Physical Therapy And Rehabilitation

Inflammatory joint rheumatism is a general term and not a single disease; there are nearly 200 rheumatic diseases. Of these, inflammatory rheumatism is the most common;

• Rheumatoid Arthritis (RA),
• Spondyloarthropathies (SpA) (such as Ankylosing Spondylitis (AS), Psoriasis Rheumatism (PsA), Reactive Arthritis and arthritis due to Inflammatory Bowel Disease),
• Connective Tissue Diseases (Systemic Lupus Erythematosus and Sjögren’s Syndrome etc.).
• In addition, diseases such as Behçet’s Disease, Familial Mediterranean Fever (FMF) and Gout are also defined as “inflammatory” rheumatic diseases.

What Causes Inflammatory Joint Rheumatism?

Most of these types of diseases are autoimmune and immune system-induced diseases. Most of these inflammatory ones are known for the mechanisms by which the immune system and / or inflammatory mechanisms work inappropriately and the body creates a disease against itself. Most diseases caused by a genetic predisposition are triggered by an external factor. Joint pains and symptoms that can cause permanent damage to the body can develop.

What are the general symptoms of inflammatory rheumatism?

• Swelling in the Joints
• Joint Pain
• Limitation of movement in the joints
• Morning stiffness
• Low back/hip or back pain (if there is inflammation of the spine such as spondyloarthropathy)
• Loss of function in joints
• Skin Rashes or Dry Eye (in Connective Tissue Diseases)
• Recurrent sores/shafts in the mouth (Behçet’s Disease)
• Recurrent Abdominal Pain and Fever (FMF/Familial Mediterranean Fever)
• Inflammatory rheumatism of the big toe (Gout)

Which Department Treats Inflammatory Joint Rheumatism Diseases?

A rheumatologist (rheumatologist) provides services for rheumatic diseases. A rheumatologist is a doctor who specializes in the diagnosis and medical treatment of arthritis and other rheumatic diseases. In a more limited sense, a rheumatologist is a doctor who has completed a specialization in internal medicine (5 years) followed by training in rheumatology (3 years); a rheumatologist focuses on diagnosing rheumatic disease before treating it. “Inflammatory joint rheumatism” is a general term and refers to all types of arthritis and rheumatism. In addition to inflammatory systemic (involving the whole body) and joint-specific rheumatic diseases, degenerative, metabolic and mechanical musculoskeletal problems also fall within the specialty of the Rheumatologist. Since the rheumatologist is an internal medicine specialist, he/she has the infrastructure to solve most of the internal organ (heart, kidney, lung, liver, gastrointestinal tract, etc.) problems that can be seen frequently in rheumatism patients due to the disease itself or treatments.

How is Inflammatory Joint Rheumatism Diagnosed?

First of all, the rheumatologist inquires about the medical history and complaints and takes an anamnesis. He or she then focuses on the Physical Examination, not only physically examining the joints, but also paying attention to systemic findings that may affect the whole body. Often, a single test is not enough to make a definitive diagnosis of inflammatory rheumatism. The rheumatologist may order several blood tests or imaging tests (X-ray, ultrasound or MRI) to confirm the clinical findings and to confirm the diagnosis.

What are the tests for inflammatory rheumatism?

• Rheumatoid Factor (RF): High levels (positive) of rheumatoid factor are associated with autoimmune diseases, especially inflammatory rheumatism.
• Anti-Citrullinated Cyclic Peptide (Anti-CCP) Antibody test: A positive anti-ccp antibody in combination with RF confirms rheumatoid arthritis and provides prognostic information. Individuals with this antibody are generally considered to have rheumatism.
• Anti-Nuclear Antibody (ANA) test: This test is done to see if the body produces autoantibodies, the presence of which highlights a possible autoimmune disease and consideration of Connective Tissue Disease.
• Anti-ds DNA Antibody: An autoantibody specific for Systemic Lupus Erythematosus.
• Anti-SSA/SSB Antibodies: An autoantibody test that appears in the Connective Tissue Disease known as Sjögren’s Syndrome.
• HLA-B27 Genetic Testing:
• Erythrocyte Sedimentation Rate (also known as Sedim or ESR): Helps to determine the level of inflammation in the body. It is usually high in inflammatory joint rheumatic diseases, but may not always be high.
• C-Reactive Protein test (CRP): Like the ESR, it detects the presence of a serious infection or inflammatory rheumatism somewhere in the body. High levels of CRP in the blood are usually elevated in patients with inflammatory joint rheumatism, but like ESR, it may not always be elevated despite the presence of rheumatism.

