Popularization of health knowledge on gout prevention and treatment

Gout concept formula

Now that living standards are better, the incidence of gout is increasing

Purine products are uric acid, which is produced more in the body but excreted less.

The toe joint is red, swollen, hot and painful.

In recent years, as the domestic diet has become increasingly rich and the living standard has greatly improved, people have eaten a lot of high-purine foods. Excessive uric acid is produced in the body, or due to kidney dysfunction, uric acid excretion is blocked, so that excessive urate is deposited in the blood and tissues, and then attached to the distal toes and finger joints of the human body, causing redness, swelling, heat, pain and inflammation of the joints, leading to gout.

Gout diagnostic criteria

Diagnosis of gout is not difficult. Crystals are found in joint fluid.

Six manifestations of tophi under the microscope can be diagnosed

First, acute arthritis peaks in one day.

Third, inflammation of a single joint can be distinguished by redness of the joint.

Metatarsophalangeal joint pain and swelling unilateral attack involving me

There are also changes in the tarsal joints, and suspected tophi are visible

9. Hyperuricemia: Asymmetric joint swelling

Multiple subcortical cysts but no bone erosions

A piece of biological culture between joint inflammation attacks

[explain]

The “gold standard” for diagnosing gout

(1) There are specific urate crystals in the joint fluid.

(2) The presence of tophi can be confirmed by chemical methods or polarized light microscopy to contain urate crystals.

(3) Those who have 6 of the following 12 clinical, laboratory and X-ray signs.

① More than one acute arthritis attack.

②Inflammatory symptoms reach a peak within 1 day.

③Attack of monoarthritis.

④Redness of the joints was observed.

⑤Pain or swelling in the first metatarsophalangeal joint.

⑥Unilateral attack involves the first metatarsophalangeal joint.

⑦ Unilateral attacks involve the tarsal joints.

⑧Suspected tophi.

⑨Hyperuricemia.

⑩Asymmetric swelling within the joint (X-ray).

⑪Subcortical cyst is not accompanied by bone erosion (X-ray).

⑫ Negative microbial culture of joint fluid during an attack of joint inflammation

Tips for acute phase management

Reduce activity and rest more during an acute attack of gout

Elevate the affected limb and apply cold compresses, but soak the feet and massage are not recommended.

Drug treatment should be started early. Three types of drugs should be remembered

Colchicine and hormonal nonsteroidal anti-inflammatory drugs

Both hormone anti-inflammatory drugs are equally effective when used alone

If the patient has contraindications to taking autumn water medicine alone

During this period, uric acid should be stable and no acid-lowering drugs should be used

[explain]

During the acute attack of gout, patients should be advised to reduce activity as much as possible, rest in bed, elevate the affected limb, and apply local ice compresses (or magnesium sulfate wet compresses) to reduce temperature, relieve redness, swelling and pain. In addition, topical Voltaren emulsion can also help relieve local pain. Remember, massage and hot compresses should not be performed at this time, as hot compresses will dilate blood vessels and aggravate local swelling and pain. It is recommended to treat symptomatically as soon as possible (within 24 hours). There are three major categories of drugs available: non-steroidal anti-inflammatory drugs, colchicine and glucocorticoids. Patients who are contraindicated for non-steroidal anti-inflammatory drugs are recommended to use low-dose colchicine alone. The efficacy and safety of short-term use of glucocorticoids alone are similar to those of non-steroidal anti-inflammatory drugs. During the acute attack of gout, the patient's blood uric acid concentration should be kept relatively stable as much as possible, and it is not recommended to add uric acid-lowering drugs during acute attacks of arthritis.

Uric acid-lowering therapy after the acute phase

Gout twice a year causes chronic gouty arthritis

There are also stones to accompany the treatment, which requires lowering of uric acid

The efficacy of probenecid benzbromarone in promoting acid excretion

Allopurinol inhibits uric acid production

Regularly test liver and kidney function and prevent relapse with small doses of colchicine

[explain]

If acute gouty arthritis occurs more than twice a year and is accompanied by chronic gouty arthritis or tophi are confirmed to be present, uric acid-lowering treatment is necessary. Allopurinol or febuxostat are recommended as drugs to inhibit uric acid production; benzbromarone and probenecid are recommended as drugs to promote uric acid excretion. Monitor liver and kidney function levels during treatment. Since taking uric acid-lowering drugs can lead to an increase in blood uric acid, a small dose of colchicine needs to be taken at the beginning of treatment to prevent and treat acute gout attacks.

