The physical examination showed high uric acid, but there were no symptoms. Should I take medicine?

Mr. Li was born in the year of the tiger, and this year is his zodiac year. He recently had his first grandson. During the Spring Festival, the family reunited and Mr. Li was so happy that he had a few drinks every day. After the holiday, he went for a physical examination and the results showed that his uric acid level was high. After a review, the doctor diagnosed him with hyperuricemia.

Mr. Li was very puzzled. He clearly had no symptoms. If he had no symptoms, should he just ignore it?

Let the pharmacist answer this question.

The harm of hyperuricemia should not be underestimated

Under normal circumstances, the uric acid in our body is in a state of dynamic equilibrium. The human body stores some uric acid, just like a reservoir, with a total of about 1200 mg of uric acid in the pool. Every day, the human body synthesizes 500 mg of uric acid, and the purine ingested from food also forms 100 mg of uric acid, so about 600 mg of uric acid enters the "uric acid pool" every day. In addition, 100 mg and 500 mg of uric acid are excreted through feces and urine respectively, so the uric acid discharged from the pool every day is also about 600 mg.

If this balance is broken, for example, too much water enters the uric acid pool, or too little water is discharged from the outlet, or both too much water enters and too little water is discharged, then hyperuricemia may occur.

The saturation concentration of uric acid in the human body at 37°C is about 420 μmol/L. Exceeding this concentration, urate will form crystals and deposit in the joint cavity and other tissues, causing gout symptoms and other diseases.

According to the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)" (hereinafter referred to as the "Guidelines"), a fasting blood uric acid level exceeding 420 μmol/L twice on different days is called hyperuricemia (regardless of gender).

When urate crystals accumulate in large quantities, pain, swelling and inflammation will occur in the joints. Patients often experience sudden, severe pain at night, which usually lasts for several days or weeks. This is a gout attack. Long-term high uric acid levels may also cause kidney stones, chronic kidney disease, and increase the risk of hypertension, cardiovascular and cerebrovascular diseases, and diabetes, which can reduce daily living ability and even endanger life.

The "Guidelines" point out that the overall prevalence of hyperuricemia in my country is 13.3%, and gout is 1.1%, which has become another common metabolic disease after diabetes.

Diet and exercise intervention

It is recommended that all patients with hyperuricemia maintain a healthy lifestyle, including weight control and regular exercise (aerobic exercise, such as brisk walking, jogging, swimming, etc.); the intake of dairy products and fresh vegetables and moderate drinking of water are encouraged, while the intake of alcohol and high-purine, high-fructose foods is limited. The intake of soy products (such as tofu) is neither recommended nor restricted.

The timing and control goals of medication treatment

The timing and control targets for starting uric acid-lowering drug treatment recommended by the Guidelines are:

aComorbidities include: hypertension, dyslipidemia, diabetes, obesity, stroke, coronary heart disease, heart failure, uric acid nephrolithiasis, and renal impairment (≥CKD stage 2).

bComorbidities include: gout attacks ≥ 2 times/year, tophi, chronic gouty arthritis, kidney stones, chronic kidney disease, hypertension, diabetes, dyslipidemia, stroke, ischemic heart disease, heart failure, age of onset