Is there a cure for inflammatory rheumatism?

In general, there is no treatment that completely cures inflammatory rheumatism, but there are many treatments that can put the disease into remission, reduce joint pain and improve quality of life. The priority of the rheumatism specialist is always to reduce and prevent inflammation in the body. Reducing inflammation helps prevent permanent damage to both joints and internal organs. Different medications and various methods are used to treat inflammatory rheumatism. Some of these include;

• Cortisone and non-cortisone anti-inflammatory drugs,
• Classical medicines for inflammatory rheumatism (DMARDs) that change the course of the disease: especially those containing Sulfasalazine, Hydroxychloroquine and Methotrexate,
• Biologic Agents (bDMARDs): This new generation of rheumatism drugs is often used in people who do not respond to conventional rheumatism drugs and is very effective in reducing inflammation,
• Complementary Medicine Methods (e.g. Ozone Therapy, Laser Treatments)
• Pilates, Hydrotherapy, Aqua/Pool Treatments and Exercise types performed under the supervision of a Physical Therapy and Rehabilitation and PTR specialist,
• Special Nutrition

What is needed for successful treatment of inflammatory rheumatism?

Early diagnosis is very important for successful treatment of rheumatism. Early diagnosis requires a long examination process and follow-up of the patient. Because the symptoms change during the period when the complaints decrease or increase. The type of treatment varies from person to person and each patient should be treated differently. Long-term treatment may be required as a result of chronic diseases. As a result of medication and physiotherapy under the supervision of a doctor, the disease cannot be completely eliminated, but its progression is stopped and the patient’s life is made easier by relieving pain.

In drug treatment, drugs are used to relieve the patient’s pain, to stop the disease or to relieve swelling and pain. These drugs affect the inflammation caused by rheumatism. In addition, muscle relaxants, vitamin supplements and blood pressure lowering drugs are used to eliminate other symptoms. These medicines should be taken with plenty of water. It should also be noted whether there are side effects (some drugs can prevent pregnancy). Rheumatism treatment methods include medication, intra-articular injections, physical therapy and surgery. The most important aspect of a rheumatologist’s role and service is to manage which treatment, when, how and for how long. Therefore, treatment options should be made under the direction of a rheumatologist.

What are the Types of Inflammatory Rheumatism?

The most common inflammatory rheumatisms;

• Rheumatoid Arthritis (RA),
• Spondyloarthropathies (SpA) (such as Ankylosing Spondylitis (AS), Psoriasis Rheumatism (PsA), Reactive Arthritis and arthritis due to Inflammatory Bowel Disease),
• Connective Tissue Diseases (Systemic Lupus Erythematosus and Sjögren’s Syndrome etc.).
• In addition, diseases such as Behçet’s Disease, Familial Mediterranean Fever (FMF) and Gout are also defined as “inflammatory” rheumatic diseases.

What is Rheumatoid Arthritis (RA)?

Seropositive Rheumatoid Arthritis: The most common type of inflammatory rheumatism. It can have more severe and serious symptoms than other types of rheumatism. General symptoms include swelling and pain in the small joints (fingers or wrists), stiffness in the joints for more than 30 minutes in the morning and a feeling of stiffness that decreases with movement, general weakness and fatigue. In uncontrolled patients, swelling, redness and sensations of warmth in the joints of the hands and/or wrists may also be present.

What are the diseases of the Spondyloarthropathy (SpA) group?

