Near the end of the year, friends and relatives, colleagues, inevitably have to get together, friends gather, unit dinner, chicken, duck, fish, seafood and white wine, can be said to be a full “mouth addiction”, and now people’s enthusiasm for raw shabu-shabu eating method is increasing, gout disease is also quietly heating up. The cold season is an important time to prevent gout attacks, and men over 40 and postmenopausal women should pay attention to early prevention, because once gout arthritis strikes, it can be prolonged.
Compared to other chronic diseases such as hypertension, hyperlipidemia and diabetes, there is a lack of awareness of gout. Below, the most common questions about gout are addressed.
What is the incidence of gout in China?
In the past few years, there has been a gradual rise in the overall incidence of gout, a disease associated with elevated blood uric acid. It is speculated that the prevalence of hyperuricemia is close to 10% nationwide, and about 20-30% of patients with hyperuricemia will eventually develop gout.
In the 1980s, there were only about 1-2 gout patients a month in the rheumatology department of Peking University People’s Hospital, but now the number of gout patients has grown to about 10 a day. Most of the reasons for the increase of gout patients are closely related to modern lifestyles, such as mental tension, strain, and changes in diet structure, in addition to the increase in diagnosis rate due to the advancement of medical technology. Of course, the increase of metabolic diseases like diabetes, hypertension, hyperlipidemia, obesity, etc. also increase the probability of developing gout to some extent.
Are gout and hyperuricemia the same thing?
Hyperuricemia is a prerequisite for the development of gout, but not all hyperuricemia leads to the development of gout. In fact, most patients with elevated blood uric acid have no symptoms, which we call asymptomatic hyperuricemia. Some patients can develop nodules around the auricles and joints, which we call gout stones. A small percentage of patients will also develop kidney problems, including uric acid kidney stones or renal insufficiency.
In normal people, uric acid in the body is slowly metabolized by the kidneys under the action of metabolic enzymes. Very few people have congenital genetic factors that cause a deficiency of uric acid metabolizing enzymes in the body, resulting in a continuous increase in blood uric acid, which predisposes them to develop gouty arthritis or renal insufficiency earlier, but the vast majority of patients with hyperuricemia have unknown causes. The most common triggers are improper diet, poor lifestyle and the use of certain medications.
What are the characteristics of the onset of gout in people with gout?
Most people with hyperuricemia are asymptomatic for life, with only elevated uric acid found on physical examination. In terms of the population with hyperuricemia, gout is more likely to occur in middle-aged and older men, while in women it may occur after menopause.
Gout occurs in the first metatarsophalangeal joint, and the other joints are, in order, the dorsum of the foot, ankle, heel, knee, wrist, fingers, and elbow joints. The most important characteristic of gouty arthritis is its suddenness, without any aura. Most people have their first attack in the evening when friends gather for dinner, eat seafood and drink beer, and then suddenly after sleeping at night, the redness, swelling and pain of the joints appear, and the patient’s joints cannot even tolerate a breeze blowing next to them. However, this disease comes and goes quickly, and if no medicine is used, the symptoms can be relieved in three or four days, but after a period of time, it will be repeated. Moreover, the more severe the attack, the shorter the interval, and gradually it can spread to many joints throughout the body.
The direct cause of gout is a sharp rise in the amount of uric acid in the body, so is it possible to take uric acid-lowering drugs immediately in the treatment?
Some gout patients are painfully determined at the onset of the disease, but forget the pain when they don’t, they must go to a social gathering today and drink wine tomorrow, because they don’t see the danger of long-term hyperuricemia to their body, and now many people only see the danger of gout arthritis, and don’t notice the danger to kidneys, blood vessels and pancreatic islets.
The treatment of gout is divided into the acute phase, chronic phase and treatment of comorbidities. In principle, patients should pay attention to improving their lifestyle, controlling their diet, exercising properly, and combining work and rest. When the acute attack of gouty arthritis occurs, do not rub vigorously, cold compresses are an aid to effectively control the symptoms, joint trauma and strenuous exercise should be avoided, or foot bath, massage, sauna, physical therapy, acupuncture, etc. The above methods will promote blood circulation and cause the patient’s pain to worsen. Patients should take rest, drink more water to speed up the metabolism of uric acid in the body, and be given oral or topical anti-inflammatory painkillers as soon as possible, but not antibiotics, but non-steroidal anti-inflammatory drugs, such as Fenbid.
It should be noted that patients in the acute phase should not add uric acid-lowering drugs. If uric acid-lowering drugs are used in the acute stage, they just make the body excrete more uric acid and let the blood uric acid concentration drop. If the blood uric acid drops very low, the uric acid in the body tissues will be excreted outward quickly, but the acute phase will not pass easily, and the pain will be prolonged and may be more intense.
This is the principle of medication for gout patients in the acute phase. You must wait until the joint pain is gradually relieved, and then gradually add uric acid-lowering drugs from small doses according to the patient’s blood uric acid situation. Otherwise, uric acid-lowering drugs will speed up the release of uric acid in the body, making the pain worse and longer. Therefore, it is important to stabilize the symptoms and lower uric acid slowly. In fact, the higher the blood uric acid, the smaller the starting amount of uric acid-lowering drugs should be, just like a large auditorium dispersal, the exit is not large, open the door if 10,000 people are crowded out, the door is broken, need to be evacuated one by one.
Some common comorbidities of gout patients, such as hypertension and hyperglycemia, should be controlled very regularly at the same time. In particular, hypertensive patients, the emergence of gout, in the choice of antihypertensive drugs, to avoid taking drugs that will lead to an increase in blood uric acid.
Do gout patients need to continue to take uric acid-lowering drugs when they usually have no symptoms?
The consensus of several consultations now suggests that once you have had one attack of gouty arthritis you may have a second attack, and you still need to take uric acid-lowering medication at ordinary times in order to control the second attack or more attacks in the future.
According to the normal rule, if you do not lower uric acid, the first attack to the second may be relatively long, but later the interval will gradually shorten, and slowly there will be no interval between. By that time, there may be damage to your joints and irreversible lesions in your kidneys or blood vessels. Especially for patients with other risk factors in combination, such as triglycerides or their own renal insufficiency, it is still recommended to take uric acid-lowering drugs.
Although this is what we recommend, many gout patients feel that it doesn’t matter whether they take medication or not because they usually have no symptoms, and their compliance is not good, and some people only remember to take medication after eating a lot of purine food each time. In fact, from the point of view of scientific treatment, we do not recommend doing so.
Of course, some patients do ask this, saying how long to take this uric acid lowering medication. Basically, blood uric acid goes down quickly with medication, but it takes a longer period of time for the excess uric acid to be deposited around the joints, or for the gout stones to be relieved or reduced or to disappear completely, generally speaking, it takes more than six months of medication to get rid of as much excess uric acid as possible.