1.What is hyperuricemia and gout? Hyperuricemia and gout are metabolic diseases caused by purine metabolism disorders, but there is obvious heterogeneity in the development of gout, which can manifest as acute arthritis, gout stone, chronic arthritis, joint deformity, chronic interstitial nephritis and uric acid urinary tract stones in addition to hyperuricemia. Patients with hyperuricemia are called gout only when they have the above clinical manifestations.2. How is gout classified clinically?
(1) Primary gout primary gout is related to genetic factors, and more and more studies have shown that primary gout is closely related to obesity, primary hypertension, dyslipidemia, diabetes, and insulin resistance.
(2) Secondary gout is mainly caused by diseases such as kidney disease, blood disease, or drugs or high purine food.
1 Enzyme and metabolic defects:myogenic hyperuricemia.
2 Excessive cell destruction: hemolysis, burns, trauma, chemotherapy, radiotherapy, excessive exercise.
3Cell proliferation: leukemia, lymphoma, myeloma, erythrocytosis.
4 Dietary factors: High purine diet such as beans, seafood, beef and mutton, excessive alcohol consumption, etc.
5Decreased renal clearance/renal failure, ketoacidosis, gestational hypertensive syndrome, drugs, toxins.
6 Decreased amount of extracellular fluid : dehydration, uremia.
3.The pathogenesis of gout gout should depend on the concentration of blood uric acid and its solubility in body fluids.
(1) Mechanisms of hyperuricemia The balance of blood uric acid depends on the absorption and production of purines versus decomposition and excretion.
1 Absorption: 20% of uric acid in the body comes from the intake of purine-rich foods, and excessive intake can induce gout attacks, but is not the cause of hyperuricemia.
2 Decomposition: uric acid is the end product of purine metabolism, about 1/3 of uric acid in normal people is processed by bacterial degradation in the intestine, about 2/3 is excreted by the renal prototype, humans lack uric acid enzymes, so lower uric acid decomposition as a mechanism of hyperuricemia has been ruled out.
3 Generation: 80% of uric acid in the body comes from purine biosynthesis in the body. In the process of purine metabolism, there are enzymes involved in the regulation of each link, and once the regulation of enzymes is abnormal, an increase or decrease in blood uric acid occurs.
4 Excretion: In primary gout, 80% to 90% of the direct mechanism of pathogenesis is a decrease in renal tubular clearance of uric acid salts, and the main link to increased blood uric acid is thought to be a decrease in renal tubular secretion, which also includes elevated reabsorption. Decreased uric acid excretion is often accompanied by increased production.
(2) The mechanism of gout development is that uric acid is supersaturated in body fluids. The normal range of blood uric acid has a certain span, and generally the blood uric acid concentration that leads to supersaturation is more than 7.0 mg/dl. There are some factors that also affect the solubility of uric acid, such as estrogen, temperature, and H+ concentration that can promote uric acid free. In hyperuricemia, even in combination with uric acid stones, it is not called gout. Gout occurs in only 10%-20% of hyperuricemia.
4, the clinical characteristics of gout long-term history of hyperuricemia, mostly seen in obese middle-aged and elderly men and post-menopausal women, 5% to 25% may have a family history of gout.
(1) Acute arthritis Acute arthritis is the first symptom of gout, which is an inflammatory reaction caused by urate crystallization and deposition.
The most susceptible site is the m-metatarsal joint, followed by the ankle, heel, knee, wrist, finger, elbow, etc. 90% are single, occasionally bilateral or multiple joints are involved at the same time or successively, showing redness, swelling, heat and pain, there may be joint cavity fluid, but also with fever, leukocytosis and other systemic symptoms. The attacks are often self-limiting and resolve spontaneously within hours, days, or weeks, with local flaking and pruritus characteristic of the disease. The remission period can last for months, years or even a lifetime. However, most of the attacks are recurrent, even to the stage of chronic arthritis. In some patients, there is no remission period until the chronic arthritis stage. The pain is usually pronounced, but a few have mild symptoms. Alcohol consumption, high protein diet and foot sprains are important triggers, as well as wearing tight shoes, walking more often, cold, strain, infection and surgery are also common triggers.
