Gout belongs to the category of rheumatism, and its name is determined by the characteristics of its painful attacks, which come and go like the wind, coming and going quickly. With the continuous change of people’s lifestyle and life rhythm and the improvement of living standard, in recent years, the number of gout patients in China has increased year by year, and it has become a common medical disease, and there are more men than women. In our surroundings, we often encounter people with gout attacks, which are sudden and painful to patients.
A. The basic cause of gout attack is hyperuricemia
Hyperuricemia, that is, an increase in the level of uric acid in the blood. It is generally accepted that a blood uric acid level of more than 420 mmol/L (about 7 mg per 100 ml of blood) is considered hyperuricemia. Uric acid is a metabolic product of purines in the body. Under normal conditions, the production and excretion of uric acid are in balance. Once a disturbance in the metabolism of uric acid (increased synthesis or decreased excretion) occurs, hyperuricemia can result. When the blood uric acid concentration is too high, uric acid will precipitate as sodium salts and crystallize in the local tissues, causing an acute inflammatory reaction in the tissues, i.e. an acute attack of gout.
What is purine? Purine is a chemical component of the cell nucleus and is found in all plant and animal cells, such as fish, meat, yeast, etc. Some foods contain relatively high levels of purine. In fact, in the human body, 80% of uric acid comes from its own cellular metabolism and 20% from diet. Thus, it is clear that endogenous factors are the main ones for the occurrence of hyperuricemia.
Second, the common triggers that lead to the acute attack of gout
In addition to increased uric acid, there are some factors that can easily lead to an acute attack of gout. For example, diet. People usually think that gout is caused by “eating”, for example: gout patients can not eat seafood, beer, animal offal, etc.. Therefore, it is a common medical knowledge that gout patients should pay attention to their diet. The reason for this is that seafood, beer, animal offal and other foods contain a lot of purines, and too much of them can easily lead to a rapid increase in blood uric acid in the short term and cause gout attacks; therefore, it is still the increase in blood uric acid that is to blame. In clinical practice, we see that some gout patients have already achieved strict control of their diet, but still have gout attacks, which is due to the lack of good control of hyperuricemia. This is also the fundamental reason why many patients complain that they have paid close attention to their diet, but still have gout attacks.
In addition to the above, overexertion, excessive walking, trauma, tumor chemotherapy, etc., are also causes of hyperuricemia. Especially after tumor chemotherapy, a large number of cell necrosis will release purines in the body in the blood, resulting in the precipitation of crystals after uric acid rapidly reaches a certain high level and causing gout attacks.
Third, gout is harmful to human health
Long-term gout (hyperuricemia) is harmful to human health in the following ways.
1. Acute inflammation of gout. Uric acid crystals deposited in the joint cavity, stimulating tissue cells to produce a large number of inflammatory factors, will release a lot of metabolic enzymes, resulting in acute gout attacks.
2, joint damage. Repeated gout attacks lead to a continuous acute and chronic inflammatory response, eventually leading to tissue destruction; for example, the local destruction of gouty osteoarthritis lesions is gouty chronic inflammation slowly “eat” the bones, resulting in joint destruction and deformity.
3. Kidney. The deposition of uric acid crystals in the kidneys can form gouty nephropathy, kidney stones, resulting in the obstruction of urine discharge to form hydronephrosis, and in severe cases, can cause hypertension, kidney failure.
4, skin. Uric acid accumulates in the skin to form gout stones (a kind of white nodules), and once the skin breaks down, the wound is difficult to heal.
4. High-risk groups prone to gout
People with the following conditions belong to the group of high-risk factors, should be vigilant and regularly check the blood uric acid at the hospital.
1. Obesity. Especially middle-aged men and postmenopausal women.
2, cardiovascular disease. Such as hypertension, atherosclerosis, coronary heart disease, cerebrovascular disease, etc.
3, metabolic diseases, especially type 2 diabetes, hyperlipidemia, etc.
4, people with bad habits, such as: long-term excessive meat, seafood, and alcohol consumption of the middle-aged and elderly groups.
5, people with a family history of gout.
If you have one of the above, you should be alert to the possibility of gout and go to the hospital for blood uric acid examination as soon as possible, so as to detect, diagnose and treat gout in the early stage.
V. Graded treatment of gout
An important biochemical marker of gout is hyperuricemia. The crystals precipitated by excessive concentration of uric acid can be deposited in all tissues of the body (except the nervous system), around the joints leading to acute arthritis attacks; inside the kidney tissue leading to uric acid stones and gouty nephropathy. This is the pathogenesis of gout. So elevated blood uric acid is a very important marker. Therefore, for the harm of gout to human body, different graded treatment should be taken for different gout patients in order to better maintain the quality of life.
Gout is divided into hyperuricemia phase, gout acute attack phase, stable phase, and gouty nephropathy phase.
Hyperuricemia is asymptomatic, and most patients are not detected until they have a gout attack or urinary stones. Hyperuricemia can be detected in time if a special physical examination of blood uric acid is performed regularly, which is very important for early detection and prevention of gout attacks. The main tasks in this period are learning about the disease, healthy diet and prevention.