Avoid uric acid-raising drugs

Relieve joints with non-steroidal high uric acid

Blood pressure lowering, blood sugar lowering, insulin, anticancer, antibacterial, immune agent

There are also various diuretics, niacin, vitamin C and vitamin B1

[explain]

The following drugs should be avoided for patients with hyperuricemia and gout

(1) Non-steroidal anti-inflammatory drugs: Aspirin and benoyl ester can cause increased uric acid.

(2) Diuretics: loop diuretics and thiazide diuretics.

(3) Antihypertensive drugs: reserpine, diazoxide, telmisartan, and losartan.

(4) Antidiabetic drugs: insulin.

(5) Immunosuppressants: cyclosporine, mercaptopurine, mycophenolate mofetil, tacrolimus, sirolimus, and basiliximab (dose-related effect).

(6) Antibacterial drugs: penicillin, lomefloxacin, moxifloxacin; anti-tuberculosis drugs such as pyrazinamide and ethambutol reduce uric acid excretion and cause hyperuricemia.

(7) Vitamins: niacin, vitamin C, vitamin B1.

(8) Antineoplastic drugs: Cyclophosphamide, ifosfamide, busulfan, thiotepa, cytarabine, thioguanine, mercaptopurine, hydroxyurea, vinblastine, vincristine, asparaginase, teniposide, cisplatin, carboplatin, lobaplatin, oxaliplatin, etc. can all cause hyperuricemia. During treatment, allopurinol should be given at the same time and the urine should be alkalinized.

Drug contraindications for acute gout attacks

Allopurinol suppresses uric acid and is used for long-term use as a gout stone powder

But be careful not to use analgesics or anti-inflammatory drugs in the acute phase

Gouty arthritis caused by dissolution of tophaceous stones into crystals

In the above cases, avoid taking colchicine as early as possible.

It is not too late to use allopurinol after the acute phase has stabilized for two weeks.

Aspirin can relieve pain and increase blood uric acid levels

Elevated uric acid and renal retention: these taboos should be remembered

[explain]

Long-term use of allopurinol can gradually shrink and dissolve the formed tophi. However, it has no anti-inflammatory and analgesic effects in the acute phase. To avoid the above situation, take colchicine as soon as possible. Allopurinol is usually started 2 weeks after the gout attack stabilizes, but patients who have already used it in the remission period can continue to use it during the acute attack. Although aspirin, benolate, etc. can relieve mild and moderate joint pain, they can reduce the excretion of uric acid in the blood, causing uric acid to remain in the body, resulting in an increase in the level of uric acid in the blood.

Diet Rhymes

Avoid offal and broth, grilling, frying and high sugar content

Don't eat fungi, eat less beans, shrimps, crabs, and don't try turtles and tortoises.

Eat more alkaline food, less yogurt, eggs, and meat in moderation

Eat more fresh fruits and vegetables, and limit white and red beer to appropriate amounts

[explain]

Reasonable adjustment of dietary structure can not only meet the nutritional needs of the body and enjoy the pleasure of eating, but also control blood uric acid to meet the standard and minimize the maintenance medication dosage.

(1) Avoid eating animal offal, fatty meat, gravy, thick soup, and high-sugar foods (such as fruit juice drinks and canned fruits).

(2) Avoid eating grilled or fried foods (such as barbecue and fried chicken), stewed meat, or braised meat.

(3) Avoid eating hard-shell seafood (such as shrimp and crab). Deep-sea fish can be eaten in moderation.

(4) Try to eat less or no fungi and less soy products.

(5) Eat more alkaline foods and less acidic foods.

(6) Milk, eggs, lean meat, etc. are high-quality proteins and should be supplemented in appropriate amounts. You can eat meat appropriately (100-200 grams of lean meat and lean meat can be consumed every day).

(7) Eat more fresh fruits and vegetables.

(8) Promote smoking cessation, ban beer, limit white wine, and allow red wine in moderation.

Exercise tips

Aerobic exercise should be moderate, including jogging, swimming and cycling

If you want your heart rate to be exactly 170 minus your age

Exercise for 15 minutes at first and then increase it gradually after two weeks

Keep doing your best every five to thirty minutes

[explain]

Adhere to moderate exercise. Aerobic exercise is more suitable for gout patients, such as brisk walking, jogging, swimming, etc.

(1) The amount of exercise should be moderate. The maximum suitable heart rate for aerobic exercise is: 170 - age.

(2) Exercise should be gradual. The first exercise time is 15 minutes. After 2 weeks, increase to 30 minutes. After another 2 weeks, increase to 45-60 minutes. You can keep doing it. If you stop exercising for some reason, you need to recalculate the exercise time.

(3) Exercise 5 times or more per week.