(2) Gout stone and chronic arthritis Gout stone is a chronic foreign body-like reaction caused by the precipitation of fine needle-like crystals of monosodium urate, surrounded by mononuclear cells, epithelial cells, giant cells formed by foreign body nodules, causing a mild chronic inflammatory reaction. Gout stones can involve any part of the body except the central nervous system, most commonly in and near the joints and the otoconia. They appear as yellowish-white elevations of varying sizes, as small as sesame seeds or as large as eggs; they are soft at first and become hard as stones as fibers proliferate, which is characteristic of gout damage. The nodules are easy to wear and tear near the joints, and the nodules make the epidermis thin, easy to break into fistulas, with white paste discharge, the tissue around the fistula is chronic granuloma is not easy to heal, but rarely secondary infection, poor recoverability. The subcutaneous tissues, synovial bursa, cartilage, bone, resulting in tissue fracture and fibrous degeneration, cartilage, bone destruction is the most significant, involving more joints, even to the spine, jaw and other joints, the cartilage shows degenerative changes, the formation of vascular opacities, bursal thickening, bone erosion defects and even fractures, coupled with the increase in gout stones, resulting in joint stiffness, rupture, deformity.
(3) The clinical manifestations of gouty nephropathy are proteinuria, hematuria, isotonic urine, and then hypertension, azotemia and other renal insufficiency manifestations. Gout patients die from uremia in 17-25% of cases, but it is rarely caused by gout alone and is often associated with a combination of factors such as advanced age, hypertension, atherosclerosis, renal calculi or infection.
Acute obstructive nephropathy, also known as hyperuricemic nephropathy, is mainly seen in patients with acute and marked increase in blood uric acid due to radiotherapy and chemotherapy, resulting in acute, massive and extensive blockage of uric acid crystals in the renal tubules – acute renal failure. Pathological studies have confirmed that 90% to 100% of patients with gout have renal damage.
(4) Uric acid urinary tract stones can appear during the hyperuricemic phase, accounting for 40% of hyperuricemia and 25% of gout patients. The vast majority are pure uric acid stones, characterized by non-visible X-rays, and some mixed with calcium oxalate and calcium phosphate, which can be visible on X-rays.
(%) Gout and metabolic syndrome has now included hyperuricemia and gout as a manifestation of metabolic syndrome, which is often accompanied by gout, characterized by obesity, primary hypertension, hyperlipidemia, type 2 diabetes, hypercoagulability and hyperinsulinemia, and accounts for the majority of obese middle-aged and elderly people, with a trend of younger onset in recent years.
5.How high is the prevalence of gout in China?
The prevalence of gout varies from region to region and from ethnic group to ethnic group, but the prevalence in China is about 0.15%-0.67%, which is significantly higher than before.
6.Why are men prone to gout?
95% of gout occurs in men, and the disease usually starts after 40 years of age, and the prevalence increases with age, but in recent years there is a trend toward younger patients, and most female patients appear after menopause.
It has been found that gender and age have a strong influence on blood uric acid levels. From infancy to youth, the blood uric acid level is about 3-4 mg/dl due to the strong excretion of uric acid by the kidneys, and after puberty, the blood uric acid level rises more obviously in men, while in women, the blood uric acid level does not rise significantly due to the decrease in the reabsorption capacity of the renal tubules after the secretion of uric acid, resulting in an increase in the fraction of uric acid excreted by the kidneys.
7.Why are fertile women less likely to get gout and postmenopausal women more likely to get gout?
It is generally believed that the risk of acute gouty arthritis is significantly lower in pregnant women because of the corresponding increase in adrenocorticotropic hormone secretion. Adrenocorticotropic hormones have an anti-inflammatory effect, so the incidence of other arthritis is also lower during this period. Gout rarely occurs during menstruation in women with normal menstruation, which may be related to changes in ovarian function and changes in the level of sex hormone secretion. After menopause, women’s blood uric acid only rises to a level similar to men’s due to a significant decrease in estrogen levels and a decrease in uric acid excretion by the kidneys.
8.What is the danger of gout?
Gouty arthritis is mostly self-limiting and resolves on its own within 1-2 weeks; recurrent episodes of arthritis can leave behind chronic joint pain. Temporary pain often does not attract the attention of patients, but the danger of gout is the long-term recurrent attacks caused by the joint broken ring, uric acid crystals deposited in the kidneys caused by kidney function damage, and hyperuricemia accompanied by metabolic disorders syndrome, such as obesity, hyperlipidemia, abnormal blood sugar, significantly aggravate the development of atherosclerosis, so that the incidence of myocardial infarction stroke in gout patients significantly increased.
