How does uric acid drop？ How to prevent gout？ It’s not enough to take medicine and avoid eating.
Epidemiological research data show that there are about 180 million people with hyperuricemia in China, and "high uric acid" has become an increasingly frequent word in physical examination reports. Because gout has not yet broken out, many people lack due vigilance against high uric acid, and even continue to eat high purine. As everyone knows, hyperuricemia is not only easy to induce gout, but also an independent risk factor for diseases such as diabetes, hypertension, chronic kidney disease, coronary heart disease and stroke.
How does uric acid drop? How to prevent gout? What else do you need to do besides taking medicine and avoiding food? A few days ago, Professor Huang Jianlin, director of the Department of Rheumatology and Immunology of the Sixth Affiliated Hospital of Sun Yat-sen University, was invited to answer the questions in the micro-class of Guangzhou Daily’s famous doctor lecture hall.
Chronic hyperuricemia
These diseases are easy to come to the door.
How much blood uric acid is high? Huang Jianlin introduced that hyperuricemia (HUA) means that under the normal purine diet, the fasting blood uric acid level of men is higher than 420&mu twice on different days; Mol/L, higher than 360&mu in women; Mol/L, which is called hyperuricemia.
It is worth noting that hyperuricemia often has no symptoms, and not every patient will eventually develop gout. Therefore, many people do not agree with this disease. In fact, if blood uric acid exceeds the standard for a long time, some diseases in the body will easily come to the door.
Huang Jianlin introduced that long-term blood uric acid exceeding the standard is closely related to cardiovascular and cerebrovascular diseases, diabetes and end-stage renal disease. Hyperuricemia is an independent risk factor of coronary heart disease death, and long-term hyperuricemia has causal relationship with abnormal glucose tolerance and diabetes.
Studies have shown that the serum uric acid level is 300~384μ Compared with the population with mol/L, the serum uric acid is > ＞510μ The risk of renal failure in mol/L patients increased by 7 times. Serum uric acid level > 420μ The incidence of new-onset chronic kidney disease with mol/L increased significantly by about 3 times. At present, many epidemiological studies have confirmed that serum uric acid is an independent risk factor for hypertension, and every increase of serum uric acid level is 59.5μ Mol/L, the relative risk of hypertension increased by 25%.
Exceed this index
To start medication.
In the absence of gout symptoms, how much higher uric acid should be before starting treatment?
Huang Jianlin introduced that patients who do not exceed the standard seriously should be treated mainly by adjusting their daily living habits, such as reducing the intake of high purine food. Because high uric acid often occurs in combination with hyperlipidemia and hyperglycemia, they should also eat less high-sugar drinks and diets and exercise more to eliminate metabolites.
If the blood uric acid in physical examination exceeds 538.2μ Mol/L, no matter whether there are symptoms or not, and whether there are high-risk factors of cardiovascular and cerebrovascular diseases, treatment should be started.
If the serum uric acid exceeds 478.4μ Mol/L, even if there are no symptoms, people with cardiovascular risk factors should start treatment. The cardiovascular risk factors include smoking, dyslipidemia, diabetes, little physical exercise, obvious overweight and family history of stroke.
Acute attack medication
It is suggested that within 12~24 hours.
Hyperuricemia is also called pre-gout, and about one-third of patients will eventually develop gout. Oversaturated uric acid will precipitate in the form of urate crystals and deposit on various joints, thus causing gout.
Long-term hyperuricemia patients, when gout attacks for the first time, the first attack site is common in toe joints, and some attacks occur in knee joints, finger joints and other parts, which are often caught off guard because of severe pain, and this pain often reaches its peak within 24 hours.
For acute gout attack, many people choose to go to the pharmacy to buy medicine immediately. At this time, they are often in a state of being in a hurry and it is difficult to identify the medicine that suits them. Huang Jianlin introduced that there are many kinds of drugs to treat acute gout attacks, and patients should choose according to their own conditions. It is suggested that the medication time in acute attack should be within 12~24 hours or even earlier, and non-steroidal anti-inflammatory drugs are the first choice. For patients who cannot take non-steroidal anti-inflammatory drugs, low-dose colchicine can be used alone or glucocorticoid can be used for a short time.
