Health Q&A – Gout
1. What is gout?
Gout, is the common name for hyperuricemia. As the name implies, it means high levels of uric acid in the blood, which is a metabolic product of purines. When purine metabolism is abnormal for various reasons, excessive production of uric acid or poor excretion of uric acid will occur, and the high level of uric acid in the blood will cause a series of related symptoms, including gouty arthritis, gouty kidney stones, and gouty interstitial nephritis, the last of which will lead to kidney failure.
2. What is gouty arthritis?
Gouty arthritis is a kind of gout disease, which refers to the deposition of uric acid crystals around the joints, causing an inflammatory reaction around the joints, and in severe cases, erosion of joints and bones, resulting in destruction of joints. As this inflammatory reaction appears severe joint pain like the wind comes very quickly, all commonly known as gout.
3. How does gouty arthritis develop?
In gout patients, high levels of uric acid in the blood leaks out into the synovial membrane of the joints and the bursa deposits down to form uric acid crystals, which stimulate the cartilage and other tissues causing recurrent inflammatory reactions, leading to damage to cartilage and bone and causing destructive changes in the bones and joints.
4. What are the most common sites of gouty arthritis?
The most common site for gouty arthritis is the first metatarsophalangeal joint, or the big toe. Other joints include the ankle, the interphalangeal joints of the hand, the knee, and even the knee, elbow, and occasionally hip joints.
5. Are there many people who have gouty arthritis?
With the improvement of life, people’s diet structure and nutritional status have changed fundamentally, and the consumption of meat, animal and seafood has increased, resulting in the deposition of purines in the body.
6. Who is prone to gouty arthritis?
People with high uric acid are prone to gouty arthritis if they don’t pay attention to control, plus the risk factors that can trigger gouty arthritis are eating animal food and drinking beer.
7. What are the symptoms of gouty arthritis?
Gouty arthritis is usually seen in middle-aged men, the onset of the disease is rapid, can be painful at night often first invade a joint, mostly in the first metatarsal toe joints, followed by the back of the foot, heel and ankle joints, the joint local swelling, red and hot skin, pressure pain is obvious, afraid to move.
The disease can have an acute phase and an intermittent phase.
(1) During the acute attack, there may be systemic reactions such as fever (38^39), headache, palpitations and anorexia. About 1 week after the acute attack, the symptoms gradually disappear and the joints may return to normal.
(2) Intermittent period refers to the period of symptom relief, which is usually asymptomatic and may last for months or years, but with the aggravation of the disease, the intermittent period may become shorter and shorter, and may appear in the ear whorl, earlobe, and joint subcutaneously with corn pulling large painful stones. In some patients, pain persists without relief, and in severe cases, joint structure is destroyed and joint function is abnormal.
8. What are the dangers of gouty arthritis?
Gouty arthritis, once developed, can cause great danger to patients.
(1) joint disability, in the long and slow course of the disease, the patient’s condition will be frequent recurrent attacks, bringing more and more serious harm to the joints. The pain gradually increases, and the joints involved are mostly knee, ankle and elbow joints, and in severe cases, the shoulder, hip and spine can be involved, which can easily lead to joint destruction and deformity, affecting joint function and even leading to disability.
(2) Gout stone, the high accumulation of uric acid in the patient’s blood will cause serious tissue damage, resulting in the formation of gout stone; deposition in the joint capsule, affecting joint movement; can lead to “chisel hole”-like damage to the bones of the joint, which can lead to fracture, joint dislocation and deformity in serious cases; gout stone breaks, it is not easy to heal, and if secondary to serious bacterial infection, it is easy to lead to tragic amputation.
(3) Damage to the kidney, the uric acid in the body of patients in the process of repeatedly delaying the disease will gradually form a health hazard to the kidney, specifically uric acid kidney stones, gouty interstitial nephritis, gouty kidney failure. According to WHO statistics, 1/4 of gout patients will develop kidney failure and develop into serious uremic syndrome.
9. How can I tell if I have gouty arthritis?
If you have sudden and severe pain in your big toe, if your previous diet was heavy on fish and meat, and if you have consumed a lot of animal food or seafood, or if you have had a lot of alcohol (including a lot of beer) before the onset of the disease. It is likely that the pain in the big foot is due to gouty arthritis, you need to go to the hospital to let the doctor give a diagnosis.
10.What tests are needed for gouty arthritis?
11. Is it true that a normal uric acid level does not exclude gout?
Gout is a high blood uric acid disease, but it does not mean that the uric acid will always be high.
Blood uric acid has a self-regulation process in the body, and it reaches its peak in the first three days of the disease, and then it will fall back.
12. What is the diagnosis of gouty arthritis?
(1) Elevated uric acid concentration in the blood and fast sedimentation rate of blood cells during the attack.
(2) joint fluid examination
(3) X-ray plain film: X-ray is taken to understand whether gouty arthritis has caused bone damage and to determine the extent of bone damage. In the early stage of gouty arthritis, there is joint swelling, and in the later stage, there are worm-like or round hole-like defects at the proximal end of the joint, and in the late stage, the inter-articular space is narrowed, and in the severe cases, there is extensive bone destruction and obvious soft tissue swelling, and calcification shadow is seen in the calcified gouty stone.
(4) CT and MRI examinations: they are useful for the early diagnosis of the disease and can be used as appropriate.
13. What diseases should be distinguished from gouty arthritis?
Mainly the following diseases are differentiated.
(1) rheumatoid arthritis: occurs in young and middle-aged women with symmetrical joint deformities in the distal small joints, which can be detected by rheumatoid factor tests.