9.Why does gouty arthritis attack more at night and why does it involve toe joints?
The solubility of uric acid is influenced by temperature and blood pH value. The low temperature at night reduces the solubility of uric acid and makes it easy to precipitate and form crystals in the tissues, which is the reason why gout attacks are more frequent at night. The toe joint is the best site for gouty arthritis. It can also affect the small joints at the end of the body, such as the fingers, ankles and wrists, while gouty arthritis is less likely to occur in the joints of the trunk. This is because the small joints at the end have less subcutaneous fat and lower temperature, while the blood circulation is poor, the tissue is relatively hypoxic, and the local PH value is low, which is conducive to uric acid deposition.
10.Why should gout patients drink more water?
(1) As we all know, the cause of gout is the deposition of uric acid crystals in the joints and kidneys, etc., and the deposited urate crystals have a great characteristic – soluble in water (water-soluble), which is good, drink more water, water into the blood and tissue, can not dissolve uric acid crystals? (2) At the same time, drink more water, urine is also more, uric acid can be accelerated out of the body.
11.How much water should gout patients drink every day?
Generally more than at least 2000 ml per day, such as this a plastic bottle capacity is 500 ml, a thermos is 2000 ml, then drink at least 4 plastic bottles or 1 thermos water, we drink enough every day? Of course there are several places worth stating: (1) different weather, the amount of water drunk is not consistent, summer temperatures up to 40 degrees, sweating so much, 2,000 ml per day is certainly not enough, this should be assessed by calculating the amount of urine, requiring a daily urine volume of more than 2,000 ml, generally speaking, a bubble of urine is 200 ml, then go to the toilet 10 times a day, you meet the standard? (2) Do not binge drink, take the initiative to drink water: do not wait for thirst to drink water. (3) hypertension, heart function and poor kidney function, in addition to not binge drinking, but also not in excess to prevent the burden on the heart and kidneys, soda containing more sodium to limit.
12.Is there a time to drink water?
The time to drink water also has a precaution: one has four time periods, namely, after waking up in the morning to 30 minutes before breakfast, between meals and 45 minutes after dinner to bedtime. Do not drink water within 30 minutes before and 45 minutes after a meal to prevent dilution of gastric juices and affect digestion. Drink water before bedtime is good to prevent urinary stones, with urinary stones at night to add a drink of water better.
13, drink which water has no judgment direction?
Mainly two directions: (1) the pH of water: (2) the presence of trace elements and minerals.
14, why choose alkaline mineral water?
The benefits of mineral water are: (1) slightly alkaline (PH 6.5-8.5), both to meet the requirements of the human body (the human body is a weak alkaline body), but also to help the dissolution of uric acid. Uric acid is more easily dissolved in an alkaline environment, for example, the solubility of uric acid in a PH=7.0 environment is more than 10 times that in a PH=5.0 environment, so if the joint is alkaline, uric acid is dissolved and not deposited; urine is alkaline, and uric acid stones are not produced, therefore, clinically we pay great attention to the PH value of urine, and measure the urine PH value several times a day to see if it is acidic or alkaline urine, and use this as a basis Adjust the dose of alkaline drugs. (2) contains trace elements beneficial to the human body, such as selenium and zinc can improve human resistance, lithium has a calming effect, (3) contains metasilicicic acid, has the prevention of osteoporosis and loose teeth; it is worth noting that: mineral water is not suitable for freezing and heating, it will destroy elements such as calcium and magnesium in the water, reducing the nutritional value. The disadvantage of pure water is that (1) the water is acidic: made by reverse osmosis, PH value at 6.0. (2) removes beneficial minerals and trace elements, losing nutrition; distilled water also belongs to the category of pure water, made by distillation, losing the role of nutrition.
15.The alkaline mineral water on the market is more expensive, can I drink tap water?
