Since ancient times, gout is a “disease of the rich” and “disease of the middle-aged and elderly”. These days, more and more young people are suffering from the disease. Moreover, these “gout men” have a similar pattern in their lives.
Yang Xiuyan is the “founding father” of the rheumatology department at the First Hospital of Sun Yat-sen University. In the 30 years he has been dealing with gout, he has found that the symptoms are still the same, but more and more people are getting sick, and younger and younger, including young people in their twenties.
”To put it bluntly, gout is a drinking disease.” Professor Yang pointed out that the youthfulness of gout is closely related to the dietary structure of young people.
A “little silver needle” is hidden in your joints
The pain of gout is a painful one. It strikes in the middle of the night, and the first attack often brings severe pain to the big toe (the first metatarsophalangeal joint), like a knife cut, like a bite, a cone stabbing the bone. This pain, the next day people will not be able to walk. This kind of torture, usually proud of the strong man can only run to the hospital in the dust.
Why does gout hurt so much? “We’ll see under the microscope.” Professor Yang sold a story.
It turns out that the essence of gout is hyperuricemia. In plain English, that means there is too much uric acid in the blood. What is uric acid? It is a metabolic waste product of the human body. If you have studied chemistry, you know that any solution has its solubility. When the blood uric acid concentration is higher than the saturation concentration, uric acid will precipitate out and form urate crystals, which are deposited in the joint cavity. It is like putting salt in a glass, when the amount exceeds a certain level, the salt cannot be dissolved and settles at the bottom of the glass.
The pain in the joint is caused by the uric acid crystals. The blood flow in the toe is slow and the temperature is low, so the crystals are more likely to be deposited there.
Cuiyan Yang told the reporter that under the microscope, it was a “little silver needle”, thin, sharp, white and transparent. The “little silver needles” stimulate the synovial membrane of the joint, inducing an inflammatory response, which results in redness, swelling, heat and pain. To the naked eye, the joints look red and white.
When gout recurs, uric acid is deposited in large quantities and clumps together to form gout stones. The gout stones are as small as sesame seeds or as large as eggs, and if pierced with a needle, the toothpaste or white lime material that comes out is urate crystals. Gout stones are often persistent and can erode bone and joint cartilage. Cuiyan Yang showed a picture of an old patient with gout whose bones had been “hollowed out” by gout stones.
As the disease progresses, the fingers, toes, wrists, ankles, knees, and even kidneys are not spared.
If gout had been a precursor, it might not have been so frightening. But Yang says, “At most, you feel a difference in your toes before you go to bed, a soreness and swelling, but it’s not specific.”
Suddenly a “meat eater”, the body does not adapt
At Professor Yang’s hospital, the number of gout visits has overtaken the common rheumatoid arthritis. This is the current situation in many hospitals in China. Some estimate that the number of people with gout in China is now over 10 million.
It is only in the last 20 years that gout has entered the Chinese body in large numbers. In the past, gout was a rare disease. By 1958, only 25 cases of gout were reported nationwide, according to data.
Professor Yang was one of the first people in China to smell it.
In 1996, he published a paper in the Chinese Journal of Epidemiology, revealing for the first time in China that gout had changed from a rare disease to a common one. The paper studied the trend of 15-year (1979~1993) change of gout hospitalization composition ratio in 21 urban hospitals in China. The results showed that with the reform and opening up, people’s living standard improved and food structure changed, the incidence of gout was on a steep rise.
Cuiyan Yang pointed out that the root cause of the steep rise in the incidence of gout was that the Chinese diet, which had been inherited for thousands of years, suddenly changed in our generation from a cereal-based diet to a meat-based one.
The traditional belief was that gout was a common disease in Westerners and genetics was the main cause. It was later confirmed that genetic factors only account for a small part of the cause, and that excessive intake of meat protein, which causes disorders of purine metabolism, is the main cause of elevated blood uric acid levels.
Purines are found in all animals, plants and humans. Uric acid is the end product of purine metabolism. In the human body, 20% of uric acid is converted from exogenous purines, and this 20% affects the fluctuation of blood uric acid in the human body. Most meat foods, rich in purines.
”Eastern peoples, have always had cereals as their main food. After the reform and opening up, the diet of many people has changed to animal-based foods, and our physiological metabolic system has long been adapted to cereal-based low purine foods. When meat foods with high purine content replace traditional low purine foods and exceed our physiological metabolic capacity, disorders of purine metabolism occur.”
Talking about the rejuvenation of gout, Cui Yang said, “In the old days when we were poor, meat was left for our elders to eat. At the same time, it was mainly the middle-aged and elderly who suffered from gout because of the decline of kidney function in the elderly or because of taking drugs such as aspirin and diuretics, which affect uric acid excretion. And now, with better economic conditions and young people eating more meat, the problem has been exposed.”
Despite this, Yang does not recommend that gout patients give up meat. “It’s not cost-effective to lower uric acid completely by controlling the diet. On the flip side, the shift in diet facilitates nutritional intake, strengthens people’s physique and extends their life span. It is unnecessary and unrealistic to return gout patients to the pre-1970s diet structure.”
Hyperuricemia ≠ gout
The physical examination report says “hyperuricemia”, does it mean gout? In fact, as long as you don’t have acute joint pain, you don’t need to get it right.
According to Yang, “hyperuricemia is an important basis for the development of gout, but it is not the same as gout, and gout cannot be determined or ruled out based on blood uric acid levels alone.”
