Some people are troubled by the recurrence of gout within a few years, but they are still wondering why there is no effect even though they have avoided eating. Why do they still have gout attacks even though their blood uric acid has been reduced to normal value? In the face of these common questions of gout patients, gout requires long-term, systematic treatment in order to control the blood uric acid to normal values.
It is better to stop drinking than to lower blood uric acid
The blood uric acid can be said to be the “number one enemy” of gout patients. 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 metabolic 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 fitter 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 controlled properly.
Blood uric acid down to 360 umol/L to avoid recurrent attacks
In blood tests, the upper limit of the normal range of uric acid for the average male is 416 umol/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 416 umol/L. This is also a common misconception among gout patients.
The saturation value of uric acid in the blood is about 400 umol/L. At the highest normal value of 416 umol/L, uric acid is already at saturation in the blood. Therefore, in the systematic treatment of gout, patients 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 touch and if broken some burnt substance 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 reduce the blood uric acid to below 360 umol/L to avoid recurrent arthritis. For patients who have developed gout stones, the target value of blood uric acid should be below 300 umol/L to facilitate the slow dissolution of gout stones to a smaller size.
It is not necessary to take medication if there is no pain
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 take it again, which makes the condition repetitive and prone to the formation of gout stones.
You need to take medication even when you don’t have a gout attack, and you can adjust the amount of medication according to your blood uric acid situation. Generally, after reducing to the target value, you can reduce the dosage 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.
1, one is to inhibit the formation of uric acid, such as allopurinol.
Allopurinol is very inexpensive and effective in lowering uric acid, but it should be noted that 2% of people may experience 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 multi-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.
2, another type of drugs to promote the excretion of uric acid, 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 a consistent, regular exercise habit.