The pH of tap water is about the same as mineral water, tap water after precipitation, filtration, disinfection and sterilization, for reaching the national “drinking water hygiene standards” tap water is also possible. The new standard also requires a pH value between 6.5-8.5. But the water pH varies in different places, such as Beijing tap water taken from reservoirs and underground, is weakly alkaline, while Shanghai tap water taken from the Yangtze River and near the sea, acidic. Of course, some cities add some alkaline lime when treating tap water to make it alkaline. How to solve this problem for acidic tap water? Buy some baking soda (sodium bicarbonate, not edible alkali sodium carbonate, sodium carbonate is too strong alkaline), take 2 grams and add it to 500 ml of cool boiling water, dissolve and shake well, then you can drink. This often dry mouth is not good, then, you can add some citric acid or white vinegar, seal and shake well, drink a bottle in parts daily. Note: Tap water needs to be boiled once, although the calcium and magnesium ions are reduced, it helps to eliminate the chlorine in the water and the 13 toxic substances it brings including hydrogen halide and chlorophenol (carcinogenic and teratogenic effects), etc., and to kill possible bacteria. However, it cannot be boiled repeatedly, as distillation loses some water, making the heavy metal ions and nitrites in the water concentrated, causing gastrointestinal symptoms and lack of oxygen, etc.
16.What does wine have to do with gout?
There is a saying that “wine is the essence of grain, the more you drink, the younger you are”, but it is not true. Among the gout patients who come to us, 8 out of 10 are alcohol drinkers. For patients like this who drink too much alcohol, a few jingles should be the most realistic portrayal of them: this wine, looks like water, drink to the mouth spicy mouth, swallow to the belly haunted, walk to trip legs, get up in the middle of the night to find water, wake up in the morning regret!
17.Why is beer the most unsuitable for gout drinking?
First of all, the brewing of beer, is a large number of malt fermentation brewing, containing a large number of purines, alcohol-free beer is only less alcohol, but contains a large number of purines. Studies have shown that drinking more than two beers a day can significantly increase the risk of gout.
18.What about white wine! White wine is not said to grain essence?
Wine are a variety of raw materials in the sugar by the yeast secretion of alcoholase action, into alcohol. Just the post-processing is not the same. Wine is divided into distilled spirits (mainly white wine) and non-distilled spirits (rice wine, yellow wine, wine, etc.) two categories. Distilled spirits are distilled and contain less purines, while non-distilled spirits are high in purines. White wine is related to gout is mainly a matter of alcohol, alcohol metabolism for lactic acid, lactic acid inhibits uric acid excretion, not good for gout, but low white wine than beer or better, because of the low alcohol content, the role of low, plus less purines. But be careful to drink less.
19, I think even red wine don’t drink?
A moderate amount of red wine (red wine) is fine. Note: Not white wine. Research shows that although wine also contains more purines, red wine is rich in antioxidants, anticoagulants (platelet inhibition) and vasodilators, including a component called quercetin, which has significant antioxidant and anticoagulant effects. On the one hand, they reduce the effects of alcohol on uric acid and cause a mild decrease in blood uric acid, and on the other hand, keep the blood vessels elastic and blood flowing smoothly, reducing the occurrence of heart disease (the reason why the French have less heart disease). White wines lose all their quercetin during the winemaking process and have no cardioprotective effect. Be careful not to overdo it.
20, moderate is how little ah 50 ml per day (2-3 small glasses) or less. Once there was a professor of internal medicine suffering from gout, himself a doctor, learned that gout patients can drink glucose, so one day really drank too much, and in the middle of the night there was a gout attack. The point to emphasize is that wine can be drunk, but the amount should be controlled.
21. Can I drink yellow wine and medicinal wine?
Neither can be drunk. Yellow wine, yellow wine is brewed with glutinous rice and wheat, yellow wine is rich in purines, sugar and amino acids (such as tyrosine and tryptophan oxidation by light is yellow; or amino acids and sugar combined to form amino sugar is also yellow, mixed with iron ions color deepened, add red currant also darkened color), known as the crown of wine. Medicine wine is white wine put some herbs such as angelica, party ginseng, etc., can not reduce the impact of alcohol on the human body.
22.What would be the order of these wines if they were ranked according to the risk of inducing gout?
The risk of gout induced by alcohol is ranked as follows: six stars: aged yellow wine; five stars: beer; four stars: fresh yellow wine; three stars: white wine; two stars: red wine. Aged yellow wine is mainly a slow entry of air into the altar, which is oxidized to organic acids, and the acids inhibit uric acid excretion. Research in the Lancet suggests that beer has the greatest potential to trigger gout, followed by strong white wine, while wine is basically non-existent.
23.Is there a kind of rice wine that gout patients can drink?
No, it is a non-distilled wine, no different from other wines, it has both alcohol and purines. Remember, only wine can be drunk in small amounts.
24.I really want to drink it. Is there any trick to make it drinkable?
