1.What is gout?
Gout consists of the words “pain” and “wind”, including two layers of meaning: pain comes and goes quickly, without trace, without shadow; pain is intense: when the wind blows, the pain is too much.
2. Are there many people with gout?
There are many such people now, and there are several outpatient clinics every day. In the past there were very few, in recent years there are more than 10 million statistics, the potential population suffering from gout (i.e. hyperuricemia) is even more, there are about 100 million people, accounting for about 10% of China’s 1.3 billion population. The more developed the region, the more gout, China Taiwan and Qingdao Yantai area is very much, what does this mean? Life is too good, all day long, big fish and meat and drink, eat out of the disease. As this disease is related to eating and drinking, it is also commonly known as “rich and noble disease”, “emperor’s disease” (ancient emperors such as Kublai of the Yuan Dynasty had this disease).
3, gout is a problem with the internal organs?
On the surface, gout has joint pain, it is a joint problem, but in fact, it is a problem with the internal organs, the liver and kidney problems, why do you say so? The culprit of gout is the combination of genetic factors and eating too well, which leads to high uric acid in the body, which is deposited in the joints and causes joint pain. And where does uric acid come from? There are endogenous and exogenous sources of uric acid, and since we are mainly talking about diet, we will focus on exogenous sources here. The meat we usually eat contains a lot of nucleic acid, which is converted into purine in the intestine, which is circulated through the blood to the liver, where it is converted into uric acid, which is excreted through the kidneys and intestines. If there is a problem with the liver and kidneys – an abnormality in the enzyme that metabolizes purines into uric acid in the liver – and too much uric acid is produced, and the kidneys can’t get rid of it in time, doesn’t that mean there is too much uric acid in the body? For example, like the water in the pipe, the upstream water is constantly flowing, and the faucet is blocked, the water is stagnant in the pipe.
4. How does uric acid grow?
What we can see is mainly uric acid crystals. The uric acid runs to various parts of the body, under the right environment will precipitate out, forming crystals, just like our home sewing needle, this is the performance under the ordinary microscope, this is the performance under the polarized light.
5.Since the problem is internal organs, but the manifestation is joint pain, which department should I go to?
Many patients think that when they suddenly have joint pain and redness, they think they have broken their feet or have a local infection, so they go to surgery. In fact, gout is a cool non-infectious inflammatory disease that resembles an infection and does not need to be treated with antibiotics. If you have joint pain, you should see the rheumatology and immunology department. If you do not have pain in the early stage, you can also see the endocrinology department, and in the late stage, if you have uremia, you should see the nephrology or urology department to see if you want to replace your kidney.
6.Why is there not a problem with the joints?
It is not that there is no problem with the joints at all. Here we have to distinguish between the primary and secondary problems, the symptoms and the root problem. The most fundamental cause of gout attack is too much uric acid in the body. The joints are neither the place where uric acid is produced nor the place where it is excreted, but only the place where it is deposited. And just like the plumbing mentioned earlier, the joints are neither the source of the water nor the faucet, but the “plumbing” in the middle. Why is it easy to deposit in the joints? The main reason is that the joints have a lot of movement, more movement will produce lactic acid, making the local acidic environment, in this acidic environment, the solubility of uric acid is low, so precipitation out.
7.Why is the first metatarsophalangeal joint the most affected?
About 50-90 % of the disease develops in the first metatarsophalangeal joint, and more than 90 % of the whole course of the disease will involve this joint. Reasons: low local temperature, uric acid precipitation: at the end of the limb; little subcutaneous fat, poor blood circulation; local external force (the largest pressure per unit area): easy to be injured, uric acid crystals easily dislodged and inflammation. The acidic environment is obvious: much movement and poor blood flow, tissue hypoxia. With the prolongation of the disease, other joints can be involved, but mainly joints farther away from the torso, because the farther away the lower the temperature, the easier it is to get cold, including the foot and ankle joints and knee joints. And joints close to the torso such as the hip and shoulder joints are generally not involved.
8.How is the pain in the toe considered gout?
Severe pain, localized redness, swelling and heat, afraid to touch, once touched, the pain jumped up. No matter what kind of body position can not be relieved. Some people say that the pain of gout is the worst pain in the world, similar to the pain in childbirth, but most of the people with gout are men, who have not had children, so I don’t know how they experience it. These people wake up in the middle of the night in pain, wailing, and have to get up as a family to go to the hospital for emergency care. Even touch and put a piece of paper, let alone cover the quilt. Can not walk, can only take a wheelchair, no elevator place, rely on a few people to carry up.
9. How to distinguish between broken foot and gout?
Indeed, it is easy to confuse these two. Generally speaking, the pain of a broken foot (ankle sprain) is not as intense as gout, which is a severe spontaneous pain, burning-like, tearing-like pain. The local redness of the broken foot is also not obvious and can be touched. However, there is a situation to pay attention to, the patient has both a broken foot and a gout attack, if the patient originally had gout, once the broken foot, so that the local gout crystals off, and induced gout. This does not need to be identified.
10.In which parts of the body are gout stones most likely to be deposited?
Gout stones can be deposited everywhere except the central nervous system, but they are most likely to be deposited at the ends of the limbs and the auricles, etc., because of the low temperature and poor blood circulation in these areas, which tend to have an acidic environment. I remember a gout patient, the course of the disease for more than 10 years, when I saw his whole body to grow gout stones, especially the hands and feet are more, larger, usually can not wear shoes, sitting in a wheelchair, often arthritis attacks, very painful.
11.Why are men prone to gout?
The reason why men are more prone to it than women: men have to support their families, make friends with foxes, do business and often go out to eat and drink; men have more androgens, women have more estrogens, androgens can prompt urate precipitation, while estrogens can resist urate precipitation. However, when women go through menopause, the estrogen level decreases and the onset of the disease is not much different from that of men.