(2) Pseudogout: is caused by calcium pyrophosphate deposition and is common in the elderly, with the knee joint being most commonly involved. Gouty arthritis is caused by the deposition of uric acid hydrochloride, mostly in middle-aged people, and symptoms are most common in the foot and ankle. The two diseases can be differentiated by x-ray.
(3) Septic arthritis and traumatic arthritis: the diagnosis can be confirmed by detailed medical history, physical examination, and examination of the joint capsule.
(4) simple bunions, often with a history of external or local chronic injury factors, in the bunions are seen in bunions, shoe size and other local abrasion or foot weight bearing caused by improper, without treatment or etiology correction, not easy to subside on their own, in addition to the attack time, the degree of pain is not as serious as gout, colchicine treatment is not effective.
14. Is gouty arthritis hereditary?
Although it cannot be considered a genetic disease, genetic factors play an important role in the development of gouty arthritis. Currently, most scholars believe that there is a family history of gout, and the younger the year of fever, the higher the proportion of family history, generally 15-35% of gout two have a family history.
15. What are the treatments for gouty arthritis?
Gouty arthritis is often treated with drugs that can reduce uric acid production, promote uric acid excretion, and inhibit inflammation.
Infrared, ultrashort wave or short wave heat transmission can also increase local blood circulation, promote inflammation and swelling, pain reduction, and increase the effect of drugs on the local.
16. Can drugs eliminate gouty arthritis?
There are three types of drugs used to treat gouty arthritis.
(1) drugs that reduce uric acid production, such as allopurinol; (2) drugs that promote excretion, such as benzbromarone, and (3) drugs that inhibit inflammatory reactions, such as colchicine.
17. Why can’t I take uric acid-lowering treatment when gouty arthritis attacks?
The so-called “uric acid-lowering drugs” in daily life mainly include drugs that inhibit uric acid production (such as allopurinol), drugs that excrete uric acid (such as benzbromarone) and alkaline drugs (sodium bicarbonate).
Once uric acid-lowering drugs are used during the acute attack of gout, there is a high probability of a sudden decrease in the concentration of uric acid in the blood, which can lead to the release of uric acid nadir in the bones and joints, thus causing transient hyperuricemia and aggravated attacks of gout.
18. What is the effect of taking sodium bicarbonate for gout patients?
Sodium bicarbonate is alkaline, because urate is soluble in alkaline urine, that is to say, it is easily excreted when the urine is alkaline, so the joint use of sodium bicarbonate can promote the excretion of urate out of the body, so as to achieve the effect of reducing uric acid in the blood.
19. What precautions should be taken when using colchicine for patients with gouty arthritis?
Colchicine has more side effects, such as gastrointestinal reactions, bone marrow suppression and causing malformations in newborns, so the following points need to be noted when using the drug.
(1) If reactions such as vomiting and diarrhea occur, the dosage should be; reduced, and in severe cases, the drug should be discontinued immediately.
(2)Use with caution in patients with bone marrow hematopoietic insufficiency, severe heart disease, renal insufficiency and gastrointestinal disorders.
(3) The medication should be scheduled for examination during use.
(4) Female patients need contraception during the medication period and within six months after stopping the medication.
20. Do I need surgery for gouty arthritis?
The presence of large uric acid crystals in the chronically affected joints and gout stones constitutes a reservoir of uric acid crystals in the body, and along with the growth of uric acid crystals in the reservoir, uric acid in the blood is often maintained at a high level. Therefore, in order to reduce the total amount of uric acid in the body, prevent further destruction of joints and soft tissues, correct deformities, and improve joint function, surgical treatment should be used to eliminate gout stones while restoring joint function as much as possible.
21. What should I pay attention to when using common drugs for gout?
The use of common drugs for the treatment of gouty arthritis should pay attention to the following points.
(1) Do not use uric acid-lowering therapy during the acute phase of gouty arthritis to avoid aggravation of symptoms.
(2) Gouty arthritis has a long-term treatment process, so during the interdigitating period, it is still necessary to insist on taking the lowest dose of uric acid-lowering therapy.
(3) It is necessary to take sodium bicarbonate tablets for a long time to promote uric acid excretion.
(4) If there are kidney stones and kidney function damage, it is necessary to promptly smelt boils, otherwise kidney function damage will aggravate uric acid excretion obstacle, which will lead to further increase of blood uric acid.
22. Is gouty arthritis preventable?
The acute attack of gouty arthritis can be prevented. We know that the acute attack of gouty arthritis is caused by a high purine diet, so we need to avoid a high purine diet in our life.
23. What are the considerations for living with gouty arthritis after the disease?
Gouty arthritis patients need to pay attention to a regular life, and strict abstinence from alcohol. Avoid high purine foods such as animal offal, seafood and hot pot.
Avoid: animal offal, high fructose beverages, high calorie beverages, excessive alcohol consumption (2 servings per day for men and 1 serving per day for women) for any patient, alcohol is prohibited during acute attacks of gout or in patients with poor control; limit consumption of: beef, lamb, pork, seafood containing high purines (sardines, shellfish), sweet juices, desserts, sweet drinks, alcohol, especially beer; encourage consumption of: low-fat or fat-free Dairy products, vegetables.
24. Now that my gouty arthritis has improved, can I just ignore it?
Gouty arthritis is a disease that requires long-term treatment. During the intermittent period, it is still necessary to take a minimum dose of medication to keep the uric acid at a certain level to reduce acute attacks and improve the quality of life.