(1) time to choose: morning and morning do not drink alcohol (the lowest concentration of enzyme – alcohol dehydrogenase secreted by the stomach to break down alcohol), while the afternoon 15 ~ 17 hours is most appropriate. Do not drink alcohol on an empty stomach, before going to bed or when you have a cold. (2) Choice and amount of alcohol: choose red wine; control the amount of alcohol consumed, not exceeding 50 ml. (3) Measures when drinking alcohol: drink more water or alkaline mineral water to dilute alcohol and reduce the degree; eat less meat and vegetables, eat more fruits and vegetables, and avoid using smoked and pickled foods such as salted fish, smoked sausage, bacon, etc. as an accompaniment to alcohol, because they contain a lot of pigments and nitrosamines, which react with alcohol and harm the liver, oral and esophageal mucosa, and even induce cancer.
25.Does asymptomatic hyperuricemia need to be treated?
Hyperuricemia and gout are not synonymous. Only when uric acid crystals are deposited in joints or kidneys on the basis of hyperuricemia is gout called gout. The risk of asymptomatic hyperuricemia lies in the development of gout attacks or, eventually, kidney stones. The likelihood of developing gout in patients with hyperuricemia is roughly proportional to the degree of increase in serum uric acid levels. The causes of hyperuricemia and related factors such as diuretics, antihypertensive drugs, chemotherapy drugs and kidney diseases, blood diseases, diabetes, hypertension, dyslipidemia, etc. should be searched for, and obesity, high purine and high calorie diet, alcoholism and other bad habits should be avoided.
26.How to detect gout early?
Large-scale blood uric acid screening of the population can detect hyperuricemia in time, which is very important for early detection and prevention of gout. In the absence of conditions for large-scale blood uric acid testing, at least the following people should undergo regular blood uric acid testing: ① elderly people over 60 years old, regardless of male or female and whether they are obese or not. (2) Obese middle-aged men and post-menopausal women. ③Patients with diabetes mellitus, hypertension, atherosclerosis, coronary heart disease, cerebrovascular disease (e.g. cerebral infarction, cerebral hemorrhage). (iv) Patients with arthritis of unknown cause, especially those over middle age characterized by the onset of monoarthritis. ⑤ Kidney stones, especially multiple kidney stones.
27.What is the difference between the treatment of gout attack and remission period?
The purpose of treatment in the acute phase of gout attack is to rapidly control the symptoms of arthritis. General treatment includes bed rest, elevation of the affected limb, and avoidance of joint weight-bearing. NSAIDs are preferred, as they not only relieve joint pain but also reduce the inflammatory response of the joints. Treatment in remission is mainly to maintain blood uric acid in the normal range and prevent gout attacks. If the blood uric acid still cannot reach the standard under strict dietary control, uric acid-removing drugs such as allopurinol, febuxostat and benzbromarone can be applied; it is important to confirm the diagnosis of gout, because once diagnosed, lifelong uric acid-lowering treatment is often recommended.
The principles of treatment are early, rapid, and effective pain relief, complete termination of acute arthritis, and prevention of chronic arthritis. Bed rest should be provided and the affected joint should be placed in the most comfortable position.
(1) Acute treatment1 Colchicine: It can reduce or terminate chemotactic factors secreted by leukocytes and synovial endothelial cells that phagocytose uric acid salts. Note: Colchicine has great side effects and toxicity, nausea and vomiting, diarrhea, liver cell injury, bone marrow suppression, hair loss, respiratory depression, etc. Therefore, those with bone marrow suppression, hepatic and renal insufficiency, and leukopenia are prohibited, and those whose treatment is ineffective should no longer be used and should be switched to NSAIDs.
2 NSAIDs: Indomethacin (anti-inflammatory pain) 25-50mg once, 3 times a day; diclofenac, ibuprofen, ketoprofen, aminoprofen, acemetacin, nimesulide, sulindac, naproxen, meloxicam, piroxicam and other NSAIDs can be used as appropriate, and the dosage should be reduced after the symptoms are controlled. It should be noted that NSAIDs also have more digestive system, blood system, kidney and other side effects.
3 Glucocorticoid therapy: When the above two types of drugs are ineffective or contraindicated, prednisone 30mg/day is generally relieved in 24 to 36 hours. Glucocorticoids also have significant side effects and need to follow medical advice when contraindicated.
