How painful is gout? There are two ways to relieve gout

How painful is gout? Treat the symptoms in an emergency and treat the root cause in a slow manner. Gout also needs to be treated in stages.

April 20th of every year is World Gout Day.

Gout refers to acute gouty arthritis, which is an aseptic inflammation of the joints caused by the deposition of uric acid in the joints. It is more common in middle-aged and young men.

The prevalence of hyperuricemia and gout in my country is 13.3% and 1.1% respectively, and shows a clear upward trend. It has become the second largest metabolic disease after diabetes.

1. How painful is gout?

Typical process:

I was fine when I went to bed, but my feet started hurting in the second half of the night and it became increasingly severe. My joints became red, swollen, hot, and painful and the pain was unbearable.

In severe cases, fever and elevated white blood cell count may occur, which can be easily misdiagnosed as bacterial infection.

2. What are the hazards of gout

Hyperuricemia can cause gout. Persistent hyperuricemia usually coexists with other metabolic syndromes, including obesity, hyperlipidemia, hypertension, diabetes, atherosclerosis, coronary heart disease, etc., and they affect each other, forming a vicious circle and increasing the risk of death in patients.

It can cause continuous damage to the joints, leading to joint destruction, deformity, and even disability.

It often causes kidney disease and impairs kidney function. As the condition worsens and is ignored, it will gradually develop into chronic renal failure and uremia, which is life-threatening.

20% of gout patients have chronic, slowly progressive kidney disease, which is directly related to the duration of the disease and the effectiveness of treatment.

Clinical manifestations include low back pain, edema, hypertension, proteinuria, hematuria, and uremia may occur in the late stage.

3. What are the common causes of gout?

Hyperuricemia is a metabolic disease caused by purine metabolism disorder or uric acid excretion disorder in the body.

Gout is caused by high uric acid. Gout occurs when uric acid crystals in the blood are deposited in the synovial membrane of the joints and cause synovial inflammation.

It does not mean that high uric acid will definitely lead to gout. For some acute attacks of gouty arthritis, the uric acid level may not be significantly elevated during an attack. It may be caused by some triggering factors, such as drinking, strenuous exercise, and cold.

4. What inspections are needed

1. Routine tests include blood and urine routine, liver and kidney function, blood sugar, blood lipids, erythrocyte sedimentation rate, C-reactive protein and urinary system ultrasound examination.

During the acute attack of gout, most patients have increased erythrocyte sedimentation rate and C-reactive protein.

In chronic urate nephropathy, urine routine may show low specific gravity urine, small molecule proteinuria, leukocyturia, mild hematuria and tubular urine.

2. Serum uric acid determination: Under a normal purine diet, two fasting tests on different days show a serum uric acid level > 420 μmol/L (7 mg/dl), which is considered hyperuricemia.

3. Select imaging examination based on symptoms.

5. The selection of uric acid-lowering drugs should be individualized

Currently, the commonly used uric acid-lowering drugs in China include two types: those that inhibit uric acid synthesis (allopurinol and febuxostat) and those that promote uric acid excretion (benzbromarone).

Allopurinol: Patients with renal impairment should use allopurinol with caution, increase the dose slowly, and monitor skin changes and renal function closely.

HLA-B*5801 gene testing: It is closely related to severe adverse reactions to allopurinol use, such as Steven-Johnson or toxic epidermal necrolysis and other severe drug rashes.

Since HLA-B*5801 gene positivity is a risk factor for adverse reactions to allopurinol, it is recommended that HLA-B*5801 gene testing be performed before treatment if conditions permit.

The HLA-B*5801 gene positive rate in the mainland population is 11.51%, with the highest rate in South China, reaching 20.19%. Genetic testing should be performed before using allopurinol in areas with conditions to reduce the occurrence of serious adverse drug reactions.

6. Ways to relieve gout

There are two main ways to relieve gout: diet control and drug treatment.

1. Once diagnosed, standardized treatment should be initiated as soon as possible, follow the doctor's orders, take medication on time and in the prescribed dosage, follow up regularly, do not reduce or stop medication at will, actively cooperate with the doctor to develop a treatment plan, and control uric acid levels at an ideal level for a long time.

The course of gout can be roughly divided into "acute attack phase" and "clinical remission phase". In an acute case, treat the symptoms; in a slow case, treat the root cause. Gout also needs "staged treatment".

2. You can follow the following principles in your daily diet:

It emphasizes that the daily dietary purine content should be controlled below 200 mg, avoid consuming high-purine animal foods (such as animal offal, shellfish, thick broth and gravy, etc.), and limit or reduce red meat intake.

Purine content - animal offal > fish, meat > dried beans, nuts > leafy vegetables > cereals > starchy fruits and vegetables.

How to choose vegetable and fruit foods?

1. Fresh vegetables are preferred.

It is recommended to eat low-glycemic index cereals and whole grains.

It is not advisable to eat too much high-purine foods such as seaweed, kelp, and mushrooms.
2. It is not recommended to consume fruits with high sugar content, especially fructose, such as longan, lychee, etc.

Please note:

Vegetables rich in purine (such as lettuce, spinach, mushrooms, cauliflower, etc.), beans and bean products have little to do with high uric acid and gout attacks, so there is no need to strictly control them.

But it is not advisable to eat dried beans because the seed coat of the beans is rich in purine.

3. Most animal foods are rich in purine. It is recommended to eat less red meat, such as meat from pork, beef, sheep and other mammals.

Choose white meat with relatively low purine content, such as chicken, duck and other poultry meat.

Avoid eating animal offal and crustaceans such as scallops, oysters and lobster.
When cooking, it is recommended to boil it in water and discard the soup, especially thick broth.

It is also not advisable to use too much salt, sugar and spices.

4. Maintain a healthy weight and waist circumference, and increase physical activity to a moderate level.

Physical exercise should be stopped during a gout attack. Even if it is a mild attack of arthritis, it is advisable to temporarily stop exercising until you recover before considering resuming exercise.

5. Drink water scientifically

Try to drink more than 2000 ml of water every day to increase urine volume and promote uric acid excretion.
Avoid alcohol and alcoholic beverages, especially during acute attacks, and avoid sugary drinks, especially those high in fructose.