Gout treatment
The key is the intermission.
After the attack of acute gout, many people often let their guard down. According to Huang Jianlin, research data show that 50% of patients go to the hospital within one month after gout attacks, and the proportion drops to 4% after six months. "This shows that patients’ compliance is very low.".
This low compliance is often an important reason why gout cannot be cured and uric acid cannot be reduced to the target value. Experts pointed out that the main function of drug treatment during acute gout attack is to relieve pain, and uric acid lowering drugs are generally not used at this time. The key step of gout treatment lies in the intermittent period. At this stage, it is necessary to insist on taking medicine to reduce uric acid to avoid recurrent gout attacks. "After acute gout attacks, a large number of urate crystals are deposited in or around the joints, and it takes a lot of time to remove uric acid crystals around the joints." Therefore, experts added that even after uric acid is reduced to the normal value, it is necessary to keep taking medicine until urate crystals are cleared and the normal value of uric acid is maintained at a stable level, so as to reach the target value.
Huang Jianlin pointed out that in human metabolism, about 750g uric acid is produced every day, of which 80% uric acid is brought by metabolism, and the other 20% comes from food. Therefore, it is not enough for gout patients to reduce uric acid just by eating a diet that is taboo, and drugs are also needed to adjust the uric acid balance brought by 80% metabolism.
Eat more eggs and drink more milk
"Three highs" should be monitored at the same time
Both patients with hyperuricemia and gout need to be adjusted from their daily living habits. Fish and seafood are high purine foods, and excessive intake should be avoided in a short period of time. If you eat meat, you can consider "flying water" first and boiling the water slightly to reduce the purine content. Milk and eggs are hypopurine foods, and the proportion of these foods can be appropriately increased on the diet menu.
It is worth noting that hyperuricemia, hyperlipidemia and hyperglycemia often come together, so patients with hyperuricemia should also pay attention to avoid eating too much high-fat and high-sugar diet and drink less high-sugar drinks. In the annual physical examination, in addition to monitoring blood uric acid data, we should also observe blood lipid and blood sugar data. For patients with acute gout attack, we should do liver and kidney ultrasound examination to see if there is fatty liver and kidney calculi, and then make a targeted medication plan.
When acute gout attacks,
How to choose medicine?
1. The time of acute gout attack is 12-24 hours or even earlier. Non-steroidal anti-inflammatory drugs (NSAIDs) should be the first choice. Selective COX-2 inhibitors can inhibit COX-2 more specifically and reduce side effects such as gastrointestinal injury, which can be used for patients with high risk factors of digestive tract. If you have stomach trouble, you should be very careful when taking non-steroidal anti-inflammatory drugs, and you can take them together with stomach medicine; If you have kidney disease or dysfunction, you can’t take these drugs.
Non-steroidal anti-inflammatory drugs are divided into traditional non-steroidal anti-inflammatory drugs and selective COX-2 inhibitors. The former represents diclofenac, ibuprofen and meloxicam, which is more likely to hurt the stomach. The latter represents celecoxib, aricoxib and etoricoxib, which are less likely to hurt the stomach.
2. Patients with acute gout and contraindications to NSAIDs are advised to use low-dose colchicine alone. Attention should be paid to the dosage of colchicine, and the dosage indicated in the instructions should be reduced, otherwise side effects such as diarrhea will easily occur. The usage is 0.5mg in the morning and evening. If there is no diarrhea, you can take one capsule in the morning, middle and evening. Because the effective dose of colchicine is close to the toxic dose, 20% of colchicine is not easy to be removed by dialysis, and patients taking cyclosporine, clindamycin and diltiazem cannot take colchicine.
3. In acute attack of gout, short-term use of glucocorticoid alone is similar to NSAIDs in efficacy and safety. Short-term glucocorticoid alone can play the same effective analgesic effect as NSAIDs and has good safety. Also pay attention to the problem of hurting the stomach, and add stomach medicine.
It should be reminded that due to great individual differences and different physical qualities, gout patients should give priority to the hospital as far as possible and follow the doctor’s guidance when conditions permit.
(Text/Guangzhou Daily All-Media Reporter Liang Chaoyi Correspondent Jian Wenyang, Li Raoyao)