Gout is a common disease caused by disorders of purine metabolism and/or decreased uric acid excretion resulting in urate deposition. The pathogenesis of the disease is clear and there are many effective treatments, but the disease is often prolonged due to inappropriate treatment in clinical work. It is the most common type of inflammatory arthritis in men. Its incidence increases annually with age, with a prevalence of up to 7% in men >65 years of age.
What is the difference between the joint pain of gout and other joint pains? As an ordinary patient, how can I initially determine whether it is gout or other causes of joint pain? Below I will briefly introduce some common symptoms of gout.
Common symptoms.
(1) Acute attack: the attack can be without any signs, mostly single joint pain, if not treated, the pain is progressively worse and unbearable; “pain is going crazy” (maybe this is the origin of the name of gout, just guessing). The affected joints become red, swollen, and burning, with increased local skin temperature, pronounced tenderness, and marked restriction of movement. More than 50% of gout attacks occur in the first metatarsophalangeal joint (where the thumb is located), and 90% of patients are involved in this area later in the course of the disease; other joints can also be involved. In short, the pain is mostly in one joint at a time, not in several joints at the same time, and the thumb is easily affected.
(2) Intermittent episodes: Acute gouty arthritis generally has no sequelae after remission, and the length of the asymptomatic interval varies greatly (some patients are pain-free for 1-2 years after the pain has passed, and some have pain again in 1-2 months). As the disease progresses, if no treatment is given, the number of gout attacks gradually increases, the duration of pain symptoms lengthens, the asymptomatic interval gradually shortens, and even the symptoms are not completely relieved and persistent pain appears, the number of affected joints gradually increases, and the signs and symptoms gradually become atypical. Simply put, if not properly treated and disobeyed; the interval between two pains will become less and less, and the pain may persist.
(3) Chronic gouty stone lesion stage: If hyperuricemia is not controlled for a long time, subcutaneous gouty stones and chronic gouty stone arthritis will appear. The typical site of subcutaneous gout stones is the auricle, and they are also common around recurrent joints. They appear as elevated yellowish-white flabby lesions of varying size, with a thin surface that breaks down and discharges a white powdery or pasty substance that is persistent, but less likely to be secondary to infection. Gout stones deposited in large quantities in joints can cause bone destruction of joints, fibrosis of periarticular tissues, and secondary degenerative changes. Simply put, it is uric acid salts and some proteins in your body successfully stick together and form crystals in your body; however, this crystal is not a diamond, which is not valuable; moreover, it is not a relic, which can bring you Buddha’s fate; it can only bring you pain.
(4) Kidney lesions.
1, chronic uric acid nephropathy.
2, uric acid urinary tract stones: the incidence in gout patients is more than 20%, and may appear before the onset of gouty arthritis. Smaller ones are excreted in the form of gravel with urine and may have no obvious symptoms; larger ones may block the urinary tract, causing renal colic, hematuria, difficulty in urination, urinary tract infection, dilated renal pelvis, and fluid retention.
3, acute uric acid nephropathy. Simply put, if gout is not treated properly, it is easy to develop kidney problems, and if this problem really occurs, it is a little more troublesome. Therefore, gout should be treated early.
Treatment plan and principles
The objectives of gout treatment are.
① to rapidly and effectively relieve and eliminate the symptoms of acute attacks.
② Prevent recurrence of acute arthritis.
③ Correct hyperuricemia, induce dissolution of urate crystals deposited in tissues and prevent formation of new crystals, thus reversing and curing gout.
④Treatment of other concomitant diseases. In short, stop the pain when it hurts, drain the uric acid when it doesn’t, and when the uric acid is cleared, the joints won’t hurt.
The best treatment plan for gout should include both non-pharmacological treatment and pharmacological treatment. If necessary, surgical treatment such as removal of gout stones and orthopedic treatment of destroyed joints may be an option.
Drug treatment
(1) Treatment during acute attack
The following three types of drugs should be used early and in sufficient quantity, and gradually reduced and stopped when they are effective. The acute attack of arthralgia should not be treated with uric acid-lowering therapy, and those who are already taking uric acid-lowering drugs should not stop using them when an acute attack occurs, so as not to cause fluctuations in blood uric acid and prolong the attack or cause another attack.
1, non-steroidal anti-inflammatory drugs (NSAIDs): all kinds of NSAIDs can effectively relieve the symptoms of acute gout, and have become the first-line drugs. Etoricoxib has been approved for the treatment of acute gouty arthritis.
2, colchicine (colchicine): due to its side effects such as causing diarrhea, it is now less used.
3.Steroid hormone: If you cannot tolerate NSAIDs, you can consider using prednisone 30mg once a day treatment.
(2) Treatment of intermittent and chronic phase.
The main purpose of intermittent and chronic phase is to reduce uric acid and promote urate dissolution and discharge; NSAIDs can be taken at the same time as starting uric acid-lowering drugs for 1 month to play a role in preventing recurrence of acute arthritis.
1.Uric acid production inhibitors: Allopurinol: initial dose 100mg/d, then increase 100mg every 2-4 weeks until 100-200mg, 3 times daily (daily dose within 300mg can also be taken once).
2.Uric acid excretory drugs: benzbromarone: initial dose 25mg/d, gradually increase to 50-100mg, 1 time daily.
3.Alkaline drugs: sodium bicarbonate tablets: oral 0.5-2.0 each time, 3 times a day.
Gout is often accompanied by one or several of the metabolic syndromes, such as hypertension, hyperlipidemia, obesity, type II diabetes, etc. The presence of these disorders increases the risk of gout. Therefore, gout treatment should be accompanied by active treatment of the associated concomitant diseases. Some of the drugs used in the treatment of these diseases have weak blood uric acid-lowering effects through mechanisms such as increased uric acid clearance, and are worth choosing, but they are not recommended for gout treatment alone. (1) lipid-lowering drugs: fenofibrate (has the effect of lowering uric acid while lowering lipids), etc.; (2) antihypertensive drugs: cloxacin (has the effect of lowering uric acid).
Gout is a simple and complex disease. In the early stage, as long as active control can get very good results, and many can be cured; however, in the late stage of gout, if there is serious joint destruction and kidney damage, it is difficult to recover. Therefore, timely treatment is very necessary.
So, in short, gout is a not too troublesome disease, the main thing is that the patient should listen to the doctor and insist on treatment, while keeping his mouth shut and moving his legs. Then there will be hope for curing this disease.