Mr. Wang, 52, had his first gout attack three years ago, and it has been recurring from time to time for several years, leaving him troubled and puzzled: He has obviously avoided eating, but why is there no effect? His blood uric acid has been reduced to normal value, why does gout still attack? In the face of these common questions of gout patients, doctors reminded that gout requires long-term, systematic treatment to control the blood uric acid to normal values. The actual fact is that you can find a lot of people who have been in the business for a long time, and that is why it is so important for you to have a good time. After suffering from gout for the first time, many people will be determined to refuse all meat, seafood, etc., or even a completely vegetarian diet. Is such a painful diet effective? Although a vegetarian diet has some significance in reducing blood uric acid, it is not cost-effective to reduce uric acid completely by controlling the diet. The Chinese people have been eating mainly cereals for generations, but in our generation, the food structure has changed fundamentally: from a cereal-based diet to a meat-based diet. However, due to genetic background and ancestral food structure, Oriental people generally have poor adaptation and metabolism ability to high purine diet, prone to increased blood uric acid, leading to the occurrence of gout. On the other hand, the shift in diet structure facilitates the intake of nutrients, allowing people to be more physically fit and live longer. Therefore, he believes that it is not necessary or realistic for gout patients to go back to the diet they had before the 1970s. Gout patients should quit drinking rather than “quit eating”. The effect of alcohol on gout is greater than the effect of meat on gout, so gout patients should try to drink less alcohol, especially white wine and beer. The actual fact is that you can have a small glass of red wine, but you can’t drink too much, too much red wine is also harmful to gout patients. Of course this does not mean that gout sufferers can gorge on meat without restraint. The intake of meat, offal and shellfish needs to be properly controlled. Blood uric acid down to 360umol/L to not recur in the blood test, the upper limit of the normal range of uric acid in the average male is 416umol/L, leading many gout patients to take that value as their goal for lowering uric acid, thinking that everything will be fine if they lower it to 416umol/L. This is also a common misconception among gout patients. The saturation value of uric acid in the blood is about 400umol/L. At the highest normal value of 416umol/L, uric acid is already in saturation in the blood. Therefore, in the systematic treatment of gout, the patient should not be satisfied with just getting down to the “normal value”, but to the “target value”. Generally speaking, the target value is definitely lower than the normal value, and the target value to be achieved varies according to the severity of the disease. The target value depends on whether the patient has developed gout stones or not. Gout stones are formed only after repeated attacks of gouty arthritis. Gout stone is a mass that bulges around the joints of the distal extremities due to the deposition of uric acid crystals in the joint cavity and under the skin when the concentration of uric acid in the blood is high. The surface is hard to the touch and if broken some paste like toothpaste or lime mud is squeezed out, mostly seen at the joint on the side of the thumb of the foot. For patients with swelling and pain without gout stones, it is important to lower the blood uric acid to below 360umol/L to avoid recurring arthritis attacks. For patients who have developed gout stones, the target value of blood uric acid should be below 300umol/L to facilitate the slow dissolution of gout stones and make them smaller. Many gout patients take medication during a gout attack and feel they are “fine” after the pain is relieved, so they unknowingly stop taking the medication on their own until the next attack, and then eat it again. Patients should take medication even when they do not have a gout attack, and they can adjust the amount of medication according to their blood uric acid situation. Generally, after reducing to the target value, the dosage can be reduced appropriately to maintain the blood uric acid at the target value for a long time. While taking medication, you should go to the hospital every 3-6 months for a checkup to know your blood uric acid situation in real time to prevent recurrent attacks of gout. Drugs to lower uric acid are divided into two categories. One type is those that inhibit the formation of uric acid, such as allopurinol and febuxostat (Ulipristal). Allopurinol is very inexpensive and effective in lowering uric acid, but it should be noted that 2% of people may develop skin allergy when taking it, and once it occurs it must be stopped promptly, otherwise it may lead to severe allergic symptoms, including exfoliative dermatitis and multiple organ damage, or even shock and death. When taking it for the first time, take only one capsule a day and observe closely for skin discomfort, and gradually increase to the regular dose after half a month to a month of continuous use. The advantage of febuxostat, which is comparable to allopurinol, is that it has a very low incidence of allergy, but the disadvantage is that it is more expensive. Another class of drugs that promote uric acid excretion, such as benzbromarone. Patients with poor kidney function and kidney stones should use drugs that promote uric acid excretion with caution, so as not to increase the burden on the kidneys. When taking such drugs, you can drink some soda water, because in an alkaline environment, urate is highly soluble and less likely to form crystals. Drinking more water and urinating more often can also reduce the formation of urate crystals in the kidneys. Finally, many gout patients are also accompanied by high blood pressure, hypertension, obesity and other affluenza, and need more exercise, but explosive exercise may lead to the exacerbation of gout symptoms. Gout patients should be careful to form consistent, regular exercise habits. Tips on why women are less likely to get gout I’m sure you’ve noticed that most of the gout patients around you are men, and it’s rare to see women with gout. What is the reason for this? This is because the estrogen in women’s bodies fights against uric acid crystals, and estrogen can promote the excretion of uric acid from the body. Therefore, the high incidence of gout in women is after menopause.