Spondyloarthritis or Spondyloarthropathy (SpA) is the name given to a group of rheumatic diseases. This group of diseases affects approximately one in a hundred patients in the population. The symptoms of SpA are very diverse, but they usually start in the joints we call sacroiliac joints (the joint between the coccyx and pelvis). In addition to the sacroiliac joints, the joints of the spine, peripheral joints (such as the knee, hip, shoulder and ankle), and the points where tendons and ligaments attach to the bones (especially heel and sole pain) are also involved. Patients with this group of SpA also suffer from psoriasis of the skin, inflammation of the eyes known as uveitis and inflammatory bowel disease. The main diseases in the SpA group are Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Reactive Arthritis and Enteropathic Arthritis (Enteropathic Arthritis) due to Inflammatory Bowel Disease.

What are Connective Tissue Diseases, especially Systemic Lupus Erythematosus (SLE) and Sjögren’s Syndrome?

What is Systemic Lupus Erythematosus?

Systemic lupus erythematosus (also referred to as SLE or just lupus) is a disease that causes different health problems. It can cause skin rashes, arthritis, anemia, epileptic seizures or psychiatric illness and often affects internal organs such as the kidneys, lungs and heart. Once a disease with a high mortality rate, it has now become a chronic (long-lasting) disease. In 1954, the survival rate after 4 years of illness was 50%; today it is over 97%.

Cause

SLE is a chronic (long-lasting) inflammatory disease caused by abnormal functioning of the immune system, which is normally responsible for protecting the body against infections and cancer. In SLE, the immune system overworks and produces large amounts of abnormal antibodies. These abnormal antibodies attack the patient’s candida tissues. The cause of lupus is not known exactly, but hereditary causes, environmental and hormonal changes are thought to play a role.

Impact on health

The prevalence of SLE is 40-50 per 100,000 people.

It is more common in some ethnic groups, for example black people.

More than 80% of people with lupus are women.

Diagnosis

• Because of the wide variety of symptoms, diagnosis is often difficult and requires the physician to be very careful. Typical features of SLE are:
• Butterfly-shaped skin blemish on the cheeks
• A skin blemish that appears on sun-exposed skin areas
• Sores in the mouth and nose
• Arthritis involving one or more joints
• Kidney inflammation
• Nervous system disorders such as epilepsy, mental illness and stroke
• Common symptoms include fever, weight loss, hair loss, poor circulation in the fingers and toes, chest pain when breathing deeply (pleurisy = inflammation of the lining of the lung) and abdominal pain.

Laboratory tests are very important in the diagnosis of SLE. In particular, the antinuclear antibody (ANA) test is always positive in SLE.

The disease can manifest itself slowly, so the final diagnosis is often delayed.

Treatment

The treatment of SLE depends on the clinical problems present and whether the disease is currently active. Earlier and more accurate diagnosis, a better understanding of the immune abnormalities in SLE and research into treatments will all contribute to improving the treatment of patients with SLE.

Regular medical evaluation is important in monitoring a patient with SLE. Medication should be adjusted for each patient according to their specific problems and the severity of the disease. If there is mild inflammation, non-steroidal anti-inflammatory drugs may help. Corticosteroids, the single most important drug in the treatment of SLE, should be used with caution. It is important to protect the bones when using steroids. Antimalarials (antimalarial drugs) such as hydroxychloroquine reduce the activity of the disease and help with skin and joint symptoms. More severe cases of SLE require immunosuppressive drugs such as azathioprine and cyclosporine. The disease often goes through periods of silence and little or no activity (remission), during which medications can be reduced and sometimes treatment can be stopped.

SJÖGREN’S SYNDROME

What is Sjögren’s syndrome?

Sjögren’s syndrome is a chronic, long-term disease characterized by symptoms of dry eyes and dry mouth.

It is named after Henrik Sjögren, the Swedish ophthalmologist who first described it.

It is often associated with rheumatic diseases such as rheumatoid arthritis, lupus erythematosus, scleroderma and polymyositis.

However, it occurs alone in about half of patients.

How does Sjögren’s syndrome develop?

