What is gout
Gout is a group of diseases caused by disorders of purine metabolism and/or impaired uric acid excretion. It is characterized by hyperuricemia as a common feature. The clinical manifestations are characteristic arthritis, gout stone formation, joint deformities, kidney stones, obstructive nephropathy, and even induced uremia.
Epidemiology of gout.
Gender: mostly seen in men, with a male to female ratio of 20:1.
Age: Mostly seen in people over 40 years old, with a peak age of 50-59 years old. It almost always occurs in women after menopause, and almost never during menstruation and pregnancy.
Lifestyle: Most often seen in obesity, alcohol abuse, less physical activity, and those who work mentally.
Common triggers: alcohol consumption (especially beer), high-protein, high-purine diet, exertion, exposure to cold, drugs (e.g. diuretics), etc.
Clinical features of gout.
Acute gouty arthritis.
It mainly appears in the joints of the lower extremities, most often in the first metatarsophalangeal joint, with single joint attacks. The first attack often starts in the early morning, but it is also common to have a sudden onset at midnight and wake up every time due to joint pain. The affected joints are red, swollen, hot, painful and dysfunctional. It is self-limiting and resolves on its own within a few hours to a few weeks, leaving no trace. The intervals between attacks are completely normal and can recur.
Gout stones.
Gout stones, also known as gouty nodules, are characteristic changes of gout. The typical gouty stone appears in the olecranon, but the most common site is around the first metatarsophalangeal joint. Gout stones vary in size and texture and are yellowish-white in color, and can break down to discharge white toothpaste-like material when larger. In later stages, they can damage subcutaneous tissue, joints and bones, resulting in stiffness and deformity of the joints.
Renal damage of gout.
It mainly includes uric acid nephropathy and uric acid nephropathy, uric acid kidney stones, etc.
Treatment of gout.
Acute attack period.
Rapid termination of acute arthritic attacks can be treated with.
1. Colchicine: It has special inflammation inhibition and pain relief effect for acute gouty arthritis, but not significant effect for other arthritis, and is a special drug for gout attack. It can be used for differential diagnosis and diagnostic treatment. However, because of its obvious toxic side effects, it needs to be taken under the guidance of a specialist and strictly avoid long-term use.
2.Non-steroidal anti-inflammatory drugs: less effective than colchicine, but with less side effects, such as anti-inflammatory pain, ibuprofen, etc.
3, ACTH or glucocorticoids: generally not used, easy to stop the drug rebound. Only when the above two types of drugs are ineffective, contraindicated or particularly severe and recurrent.
Intermittent and chronic treatment:
Maintain normal blood uric acid levels, prevent arthritis attacks, shrink gout stones, and protect renal function.
(1) Pro-uric acid excretory drugs: such as benzbromarone (Gout Lixin). It is suitable for people with hyperuricemia, no increase in uric acid excretion, no kidney stones and normal kidney function. Also pay attention to drinking more water and alkalinizing urine (oral sodium bicarbonate).
(2) Drugs to inhibit uric acid production: such as allopurinol. It is suitable for those who have increased uric acid excretion or are not suitable for uric acid excretion drugs. The two can also be used together.
How to prevent the occurrence of gout in daily life
It can be summarized into 12 words: reasonable diet, weight reduction, and avoid straining.
Reasonable diet: Patients who already have gout should prohibit alcohol (especially beer), limit meat, and eat protein mainly milk and eggs. Eat more alkaline foods such as fruits and vegetables, and drink plenty of water (2000-3000 ml daily) to promote uric acid excretion. Gout patients should limit the intake of meat, especially animal offal (such as liver, kidney, brain), seafood (such as crab, har gow, etc.), gumbo, etc. should never be eaten in the acute attack period, and should also be limited at ordinary times, because they contain high purines. At the same time, mushrooms, nori, are also not allowed to be eaten and can induce gout attacks.
Table of purine content in food.
The first group of foods with high purine content (100-1000mg of purine per 100g of food).
Animal offal, minced meat, gravy, broth, mackerel, wind-tailed fish, sardines, fish eggs, small shrimp, tamari, goose, spotted chicken, stone chicken, yeast.
The second group of foods containing medium purine (75-100mg of purine per 100g of food).
1.Fish: carp, cod, halibut, sea bass, pike, shellfish, eel and eel.
2, meat: smoked fire retreat, pork, beef, beef tongue, veal, rabbit, venison.
3.Poultry: duck, pigeon, quail, pheasant, turkey.
The third category of food containing less purine (purine <75mg per 100g of food).
1. Fish and crab: mackerel, herring, salmon, shad, tuna, white fish, lobster, crab, oyster.
2, meat: ham, lamb, beef soup, chicken, bacon.
3. Bran: cereals, bread, coarse grains; 4. Vegetables: asparagus, string beans, green beans, peas, kidney beans, spinach, mushrooms, dried beans, tofu.
The fourth group of foods containing few purines.
1. Grains: rice, wheat, millet, rice, caper wheat, cornmeal, refined white flour, rich flour, macaroni, noodles, bread, steamed buns, soda crackers, buttered snacks.
2. Vegetables: cabbage, cabbage, carrot, celery, cucumber, eggplant, kale, turnip greens, collard greens, lettuce, cut beans, pumpkin, bonito, zucchini, tomato, yam, potato, kimchi, pickles.
3, fruit: a variety of fruits. Eggs, dairy: fresh milk, condensed milk, cheese, yogurt, cream of wheat drinks: soft drinks, tea, coffee, cocoa, chocolate.
4, other: all kinds of fats, peanut butter, foreign vegetable jelly, jam, dried fruit, etc.