Weight loss and drinking water

Keep your mouth shut, move your legs, control your weight, drink more water

Eating until you are 80% full and hungry is not effective for weight loss

The salt content should not exceed 6 grams and 3,000 milliliters of water is good.

[explain]

Keep your weight under control, and don't use starvation therapy to lose weight. Follow the gout diet and stick to eating until you are 80% full for a long time, and you can achieve the goal of gradual weight loss. It is best not to consume more than 6 grams of sodium salt per day. It is best to drink 2000-3000 ml of water per day.

What causes gout?

When the uric acid level in the blood exceeds the standard for a long time, uric acid will precipitate around the joints, forming crystals and accumulating, causing inflammation, damaging joint tissue, and causing pain, which is called gout. Uric acid is produced when the human body breaks down a chemical called purine. Purine exists naturally in our bodies and is also found in many foods. Under normal circumstances, uric acid in the blood is excreted from the body through the kidneys and intestines, of which 90% is excreted through the kidneys and 10% is excreted through the intestines.

Excessive uric acid production and/or inadequate excretion can cause high uric acid levels in the blood. Recent studies on gout have found that gout caused by increased uric acid production only accounts for 10% of gout cases, while the remaining 90% is caused by insufficient excretion by the kidneys.

However, high uric acid levels do not equal gout. Although gout is caused by long-term hyperuricemia, people with high uric acid levels do not necessarily develop gout. Everyone's body's ability to excrete uric acid is different, and it is related to age, gender, overall health, genetic factors, kidney function, medications taken, etc.

Risk Factors for Gout

Age and gender Gout is usually seen in men over the age of 40. Postmenopausal women have uric acid levels close to those of men, and their likelihood of developing gout is greatly increased.

Diet: Meat and seafood, alcohol, and sugary drinks increase uric acid levels, which increases the risk of gout.

Obesity If you are overweight, your body produces more uric acid, and your kidneys have a harder time eliminating it.

Health conditions Certain medical conditions can increase your risk of gout, including untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney disease.

Certain medications , such as thiazide diuretics commonly used to treat high blood pressure and low-dose aspirin, can increase uric acid levels.

Family history of gout

Recent surgery or trauma

Complications of gout

If not treated and controlled in time, occasional gout can develop into frequent gout, eroding and damaging joints, affecting daily life. Urate crystal deposits may also form under the skin, called tophi, which are common in the hands, feet, elbows or Achilles tendons. In addition, it may lead to kidney stones.

Can gout be treated with diet?

For a long time, gout was mistakenly believed to be a disease of the rich, and only those who had wine, meat and seafood could afford it. Before the cause of gout was understood, doctors did observe that controlling diet could help control gout. Therefore, for many years, gout control focused on avoiding purine-rich foods, and a long list of foods to avoid was listed, which was difficult for people to strictly follow. Recent studies have found that most gout is caused by poor uric acid excretion, which also more clearly reveals the role of diet in gout disease management.

Gout patients do need to avoid some foods, but not all foods containing purines are off-limits. Other foods that help control uric acid levels should be included in the diet of gout patients. Therefore, the current gout diet recommends avoiding and limiting some foods, adding other foods, and controlling weight through a healthy diet to reduce the risk of gout.

At the same time, such a diet can also prevent many other diseases. For most people, controlling the diet may help lower the level of uric acid in the blood, but it does not play a major role in controlling uric acid levels. Controlling pain and lowering uric acid levels often requires medication. Although controlling the diet cannot cure gout, it may reduce the risk of gout attacks and slow the progression of joint damage.

The dietary principles for gout are basically the same as those for a balanced, healthy diet:

• Lose weight Being overweight increases your risk of gout, but losing weight can reduce your risk. Studies have shown that reducing calorie intake and losing weight - even without restricting purine-rich foods - can lower uric acid levels and reduce gout attacks, meaning you can enjoy more delicious foods if you lose weight. Losing weight also reduces overall stress on your joints.

• Complex Carbohydrates Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid white bread, cakes, candy, sugary drinks and foods containing high fructose corn syrup.

• Drink more water. Drinking water helps to excrete uric acid and reduce the frequency of gout attacks. It is recommended to drink 8 to 16 glasses of liquid per day, at least half of which should be water. One glass is 8 ounces, about 237 milliliters. Sugary drinks should of course be avoided.

• Fat Eat less or no red meat, fatty meat and high-fat dairy products.

• Protein Limit your protein intake to 4 to 6 ounces (113 to 170 grams) per day from lean meat, fish, and poultry. Providing needed protein with low-fat or fat-free dairy products, such as low-fat yogurt or skim milk, can help lower uric acid levels.