The exact cause is unknown. There is evidence that genetic or viral infections can cause Sjögren’s syndrome through unknown mechanisms. It is thought that this disease is mainly caused by a disorder in the immune system. The immune system is the body’s defense mechanism against diseases. In Sjögren’s syndrome, there is a defect in the normal control mechanism of the immune system, resulting in an excessive production of white blood cells. These cells, called lymphocytes, travel to the lacrimal and salivary glands and destroy these tissues. This leads to a decrease in the secretion of both salivary glands and lacrimal glands, i.e. dryness. At the same time, these cells secrete protein substances called “autoantibodies”, which can be detected in the blood. These autoantibodies are an indication that the immune system is not working properly and have the potential to damage the salivary and lacrimal glands. Sjögren’s syndrome can also involve other organs such as joints, lungs, kidneys, nerves, thyroid, liver and brain.

Who has Sjögren’s syndrome?

Although Sjögren’s syndrome can occur at any age, it is most common in women over the age of 45. It is very rare under 20 years of age.

What are the symptoms of Sjögren’s syndrome?

It usually starts slowly. The patient feels severe dryness in the eyes and mouth. Many also have a dry cough and a tickling sensation in the throat. Swelling of the salivary glands, impaired sense of taste and smell may be observed. Eyes develop redness, burning, itching and hypersensitivity to light due to dryness. If not treated appropriately, ulcers on the outermost transparent membrane of the eye called “cornea” and rarely blindness may develop. Patients with Sjögren’s syndrome may also experience dryness in the nose, skin and female genital organs.

Dry mouth may cause difficulty in chewing, swallowing and speaking. Therefore, patients should drink plenty of fluids.

Dental caries is also common in patients. This is because saliva is a fluid that fights against bacteria and prevents cavities from forming. In Sjögren’s syndrome, saliva secretion is impaired, making it easier for cavities to form.

Sometimes patients develop a type of lymph node cancer called “lymphoma”. Although it is rare, it should be kept in mind during the examination and follow-up of patients.

How is Sjögren’s syndrome diagnosed?

This diagnosis should be suspected in patients who feel dryness in the mouth and eyes. During the examination, findings such as red and itchy eyes, swollen salivary glands, dry tongue and enlarged lymph nodes in the neck may be detected. The presence of autoantibodies in blood tests also supports the diagnosis.

Dryness in the eye is detected with the “Schirmer test”. Examination of the cornea by an ophthalmologist will also provide information about dryness.

A “sialogram” can be performed to check whether the salivary glands are working properly. This test is done by injecting dye into the salivary gland and then taking special films. For a definitive diagnosis of Sjögrens syndrome, a lip biopsy, i.e. a small piece of the small salivary glands in the lip, should be taken and evaluated under a microscope for the presence of lymphocytes.

Monitoring of lung and kidney function with both direct radiographs and laboratory tests may be helpful.

How is Sjögren’s syndrome treated?

Although there is no definitive diagnosis of this disease, patients’ complaints can be relieved and their quality of life can be improved with specific treatments for the symptoms. Since not all patients have the same symptoms, the treatment program should be planned individually by the physician according to the needs of the patient. Regular medical and dental check-ups are essential.

• Artificial tears and eye drops can be used for dry eyes.
• One of the most effective ways to relieve dryness in the mouth is to drink plenty of fluids. Special chewing gums (provided they are sugar-free to prevent decay), toothpastes and regular tooth brushing will also help patients.
• If the skin is dry, moisturizers recommended for sensitive skin can be used. It may be recommended to use steam machines that humidify the steam air at home and at work.
• Non-steroidal antirheumatic drugs may be used to prevent swelling, stiffness, muscle pain and joint inflammation. Cortisone may also be recommended in severe patients, but it is recommended to be taken under the supervision of a physician due to the severity of side effects. If patients have another rheumatic disease (such as rheumatoid arthritis, lupus, etc.), its treatment is also essential.
• Light exercises such as walking and swimming are beneficial for maintaining the elasticity of muscles and joints. Since exercises also have a preventive effect on joint damage, they should be included in the treatment program. Patients should also be given information about their disease and advice on how to reduce stress.
• A certain “antibody” in the blood of female patients with Sjögren’s syndrome is rarely associated with heart problems in newborn children. Therefore, women who are pregnant or who want to have a child should consult their doctor about this.
• Sjögren’s syndrome is generally not life-threatening. However, dryness in the mouth and eyes is long-lasting and may persist for the rest of life. The use of artificial moisturizers and attention to dental hygiene can often prevent serious problems.

