Pharmacist's Antidote | If there are no symptoms of high uric acid, there is no need to take medicine? You may be wrong to think so!

Uncle Li retired gloriously and started an enviable life: he often met with old classmates, traveled, and drank and talked happily at every meal! Soon, the unit arranged a physical examination for retired employees. After Uncle Li got the physical examination report, he looked at the up and down arrows and muttered in his heart: "The uric acid value is 526 micromoles/liter (μmol/L) (normal range: 210~430μmol/L). It's gout, but I don't have any symptoms! I don't hurt anywhere. Is it a mistake? Even if I really have gout, I don't want to take medicine." In response to Uncle Li's confusion, let's listen to Yaowa's analysis and answers.

Do hyperuricemia and gout require medication?

Whether male or female, if the blood uric acid level exceeds 420μmol/L twice on different days, it is called hyperuricemia.

Some patients only have hyperuricemia but no symptoms such as arthritis, which is asymptomatic hyperuricemia. Uncle Li's case belongs to this category.

Some patients also have hyperuricemia due to purine metabolism disorders or decreased uric acid excretion, which leads to urate crystal deposition and causes joint disease, namely gout.

Some people may think that patients with hyperuricemia like Uncle Li who have no symptoms do not need medication. In fact, hyperuricemia and gout can both cause damage to multiple target organs and have a clear causal relationship with kidney stones and chronic kidney disease. At the same time, elevated blood uric acid is also an independent risk factor for cardiovascular and cerebrovascular diseases, diabetes and other diseases. Hyperuricemia and gout are a continuous and chronic pathophysiological process that requires standardized drug treatment and long-term or even lifelong monitoring and management.

(Note: It is recommended to start uric acid-lowering drug treatment 2 to 4 weeks after the acute attack of gout is completely relieved. Patients with acute attacks who are taking uric acid-lowering drugs do not need to stop taking them.)

Source: "Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019)"

How to use medication for hyperuricemia and gout?

Febuxostat, benzbromarone, and allopurinol are the first-line therapeutic drugs for lowering uric acid in gout patients.

Benzbromarone and allopurinol are the first-line therapeutic drugs for lowering uric acid in patients with asymptomatic hyperuricemia.

Source: Product Manual

In addition, sodium bicarbonate and citric acid preparations can alkalize urine, which is the main method to prevent and dissolve uric acid kidney stones; small doses of colchicine can be used for anti-inflammatory and analgesic treatment of acute gout attacks; non-steroidal anti-inflammatory drugs can also be used to treat acute gout; glucocorticoids can also relieve joint pain in acute gout attacks. However, the above drugs should be used reasonably under the guidance of a doctor, and never take them at will.

How to control diet for hyperuricemia and gout?

●General principles: Limit high-purine animal foods, control energy, maintain a balanced diet, control weight, cooperate with standardized uric acid-lowering drug treatment, and conduct regular monitoring and follow-up.

●Avoid eating: Animal offal such as liver and kidneys, shellfish, lobster and other shelled seafood, and all thick broths and gravies.

●Prohibited from consumption: Patients with acute gout attacks, poorly controlled disease with medication, or chronic gouty arthritis are prohibited from drinking alcohol or alcoholic beverages.

●Restricted consumption: Animal meat with high purine content, such as beef, lamb, pork, etc.; foods containing more fructose and sucrose.

● Recommended food:

GI: Glycemic Index (a quantitative measure of how fast blood sugar levels rise after eating a food compared to a baseline value)

Hyperuricemia and gout require long-term, scientific, and standardized management, as well as drug treatment.