Gout is also a kind of “wealthy” disease. In ancient times, kings, generals and dignitaries ate, drank and played all day long, so it is said that “fatty, sweet and thick tastes will produce big boils”. In the West, it is also the most common form of arthritis in men over middle age. In the past, it was thought that gout was rare in Eastern peoples. In recent years, as people’s living standards continue to improve, the diet structure has changed, from the traditional carbohydrates and lower levels of protein foods to foods with higher protein content, coupled with the lack of appropriate physical activity in some people, so that the weight exceeds the standard, the incidence of gout has also increased significantly.
Gout.
It is a group of diseases caused by disorders of purine metabolism or reduced uric acid excretion. Its clinical features are hyperuricemia, recurrent acute arthritis, gout stone deposition and hyperuricemic nephropathy. Gout is mostly seen in middle-aged men and above, and only 5% of women. There is a tendency for gout to develop familially, with about 10% to 20% having a positive family history of gout.
Acute gouty arthritis.
It is an inflammatory response caused by the shedding of urate crystals. In typical cases, the onset of the disease is rapid, with the foot pain waking up at midnight, and the pain peaking at about 48 hours, with severe pain like cutting and biting. The first attack is in the unilateral bunion joint in 60% to 70% of patients, and the joint is involved in more than 90% of patients during the course of the disease. The pain decreases in 3 to 4 days and then becomes locally dark red with flaking. Gout attacks usually last a few days to a few weeks and then resolve on their own. Most patients have a recurrence within 1 year.
Most patients with untreated gout have elevated blood uric acid levels, with normal blood uric acid ranging from 90 to 420 umol/l.
X-rays.
In early acute arthritis there is only soft tissue swelling. After repeated attacks, there is destruction of the articular cartilage rim, irregularity of the joint surface, followed by narrowing of the joint space, and changes such as gouty stone deposits are seen in the subchondral bone and bone marrow.
Treatment of acute gouty arthritis.
1.Patients should rest in bed, elevate the affected limbs, and resume activities only after 72 hours of pain relief.
2, the application of non-steroidal anti-inflammatory drugs (NSAIDS). Commonly used are: fotarine, ibuprofen, neprone, anti-inflammatory pain, aspirin, etc.
3.Application of colchicine, which can inhibit granulocyte infiltration, has a selective anti-inflammatory effect on acute gouty arthritis, but the side effects are large.
Treatment of intermittent gout and chronic phase.
Apply drugs to lower blood uric acid. (Please combine the specific medication with the clinical situation and be guided by the doctor’s interview.)
1.Promote uric acid excretion drugs, mainly by inhibiting the reabsorption of uric acid in the proximal renal tubules to promote uric acid excretion. Commonly used are: propofol, thiopidone, benzbromarone (gout Lisian).
2.Inhibit uric acid production drugs: Allopurinol has a strong inhibitory effect on xanthine oxidase, thus blocking the conversion of hypoxanthine to xanthine and uric acid. The above two groups of drugs have no anti-inflammatory and pain-relieving effects, so they should not be used in the acute phase.
Self-care for gout patients.
For most people, gout attacks are caused by “cravings”, so diet control is especially important.
1, avoid eating high purine food: pig, beef, mutton, chicken, duck, goose, rabbit and various animal offal (heart, brain, liver, kidney), bone marrow, as well as sardines, oysters, clams, crabs and other high purine content, should try not to eat.
2, fish and shrimp, spinach, beans, mushrooms, shiitake mushrooms, peanuts, etc. also have a certain amount of purines to eat less.
3.Most vegetables, various fruits, milk and dairy products, eggs, rice and sugar can be eaten.
4, avoid overeating or hunger; abstain from smoking and alcohol, especially not alcohol, especially beer; do not drink strong tea, coffee and other beverages. It is advisable to drink more water to facilitate the discharge of uric acid, to keep the daily urine volume above 2000 ml.
5, obese patients should reduce the intake of calories and reduce body weight.
6, gout patients should pay attention to avoid overwork, tension, cold and joint injury and other factors that trigger an acute attack of gout.
7.To wear comfortable shoes.
8.Regularly monitor blood uric acid and kidney function.