Gout

What awaits you at Centrokinetic?

Centrokinetic welcomes patients, having a complete rheumatology department, a medical branch that deals with the diagnosis, treatment, and recovery of patients with non-surgical musculoskeletal disorders. These conditions are usually painful, acute, or, most often, chronic, preventing the proper functioning of the musculoskeletal system. They are generally called rheumatism or rheumatic and musculoskeletal diseases.

Most of the times, the patient's evaluation is complex, multidisciplinary, considering the systemic, generalized character of most rheumatological diseases, that is why Centrokinetic has experienced doctors:

• Rheumatologists: Dr.  Alizzi Khalid and Dr. Oana Olteanu.
• Medical rehabilitation doctors: Dr. Tache Georgiana, Dr. Edis Mustafa, Dr. Matei Adina, Dr. Czego Renata.
• Orthopedic doctors: Dr. Andrei Bogdan, Dr. Vlad Gican and Dr. Crintea Alexandru.
• Radiologists: Dr. Pantu Cosmin and Dr. Ghiea Sorin.
• Neurologists: Dr. Rotaru Bogdan, Dr. Simona Man and Dr. Simion Laurentiu.
• Doctor of nutrition and metabolism diseases: Dr. Elian Viviana.

What is gout?

Gout is a type of arthritis that causes inflammation, usually in a joint, which has a sudden onset. Gouty arthritis occurs due to the sedimentation of uric acid crystals in a joint, the most commonly affected being the metatarsophalangeal joint of the hallux.

Gout symptoms

Gout symptoms and signs include:

• nodules under the skin called tophi (uric acid crystals)
• joint redness
• swollen joints (swelling)
• joint pain
• local heat

The characteristic symptoms and signs of gout are the sudden  joint pain, swelling of the joints, heat in the affected area, and joint redness. The affected joint is often sensitive to touch, to the point where some people with gout attacks suffer from pain from something as simple as pulling bedding over the inflamed joint. 

The medical term for excessive fluid in a joint is a "joint spill." Gout frequently involves joints in the lower extremities, the classic location for the appearance of gout being the thumb of the lower limb (the first metatarsophalangeal joint). Gout can also affect the foot, knee, ankle, elbow, wrist, hands, or almost any joint in the body.

Diagnosis

The most reliable method to diagnose gout is to remove fluid from a swollen joint and examine it under a microscope to see if uric acid crystals are present.

The simplest method of diagnosis is to measure uric acid levels in the blood.

Chronic gout is treated with drugs that lower uric acid levels in the body. If left untreated, gout can cause irreversible joint damage and kidney problems. 

Factors that can trigger acute attacks (rashes) of gout include surgery, dehydration, drinks sweetened with sugar or fructose-rich corn syrup, beer, liqueur, red meat, and seafood. Cherries can help prevent gout attacks.

At Centrokinetic, our doctors will perform a complete clinical examination. You may have muscle and joint pain, stiffness after rest, and decreased mobility. The doctor will also do a complete, vascular, and nervous examination of the affected limb. 

Our medical team can complete the investigations to establish a correct diagnosis, with imaging investigations (musculoskeletal ultrasound, joint MRI), functional tests (electromyography), and arthrocentesis. Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

The osteoporosis diagnosis can be easily made by our doctors by recommending the dosage of uric acid in the blood. Gout is caused by high levels of uric acid in the bloodstream and the accumulation of uric acid crystals in the body's tissues. Uric acid is normally found in the body as a byproduct of how the body breaks down certain proteins called purines. Causes of high levels of uric acid in the blood (hyperuricemia) include genetics, obesity, certain medications such as diuretics and chronic decreased kidney function (kidney disease).

