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Gout sa Kamay, Pulso, at Siko

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Gout in the upper limb — what causes the attacks and lumps (tophi), how flares and high urate are treated, and when surgery is needed.

Illustrasyon ng dalawang kamay na may matitigas na bula (tophi) ng kronikong tophaceous gout sa ilang mga kasukasuan ng daliri.
Ang kronikong gout ay maaaring mag-iwan ng matitigas na mga bula na tinatawag na tophi sa paligid ng mga kasukasuan ng daliri, na maaaring limitahan ang galaw at pag-andar ng kamay. Arthritis Research UK Primary Care Centre / Wikimedia Commons, CC BY 2.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Ang gout ay madalas na nagpapakita ng sarili sa loob ng isang gabi. Isang kasukasuan (minsan ang base ng hinlalaki, isang knuckle, ang pulso, o ang puntong ng siko) ay nagiging napakasakit sa loob lamang ng ilang oras. Mukhang mainit, pula, at pamamaga, at napakabaliw ng sakit kaya kahit ang bigat ng kumot ay tila hindi na kayang tiisin. Ito ay isang flare, at ang unang flare ay madalas na tumatama sa paa, ngunit karaniwan din ang kamay at pulso.

Sa pagitan ng mga flare, maaaring mukhang ganap na normal ang kasukasuan, kaya’t madalas na pinapabayaan ng mga tao ang unang atake. Sa loob ng ilang buwan at taon, gayunpaman, maaaring mag-iwan ang gout ng mga matigas na butil sa ilalim ng balat, sa paligid ng mga kasukasuan ng daliri, mga knuckle, o sa ibabaw ng siko. Tinatawag itong tophi. Maaari itong magkaroon ng puting o chalky na anyo sa ilalim ng balat, at habang lumalaki, maaari nitong gawing matigas ang kamay, mahinahin ang hawak, at gawing mahirap ang mga masusing gawain tulad ng pag-button ng damit. May ilang tao rin ang nakakaramdam ng pagkaka-numb o pangangati sa mga daliri kung may butil na pumipindot sa isang nerbiyos sa pulso.

Ano ang talagang nangyayari

Ang gout ay isang problema sa buong katawan na nagpapakita sa iyong mga kasu-kasuan. Ang iyong katawan ay gumagawa ng isang waste product na tinatawag na uric acid (urate). Kapag sobrang dami nito sa dugo, maaari itong bumuo ng maliliit, matulis na crystals na naninirahan sa loob ng mga kasu-kasuan at sa mga malambot na tissue sa paligid nito, kabilang ang sa kamay at pulso.

Ang iyong immune system ay nagtatrato sa mga crystals na ito bilang mga mananakaw at atakein ito, at ang reaksyong iyon ang biglaang, matinding inflammation na nararamdaman mo bilang isang flare. Kung hindi kontrolado ang mataas na antas ng urate sa loob ng mga taon, ang mga crystals ay magbubuo ng mga matitigas na deposit (tophi). Sa paglipas ng panahon, ang mga deposit na ito ay maaaring magpunas ng buto, makasama sa mga tendon, at minsan ay makapindot sa isang nerve. Ang mahalagang punto ay ang mga flare at ang mga bula ay dalawang mukha ng iisang bagay: sobrang dami ng urate sa katawan. Kontrolin ang urate, at kontrolado mo ang sakit.

Ano ang maaari naming gawin dito

Ang paggamot ay may dalawang hiwalay na bahagi, at pareho silang mahalaga.

Pagpapahina ng atake. Ang isang flare ay pinapahina gamit ang anti-inflammatory na gamot, kadalasan ay isang anti-inflammatory na tablet (isang NSAID), colchicine, o maikling kurso ng steroids. Pinakamabisang gumagana ang mga ito kapag nagsimula nang maaga, kaya't maganda na magkaroon ng plano na kinilala ng iyong doktor bago bumalik ang susunod na atake.

Pagbaba ng urate nang tuluyan. Ito ang tunay na nagpapagaling ng gout sa paglipas ng panahon. Ang isang araw-araw na tablet, kadalasan ay allopurinol, dahan-dahang binababa ang iyong blood urate sa ilalim ng isang target na antas. Kapag panatilihin ito sa loob ng sapat na tagal, unti-unting natutunaw ang mga crystals, humihinto ang mga flare, at lumiliit ang mga tophi. Nakakatulong ang diyeta at lifestyle (mas kaunting beer at distilled spirits, mas kaunting mga inuming may asukal, pagpapanatili ng malusog na timbang, at sapat na pag-inom ng tubig), ngunit para sa karamihan ng mga tao, ang araw-araw na tablet ang nagtatrabaho nang mabigat.

Ang operasyon ay kailangan lamang minsan, para sa isang malaking tophus na sumisikat sa balat, nakakaapekto sa isang tendon, o pumipindot sa isang nerve (halimbawa, nagdudulot ng mga sintomas ng carpal tunnel). Kahit ganun, patuloy pa rin ang medikal na paggamot upang babaan ang urate pagkatapos.

