Understanding gout.
Gout is a sudden onset of arthritis caused by high uric acid crystals in the blood caused by a combination of congenital, acquired dietary and environmental factors, and the immune system.
Gout is often triggered by high uric acid levels in the blood, resulting in the deposition of uric acid crystals, combined with certain sudden conditions such as alcohol consumption, intense exercise, overeating, stressful life, and changes in habits.
Gout is commonly known as the emperor’s disease, and many famous people and monarchs in history often suffered from gout, hence the name. In a narrow sense, gout is a sudden onset of arthritis caused by high uric acid in the blood. However, in a broader sense, gout is a symptom of hyperuricemia.
When hyperuricemia is fully manifested, it often progresses in the following steps:
1. high levels of uric acid in the blood.
2. deposits of uric acid in body tissues and organs, including the kidneys, heart, and blood vessels, causing chronic damage.
3. Increase in uric acid concentration in the urine.
4. Gout attacks: recurrent attacks with characteristic arthritis. Gout stone formation and joint deformation.
5. Uric acid deposition, resulting in kidney lesions and dysfunction.
6. uric acid urinary tract stones.
7. deposition of uric acid, which can lead to hardening of blood vessels, high blood pressure, heart disease, and stroke.
Gout is an amazing disease. Gout is named after the fact that it comes and goes as quickly as the wind, with no warning signs. Gout is also named for the pain it causes when it strikes, and when it is severe, it can be difficult to walk and even painful when the wind blows through your mouth. Even if the gout attack is not treated, it will dissipate and heal naturally within a few days, even without leaving a trace. Because of this, gout sufferers find that the pain is gone after a few days of taking herbs or worshipping the gods, they think they are fine and lose caution, which may lead to more serious complications. Gout is more common in men between the ages of 35 and 55, and the ratio of men to women is 20 to 1. Most of the 80 percent of gout patients have no family history of gout, and only about 20 percent of gout patients have a family history of gout.
Gout has a congenital predisposition, but 80% of people who have gout do not inherit it. People who do not have gout are less likely to have gout due to overeating or lifestyle disorders. However, people with gout can reduce or prevent the development of gout through dietary control.
At present, except for a very small number of people who are found to have the potential gene for gout, more than 99% of people cannot be diagnosed as having a congenital gout constitution in advance. However, people over the age of 60 who have never had gout or high uric acid blood can be said to be gout-free.
The following views are widely accepted.
l. Gout is a manifestation of excessive blood uric acid disorder
2, Ninety-five percent of people with gout have uric acid concentrations in their blood that are significantly above the normal range.
3. A sudden increase in uric acid is often a precursor to a gout attack.
4, high uric acid is not the same as gout: only one in ten people with high uric acid will get gout, and the rest may not have any gout symptoms throughout their lives, so the two should not be confused.
5, high uric acid does not necessarily get gout immediately, it is related to the high concentration of uric acid and the length of time it has been accumulated. Generally speaking, the higher the value of uric acid, the more likely to get gout. In particular, people with uric acid levels of more than nine milligrams per 100 milliliters of blood have a 70 to 90 percent chance of getting gout. The longer the duration of high uric acid, the more likely you are to get gout. Generally speaking, at least two to three years, but it usually takes five to ten years before the symptoms of an acute attack of gout appear.
6, very easy to control (treatment): control (cure) rate of more than 98%. In case of a gout attack there is no need to worry too much, there are very effective drugs available to treat gout.
The most important thing is to find out the cause of gout. The first thing you should do is to get proper tests to find out the cause of gout and whether there are any related diseases (although gout is a disease, there are many diseases or conditions that can cause gout and should be treated together), and discuss with your doctor when to start using uric acid-lowering medication, and long-term patient treatment is the only way to overcome gout.
Causes.
Clinically, there are two types of gout: primary and secondary. The so-called secondary gout is caused by obesity, medications (such as diuretics, aspirin, anti-tuberculosis drugs), blood disorders, tumors or poor kidney function, etc. The uric acid level usually returns to normal after these causes are removed, so the cause of gout should be identified first. Primary gout, however, has none of these causes and is predominantly male (over 90%), with a male to female ratio of 20:1 (i.e., only 5% female). Approximately 25% of patients with gout have a family history of gout (reported range of 8-30% in various countries). Approximately 20% of patients with gout have a combination of urinary stones (range 10-25% in all countries).
The age of onset of gout tends to be younger, which may be related to the increasing abundance of diet, and it is advisable to develop good and healthy dietary habits from childhood, especially if gout runs in the family.