BEHCET DISEASE

What is Behçe disease?

First described in 1937 by Dr. Hulusi Behçet, a Turkish professor of dermatology, Behçet’s disease is a chronic disease that causes sores (aphthae, ulcers) in the mouth and genital areas and inflammation in the eye.

In some patients, it also causes arthritis, inflammation and blockage of blood vessels, inflammation in the digestive tract, brain and spinal cord.

Behçet’s disease presents differently in each patient. In some patients, the disease is mild and there are only ulcers in the mouth and genital area.

In others it is more severe and can cause meningitis (inflammation of the membranes surrounding the brain). Severe symptoms usually appear months or even years after the first symptoms begin. Symptoms may persist for a long time or may go away in a few weeks. Typically, symptoms appear, disappear and reappear (flare-up periods).

Cause

The cause of Behçet’s disease is not known exactly. Most of the symptoms are caused by inflammation of the blood vessels. This inflammation of the blood vessels is thought to be caused by the immune system, but it is not known what initiates this reaction.

Behçet’s disease is not contagious. In addition to a defective immune system, hereditary causes are thought to play a role in its development. Environmental factors (such as viruses or bacteria) are also thought to initiate the disease in susceptible individuals.

Behçet’s disease is common in countries along the “silk road” (Mediterranean region, Turkey, Iran, Asian countries, Far East, Japan). Although it tends to start in the 20s and 30s, it can occur at any age. The “pathergy test”, which involves pricking the skin with a needle using a certain method, can be used in the diagnosis, but this test is positive in only 40% of patients.

Treatment

Although there is no cure for Behçet’s disease, it is often possible to control the symptoms with appropriate medication. The aim of treatment is to reduce symptoms and prevent complications such as disability or blindness. The choice of medication and the duration of treatment depends on the patient’s condition. Some symptoms may require a combination of several treatments to relieve them.

• Topical (local, regional) treatment: To relieve pain and discomfort, ulcers can be treated with corticosteroids to reduce inflammation or pain ointment to reduce pain. Mouthwash can be prescribed for mouth ulcers.
• Oral medications: Depending on the severity of the patient’s symptoms, corticosteroids such as prednisolone, immunosuppressive drugs such as azathioprine, chlorambucil, cyclosporine, colchicine may be prescribed. If these drugs are not effective on the symptoms, other drugs such as cyclophosphamide or methotrexate may be prescribed.

Flare-ups can occur even if treatment is effective.

What is Familial Mediterranean Fever – FMF?

Familial Mediterranean Fever (FMF) is a disease with a predominantly hereditary characteristic seen in Turkey, North African countries, Armenians, Arabs and Jews. It is known as Familial Mediterranean Fever (FMF) in the medical literature. The main characteristic of the disease is recurrent acute (sudden onset), short-term, painful attacks of peritonitis (inflammation of the peritoneum), pleuritis (inflammation of the pleura) or arthritis (inflammation of the joints), which may be accompanied by a skin rash. In some patients, the kidney may be affected and this is called amyloidosis. Rarely, kidney involvement and vascular inflammation can occur in addition to amyloidosis. Kidney involvement can lead to kidney failure.

Cause

Recently, a mutation (change) in a gene called “Pyrin” has been found in this disease, but the exact cause is not known.

Diagnosis

In patients with an attack, the diagnosis is based on clinical signs, family history, examination findings and laboratory tests. The benefit of genetic analysis in patients is limited, as mutations identified to date have only been found in 80% of patients with AAA. However, genetic analysis may be useful in atypical cases.

Treatment

Continuous treatment with colchicine 1-2 mg daily has been found to prevent attacks and the development of amyloidosis in a significant proportion of patients. However, amyloidosis is still a serious problem in patients who do not comply with treatment or who are late in starting colchicine. It is not known how colchicine prevents attacks or prevents the development of amyloidosis. In some patients treated with colchicine, the frequency of attacks does not change, while the development of amyloidosis stops. Therefore, colchicine treatment should be lifelong. Colchicine treatment is known to be a safe, appropriate and vital treatment for patients with AAA. It is recommended even if the patient becomes pregnant. Although colchicine has not been shown to have a harmful effect on the baby, amniocentesis (taking a sample from the water sac containing the baby) and genetic examination of the fetus are recommended for pregnant AAA patients.