Acute phase treatment. Acute gout is relatively easy to identify, mostly with a rapid onset and pain that can reach its peak within a day, slash or insect bite like. Local tissue redness and swelling are evident, and tenderness is obvious. Typical attacks are mostly seen in the joints of the big toe and lower limbs. In addition, there are many atypical attacks of gout, especially in the elderly, which can easily be misdiagnosed as dermatitis, etc. and delay treatment. Treatment in this phase is mainly anti-inflammatory and analgesic. Measures against acute inflammation, such as analgesia and anti-inflammation, and suppression of white blood cells such as non-steroidal anti-inflammatory drugs, colchicine, glucocorticoids, etc.
Stable phase treatment. After the acute attack, the pain disappears, the local redness and swelling also disappears, and the patient is like a normal person again, without the symptoms of pain, which is called the “stabilization period”. It can last for several months or even years. If the blood uric acid level is well controlled during this period, gout is less likely to recur. Therefore, the main goal of treatment is to keep the blood uric acid at the desired level. If the blood uric acid is controlled at the desired level, the recurrence of gout can be prevented.
The main treatment at this stage is uric acid-lowering medication, and blood uric acid levels should be monitored consistently and regularly to ensure a definite outcome.
Some people say that gout should not be treated when it is not painful, which is a misconception. Patients in the “stable phase” of gout, although they do not have any symptoms, are still undergoing wonderful pathological changes in their bodies, and gout is bound to come back at some point with a trigger. Therefore, the focus of “stable” gout treatment is to maintain the blood uric acid at a normal level to avoid the next attack, and not to “forget the pain after the wound”.
The treatment of gout varies from person to person, and there are two main types of drugs used to reduce uric acid: one is to reduce uric acid synthesis, and the other is to increase uric acid excretion. Each has its own indications, and should be used under the guidance of a doctor, with a good grasp of dosage and method of administration, to avoid large fluctuations in blood uric acid. Sometimes, some people are overly sensitive to uric acid-lowering drugs or the dosage is not appropriate, resulting in the blood uric acid dropping too fast, which can cause the uric acid crystals to “dissolve”, but also cause gout attacks. Therefore, the dose of medication needs a “break-in period”, and you must follow the doctor’s instructions to receive regular checkups and adjust the dose of medication.
Six, the treatment of gout needs to be alert to other metabolic syndrome
Hyperuricemia is one of the aspects of metabolic disorder syndrome. The most common other manifestations of metabolic syndrome, such as hypertension, hyperlipidemia, diabetes, etc., are interrelated with hyperuricemia and “go hand in hand”. Therefore, it is important to treat gout while also correcting other metabolic disorders. In animal experiments, it was found that rats with gout had increased blood pressure, damaged kidney function, and thickened capillary walls. When unexplained hypertension occurs, if there is no family history and no other cause, it is important to consider whether you have gout.
Also be alert to gouty nephropathy. If hyperuricemia persists for a long time, it can cause excessive urate crystals to precipitate in the kidneys, resulting in gouty nephropathy, or causing kidney dysfunction. Also the higher the amount of uric acid in the urine, the more likely stones will occur. According to statistics, gout patients are about a thousand times more likely to develop kidney stones than normal people. Therefore, when diagnosing gout, your doctor will also check your kidney function, such as routine urine tests, creatinine, urea nitrogen, etc., to better determine whether your kidneys are being attacked by gout. To determine whether there are stones in the kidneys, ultrasound examination of the urinary system is also one of the items often used by doctors.
7. How to prevent gout
For gout patients, the key to gout prevention lies in the treatment of the “stable phase”, in addition to medication, the following aspects should be noted.
1, the choice of diet, in the blood uric acid level has not dropped to normal before, should be properly controlled diet, especially seafood, animal offal, beer, broth, etc. to eat less. If not controlled, uric acid is difficult to drop. Some data show that most patients with high uric acid are accompanied by metabolic disorder syndrome. High blood lipids are a major obstacle to uric acid metabolism, and when blood lipids are high and blood flow is slow, uric acid is easily deposited. For patients with co-morbidities, only lowering uric acid alone is often ineffective, and the only effective method is to lower both lipids and uric acid. When the blood uric acid normal disease is maintained at the ideal level, dietary restrictions can be relaxed appropriately, but do not crave for food. This ideal blood uric acid level is not more than 6mg/dl.
2.Adhering to medication, paying attention to regular check and monitoring, keeping blood uric acid at a reasonable level is the key to prevent gout recurrence, especially during the stable period of gout, it is still necessary to continue the medication.
3.If during chemotherapy, you should visit your doctor and take uric acid-lowering drugs or alkalinize urine appropriately, so that prevention is the first priority.
Special reminder: to keep away from gout, the first should “keep your mouth shut”, a reasonably light diet, do not overeat, do not limit your favorite foods, less big fish and meat, do not drink too much alcohol, eat more vegetables and fruits. Secondly, regular checkups are needed to help early detection and early treatment. Thirdly, we should learn and know the general knowledge of gout disease prevention and treatment, scientific treatment and reasonable prevention, and develop good living and eating habits, so that we can avoid pain and take fewer detours and enjoy the health we deserve.