Causes of acute gout attacks:
Beer, offal, and seafood are the most common, while beans are less common. Although the purine content of beer itself is not high (2-5mg/100ml), it contains more Guanosine, and alcohol [ethanol] in the body will accelerate the metabolism of ATP to produce uric acid, and its metabolite – lactic acid can inhibit the excretion of uric acid by the kidneys, so it is easy to cause gout attacks.
Simply put, the cause of hyperuricemia is that the rate of uric acid production in the body is greater than the rate of discharge, and uric acid accumulates in the blood. In a normal human body, uric acid is produced by metabolizing purine-containing substances from decomposing cells or cellular activities to produce 500 milligrams of uric acid every day, and 100 milligrams are obtained from diet. It is excreted directly from the intestinal cells into the intestine about 150 mg per day, and is filtered by the kidneys and mixed into urine, and excreted out of the body about 450 mg per day, which is also about 600 mg per day, so that a normal and stable balance is maintained. If too much uric acid enters the blood or too little is excreted, or both, uric acid in the blood will accumulate and hyperuricemia will develop.
If the intestine is overloaded with feces, harmful bacteria, and drug poisoning, it will easily lead to the weakening of intestinal cell dysfunction and affect the normal excretion of uric acid from the intestinal cells, which is not as rapid and obvious as diet, but the long-term effect is often greater than that of a high purine diet.
The kidney is the main organ of the body that filters blood to remove waste. Each nephron unit consists of a glomerulus, a glomerular capsule and a renal tubule. The blood pressure forces the blood to be smaller than 0. 0.3 microns, about 250 percent of the diameter of a red blood cell, is dialyzed with the blood into the glomerular capsule, where it forms primary urine. The primary urine then flows through the long renal tubules, where it is selectively absorbed to recover water, glucose, sodium, potassium, iron, and small molecules of protein. In contrast, the remaining metabolic waste products such as urea, uric acid, lactic acid, ketone bodies, and creatinine are drained along with concentrated water into the urinary ducts and discharged through the bladder.
Basically, the kidney uses the principle of physical membrane osmosis to produce primary urine from blood through the glomerular wall, and the pressure, molecular concentration, ionic gradient, and acid-base difference of the aqueous solution between the blood in the glomerulus and the primary urine in the glomerular capsule determine the amount of various substances dialyzed. In addition to the metabolic role of the liver, the kidneys are also responsible for maintaining the balance of water, electrolytes and acid-base in the body. Therefore, acidic substances such as lactic acid, ketone bodies, myohepatic acid, and even other molecules compete with uric acid, and high concentrations of sodium, potassium, calcium, and other alkaline ions can stunt the discharge of acidic metabolites.
Although clinical statistics show that 90% of patients with hyperuricemia have insufficient uric acid excretion, pathological studies show that when uric acid in the blood is too high, it is deposited in kidney cells and glomerular vessels, causing kidney dysfunction and affecting uric acid excretion. According to clinical statistics, in patients with hyperuricemia, if uric acid is not controlled properly, the incidence of renal dysfunction is about 35% in the first year, 55% in the second year, and 70% in the fifth year. Therefore, the original cause of most patients with inadequate uric acid excretion is still most likely to be high uric acid in the blood. In any case, high uric acid blood will cause kidney dysfunction, and kidney dysfunction will cause insufficient uric acid excretion, which in turn will cause high uric acid blood, thus forming a vicious circle of interaction.
Gout management.
The general management of gout patients is based on the control of acute and chronic attacks and the prevention of gout stone deposition.
Drug therapy:
Non-steroidal anti-inflammatory drugs and colchicine have anti-inflammatory and pain-relieving effects; other drugs mainly inhibit uric acid formation or promote uric acid excretion. Colchicine may have the side effect of diarrhea, but reducing the dosage can improve the diarrhea, so there is no need to worry.
Exercise:
Strenuous exercise increases sweating and reduces uric acid excretion in the urine; lactic acid produced after exercise also hinders the excretion of uric acid, so gout patients should avoid strenuous exercise.
Drink more water:
Drinking more than 3000-4000 cubic meters of water a day can help the excretion of uric acid.
Avoid high purine foods: offal, seafood, broth, fish, dried beans, mushrooms, yogurt, fermented milk, germ, etc. are all high purine foods and should be avoided as much as possible to reduce the formation of uric acid. Avoid drinking alcohol: The metabolism of alcohol in the body will affect the excretion of uric acid and cause gout, so you should avoid drinking alcohol as much as possible. If you follow your doctor’s instructions and take your medication and watch your weight and diet, you will be able to control gout more effectively.