What is gout like and what is its incidence?
Gout is a joint lesion caused by an increase in blood uric acid due to a disorder of purine metabolism. This statement has three meanings: firstly, gout is a metabolic disease; the disease mainly causes high blood uric acid; and the clinical manifestations are joint lesions. Gout, like diabetes, is an ancient disease that has been documented in medical literature as early as 400 years BC. Gout is a metabolic disease that is prevalent worldwide, and the more developed the country, the higher the incidence, so it is more common in Europe and the United States.
According to statistics, its prevalence is 0.3% on average. In Asia in recent decades, the incidence of this disease is gradually increasing, Japan after the Second World War, due to the exponential increase in protein food and excess nutrition, gout has become a prevalent disease. In China, with the continuous improvement of people’s living standard and the change of diet structure in recent years, the incidence of gout is also increasing significantly, reaching 0. 2% with the large intake of high purine, high protein and high fat. Its damage to health and its impact on work and life cannot be underestimated. Therefore, it is especially important to adhere to effective prevention and treatment measures over the years, so that the majority of gout patients can enjoy the same quality of life as normal people.
Is gout an “affluenza”? Who is at risk?
There is truth in this statement. Since ancient times, gout has been considered a disease of princes and nobles. The occurrence of gout is related to eating a lot of delicacies and excess nutrition. Generally speaking, people with better living conditions are more likely to get gout than those with poorer living conditions. From the analysis of the occupational distribution of gout patients, most of them are cadres, senior intellectuals, businessmen and other people engaged in mental labor. Because these people have superior working conditions, very little physical exertion and a higher standard of living, they are prone to gout disease. In addition, gout is a genetic defective disease with a hereditary tendency, so people with a family history of gout should be aware of the possibility of developing gout.
How does gout occur?
Gout is caused by a long-term disorder of purine metabolism and an increase in blood uric acid, which leads to the deposition of urate crystals in the joint tissue and causes inflammation. And the causes of increased blood uric acid are.
1. Genetic overproduction. Mainly due to genetic mutation of enzymes, the lack of function or dysfunction of enzymes in the body.
2, acquired overproduction, including two aspects: endogenous uric acid increase (i.e. purine catabolism in the body), exogenous uric acid increase (i.e. high purine food intake ).
3. Decreased ability of the kidneys to excrete uric acid. Various organic diseases of the kidneys cause the decrease of kidney function, which reduces the excretion of uric acid.
What are the clinical characteristics of gout?
(1) Age: It occurs mostly in obese men over 50 years old, and a few in postmenopausal women, about 5%, with a male to female ratio of 20:1.
(2) Location: It mainly affects single small joints around the body. The first attack is mostly in the bunions and plantars, and thereafter it can involve the dorsum of the foot, ankle, knee, fingers, wrist joints, etc. It is wandering.
(3) Time: The attack is often sudden and acute at night and resolves in a few days to one to two weeks.
(4) Symptoms: redness, swelling, heat and pain in the diseased joints, limited movement, some with fever. (5) If untreated or improperly treated, the disease often recurs and develops into multiple joint involvement, and the joints may become hypertrophic, deformed, and stiff.
(6) In later stages, gout stones of different sizes can be seen in the bones near the auricles and joints, in the tendon sheaths and cartilage, and in the subcutaneous tissues, etc., and spill white urate crystals after breaking down.
(7) In late stage, it invades the kidney and forms kidney stones, even causing kidney failure.
(8) Metabolic examination: the blood uric acid level is increased.
(9 )X-ray examination: round defects appear in the bone near the diseased joint in the late stage.
What is the progression of gout?
(1) Hyperuricemia stage: also known as pre-gout, generally no gout symptoms, only elevated blood uric acid.
(2) Early gout stage: developed from hyperuricemia, with typical symptoms of acute gouty arthritis attack.
(3) Middle stage of gout: recurrent gouty joint attacks causing joint enlargement, dysfunction, and gouty nodule formation.
(4) Late stage of gout: obvious joint deformity and dysfunction, increased and enlarged gouty stones, uric acid nephropathy, development of kidney stones, and significant decrease in kidney function.
What are the most easily misdiagnosed diseases of gout?