Treatment

When gout attacks are frequent, uric acid stones are already present in the kidneys, tophi are present or there is evidence of joint damage from gout attacks. Medications are commonly used to reduce uric acid levels. Gout medications generally fall into one of three categories:

• drugs that lower uric acid
• prophylactic drugs 
• symptomatic medications to decrease inflammation and pain

• Anti-inflammatory solutions or corticosteroids:  are usually used for several types of musculoskeletal problems, such as tendinitis, tenosynovitis, bursitis, fasciitis, osteoarthritis, muscle injuries, ligament injuries. Corticosteroids are natural hormones made from cholesterol in the adrenal glands. In clinical practice, steroids are used for their powerful anti-inflammatory effects. Corticosteroids should not be confused with anabolic steroids, which are known to be used by athletes to increase muscle mass and strength. Corticosteroids used in resentment are injected all over the world, the administration doses are minimal, on average 0.4mg, and the side effects are similar in elderly patients, by temporarily increasing (2-3 days) blood pressure and blood sugar.
• Sterile viscoelastic solutions (hyaluronic acid): are performed mainly intraarticularly, both in the large joints (knee, shoulder, hip, ankle) and in the small ones (fist, elbow, metatarsophalangeal, or interphalangeal). The role of these infiltrations is multiple: protector of the articular cartilage through the viscous properties of the injection - the molecules of Hyaluronic Acid in the synovial fluid, act as a lubricant, protecting the articular surfaces from mechanical damage, by elastic properties - under the pressure generated by the joint load (bodyweight), hyaluronic acid in a synovial fluid acts as a shock absorber, protecting cartilage from compressive trauma, a nutrient for joint cartilage, synovial tissue protector:  Hyaluronic acid is a protective barrier for the synovial membrane and masks the receptors for inflammation in the knee, reducing inflammation.
• Infiltrations with PRP (platelet hyperconcentrate): have been used since 1978 in the USA, in the treatment of musculoskeletal disorders, with extraordinary results. The infiltration lasts on average 40 minutes, is painless, and consists of collecting peripheral blood (from the vein) of the patient, on average between 60 and 180 ml, centrifugation 20-25 minutes to separate platelets from other blood cells, and injection into the same stage in the affected area. Centrokinetic offers patients treatments with the best PRP kits in the world, brought from the USA, from Arthrex and Magellan. The rationale for using this type of infiltration is to initiate and accelerate the natural process of tissue healing and regeneration by releasing platelet-derived growth factors directly into the affected tissue. According to current studies, soft tissue lesions and cartilage lesions are receptive to this treatment. Some of these include the following: tendinitis (epicondylitis, plantar tendonitis, Achilles, patellar, etc.), tendinosis, tendon ruptures, tendon degenerative lesions, muscle ruptures, cartilage lesions (arthrosis). The therapy also has a postoperative indication in meniscus suture, ligamentoplasty, sutures/tendon reinsertions (rotator cuff, Bankard, Achilles tendon, patellar tendon, quadrigeminal, etc.).
• Autologous growth factor therapy:  is a therapy used in Germany for 15 years, and consists of harvesting the body's growth factors, multiplying them by incubation, and reinjecting them into the affected area. The duration of the treatment is 3 hours, performing 3-5 procedures, at 1-week intervals. The major indications are chronic tendinitis (epicondylitis, plantar tendonitis, Achilles, patellar), and articular cartilage lesions (arthrosis). It also has excellent results in the treatment of joint and periarticular pain.  Autologous growth factor therapy is a treatment with a cytokine-rich autologous serum (ACRS), derived from the patient's blood. To ensure high tolerability, this technology completely avoids the use of any artificial additives. This special serum, rich in autologous cytokines, can activate the body's ability to heal itself by producing positive interleukins and growth factors. These are crucial to intervene in the cascade of pain, causing it to stop and the subsequent onset of the healing process.

Centrokinetic clinic has a very experienced team, specialized in sports traumatology, accredited in: Tecar therapy, dynamic taping, massage, Graston technique, Kinesio Tape, ERGON, flossing band. Our team has attended numerous overspecialized courses with trainers from the country and abroad, being certified to perform therapies at the highest level. The experience gained in recent years has meant recovering over 250 patients per month.

Our rheumatologists advice: nutrition is the key to treatment. The main dietary goal is to limit the consumption of foods with high amounts of purine. 

Ideally, you will have little or no purine-rich foods and only small amounts of those with moderate amounts of purine. Foods considered rich in purine are some types of fish, seafood, and shellfish (anchovies, sardines, mackerel, shellfish, herring, mussels, cod, trout, and haddock), meat (bacon, turkey, veal meat, liver, kidneys beef, brain), sweet bread and alcoholic beverages.