4 Acute attacks to promote uric acid excretion and inhibit uric acid synthesis drugs can be suspended.
(2) Intermittent and chronic treatment to control the blood uric acid at normal level, prevent and protect the function of damaged organs.
1 Promote uric acid excretion drugs: Decreased uric acid excretion is the main cause of primary gout, this drug is suitable for the period of hyperuricemia and intermittent and chronic period.
Commonly used drugs are: (1) propoxur (carbenzene sulfonamide) for the first time 0, 25g, 2 times a day, within two weeks to 0, 5g, (2) sulfopiridone (benzosulfone) effect than propoxur, once 50mg, 2 times a day, gradually increased to 100mg, 3 times a day, (3) benzbromarone, stronger effect, once a day, 25-100mg. often rash, fever, gastrointestinal Side effects such as rash, fever, gastrointestinal irritation, and acute seizures. It is necessary to drink more water and take alkaline drugs such as sodium bicarbonate 3-6g per day during the drug administration.
2 Inhibitors of uric acid synthesis: The mechanism is to inhibit xanthine oxidase and block the conversion of xanthine into uric acid. It is suitable for those who produce too much uric acid or those who are not suitable to use drugs that promote uric acid excretion, such as allopurinol and febuxostat.
27. Can gout be cured?
Primary gout is a chronic lifelong disease and cannot be cured at present.
(1) Prevention and control objectives.
(1) Control hyperuricemia and prevent the occurrence of supersaturated urate deposits.
(2) Rapidly terminate acute arthritic attacks.
(3) To deal with gout stone disease, treat the primary disease, and improve the quality of life.
(2) Preventive measures.
①Examine suspected patients and family members for early detection of hyperuricemia.
(2) Reduce exogenous sources of purine and avoid diets with high purine content such as animal offal, fish, shrimp, clams, crabs and other seafood, meat and soy products.
③Adjust the diet structure, actively reduce body weight, control protein diet at lg/kg per day, carbohydrates account for 50%-60% of total calories, and eat less candy, etc.
④Increase uric acid excretion: drink more water, do not use drugs that inhibit uric acid excretion, diuretics, aspirin, etc.
⑤ Avoid triggers that promote the formation of urate crystals: get cold, overwork, stress, wear comfortable shoes, don’t make joints injured, quit drinking, take alkaline drugs, such as adding acetazolamide 0.25g at night to keep urine alkaline and prevent stone formation.
(6) In case of hyperuricemia without gout, use uric acid synthesis inhibitors or (and) uric acid excretion promoters as appropriate according to the type of occurrence.
28.Schedule: Table of purine content of food Category I Food with high purine content (100-1000 mg of purine per 100 g of food) Liver, kidney, pancreas, heart, brain, meat pies, gravy, broth, mackerel, anchovy, sardine, fish eggs, shrimp, goose, spotted chicken, stone chicken, yeast Comments: prohibited during gout attack and interval Category II Food with medium purine content (75-100 mg of purine per 100 g of food) 75-100 mg) 1. fish: carp, cod, halibut, sea bass, pike, shellfish, eel and eel 2. meat: smoked fire retreat, pork, beef, beef tongue, veal, rabbit, venison 3. poultry: duck, pigeon, quail, pheasant, turkey Comments: prohibited during gout attacks and restricted during intermittent periods Category III foods containing less purines (purines <75< per 100 g of food) Fish and crabs: mackerel, herring, salmon, anchovy, tuna, white fish, lobster, crab, oyster 2. Food with little purine 1. Grain: rice, wheat, millet, rice, caper wheat, cornmeal, refined white flour, rich flour, macaroni, noodles, bread, buns, soda crackers, butter snacks.
Vegetables: cabbage, cabbage, carrots, celery, cucumber, eggplant, kale, turnip greens, collard greens, lettuce, cut beans, pumpkin, bonito, zucchini, tomatoes, yams, potatoes, kimchi, pickles 3.Fruits: all kinds of fruits 4.Eggs, dairy: fresh milk, condensed milk, cheese, yogurt, cream of wheat 5.Beverages: soft drinks, tea, coffee, cocoa, chocolate 6.Others: all kinds of fats, peanut butter Other: various fats, peanut butter, jelly, jams, dried fruits, etc. Review: the attack period and interval can be consumed chili, curry, pepper, pepper, mustard, ginger and other food seasonings, can excite the plant nerves, inducing acute attacks of gout, should also try to avoid the application.