12.Which men are more likely to get it?
The three high people, people who are socially active and people who eat well are prone to get gout. Their common feature is a “beer belly”, often with three high “high blood pressure, high blood pressure and high blood sugar”. Many gout patients have their own “gout like”, the doctor will know at a glance.
13, how to eat out of the gout?
The main reason is to eat too much and overeat, especially meat and wine, which contain a lot of purines, metabolized into uric acid in the body; and acidic food, so that the body process acidic environment, so that uric acid is easy to deposit. Some gout patients, a day eat several pounds of meat, and a lot of alcohol, stay up late, the so-called drunkenness, not gout is strange.
14.What is the diagnosis and opinion based on the value of uric acid?
An adult male, the normal value is 420umol/L or less, his test value exceeds the standard, so he should be hyperuricemia. However, the diagnosis of gout depends on the clinical presentation. If there is arthritis or gout stone or gouty nephropathy, gout can be diagnosed. Without any clinical manifestations, the diagnosis of hyperuricemia, which is pre-gout, is not yet true gout.
15.Does high uric acid value mean gout?
Gout and high uric acid cannot be drawn equal, that is to say, high uric acid does not necessarily under the diagnosis of gout; not high uric acid also cannot exclude gout. Why? Because: (1) There are some asymptomatic patients with high blood uric acid who have not had any gout attack even after years of follow-up, but of course these people have less obvious uric acid overload, or sometimes high and sometimes normal. (2) There are some gout patients who do not have high uric acid in laboratory test, there are the following reasons: the laboratory test is total uric acid, including the combined type and free type, if the total uric acid is normal, but in which the free type uric acid is increased can also induce gout; the level of uric acid itself is fluctuating; there are too many influencing factors, various foods and drugs, exercise, etc. all affect the value of uric acid; the body endocrine adrenocorticotropic hormone during the pain attack, which can promote the excretion of uric acid, and not Increase.
16.How to read the laboratory test?
We find the indicator of blood uric acid and compare it with the reference value at the back, but note that the lab test only gives a reference value, which is the reference value for adult men and postmenopausal women. The reference value for non-menopausal women (<360 umol/L) and for children (<300 umol/L) is not given. (2) For patients who have been diagnosed with gout taking uric acid-lowering drugs, the concern is whether this indicator is below the point of uric acid dissolution (360 umol/L), and for patients with a large number of gout stones, whether it is below 300 umol/L. Other indicators need to be looked at, such as blood glucose and lipids; one needs to know whether it was previously elevated? Have you had any heavy meals and strenuous exercise the night before the test, and have you taken any medication that affects uric acid? Are there any clinical manifestations? Comprehensive judgment.
17, gout pain really came, what should I do?
The answer choice here is painkillers. We usually use painkillers, called non-steroidal anti-inflammatory drugs, i.e. non-hormonal anti-inflammatory drugs, there are many such drugs, including Fotarine, Fenbendazole, Loxone, Celebrex, etc. They are all through the inhibition of an enzyme – cyclooxygenase, to achieve the effect of symptom relief. Of course, if NSAIDs are contraindicated, other analgesics such as colchicine and glucocorticoids are used instead. Then why can’t I choose hot compresses? During the acute attack of gout, the local temperature is high and the blood vessels are dilated, so hot compresses make the temperature higher and the blood vessels more dilated, aggravating the local swelling and pain. The cold compress can constrict the blood vessels and reduce the pain. At the same time can add magnesium sulfate wet compress, magnesium ion can inhibit the central excitation, reduce pain. In addition, topical medications such as Qingpeng cream or Furtalin emulsion can be applied topically. At the same time, elevate the affected limb, more rest, avoid weight bearing.
18.Isn’t it because of high uric acid? Why can’t I take uric acid-lowering drugs during the seizure?
The first attack, not the second attack, is not to take uric acid-lowering drugs during the attack, which is confused by the old people. Why? The main reason for holding off on uric acid-lowering drugs for the first attack is to avoid excessive fluctuations in uric acid, which can prolong the attack. The uric acid-lowering drugs make the blood uric acid level will suddenly lower too fast, so that the surface of the gout stone in the joint dissolves, releasing insoluble needle-like crystals, which are phagocytosed by white blood cells, releasing inflammatory mediators and inducing persistent inflammation. And but once added after the uric acid-lowering drugs, later again, no need to stop using uric acid-lowering drugs, the purpose is also to avoid excessive fluctuations of uric acid.
19.How should I take uric acid-lowering drugs?
At present, there are 3 kinds of uric acid-lowering drugs, one is into uric acid excretion drugs such as benzbromarone, one is inhibiting uric acid synthesis drugs such as allopurinol and febuxostat, and another is synthetic uric acid enzyme such as pregabalin. Different drugs are chosen for different conditions. To use an analogy, a patient with very little uric acid excreted from the kidneys, good kidney function, and no urinary stones or gout stones, may choose benzbromarone. If the kidneys are not functioning well, there are a lot of gout stones and uric acid is already excreted from the urine, allopurinol or febuxostat should be chosen. For refractory patients, where the above medications are not effective, use Prescriptive, which is not yet available in China. All these drugs should be increased gradually from small doses, and the uric acid value should be repeatedly tested at regular intervals until it is reduced to within 300-360umol/L.
20.Can I take uric acid-lowering drugs for a long time?
Uric acid-lowering drugs should be taken for a long time, especially for patients who already have impaired kidney function. After taking uric acid-lowering drugs, they have their uric acid normalized once, and then they immediately stop taking them, and never have them tested again. In fact, regular monitoring is needed, and if uric acid cannot reach below the standard value under strict control of diet, it should be taken persistently.