Misconception 1: High uric acid equals gout
Gout comes from high uric acid, but it does not mean that high uric acid will necessarily lead to gout, only when uric acid crystals in the blood are deposited in the synovial membrane and cause synovial inflammation, in fact, only about 10% of patients with high uric acid will have gout.
In fact, only about 10% of patients with high uric acid will develop gout. In turn, due to the complex causative factors of gout, many patients may still have blood uric acid levels within the normal range when they have a gout attack.
Misconception 2: High uric acid only causes gout
Uric acid is the end product of purine metabolism in the body, and high uric acid is harmful to many tissues and organs in the body. Excessive uric acid deposited in the bones and joints will cause gout. Deposits in the kidneys can cause kidney disease and kidney failure.
High uric acid also greatly increases the risk of many metabolic-related diseases (such as obesity, diabetes, hyperlipidemia, etc.) and cardiovascular disease.
Misconception 3: Everything is fine if uric acid is normal
According to international standards, the normal range of uric acid is < 420 μmol/L for men and < 360 μmol/L for women, but for gout patients, it is not enough to control uric acid in this "normal" range. This will reduce the frequency of gout flare-ups, reduce the number of gout stones formed, and further prevent the deposition of crystals.
Misconception 4: High uric acid, no gout, no treatment
This issue has been controversial for a long time, but now the academic community has basically unified the opinion that no matter how “healthy” a person is, as long as the uric acid exceeds a certain value, uric acid reduction treatment should be carried out.
If the person also has a combination of diabetes, chronic kidney disease or risk factors for cardiovascular disease, then as long as the uric acid exceeds the normal range mentioned above, treatment needs to be initiated, even if there is no gout attack.
Myth #5: You can’t lower uric acid during an acute attack
It has long been believed that if uric acid-lowering drugs are used during the acute phase of gout, they may lead to the dissolution of gout stones on the surface of the joints and the formation of insoluble crystals deposited in the tissues to aggravate the inflammatory response. Therefore, “no uric acid-lowering drugs should be used during the acute phase of gout” has almost become a golden rule in gout treatment.
However, in 2012, the U.S. Gout Management Guidelines proposed for the first time that uric acid-lowering therapy in the acute phase is not contraindicated under the “protection” of effective anti-inflammatory drugs. This was followed by the 2013 Chinese Expert Consensus on the Treatment of Hyperuricemia and Gout, which also endorsed the idea that it is not necessary to wait until two weeks after the acute symptoms of gout have resolved, but that uric acid-lowering therapy can be started immediately.
Clinicians generally tend to take a conservative approach to this “counterintuitive” avant-garde concept. After all, the old idea has been around for a long time, and the new idea needs more evidence-based evidence, but its greater clinical significance lies in the fact that patients who have an acute attack of gout while taking uric acid-lowering drugs can be treated without stopping uric acid-lowering therapy.
Misconception 6: Diet alone can lower uric acid
80% of uric acid in human blood comes from our own purine metabolism and only 20% from food intake. Therefore, the effect of simple diet control on reducing blood uric acid level is very limited (most of them can only reduce 10%-20% or 70-90 μmol / L). Therefore, it is necessary to choose the medication reasonably according to the condition. Many patients refuse to take medication because they are worried about “side effects”, which is a typical case of “choking on food”.
As long as the medication is used scientifically and regularly, the risk of rare complications from medication is no higher than the possibility of being in a car accident when you go out, and who would stay home all day for fear of a car accident?
Myth 7: It is enough to rely on drugs alone to lower uric acid
After taking uric acid-lowering medication, some patients think they can rest easy and enjoy their diet, “The big deal is to take more pills”, but this is not only wrong but also dangerous.
For a chronic metabolic disease like gout, a “low purine” diet is the prerequisite and foundation of treatment. Without reducing purine intake at the source, the disease cannot be controlled by medication alone. The risk of adverse drug reactions is greatly increased when the dose of medication has to be increased due to the significant increase in uric acid caused by a poor diet.