”Doctor, I have a long history of gouty arthritis, what about recurrent attacks and can I develop damage to other organs? What is the best level to control my blood uric acid? Can I stop taking the medication once it is under control? What do I need to pay attention to in terms of diet? ……..” I am often asked these questions by patients in my clinical work, and health education for patients with gouty arthritis is also an important part of my work, because only when patients have a full understanding of their disease can they have better self-management, which is essential for disease recovery and control of disease progression. I will elaborate on the above questions in the following, hoping to give some help to patients suffering from gout. Question 1: What is hyperuricemia and gouty arthritis? Physician: Hyperuricemia is diagnosed when fasting blood uric acid levels are >420 μmol/L in men and >360 μmol/L in women on two non-same days under a normal purine diet. It is more common in men, with a peak age around 50 years, and in women it occurs mostly after menopause. When the concentration of urate in the blood reaches saturation, urate crystals are formed, and these crystalline substances deposited at the bone joints can induce an inflammatory response, causing local redness, swelling and heat pain and gouty arthritis. It can be seen that gout is significantly associated with hyperuricemia. Question 2: What are the dangers of persistently high uric acid? Doctor: About uric acid we can’t just treat it as something bad. Physiologically, uric acid stimulates the nerves and increases brain agility and intelligence, and it is also an antioxidant that reduces the damage of oxidative stress. However, persistent high uric acid state can lead to some pathological damages, mainly urate deposition diseases such as uric acid stones and uric acid nephropathy in kidneys, gouty arthritis in joints, and stimulation of blood vessel walls to induce atherosclerosis. Therefore, it is necessary to control uric acid at a certain level in order to effectively reduce the harm associated with hyperuricemia. Question 3: What is the best level of uric acid control for gout patients? Can I stop the medication after it is well controlled? Doctor: If you have frequent gout attacks, you should control uric acid at <300μmol/L; if you have combined diabetes, cardiovascular risk factors or chronic kidney disease, uric acid should be controlled at <360μmol/L. Only by controlling uric acid at the ideal level can you avoid recurrent gout attacks. The European League Against Rheumatism EULAR guidelines recommend that a blood uric acid level <360umol/l is the key goal of uric acid-lowering therapy. If your uric acid has been controlled at a relatively good level, it is recommended that you do not stop the medication at will, otherwise there will be a rebound and recurrent gout attacks, you should regularly review your kidney function in the clinic and adjust the medication under the guidance of your doctor. Question 4: How can gout be treated? Doctor: The treatment of gouty arthritis is divided into the acute phase and the stable phase. The acute attack is treated with non-steroidal drugs (NSAIDs), COX-2 inhibitors, colchicine or steroids to control the acute inflammation, and the uric acid-lowering medication is started when the acute phase is over and the stable phase is entered. I need to emphasize about painkillers, some patients with long-term joint pain are painful to take non-steroidal painkillers or treated with hormones, which can seriously hurt the stomach over time, and some patients come to the clinic with bleeding peptic ulcers already, which are caused by irregular treatment. It should be recognized that painkillers are used to control the symptoms in the acute stage, and should be reduced or discontinued once the pain is relieved, and enter the process of uric acid-lowering treatment. Before using these drugs, our doctors need to understand the patient's liver and kidney function, whether there are kidney stones, whether the woman is pregnant and so on, and choose the appropriate uric acid-lowering drugs according to the patient's specific situation. Therefore, do not take the medication on your own, but use it under the guidance of a doctor. Question 5: Can gout be cured? Doctor: Like all chronic diseases such as hypertension and diabetes, the treatment of gout is a long-term process. The so-called cure should be able to control the uric acid at a better level for a long time, and at the same time the symptoms of gout can be well controlled without progressing, so that is a better result. However, we have seen many patients who have developed gout to the late stage of multi-joint gout stone formation, and their quality of life is significantly reduced, and they even have critical conditions such as stomach bleeding and femoral head necrosis due to long-term non-standard treatment, which is a bad result. Therefore, early detection, early standardized treatment, regular review is very important. Question 6: What do I need to pay attention to in terms of diet? Doctor: Since gout is significantly associated with hyperuricemia and uric acid is the end product of purine metabolism, naturally you need to avoid excessive intake of high purine food in your diet. Conclusion: Gout is not a terrible disease, I believe that after you understand the above 6 issues, you will have a certain understanding of gout and know what you should do. You should do a good job of managing your own diet and habits, and cooperate with your doctor to regulate your medication and follow up regularly so that you can overcome the disease and have a better quality of life.