In ancient times, gout was a popular disease among the dignitaries and was called a “disease of wealth”. A decade ago, it was a “minor disease” in rheumatology and immunology, and compared with rheumatoid arthritis, systemic lupus erythematosus and vasculitis, it was simple to treat and could be called It can be called “a piece of cake”.
However, with the rapid development of our society and the continuous improvement of the economic level, the prevalence of gout is now in line with international standards and has quietly entered the common people’s home. Gout stone formation, accompanied by renal impairment and a variety of serious complications, such as repeated gastrointestinal ulcers, bleeding and even perforation, some patients can not be controlled by continuous blood transfusion, and had to perform gastrectomy.
Some patients quietly developed kidney stones, increased nocturia, and gradually deteriorated into irreversible chronic renal insufficiency, which aggravated the difficulty of treatment and regretted the wave; some patients had a large number of gout stones deposited around the skin, soft tissues, tendons, nerves, blood vessels, etc., causing erosion and destruction of bone and joints, long-term non-healing of skin rupture, impaired tendon activity, nerve paralysis, etc. After surgical removal of gout stones, skin wounds Some elderly patients are combined with hypertension, hyperlipidemia, coronary heart disease, arteriosclerosis, diabetes, etc., which makes the treatment contradictory and very difficult for doctors to handle. When arthritis is severe, it is not only painful, but also feverish, which is very painful for patients. If a “small disease” is “underestimated”, it will eventually lead to a big disaster.
The reasons for this are threefold.
1, the patients themselves have the following common misconceptions.
(1) Patients do not pay attention to: temporary pain relief in the acute phase has become the focus of treatment, “forgetting the pain after getting well” phenomenon is very common;
(2) Patients do not understand: mistaking allopurinol for painkillers and colchicine for uric acid-lowering drugs, lowering uric acid in the acute phase and stopping it in the remission phase, with half-understanding and completely opposite treatment plans; many patients do not have uric acid treatment at all for many years and let it go by fluke; or just short-term treatment, only caring about immediate benefits.
(3) Patients do not understand: blind fear of adverse drug reactions because they see the manual or the advice of certain friends around them, resulting in delayed treatment and irreversible disease.
(2) A part of the primary hospital doctors have not gone through formal training in rheumatology, and the treatment measures cannot keep up with the development of the discipline, which also causes the treatment to be substandard.
3, poor communication between doctors and patients: doctors are busy with outpatient work and do not have enough time to explain slowly; patients lack of scientific knowledge, do not understand and do not pay attention to the doctor’s persuasion; patients’ temporary fluctuations in their conditions cause further lack of understanding and trust in doctors, poor compliance, resulting in treatment programs are not carried out in the long term.
For a long time, hypertension and diabetes have been widely popularized scientifically, and the general public can receive the corresponding treatment, while gout, as a new disease in the new era, currently there is a lack of corresponding scientific knowledge among patients in China, and the publicity and education are not effective, resulting in a gradual increase in the number of patients whose conditions are prolonged and worsening, which has to be taken seriously. In fact, gout is closely related to hypertension, diabetes, hyperlipidemia and other metabolic syndromes, and the concept of long-term treatment or even lifelong treatment should also be established. Specific treatment should be done in person at an experienced rheumatology clinic, with face-to-face communication with the doctor, to develop a long-term treatment plan, and regular review, follow-up and adjustment of treatment, and targeted health guidance by rheumatologists, so that treatment can achieve the desired goal.
There are many misunderstandings in the diagnosis of gout, for example: many patients take elevated blood uric acid as gout and are very nervous; 1/3 of patients with acute gout attacks have normal blood uric acid and are mistakenly thought not to be gout, resulting in a missed diagnosis; some patients with chronic gouty arthritis are misdiagnosed as rheumatoid arthritis because of swollen and painful joints of all sizes and symmetry; some patients with joint trauma, puncture, moxibustion and other physical therapy Some patients with infectious arthritis are misdiagnosed as gout; some patients with spondyloarthropathy are misdiagnosed as gout because of sudden swelling and pain in the foot and ankle or knee joints. …… Timely and correct diagnosis is a prerequisite and necessary condition for effective treatment.
I briefly summarize the following regarding standardized treatment.
1.Anti-inflammatory and analgesic treatment in the acute phase of gout attack – the faster the better: the more timely the consultation and treatment, especially within 24 hours, the faster the recovery and the less damage to the body;
2, the lower the uric acid standard in the remission period – the lower the better: blood uric acid level below 6mg/dl helps prevent crystal formation, blood uric acid level below 5mg/dl helps promote crystal dissolution and excretion, for patients with gout stones throughout the body, long-term maintenance of blood uric acid level below 5mg/dl, will find that the gout stones gradually shrink to This requires persistent patience;
3, chronic gout period to prevent attacks – the less the better: chronic gout due to the presence of gout stones, inevitably recurring acute attacks, patients’ confidence in treatment is hit, let go is very common, then you need to find an experienced rheumatologist, active standardized use of preventive drugs such as anti-inflammatory painkillers ( NSAIDs, colchicine, etc., will significantly reduce acute attacks and enhance patients’ confidence in long-term treatment;
4.Maintenance of renal function in the middle and late stages of gout – the longer the better: once chronic gouty nephropathy appears difficult to reverse, actively reducing blood uric acid to the target level will help protect residual renal function;
5, gout drug use – the more precise the better: patience and meticulous adjustment of gout drugs, especially for chronic gout patients, is the key to success or failure, which requires the guidance of rheumatologists with very rich clinical experience;
6, communication between doctors and patients – the more the better, no matter how tight the time, doctors should inform in detail the hazards of gout and long-term treatment requirements for patients, to improve the patient’s enthusiasm for treatment and cooperation, patients should also often learn the scientific knowledge of gout, give up emotional domination, objective and rational adherence to treatment, close cooperation between doctors and patients. Only then can we finally overcome the disease and regain our health.
Actively and scientifically treated, gout is a completely curable rheumatic disease!