#千万IP创科普# It hurts to the bone! Keep these points in mind to stay away from "gout"

Gout is not a malignant disease, but it is extremely painful, and repeated attacks bring great pain to patients. During the onset of the disease, joints may be damaged, causing gouty arthritis, which is a common orthopedic joint disease. In this issue, a senior orthopedic expert from Fujian Second Hospital will explain to you how to prevent and treat gout.

Mr. Wang (pseudonym) has been suffering from gout for more than ten years. He often suffers from swelling and pain in many joints of his body, and tophi are deposited in some of his finger joints. Not only does his appearance suffer, but his joint mobility is also gradually limited. Although he has been to many hospitals for treatment many times, his condition has not been alleviated.

Through an introduction, he found Professor Li Yizhong of the Department of Orthopedics at the Second Affiliated Hospital of Fujian Medical University. After a period of standardized treatment, the frequency of gout attacks gradually decreased. Not only did the tophi on his hands gradually shrink, the appearance of his hands improved significantly, and the gout crystals in his knee joints also tended to decrease. The improvement of his condition gave him the confidence to continue treatment, and now his quality of life has also improved significantly.

Hyperuricemia and gout

Hyperuricemia and gout are systemic diseases that affect multiple systems. Sodium urate crystals can form and deposit in joints, inducing local inflammation and tissue destruction, i.e. gout. Sodium urate crystals can deposit in the kidneys and cause acute kidney disease, chronic interstitial nephritis or kidney stones, which is called uric acid nephropathy.

There is a lot of evidence showing that hyperuricemia and gout are independent risk factors for diseases such as chronic kidney disease, hypertension, cardiovascular and cerebrovascular diseases and diabetes.

Gout is more common in men, with a male-to-female ratio of 15:1. The main triggers of acute attacks are drinking, high-purine diet and strenuous exercise . The first attack often occurs at night or early in the morning, with symptoms including severe and unbearable pain, local redness, swelling, heat and pain. The big toe is the most common site, and the dorsum of the foot, the attachment of the Achilles tendon and the hand joints are also often involved. Patients with repeated attacks of gout may also be affected by the knee joints, hip joints, elbow joints and spine, leading to joint deformation, dysfunction and disability.

Defend

Daily Lifestyle Management

China's Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout (2019) recommends that all patients with hyperuricemia and gout maintain a healthy lifestyle. So how should gout patients manage their daily lives?

0 1 Control your weight. Weight loss can significantly improve the rate of uric acid control and reduce the frequency of acute gout attacks, so weight control is very important. Reduce food intake, especially don't eat or drink too much at night.

0 2 Regular exercise Exercise 3 to 5 days a week, each time for 45 to 60 minutes, do aerobic exercise such as brisk walking, etc. The key is not to rush for success, but to proceed step by step and persist. Do not do strenuous exercise, as excessive sweating can trigger gout attacks.

0 3 Limit drinking. Alcohol intake is positively correlated with the risk of gout. Among heavy drinkers, the risk of gout increases by 2.64 times. Regular drinking increases the risk of gout or high uric acid by 32% compared to occasional drinking. Therefore, do not drink alcohol in the early stage of gout uric acid lowering treatment. After the blood uric acid is controlled to the standard, drink moderately.

0 4 Diet and daily routine Limit the intake of high-purine and high-fructose foods. Seafood (such as oysters, clams, squid, etc.), animal offal, pork, beef, and mutton contain high purine. Purine is also present in large quantities in thick soups. Therefore, gout patients should not eat hot pot or drink slow-cooked soups. The DASH diet (refers to the intake of large amounts of fruits, vegetables, nuts, beans, low-fat dairy products, and whole grains, and limits the intake of sodium, sugary sweets and beverages, red meat, and processed meat) can significantly reduce the incidence of gout.

At the same time, we should pay attention to regular diet and rest. People with irregular diet and rest have a 1.6 times higher risk of gout and high uric acid than those with regular diet and rest.

