Nowadays, with the rapid development of the economy and the change of the diet structure of the population, coupled with the lack of moderate physical activity, the incidence of gout and hyperuricemia has been increasing in China, and the trend is younger. According to the reports on the incidence of hyperuricemia in recent years, it is conservatively estimated that there are about 120 million patients with hyperuricemia in China, accounting for about 9.0% of the total population.
One wonders: What is hyperuricemia? And what is gout all about? What can be done to prevent and treat gout? …… below we will talk about the misconceptions about gout and related questions.
A. Is hyperuricemia gout?
With the improvement of living standards, people’s health awareness is increasing and regular medical checkups have become the norm. Some people who get the physical examination report take a look at: increased serum uric acid. Then they think: “Oh, I have gout! So is hyperuricemia the same as gout? The answer is no.
Hyperuricemia (HUA) is defined as a fasting blood uric acid level higher than 420 μmol/L in men and 360 μmol/L in women on two different days under a normal purine diet, which is the saturated concentration of uric acid in the blood, above which uric acid salts can be deposited in the tissues and cause histological changes in gout. Gout is a disease that causes severe joint pain and inflammation due to the deposition of uric acid crystals in the joints. These crystals are produced as a result of an abnormally high concentration of uric acid in the blood. Uric acid comes from the normal breakdown of cells in the body and is excreted by the kidneys. If the kidneys do not function properly or if the body produces too much uric acid, the high concentration of uric acid in the blood can cause crystalline deposits in the joints. Therefore, hyperuricemia is not gout, but the likelihood of gout in patients with hyperuricemia is roughly proportional to the degree of increase in serum uric acid levels.
Therefore, patients with asymptomatic hyperuricemia should not be left alone, but should actively search for the causes of high blood uric acid and related factors and correct or avoid them, such as diuretics, antihypertensive drugs, chemotherapy drugs and kidney disease, blood diseases, diabetes, hypertension, dyslipidemia, etc. At the same time, obesity, high purine and high calorie diet, alcoholism and other bad habits should be avoided.
Second, what kind of joint pain is gout?
Some elderly people have joint pain from time to time, so is it gout? Actually, it is not quite true. Gout attacks have their own characteristics: acute attacks (also known as acute gouty arthritis) have no warning, often occur suddenly at night, and the pain is concentrated and intense, while the affected joints show redness, heat and swelling, local skin shine, and tenderness is obvious. Gout most often affects the joints at the base of the big toe, but is also common in the knee, wrist, finger and elbow joints. Most gout recurs. Initially, the attacks are occasional, often affecting one joint for a few days, and then the symptoms disappear completely until the next attack. However, as the number of attacks increases, the symptoms last longer and involve more joints. As more joints become involved at the same time, gout can develop into a chronic (long-term) disease.
Therefore, if the pain is only in the joints and there is no obvious redness, swelling or heat in the affected joints, or if the pain is not concentrated and involves more than one joint, it is often not a gout attack.
What are the dangers of gout?
Gouty arthritis is mostly self-limiting and resolves on its own within 1-2 weeks; recurrent attacks of arthritis can leave chronic joint pain. Temporary pain often does not attract the attention of patients, but the danger of gout lies in the long-term recurrent attacks caused by joint breakage and hyperuricemia accompanied by metabolic disorder syndrome, such as obesity, hyperlipidemia, abnormal blood sugar, significantly aggravate the development of atherosclerosis, so that the incidence of myocardial infarction stroke and other significantly higher gout patients. Most importantly, uric acid crystals are deposited in the kidneys causing kidney function damage.
Fourth, how to detect gout early?
Large-scale blood uric acid screening of the population can detect hyperuricemia in time, which is very important for early detection and early prevention of gout. If there is no condition for large-scale blood uric acid testing, at least the following people should have regular blood uric acid testing.
① Elderly people over 60 years old, regardless of male or female and whether they are obese or not.
② Obese middle-aged men and post-menopausal women.
③Patients with diabetes, hypertension, atherosclerosis, coronary heart disease, cerebrovascular disease (such as cerebral infarction, cerebral hemorrhage).
(iv) Patients with arthritis of unknown cause, especially those over middle age characterized by the onset of monoarthritis.
⑤ Kidney stones, especially multiple kidney stones.
V. How should gout be treated?
Some patients went to the hospital for joint pain, and the doctor gave them the diagnosis of acute gout attack. Therefore, the treatment of gout should be regular treatment under the guidance of a doctor.
When a gout attack occurs, the aim of treatment is to control the attack, mainly by relieving pain, and suspend the use of blood uric acid-lowering drugs. Gout attacks can be controlled within 24 hours at the earliest, and at the latest, generally speaking, no more than 2 weeks. Commonly used medications include: non-steroidal anti-inflammatory drugs (including Intaxin, Fentanyl, Ciloxel, Ankylosing, etc.), colchicine, prednisone, etc.
After the gout attack stops, which is called the interval period of gout attack, the aim of treatment is to lower the blood uric acid. Commonly used drugs include: allopurinol, ligarginum, etc.
