators indicate gout:

• violation of color, density, viscosity;
• the appearance of turbidity, mucin clots;
• deviation from the norm pH=7.3 to 7.6;
• detection of erythrocytes, leukocytes;
• the appearance of phagocytes, destroyed cells;
• study of synoviocytogram;
• crystals of urates, phosphates.

X-ray examination

In chronic and advanced forms of gout, radiography is prescribed. The method is effective for diagnosing a disease on the legs, establishing the stage of the disease and detecting complications. X-ray reveals irreversible changes in the structure of the bones, cartilage of the affected joints. Typical x-ray signs of gout:

Researched elements	Picture in the picture	Pathological processes
Soft tissues (muscles, membranes)	Local dimming with a blurred outline.	Thickening of tissues due to inflammation, crystallization of urates.
Articulation bones	Visual deformation of the bone surface, detection of an overhanging edge or swelling of the edge, areas with darkening.	Erosion, destruction of the bone surface, cartilage, crystallization of urates around and inside the bones.
joints	A symptom of a punch with gout is lightened areas with a diameter of 0.3-3 cm on an x-ray of a diseased joint.	Formation of intraosseous tophi, destruction of bone tissue in the late stage of gout.

Other diagnostic methods

To establish the diagnosis of gout, medicine uses modern methods diagnostics. They reveal additional signs of the disease used to confirm the diagnosis:

• Ultrasound, tomography (computer, magnetic resonance) - during the period of exacerbation, they are used to detect narrowing of the interarticular gap, inflammation, compaction of soft periarticular tissues, joint deformity, pathology in the kidneys and ureter;
• Biopsy - a detailed study of the intra-articular fluid to determine the excess uric acid in the synovial fluid in the problem joint.

How to prepare for analysis

There are cases of false indicators of a blood test for gout, biased results of a study of urine, joint fluid. Reliability, information content of laboratory research increases with proper preparation for the delivery of biological material:

• 3 days before the tests, follow a strict diet - exclude foods prohibited for gout;
• refuse to take vitamin C for 10 hours;
• do not drink diuretic drugs per day;
• do not engage in sports activities for 3 days;
• All tests are taken on an empty stomach, early in the morning.

Following these rules eliminates the possibility of distorting the results of analyzes and setting misdiagnosis.

Common systemic diseases, which are related to the violation of purine metabolism, gout. X-ray is one of the ways to detect this pathology. The diagnostic procedure is informative only if structural changes have already occurred in the joint. Laboratory tests help to confirm the correctness of the results of the X-ray examination.

If you experience pain in the joints, you should immediately seek help from a specialist. Such diseases are treated by doctors of different specializations. With complaints of discomfort in the joints, it is customary to go to an appointment with a general practitioner, nephrologist, hepatologist or rheumatologist. The latter option is considered more optimal.

To understand what exactly worries the patient, he first of all needs to undergo a full examination in the clinic. The referral for diagnostic procedures is issued by the doctor in whom it is observed. Several types of tests will be required:

• If you suspect gouty arthritis, you need to take a urine test. In the case of a joint lesion, an increased urate content will be detected in the sample. In addition, during periods of exacerbation of pathology, urine acquires a brown color. The presence of a large volume of uric acid confirms the course of gout in a patient. Another clear sign of the disease is increased acidity.
• A complete blood count is also one of the mandatory diagnostic measures. During periods of exacerbation, accelerated erythrocyte sedimentation is detected in the sample. There is also an increase in the number of leukocytes. All these results indicate the development of an acute inflammatory process in the human body, which needs to be combated. The results of a blood test do not change in periods between excesses.
• Biochemical analysis of urine reveals the presence of an increased amount of uric acid. If its content is normal, then the kidneys are working properly. An increased or decreased volume of this substance indicates failures on the part of this organ.
• An analysis of the content of uric acid in the blood should be done before the start of therapy and after its completion. As a result, the indicators should not exceed the permissible norms. In women, it is 360 µmol/l, and in men it is 420 µmol/l.
• With an exacerbation of gout in a person, the amount of C-reactive protein increases several times. To check its content, rheumatoid tests are required. With their help, it is possible to determine the rheumatic factor, which makes it possible to exclude the development of other diseases with similar symptoms in the patient.
• Desirable diagnostic measures include analysis of tophi and synovial fluid. They are prescribed only in extreme cases.
• One of the most important procedures with gouty symptoms is an X-ray examination. Thanks to him, the whole picture of joint disease becomes clear. An x-ray of a joint affected by gouty arthritis helps to determine the presence in the joint pathological changes, which are caused by formations from salt crystals. In the case of gout of a chronic nature, light spots will be clearly visible in the picture, indicating the location of the lesion.

What does an x-ray show for gout?

On x-rays, manifestations of such arthritis are clearly visible. On radiographs, the specialist recognizes places where there is an accumulation of salt crystals. Therefore, when symptoms of this disease appear, the doctor first of all sends the patient to undergo such an examination. It makes it clear whether there are indeed signs of gout, and not other articular pathology.

The main essence of the diagnostic procedure is the absorption of rays by the tissues of the affected area. This area is then projected onto film or a computer monitor. The information received is processed by the doctor. Based on the conclusions made, he can judge the current state of the patient and select the optimal treatment for him.

X-rays help to determine the degree of destruction of bone structures in gout.

X-ray signs of gout

X-rays help to accurately determine the type of disease, this type of diagnosis is one of the most accurate.

The swelling of soft tissues, characteristic of the disease, helps to determine arthritis in the early stages of development. The development of inflammation of the bone substance is not excluded. Due to the active course of the disease, bone destruction occurs. Destructive processes can occur both inside the joint and outside it.

X-ray manifestations of articular disease are primarily observed along the edges of bone structures. They take the form of a kind of shell or shell. There is a whole classification of stages according to the signs of gout, which can be seen on an x-ray:

• First stage. Cysts and accumulations of urates form in the affected area. Soft tissue thickening is observed.
• Second stage. In the joint area, large cysts characteristic of the pathology are formed. Erosive processes also begin on the articulation surface.
• Third stage. Fabrics are subject to severe erosion. It can occupy about a third of the entire joint. As a result, there is a partial destruction of the bone and the deposition of salt crystals in the empty cavities.

X-ray changes are usually observed during the 1st and 2nd stages of gouty arthritis. They are formed over 9 years. After about 10-15 years, irreversible damage occurs in the joint area. If the patient begins to properly treat his disease in a timely manner, then he will be able to avoid negative consequences and serious complications, which can even lead to disability.

Timely recognition of the pathological process in the joint helps in a short time to defeat the disease and prevent its transition to a chronic form.

Where to get x-ray

When prescribing a referral for an X-ray examination to a patient with suspected gouty arthritis, the doctor will immediately tell him where exactly this diagnosis can be made. As a rule, x-rays are done in the same clinic where the appointment was made. Such diagnostics are carried out by public and private medical institutions who have the necessary equipment.

The cost of a joint x-ray for gout depends on where exactly the diagnosis is made. Usually the price of the procedure is in the range of 800-2500 rubles.