0 5 Drink more water As long as the kidney function is normal, drink more water every day. Because uric acid is mainly excreted through urine, especially in the early stage of uric acid reduction, it is necessary to ensure that the daily urine volume reaches 2000 ml. Drink more water during the day and less water at night, otherwise it will affect sleep. In summer or during exercise, sweating will lead to less urine, so increase the amount of water you drink.

rule

Standardized treatment is required

Many patients do not have enough knowledge about the harm of gout and do not receive standardized treatment. They often suffer from acute attacks, seek medical treatment when the pain is severe, and stop treatment after it is relieved. The symptoms recur repeatedly, eventually leading to disability. In fact, even if there are tophi or urate deposits in the joints, drug treatment can still dissolve tophi and urate crystals, preserve or restore joint function, and control acute attacks of gout.

For tophi that have already been deposited, surgical removal is required to prevent further damage to bones, joints and soft tissues, reduce skin necrosis, correct deformities, improve joint function, and reduce nerve compression. More importantly, tophi removal can reduce the uric acid content in the body and reduce the damage of high uric acid to the human body. Surgical methods include open surgery, arthroscopic surgery, artificial joint replacement, etc.

Open surgery

Open surgery can quickly remove tophi. If tophi rupture and the wound does not heal for a long time; the joint cannot be worn with shoes or gloves, and it is difficult to flex and extend, seriously affecting the quality of life; symptoms of nerve compression occur, such as numbness of the hands and feet; and tophi have a huge impact on appearance and increase the difficulty of treatment, open surgery may be considered.

However, it should be noted that there may be various complications after surgery, such as poor wound healing, limited recovery of joint function, and acute gout induced by surgical trauma. Therefore, perioperative management of tophi resection is very important, and it is even more important to maintain good living habits and use uric acid-lowering drugs for a long time after surgery.

Arthroscopic surgery

Arthroscopic surgery is suitable for early diagnosis and treatment. It can reduce the destruction of articular cartilage and prevent further damage to the bone. It has less trauma than open surgery and relatively fewer complications.

Artificial joint replacement

Artificial joint replacement is suitable for advanced gouty arthritis with joint deformity. Gouty arthritis is the main painful manifestation of gout. The treatment of acute gout attacks is as follows:

1. Non-drug treatment: rest in bed, reduce the activity of the affected joint, and raise the affected limb.

2. Drug treatment: It is best to start using drugs to control acute inflammation within 24 hours of the onset. First-line treatment drugs include colchicine and non-steroidal anti-inflammatory drugs. When there are treatment contraindications or the treatment effect is poor, short-term use of glucocorticoid anti-inflammatory treatment can also be considered. If monotherapy is ineffective, the above-mentioned drugs can be used in combination. For patients who have taken uric acid-lowering drugs and have acute attacks, there is no need to stop the drug; for patients who have not yet taken uric acid-lowering drugs, uric acid-lowering drugs are not needed during the acute attack period. After the symptoms completely disappear (≥2 weeks), uric acid-lowering treatment should be started.

Target

Control within the ideal range

Professor Li Yizhong of Fujian Medical University Second Hospital suggested that all patients with hyperuricemia and gout should be aware of and pay attention to the factors affecting blood uric acid levels throughout their lives, and always keep blood uric acid levels within the ideal range: 240-420umol/L . Evidence shows that: for patients with blood uric acid <360umol/L, the recurrence rate of gout within 1 year is <14%; for patients with blood uric acid >480umol/L, the recurrence rate of gout within 1 year is more than 50%. The 2016 European League Against Rheumatism (EULAR) gout management recommendations and the 2018 multidisciplinary consensus in Taiwan, China, both recommend that the management of blood uric acid should follow the principle of individualized treatment, and recommend that all gout patients have blood uric acid levels controlled at <360umol/L, and patients with severe gout have blood uric acid levels controlled at <300umol/L. It is not recommended to control blood uric acid at <180umol/L for a long time.