It is well established that many patients with hyperuricemia do not develop gouty arthritis throughout their lives. Conversely, a proportion of patients have normal blood uric acid levels during acute episodes of arthritis. Hyperuricemia and gout are two concepts that need to be differentiated.
”You should never check uric acid as soon as you have joint pain, and when uric acid is high, you say it’s gout. For example, when some elderly people get older and develop osteoarthritis, they go to check their blood uric acid and say it’s gout, which is not right. There are many people with hyperuricemia, and there are many causes of joint pain.”
In fact, cardiovascular system disease, kidney disease and tumor lysis syndrome (mostly seen in children with tumors and leukemia that are highly sensitive to chemotherapy) may also cause elevated blood uric acid.
According to Yang, doctors diagnose gout based on blood uric acid levels, but also identify the typical symptoms of gout, the patient’s diet and lifestyle habits before the onset of gout, in order to make a general diagnosis. In some patients with acute attacks, white gout stones the size of grains of rice appear in the auricle, which is also a point of support for the doctor’s diagnosis.
The “gold standard” for gout diagnosis is the observation of uric acid crystals under a microscope. “However, the patient is in pain and you have to take a needle to puncture it, which can greatly increase the patient’s pain, so the test is not necessary and is rarely used.” Cuiyan Yang said. In addition, ultrasound examinations of the joints, which can also detect urate crystals, can help in the diagnosis of gout.
It is worth noting that in China, although only about 10 percent of patients with hyperuricemia develop gout, even young people should have their blood uric acid checked regularly, eat a sensible diet and never take it lightly.
How can I have gout when my blood uric acid is not high?
In blood tests, the upper limit of the normal range of uric acid in the average male is 416 umol/L. Some people with gout relapse only to find that their blood uric acid concentration does not exceed this value. Why is this?
Cui Yang explains that 416 umol/L is the saturation value for blood uric acid, not the target value for gout attack prevention.
He suggests, “Patients with swelling and pain without gout stones should lower their blood uric acid to below 360 umol/L to prevent gout attacks and recurrences; patients with gout stone production should lower their blood uric acid to i.e. 300 umol/L to facilitate the slow dissolution of gout stones and prevent joint destruction and kidney damage.”
What kind of men are prone to gout?
Among young people, the only ones who need to worry about gout, I’m afraid, are men.
”Gout in women, usually after menopause. Estrogen in women of childbearing age promotes uric acid excretion, so pre-menopausal women rarely have gout unless it is accompanied by kidney insufficiency, ovarian decline, or tumor disease.” Cui Yang explained.
The immediate cause of gout is high blood uric acid, but the exact mechanism of elevated blood uric acid is not fully understood. The medical community believes that only about 10 to 20 percent of gout patients have a family history, so there is a preference for defining gout as a lifestyle disease.
According to Yang, there are several lifestyles that are closely associated with gout and require particular vigilance.
▲ Meatlessness
Patients often experience heavy eating and drinking on the night of a gout attack. Meat is a high purine food, especially animal offal and seafood, which are high in purines. Once the excess consumption, resulting in excessive production of uric acid, and too late to excrete, it is possible to invite gout.
Young people are popular for hot pot, and Yang points out that eating hot pot is usually accompanied by eating large pieces of meat, seafood, and especially hot pot soup, which can trigger gout. One study showed that every 100 mL of broth contains 160-400 mg of purines, 30 times more than a normal diet.
Yang also found that in the past, gout was mostly in the so-called “rich” people, but now, many economically well-off people pay attention to health care and control their diets, instead, there are more patients of medium economic level.
The first thing you need to do is to have a good time.
The most important thing is that you can get a good idea of what you want to do. The gout is the trigger for gout.
On the one hand, ethanol promotes the conversion of adenine nucleotides, which increases the production of uric acid; on the other hand, the oxidation of ethanol increases the concentration of lactic acid in the blood, which decreases the pH of the blood, prompting the precipitation of urate crystals. Along with alcohol, people often eat meat, which leads to acute attacks of gout.
According to Yang, daily sips are not a problem, but “toasting” at the dinner table is not recommended. “The most dangerous is beer, which has a low alcohol content, but is usually drunk in large quantities.
Sudden and strenuous exercise
The reason for this is that there are many people with gout who are sedentary and less physically active than those who are physically active. The reason for this may be that “exercise boosts metabolism and helps lower blood lipids, blood sugar and uric acid.
However, improper exercise can also trigger gout. This is usually in people who don’t exercise much and have a certain amount of uric acid crystals in their joints,” says Yang. Sudden strenuous exercise causes tremendous friction in the joint cavity, which triggers acute inflammation.”
As for how to identify whether it is gout or a sports sprain, Yang cautions, “Sports sprains have obvious triggers and come on in the moment, not in the middle of the night.”
Many white-collar workers are now eager to exercise on weekends, which, in Cuiyan’s opinion, is not necessarily good for the joints. “Exercise should be gradual and persistent every day, I recommend walking 3 to 5 kilometers a day.”
▲Male Fatty
Most of the young patients with gout are “fat”. A typical example is North Korean leader Kim Jong-un, who is rumored to suffer from gout.
The company’s main business is to promote the development of the company’s products and services.
▲Workaholics
The first thing you need to do is to get a good idea of what you are doing. However, excessive fatigue and stress may also trigger gout.
Yang says that excessive fatigue can reduce the body’s resistance, and once accumulated to a certain level, some of the body’s potential inflammatory response will manifest itself.