Usually, attention should be paid to diet control (low purine diet), alkalinization of urine (baking soda tablets), and drinking more water.
Treatment of complications and comorbidities: those with kidney damage and those with urinary stones should be given appropriate treatment, and those with combined hypertension, diabetes, coronary heart disease, obesity, hyperlipidemia, arteriosclerosis, etc. should be given appropriate treatment.
It is best to choose the combination of Chinese and Western medicine, which can effectively reduce the toxic side effects of Western medicine, enhance purine metabolism and uric acid excretion, and stabilize uric acid level in the long term. It is especially important to point out that uric acid-lowering drugs should not be stopped at will, but should be gradually reduced or stopped under the guidance of doctors, and the blood uric acid level should be followed up regularly even after stopping the drugs.
Can uric acid-lowering drugs be taken for a long time?
People always have this misunderstanding about uric acid-lowering drugs: it is a medicine that is poisonous! Uric acid-lowering drugs are the king of the poison, just take a look at their instructions, so these drugs can be taken sparingly. Indeed, uric acid-lowering drugs in the benzbromarone may lead to kidney stones, severe renal insufficiency is prohibited, severe allergy to allopurinol, can appear lethal exfoliative dermatitis, colchicine high dose can cause liver and kidney function damage …… and so on, see or hear these side effects, people’s concerns come: since these drugs The “poison”, then we can not eat, can eat less, eat less. In fact, as long as the medication is used under the guidance of a doctor, there is nothing to worry about. The doctor will weigh the advantages and disadvantages according to the patient’s specific situation and use the medication safely. Some gout patients who have been taking uric acid-lowering drugs for a long time or for life have not experienced the toxic side effects mentioned above, and now that pharmaceutical technology is constantly improving and new preparations are being introduced, the toxic side effects have become less and less.
7. Can gout be cured?
It is very certain that gout cannot be cured, but it can be controlled and prevented. First of all, diet control is necessary. Bad dietary habits are the main culprit in triggering gout attacks, so gout patients should control their diet and improve their lifestyle habits, as follows.
Adequate amounts of carbohydrates and fats should be supplied. If there is no adverse effect on the heart and kidneys, you should drink more water, as well as some diuretic acid-reducing tea.
Cooking methods more braised, boiled, steamed, blanching, etc., less frying, deep-frying, boiling methods. Food should be as easy to digest as possible.
Use more foods rich in vitamin B1 and vitamin C. Available foods: rice, noodles, steamed bread, milk, eggs, fruits and various vegetable oils.
Vegetables are available except for lobelia, celery, cauliflower, spinach and parsley.
Protein can be consumed in proportion to body weight, 1 kg of body weight should be consumed 0.8 grams to 1 gram of protein, and milk, eggs as the main. In the case of lean meat, chicken and duck meat, etc., they should be boiled and eaten in the soup, avoiding stewed or marinated meat. Eat less fat.
Animal offal, fish roe, bone marrow, sardines, oysters, small shrimp skin, mackerel, tamari, liver, kidney, brain, clams, crab, fish, broth, chicken soup, peas, lentils, mushrooms, all kinds of seafood, etc., all kinds of strong condiments and foods that strengthen nerve excitement such as wine, strong tea, spicy products, etc. are prohibited. Here we need to emphasize that gout patients can eat tofu, soybean skin and dried beans in moderation, but not easy to eat whole beans and soy milk.
Maintain the ideal weight, overweight or obese should reduce weight. However, weight reduction should be gradual, otherwise it will easily lead to ketosis or acute attacks of gout.
If the gout attack cannot be controlled by diet alone while combined with hyperuricemia, you can take uric acid-lowering drugs under the guidance of your doctor.
Do nephrologists treat gout?
In medical textbooks, “gout” is classified as a disease of the rheumatic system, so many people, including some medical personnel, go to the Department of Rheumatology and Immunology to see gout, but in fact, nephrology is the main department that treats gout. Why is this so?
First of all, the diagnosis of gout is based on clinical manifestations and serum uric acid level, which is one of the biochemical tests of kidney function, and the most common laboratory report that nephrologists look at is kidney function.
Secondly, the application of uric acid-lowering drugs in patients with renal insufficiency needs to be very careful, and improper use of drugs may aggravate renal function damage, while nephrologists are very familiar with how to use drugs in patients with renal insufficiency, so they will naturally take into account both the efficacy of drugs and the protection of renal function.
The most important point is that nephrologists love kidney as their life, they think kidney is people’s second life, they are trying to protect kidney function every day, for gout patients, what they think is not only to control gout attacks, but also to reduce the long-term consequences caused by recurrent gout attacks.
Therefore, nephrologists are fully capable of treating gout and are also good at protecting the kidney function of patients, so going to a nephrologist for gout treatment is beneficial but not harmful.
In short, having gout is not terrible, although gout can not be cured, but it is not a beast, as long as you do “control your mouth, reduce weight, drink more water, exercise, listen to the doctor, take the medicine”, I believe that gout can be prevented and controlled. Don’t go to the point of “having gout and ruining your kidneys” and then go to the doctor, it will be too late to regret!