1.Definition and danger of hyperuricemia (HUA)
Absolute hyperuricemia is defined when the blood uric acid concentration exceeds the upper limit of uric acid solubility. At 37 ℃, the saturation value of blood uric acid is 7 mg/dl (417μ mol/L), and beyond this saturation point, needle-like crystals of monosodium urate will be precipitated and precipitated in tissues. General epidemiological studies use the mean value of blood uric acid in normal subjects plus two standard deviations as the upper limit, and consider blood uric acid values above 7 mg/dl (417 μ mol/L) in men and above 6 mg/dl (357 μmol/L) in women to be called relative hyperuricemia.
Uric acid crystals deposited in joint areas can cause gouty arthritis attacks, and some can form gouty stones visible to the naked eye, uric acid kidney stones, causing gouty nephropathy. The presence of hyperuricemia without an arthritic attack is called asymptomatic hyperuricemia.
Numerous studies on the dangers of hyperuricemia conducted in recent years have shown that hyperuricemia is an independent risk factor for hypertension, coronary heart disease, stroke, all-cause mortality in the general population, death from coronary heart disease, cardiovascular events, and death from acute and chronic heart failure. There is a global consensus that hyperuricemia is an independent risk factor for cardiovascular disease. Therefore, some people refer to hyperuricemia, hypertension, hyperglycemia and hyperlipidemia together as the “four highs”, in order to draw people’s attention to it.
2.How to deal with asymptomatic hyperuricemia?
For the treatment of asymptomatic hyperuricemia, almost all guidelines agree that non-pharmacological treatment should be given, and there is no consensus on whether or not pharmacological treatment should be given. 2010 Chinese Gout Guidelines suggest that non-pharmacological treatment is the main treatment for asymptomatic hyperuricemia, and uric acid-lowering drugs are generally not recommended. However, in cases where uric acid is higher than 9 mg/dl (540 μ mol/L) despite dietary control;
In the “Chinese Expert Consensus on Asymptomatic Hyperuricemia” initiated by Chinese cardiovascular experts in 2012, they are very positive about the application of uric acid-lowering drugs, and they believe that patients with cardiovascular risk factors or comorbidities should be treated with uric acid-lowering drugs. Patients with cardiovascular risk factors or comorbidities should be treated with uric acid-lowering drugs if their blood uric acid level is greater than 8 mg/dl, and patients with hyperuricemia whose blood uric acid level is less than 8 mg/dl should be treated with additional uric acid-lowering drugs if it is still higher than normal after 6 months of life coaching;
Patients without cardiovascular risk factors or comorbidities with blood uric acid levels greater than 9 mg/dl should be treated with uric acid-lowering drugs, and patients with less than 9 mg/dl should be treated with additional uric acid-lowering drugs if they are still above normal after 6 months of life coaching. Cardiovascular comorbidities or risk factors include: hypertension, abnormal glucose tolerance or diabetes, hyperlipidemia, coronary heart disease, stroke, heart failure or abnormal kidney function.
3, gout treatment medication has to be careful
Some patients think that gout is not the choice of colchicine, Ankangxin, Futalin, Qingpeng cream, gout, allopurinol, sodium bicarbonate, benzbromarone and febuxostat those kinds of drugs? When I don’t have an attack, I don’t have any symptoms at all, so why should I take medicine all the time, which doesn’t hurt my liver and kidneys? Every time you add uric acid-lowering drugs, gout flares up, so why not stop the uric acid-lowering drugs and it won’t come back?
In fact, the treatment of gout is most artistic, and all these complaints are a misunderstanding. First of all, we should distinguish which are anti-inflammatory and analgesic drugs and which are uric acid-lowering drugs? Among the above drugs, Colchicine, Ankangxin and Fotarine are anti-inflammatory and analgesic, which cannot lower uric acid and are the treatment for the symptoms (usually taken for acute attacks, not for long-term lifelong use, but longer for recurrent attackers);
Allopurinol, sodium bicarbonate, benzbromarone and febuxostat are allopurinol, sodium bicarbonate and febuxostat, which lower uric acid and are curative drugs (to be taken for a long time or even for life), among which allopurinol and febuxostat are curative drugs that inhibit uric acid synthesis, while sodium bicarbonate and benzbromarone are curative drugs that promote uric acid excretion. The doctor will choose and adjust the medication according to the period of the patient’s disease, kidney function, gout stone deposition and uric acid excretion.
4. Sustained achievement of uric acid standard is the key to successful treatment
For general gout, the ideal target value of blood uric acid is <6mg/dl (360umol/L), while for refractory patients, it should be controlled below 4mg/dl. Long-term sustained compliance can reduce the frequency of acute arthritis attacks, promote gout stone dissolution, and help slow down the progress of renal insufficiency and improve the prognosis of patients with combined heart failure. After a period of treatment, some patients with gout no longer have arthritis attacks, the uric acid is normal or meets the standard after several retests, and even the original gout stones have dissolved and disappeared, and the kidney function has also returned to normal, so is this a "cure"?
No, gout has not been cured, but all the uric acid crystals deposited in the joints and kidneys may have been dissolved, but once the uric acid-lowering drugs are completely stopped for a period of time, the blood uric acid will definitely increase again when the blood is rechecked, and over time, it will be deposited in the joints and kidneys, causing arthritis attacks and kidney damage again.
Therefore, the treatment of gout is basically lifelong and requires continuous attention to diet control and uric acid-lowering drugs, and the dosage of medication should be adjusted according to the monitored blood uric acid value, for example, if allopurinol is taken 2 tablets daily and the blood uric acid is within 200umol/L for 3 times in a row at an interval of 2-4 weeks, allopurinol can be lowered to 1.5 tablets daily; if the blood uric acid exceeds 360umol/L, the dosage should be increased to 2.5 tablets daily. If the blood uric acid exceeds 360umol/L, the dose should be increased to 2.5 tablets daily; if it is between 200 and 360umol/L, this dose should be maintained.
The same is true for adjusting the dose of sodium bicarbonate with urinary PH value. When the urinary PH value exceeds 6.8, sodium bicarbonate is reduced by 1-2 tablets/day; if the urinary PH value is below 6.2, sodium bicarbonate is increased by 1-2 tablets/day, and if the PH value is between 6.2 and 6.8, the dose is maintained unchanged.
5, the lifestyle of gout is also important
Gout patients also have to pay attention to life for a lifetime. Such as strict control of high purine diet, soft drinks and fructose, ban on beer and liquor (can drink a small amount of red wine), drink more water (the amount of water should make the 24-hour urine volume more than 2000ml) and alkalize urine (so that the urine pH value is maintained at 6.2~6.8), etc. Now there are many alkaline mineral water on the market, which is good for promoting uric acid excretion. Cherries among fruits are also very suitable for gout patients, which have mild pro-uric acid excretion and analgesic and anti-inflammatory effects.
Some people say, I love to eat meat and fish, really want to eat what to do? The best way is to blanch them in boiling water and discard the soup, as purines in meat and fish can be released into the soup, which will reduce the intake of purines, while eating less and ensuring that the attack period does not eat and drink a lot of water.