A. Gout yesterday – hyperuric acid No hyperuricemia, no gout! Everything has a cause and effect. Every patient with gouty arthritis must have a period of hyperuricemia before the attack that goes unnoticed or is detected but not taken seriously. Why hyperuricemia exists – this is the result of eating excessive seafood, animal offal, meat food, old fire soup, drinking alcohol and other high purine diet when not paying attention, high purine diet and very little exercise, the body does not metabolize up, blood uric acid level naturally dang duang duang on up. Second, the gout today – acute attacks of joint pain How does high uric acidemia cause gout? The saturation level of uric acid in normal human blood is about 400 umol/L. When the blood uric acid concentration exceeds the saturation level, urate crystals will precipitate and deposit into the joints and bones. Every time there is a cause, such as a high purine diet that causes the blood uric acid level to rise again, new crystals will be deposited; or if there is a cause, such as explosive strenuous exercise, or incorrect use of uric acid-lowering drugs such as allopurinol or febuxostat, that causes a sudden drop in uric acid levels, the crystals that have been deposited will dissolve – whether the crystals are New deposition, or dissolution, causes instability of the already deposited urate crystals, tends to release inflammatory factors, and gout attacks. The joints are “occupied” by the green urate crystals and destroyed. Treatment is based on anti-inflammatory drugs. Commonly used anti-inflammatory drugs include non-steroidal anti-inflammatory drugs (NSAID), colchicine and hormones, which are given to the doctor according to the patient’s condition and his or her underlying disease, and can be combined when the condition is severe. One of the treatment misconceptions – antibiotics + dexamethasone The science of the Chinese rheumatology and immunology community is indeed heartbreaking. To this day, evidence-based medicine is highly popular, and many primary care doctors in China treat the acute phase of gout, or based on antibiotics + dexamethasone, and this practice, to play a big cross! Antibiotics ≠ anti-inflammatory drugs! Antibiotics = antibacterial drugs, not anti-inflammatory drugs! As mentioned before, the start of gout, not related to bacterial infection, is the inflammation caused by urate crystals, antibiotic treatment is ineffective, belong to the abuse of antibiotics! And dexamethasone, which belongs to the long-acting class of hormones, has great side effects. Hormones belong to the second-line drugs for the acute treatment of gout, only when the use of NSAID or colchicine is ineffective or when there is a contraindication to choose, even if the choice, but also to choose short-acting hormones, the use of dexamethasone is also to play a big cross. Treatment misconception No. 2 – Acute uric acid-lowering treatment Doctors and patients alike know that gout attacks are related to high uric acid, so the use of uric acid-lowering drugs in the acute phase is “unanimous”. As mentioned before, once the uric acid-lowering drugs are administered, the uric acid drops sharply, which is detrimental to the control of gout. Therefore, during the acute period of gout, if you don’t use uric acid-lowering drugs, you should not add uric acid-lowering drugs at this moment, because it is not a day’s cold to freeze three feet. The gout of tomorrow Gout tomorrow – alarming Gout hazards – be careful of your heart, liver, pancreas and kidneys Gout is prone to recurrence, after repeated attacks, it can involve several joints and lead to joint deformities. In addition to gout, hyperuricemia is also closely related to hypertension, coronary heart disease, hyperlipidemia, fatty liver and diabetes. In a small number of patients, the disease starts with kidney stones, which may cause back pain and hematuria, and in severe cases, may lead to renal failure, focal segmental sclerosis of the glomerulus, and interstitial fibrosis. There is increasing evidence that hyperuricemia accelerates the rate of renal failure. In short, if gout is left alone for a long time, then tomorrow the damage will be to the vital organs of the body – heart disease, diabetes, fatty liver, kidney failure will not be absent! Treatment myth three – no pain, no treatment As mentioned before, gout must be standardized diagnosis and treatment, blood uric acid levels must be controlled, such as not controlled, once the destruction of the joints or damage to internal organs, regret is too late. Treatment misconception four – lowering uric acid without preventive anti-inflammatory As mentioned before, when uric acid brushes down, it can also induce acute attacks. Therefore, current international guidelines recommend starting uric acid-lowering treatment drugs with a small dose of colchicine prophylactic anti-inflammatory (or NSAID or hormone if contraindicated), which can greatly reduce acute attacks of gout during uric acid-lowering treatment, greatly reduce patient suffering, and improve well-being and thus compliance. Many people think that colchicine has a lot of side effects and therefore resist its use. However, colchicine has great side effects, and that is a stereotype left over from the past era of wrong usage. The original usage of taking one or two tablets in an hour naturally has great side effects. This usage has long been eliminated by regular rheumatologists. Nowadays, even in the acute stage, the maximum usage is one tablet x three times a day, and the preventive anti-inflammatory medicine is one tablet x once a day, which has very few side effects and is very safe to use.