What kind of disease is gout and is it a rheumatic disease?

Known as “the disease of kings and the king of diseases”, gout has been the subject of many studies since at least the time of Hippocrates and has affected countless people. Gout is a disease characterized by sudden, severe attacks of pain, tenderness, redness, swelling and increased temperature in some joints. It usually affects one joint at a time and this joint is usually the big toe joint. Other joints such as the knee, elbow and wrist can also be affected.

Attacks develop very quickly and the first attack usually occurs at night. It is the most painful of all types of rheumatism.

Attacks can develop for the following reasons:

• Too much alcohol intake
• Too strict diet and starvation
• Overeating of certain foods
• Having an operation (even a simple procedure such as tooth extraction can be the cause)
• Sudden, severe illness
• Excessive fatigue and worrying excessively for any reason
• Joint trauma, injury
• Administration of chemotherapy
• Taking diuretic drugs

(Diuretics are drugs used in high blood pressure, which provide fluid excretion from the body)

Remember!

If you have gout and after a minor injury or trauma your joint is very painful and takes longer than expected to heal, consider that it may be a gout attack.

Any event that disturbs your body system can trigger a gout attack. Be alert for early signs of an acute attack, because the earlier treatment is started, the better.

What causes gout?

Gout is caused by an excess of uric acid in the body. Uric acid is also present in the blood of healthy people as a breakdown product of various chemical processes.

However, an excess of uric acid is caused either by an excess of uric acid production, a low excretion rate by the kidneys or an excess intake of purines, which are converted into uric acid in the body, in certain foods. Red meat, seafood and legumes are rich in purines.

Alcoholic drinks also significantly increase uric acid levels. The view that gout is caused by eating and drinking too much is not correct. Eating too much of certain foods or gaining too much weight can make gout attacks more frequent.

Problems related to the chemical processes that uric acid undergoes in the body may be inherited in families or may occur as a complication of another disease. This problem is passed on from parents or grandparents. But environmental factors can also play a role. In addition, not every member of the family has gout attacks.

Over time, excess uric acid in the blood leads to deposits around the joints. As a result, uric acid forms crystals inside the joints that look like sewing needles, which causes gout attacks. These crystals do not only form inside the joint. Uric acid can also appear under the skin, as tofus in the earlobe and as kidney stones in the urinary tract. Tofus looks like a small, white pimple.

What are the long-term risks?

The first gout attacks do not cause permanent joint damage and your joints remain completely normal. However, if a joint is repeatedly affected by gout attacks – which is now very rare with treatment – then uric acid crystals damage the joint and chronic arthritis can develop. In mild cases, attacks are very rare and the intervals between attacks can be measured in years and no permanent damage develops.

Gout is closely associated with obesity, hypertension, hyperlipidemia and diabetes. If gout is left untreated, kidney stones can form.

How is gout diagnosed?

Since various rheumatic diseases can mimic a gout attack and treatment is specific to gout, accurate diagnosis is very important. Physical examination and medical history are very useful for diagnosis.

Your doctor may order the following investigations

Blood test. The amount of uric acid in the blood is measured. However, this result can be misleading. This is because people with gout may have normal or even low levels of uric acid. At the same time, high levels can be found in healthy people, especially obese people.

Examination of joint fluid. The synovial fluid in the joint can be extracted by your doctor with a syringe and examined under a microscope for the presence of urate crystals. If these crystals are detected, the diagnosis of gout is confirmed. This test is particularly useful if the gout starts in an atypical way. For example, gout can sometimes mimic another rheumatic disease such as rheumatoid arthritis.

Direct radiography (X-ray) of the joints. You can have a radiograph of your joints if your doctor wants, but usually the result is normal and does not help with the diagnosis.

Remember.

Repeated attacks of gout can damage your joint and cause permanent arthritis. Modern treatment methods can prevent the development of arthritis.

How is gout treated?