In acute attacks of acute gouty arthritis alone, most of them have obvious redness, swelling, heat and pain and restriction of movement, sometimes accompanied by fever and general malaise, and other symptoms are often misdiagnosed as rheumatoid arthritis and acute septic arthritis. Some gouty arthritis may be misdiagnosed as rheumatoid arthritis, cellulitis, or bursitis due to the obvious local redness and burning pain during the first attack.
Chronic gouty arthritis is most likely to be misdiagnosed as rheumatoid arthritis because of the deformity of the diseased joints. It has also been misdiagnosed as traumatic arthritis, psoriatic arthritis, chronic bursitis, and joint tuberculosis. In some cases, there is no obvious redness or swelling during the gout attack, but only joint pain and no obvious joint deformation, which is often misdiagnosed as general joint strain or osteoarthritis. In short, it is not uncommon for gout to be misdiagnosed as other joint diseases. If patients and doctors are familiar with the clinical features of gout and routinely perform blood uric acid tests on those suspected of having gouty arthritis, then misdiagnosis will not occur.
How should gout be treated?
At present, in the treatment of gout, Western medicine mainly uses two types of drugs, one is to control the acute attack of arthritis, represented by colchicine, but the side effects of this drug are large, the most common are serious gastrointestinal reactions and liver cell damage, and the efficacy of the drug is positively correlated with the side effects, which is often difficult for patients to tolerate. Next are some anti-inflammatory painkillers, such as anti-inflammatory pain, fentanyl, fotarine, etc. These drugs also have obvious gastrointestinal reactions, rash, fever, renal colic and provoke acute gout attacks, etc.
Since gout is considered a non-curative disease, patients often need to take medication for a long time, and all these side effects cause pain to patients and make medication administration difficult for doctors. In view of the many side effects of Western medicine, clinical attention is now being paid to the use of Chinese herbal medicine for the treatment of gout, which is more effective and has fewer side effects, and has been accepted by the majority of gout patients.
What other aspects should gout patients pay attention to?
The general principles of gout treatment are: reasonable dietary control, adequate water intake, regular living system, appropriate physical exercise, effective medication, and regular health checkups. On the premise of this comprehensive prevention and treatment.
(1) Remove the causes: obesity and diabetes are the causative factors of gout. Regulating diet, controlling caloric intake and avoiding overweight are important aspects of preventing gout and hyperuricemia. Especially avoid overeating and alcohol abuse. Also eliminate tension, excessive fatigue, anxiety, strong mental trauma, and also avoid trauma, cold and other triggering factors. In addition, gout is often accompanied by hypertension, hyperlipidemia, diabetes, so we should actively prevent the above diseases.
(2) Pay attention to rest and drink more water: In acute attacks, bed rest is recommended, elevate the affected limbs and avoid weight-bearing on the joints. When uric acid is easily dissolved in alkaline solution, it is advisable to take alkaline medicine when the urine PH is less than 6.0. At the same time, drink more water to keep the urine diluted, more than 2 liters per day, which is conducive to the excretion of uric acid and prevent the formation of stones. Vegetables and fruits are alkaline food, which may promote uric acid discharge by alkaline reaction of urine and supply rich vitamins, so it is advisable to eat more fresh vegetables and fruits.
(3) Pay attention to the contraindications of gout diet and avoid the intake of high purine food.
(4) Preventive medication is needed in summer and autumn, when the disease is more likely to occur.
What are the preventive measures for gout?
Although gout is closely related to heredity, some acquired factors have an important influence on the development of gout. These factors include dietary habits, nutritional status, work and living conditions, hobbies, physical activity, etc. Some of the following measures have a great role in preventing the occurrence of gout.
(1) Develop good dietary habits and try to avoid eating a diet with high purine content. Drink plenty of water to maintain an adequate daily urine output.
(2) Arrange three meals a day according to the amount of work and activity, eat quantitatively, do not overeat, and do not increase the number of meals at will, so as to avoid obesity caused by calorie and excess nutrition.
(3) for people engaged in mental labor and sitting in the office, should avoid long hours of continuous brain, sedentary, pay attention to the combination of work and rest, should arrange a certain amount of time for exercise every day.
(4) Life should be regular, regular rest and rest, three meals a day at regular intervals, eliminate bad habits, especially staying up late, emotional peace and optimism.
(5) Quit bad habits, such as smoking, alcohol, etc.
(6) Check blood uric acid once a year to detect early hyperuricemia in time, and timely treatment can prevent it from developing into gout. As long as you adhere to the above preventive measures, the chance of gout will be greatly reduced.