This generation of young people has been targeted by gout...

A younger body

I can't stand your tossing and turning

This young people

I have been targeted by gout...

According to data from 2018, the prevalence of hyperuricemia among adults in China is as high as 14.0% , with 24.5% among males and only 3.6% among females. In particular , the prevalence among young men is as high as 32.3% .

Image source: Photo Network

I know you are going to ask:

Why do I have gout even though my uric acid level is not high?

Is surgery necessary for tophi?

Keep your mouth shut, gout is not

It won’t happen anymore?

Don’t panic! Let’s take a look first——

no!

Don't underestimate gout. In addition to causing pain in the joints, it may also cause kidney and cardiovascular diseases and a series of metabolic syndrome problems.

Image source: Photo Network

For example, acute or chronic urate nephropathy, uric acid urinary stones, hyperlipidemia, hypertension, diabetes , and even ischemic heart disease and coronary heart disease can be affected by gout.

This can be determined by the following checks:

1

Serum uric acid measurement

Under a normal purine diet, two fasting blood uric acid tests exceeding 420 μmol/L can be diagnosed as hyperuricemia.

It should be noted that gout may occur even if uric acid is not high !

This is because the balance between the precipitation and dissolution of uric acid in the body is broken . For example, during an acute attack, a large amount of uric acid crystals precipitate from the blood and deposit in the joints and other tissues, causing a relative decrease in the uric acid level in the blood .

This is why some gout patients actually have lower blood uric acid levels than usual during an acute attack.

2

Imaging tests

Joint X-rays, ultrasound, dual-energy C, etc. can help observe joint damage and urate crystals .

Image source: Photo Network

3

Arthrocentesis

Gout can be directly confirmed by observing monosodium urate (MSU) crystals under a polarized light microscope**.

Except for necessary surgery to correct severe joint deformities, try not to perform surgery to scrape away tophi unless the tophi are pressing on nerves or internal organs!

Patients with "new gout" should take a look. If the uric acid level is not well controlled for a long time, you may develop tophi later .

Gout stones are not a good thing. They are caused by an overload of uric acid levels in the blood. Uric acid precipitates to form urate crystals, which are eventually deposited in the joints, around the joint capsules, subcutaneous soft tissues, kidneys and other parts to form tophi.

Image source: Health Management Center of West China Tianfu Hospital, Sichuan University

General Medicine Center/Health Management Center, West China Hospital, Sichuan University

Suzhou and Hangzhou

Tophi can cause repeated attacks of gouty arthritis, leading to bone destruction and joint deformities , and can also have certain adverse effects on some important organs of our body.

We encourage everyone to achieve the goal of curing tophi by controlling uric acid levels to meet the long-term standard ;

Because after active treatment, blood uric acid drops below 300umol/L and is maintained for a long time. After 6 months, the tophi will begin to dissolve slowly and it will take 3 to 5 years to completely dissolve.

Non-drug treatments: Lifestyle changes

In terms of "eating and drinking", Huaxi doctors recommend:

● All alcohol, tobacco, offal, seafood, and broth are prohibited ;

● The purine content of soybeans is slightly higher than that of meat, but the utilization rate of purine by the human body is low. Therefore, tofu, dried bean curd, etc. can be eaten in moderation after processing ;

● Limit the intake of sugary drinks. You can drink 3000ml of water or light tea every day ;

● Control the amount of meat to 2-3 taels per day ;

● The purine content in egg white and milk is low, so they can be consumed safely: 1-2 eggs and 250-500ml of milk per day .

Image source: Photo Network

Seek medical help: Medication to lower uric acid levels

Sometimes, dealing with gout is not just about controlling your diet !

Because the high uric acid level caused by diet may only account for 20%, and the other 80% of uric acid comes from the aging of your own cells .

So, in this case we cannot rely on lifestyle changes alone to deal with gout.

If you experience any of the following, you may need to start medication :

● Serum uric acid exceeds 540 μmol/L

● Two or more episodes of gouty arthritis

● A gout attack accompanied by a blood uric acid level exceeding 480 μmol/L

● Presence of tophi or intra-articular urate deposits

● Uric acid kidney stones or renal impairment

● Other health problems such as hypertension, diabetes, dyslipidemia, obesity, coronary heart disease, stroke, heart failure, etc.

Image source: Photo Network

1

What is the goal of achieving target treatment for gout?

Patients who have been diagnosed with gout need to reduce their blood uric acid to below 360 μmol/L and maintain it for a long time ;

If you have tophi or frequent attacks of gouty arthritis , the serum level needs to be reduced to below 300 μmol/L .

2

The lower the uric acid level, the better?

no!

Uric acid should not be too low. Levels below 180 μmol/L may increase the risk of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease .

3

How to treat uric acid kidney stones?

For stones smaller than 1 cm , the usual approach is to increase water intake and limit high-purine foods ;

If the stones are larger or complications such as urinary tract obstruction and infection occur , you will need to go to the hospital for further treatment .

Image source: Photo Network

4

Why should we screen for the HLA‑B*5801 gene?

The HLA‑B*5801 gene positivity rate in the Chinese population is relatively high. HLA‑B*5801 positivity is closely related to serious adverse reactions (severe drug rash, etc.) to the uric acid-lowering drug allopurinol , so it is best to screen before using allopurinol.

Finally, I emphasize again

Gout treatment focuses on management

Maintaining blood uric acid at the target level for a long time is the key

The "three days of fishing and two days of drying the net" approach

Fluctuations in blood uric acid levels

It will aggravate the gout condition

Gout is a long-term battle with uric acid

Relying on drugs

It also depends on lifestyle changes

Let us defeat this opponent together~

Statement: This article is a medical-related educational popular science article. It does not involve specific treatment methods or medical behaviors and cannot replace hospital visits.

Author

This article guides experts

References

1Xu Dong, Zhu Xiaoxia, Zou Hejian, et al. Gout diagnosis and treatment guidelines[J]. Chinese Journal of Internal Medicine, 2023, 62(9): 1068-1076.

2 FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout[J]. Arthritis Rheumatol, 2020, 72(6):879-895.

3 National Health Commission of the People's Republic of China. Dietary Guidelines for Adults with Hyperuricemia and Gout (2024 Edition)

Content Production

Editor: Yang Yali

Map: Eastern Zhou Dynasty