Acute gout attacks are treated with anti-inflammatory analgesic drugs. These medicines reduce pain and relieve inflammation. They are usually well tolerated and do not cause significant side effects, as they are only used for a short period of time in gout. However, indigestion, stomach pain, nausea, rash and headache may sometimes develop. Asthma patients should also be careful when using these medicines. People with a history of ulcers should warn their doctor about this so that he or she can consider less harmful treatment options. Aspirin and aspirin-containing medicines should be avoided during acute attacks.

Another drug used in the treatment of acute attacks is colchicine. Colchicine is very effective but can often cause nausea, vomiting and diarrhea. Intravenous administration of this medicine reduces the incidence of these side effects. If your doctor decides to give you colchicine, he or she will recommend that you take it every 2 hours until the pain goes away or you develop side effects such as diarrhea.

It will be more effective if you take your medication at the onset of an attack. It is therefore helpful to keep the medicines recommended by your doctor at home and take them until you see your doctor when an attack develops.

By following your doctor’s advice carefully and exactly, a gout attack can be controlled quickly and successfully. A painful joint such as the big toe needs to be protected. It is helpful to place a cage-like structure over the foot to protect the joint from weights such as blankets and quilts.

Medicines recommended for acute attacks have no effect on blood uric acid levels. In other words, they do not prevent new attacks or the accumulation of uric acid in the joints. Therefore, if your attacks become more frequent, if you develop tofus/kidney stones or if blood tests show high levels of uric acid, your doctor may recommend medicines to lower blood uric acid levels. Such a decision requires you to take medication every day, whether you have an attack or not. There are various medications that are used as preventive treatment for this purpose. Examples include allopurinol, which blocks the formation of uric acid in the body, and probenecid, which helps the kidneys to excrete uric acid. Depending on the amount of uric acid in your urine, you can choose between these two types of medication. With the right treatment, gout can be very well controlled in almost all cases.

Remember.

Preventive treatment lasts a lifetime.

You should drink plenty of fluids.

If an attack develops during preventive treatment, treat the attack separately.

Diet

Diet used to be believed to be more important, but since the discovery of effective treatments, many people with gout have been able to eat and drink what they want. Offal such as liver and kidneys should be avoided, as some foods have a high concentration of cells and uric acid is produced by cell destruction. Protein-containing foods (especially meat) should be eaten in moderation; a certain amount of these foods is beneficial for everyone, not just gout sufferers. If you are overweight, losing weight is not only good for lowering urate levels in the blood but also for your heart. However, too strict dieting and starvation can also trigger attacks.

Alcohol

Drinking excessive amounts of alcoholic beverages is not the cause of gout, but it can trigger an attack. There are various rumors about which drinks you should and should not drink; do not take them seriously. However, sometimes patients report that a certain type of alcoholic beverage triggers their attack. In this case, the patient is advised not to drink that type of drink.

SOME QUESTIONS AND ANSWERS ABOUT Gout

Can women get gout?

Mostly men over the age of 40 are at risk for gout, but it can affect women at any age. Very rarely, gout can develop in older women after menopause. In particular, it can occur in women taking diuretics, which may be recommended to treat high blood pressure or heart disease. These drugs cause uric acid to be stored in the body. The development of gout in young women is very rare and requires special investigations.

Does gout cause serious joint disease?

It can only happen in the absence of treatment. Initially, the attacks are acute, the joint returns to its normal state. However, the deposition of uric acid can cause deformity and disability. The good thing is that this can be prevented with appropriate treatment.

Is uric acid stored in places other than joints?

It can be stored under the skin in other areas, for example in the ears and hands. It can also be stored in our internal organs, especially in the kidneys. This is why kidney tests should be checked when evaluating a patient with gout. For this, a urine sample

Can long-term intake of medicines that lower uric acid levels be harmful?

These medicines are quite safe. Sometimes they may need to be stopped because of skin rashes or heartburn. But otherwise they can be taken continuously without any side effects.

Are there other types of crystals other than uric acid that can cause joint disease?

A special type of calcium crystal can also be deposited in the joints like uric acid. It can cause acute attacks similar to gout, but in this case the knee joint is affected rather than the big toe.

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