Ano ang inaasahan

Ang gout ay isa sa ilang anyo ng arthritis na tunay na maari nating kontrolin. Kung mananatili ang iyong urate sa ibaba ng target sa mahabang panahon, magiging bihira ang mga flare-up at sa huli ay titigil na ito, at unti-unting matutunaw ang mga umiiral na butas. Mabagal ang proseso: ilang buwan hanggang taon, at karaniwang buhay-lamang ang gamit ng tabletang pangbaba ng urate, dahil kapag ito ay itigil, muling magkakaroon ng kristal.

Ang katumbas ng pagiging matiyaga ay tunay: kung mas maraming tophus ang nakipon sa kamay, mas limitado ang kakayahan ng kamay na gawin ang mga bagay, kaya ang maagang pagbaba ng urate ay nagpoprotekta sa iyong hawak at function. Ang mga taong mananatili sa paggamot ay napakabuti ang kanilang resulta.

Kailan kumonsulta sa doktor

  • Unang pagkakataon ng mainit, pamamaga, at masakit na kasukasuan: kumonsulta agad sa doktor. Maaaring magmukhang pareho ang impeksyon sa kasukasuan sa gout at ito ay isang emergency, kaya mahalagang paghiwalayin ang dalawa.
  • Maulit-ulit na pag-atake, o mga pag-atake na nagiging mas madalas: ito ang senyales upang simulan ang paggamot na nagpapababa ng antas ng urate.
  • Paglitaw ng mga butil sa paligid ng mga kasukasuan, o isang butil na sumisibol sa balat o naglalabas ng puting parang alabok na materyal.
  • Pagkawala ng pakiramdam, pangangati, o kahinaan sa kamay: maaaring may depositong pumipindot sa isang nerbiyos at mahalagang suriin.

Mas malalim na pagtalakay

Ang seksyong ito ay nag-aalok ng mas detalyadong paliwanag sa antas ng mag-aaral tungkol sa biyolohiya. Hindi ito kinakailangan para pamahalaan ang gout, ngunit kung interesado ka sa bakit bigla at matindi ang isang pag-atake, at bakit may dalawang hiwalay na tungkulin ang paggamot, magpatuloy sa pagbabasa.

Ano nga ba ang gout: mga kristal ng urat

Ang asidong uriko ay isang normal na produktong basura na nabubuo kapag binabasag ng katawan ang mga sangkap na tinatawag na purines (mula sa mga cell at ilang pagkain). Kapag nananatiling mataas ang antas ng urat sa dugo, maaari itong lumabas sa solusyon at bumuo ng mga maliit, parang karayom na monosodium urate (MSU) crystals sa loob at paligid ng mga kasukasuan. Mas madaling bumuo ng mga kristal sa mga lugar na mas malamig; ito ang pangunahing dahilan kung bakit ang malaking daliri ng paa, na pinakalamig at pinakaperiperal na kasukasuan sa katawan, ang karaniwang unang target.

Ang inflammasome: bakit biglaan at matindi ang isang pag-atake

Nagsisimula ang isang pag-atake kapag ang mga scavenger cells ng immune system (macrophages) ay sumisipsip ng mga kristal ng MSU. Ang mga kristal ay nagpapagana sa isang internal na alarm complex na tinatawag na NLRP3 inflammasome, na nagpapagana sa isang enzyme (caspase-1) na naglalabas ng isang makapangyarihang inflammatory messenger, interleukin-1β (IL-1β). Binabaha ng IL-1β ang kasukasuan ng pamamaga, na nagdudulot ng mabilis, matinding pamumula, init, pamamaga, at sakit ng isang akutong pag-atake sa loob ng ilang oras. Ang parehong kristal na pinapagana ang pagbuo nito ng lamig ay nagpapaliwanag sa pattern ng gabi at peripheral na kasukasuan. Ang mga pag-atake ay self-limiting sa loob ng ilang araw habang napapagod ang tugon.

Bakit may dalawang hiwalay na tungkulin ang paggamot

  • Paggamot sa atake (colchicine, anti-inflammatories, steroids, o, sa mahihirap na kaso, mga gamot na pumipigil sa IL-1) ay nakakapagpahupa ng pamamaga ngunit walang epekto sa mga kristal.
  • Pangmatagalang paggamot (mga gamot na pababa ng urate sa dugo tulad ng allopurinol) ay nagpapababa ng antas ng urate sa dugo sa ibaba ng antas kung saan nabubuo ang mga kristal, kaya unti-unting natutunaw ang mga umiiral na kristal at humihinto ang pagbuo ng mga bago. Ito ang tunay na paggaling, ngunit kailangan ng mga buwan, at maaaring pansamantalang magdulot ng mga atake habang natutunaw ang mga kristal, kaya ito ay dahan-dahang sinisimulan at madalas ay may kasamang proteksyon.

Mga tophi at pangmatagalang pinsala

Kung nananatiling mataas ang urate sa loob ng mga taon, ang mga kristal ay nagtitipon at bumubuo ng mga putik na bukol na tinatawag na tophi, at maaari nitong kiskisin ang buto at kartilago ng kasu-kasuan. Ang pagbaba at pagpapanatili ng urate sa mababang antas ang nagpipigil sa permanenteng pinsalang ito.


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