Question 1: What is gout?
Gout is a disease caused by high serum uric acid level, which leads to the deposition of uric acid crystals in joints. The deposited crystals lead to painful inflammatory attacks in and around the joints.
Gout stone is a characteristic clinical manifestation of gout, which is common in auricle, metatarsophalangeal, fingertip, metacarpophalangeal joint, elbow joint, achilles tendon and patellar bursa.
The disease is directly related to hyperuricemia caused by purine metabolism disorder and/or decreased uric acid excretion. Its main clinical features are hyperuricemia, recurrent acute arthritis and tophi. In severe cases, it can be combined with kidney disease, joint destruction and renal function damage, and is often accompanied by hyperlipidemia, hypertension, diabetes, arteriosclerosis and coronary heart disease.
Question 2: What are the types of gout?
According to different etiology, gout can be divided into three categories: primary, secondary and idiopathic, and its clinical manifestations are similar.
Primary gout
Most of them are caused by genetic factors and environmental factors, and most of them are caused by uric acid excretion disorder, which has a certain family susceptibility.
Secondary gout
Mainly kidney diseases, drugs, tumor chemotherapy or radiotherapy.
And so on.
Idiopathic gout
The cause of this gout is unknown.
Question 3: What are the causes of gout?
The etiology and specific pathogenesis of gout are still unclear. What is certain is that gout is closely related to hyperuricemia. At the same time, we need to correct a misunderstanding: hyperuricemia does not necessarily cause gout, and only 5%~ 15% patients with hyperuricemia will have gout in clinic.
Most patients are caused by uric acid excretion disorder, about 10% patients are caused by excessive uric acid production, and metabolic disorder is caused by purine metabolism-related enzyme deficiency. These causes are called primary gout.
Some hereditary diseases, such as Lesch-Nyhan syndrome and type I glycogen storage disease, can lead to abnormal uric acid metabolism; Excessive uric acid production after chemotherapy or radiotherapy in hematological diseases and malignant tumors; Chronic nephropathy, due to renal tubular secretion of uric acid decreased, uric acid increased; Drugs such as furosemide, pyrazinamide and aspirin inhibit uric acid excretion and lead to hyperuricemia. These diseases are called secondary gout.
Question 4: What are the inducing factors of gout?
Drug-induced factors
Some drugs that can affect the uric acid excretion ability of the kidney, thus leading to the increase of blood uric acid level: such as thiazide diuretics, cyclosporine, pyrazinamide, ethambutol, nicotinic acid, warfarin, low-dose aspirin, etc.
Purine-rich food intake
The content of purine in meat, animal viscera and some seafood (such as shellfish) is too high, which can be decomposed into uric acid by the body, and a large amount of intake leads to an increase in blood uric acid level.
Drink wine/alcohol
Excessive drinking is an independent risk factor for gout attack. Beer contains a lot of purine components, and the risk of gout is the highest.
Other diseases
Suffering from kidney disease, cardiovascular disease, metabolic syndrome, psoriasis, obesity, diabetes, hypothyroidism, insulin resistance and so on. These diseases are related to hyperuricemia, and other risk factors are more likely to lead to gout attacks.
Question 5: What are the symptoms of gout?
Gout patients often have sudden and severe pain in one or more joints, which is more frequent than sudden onset at night. They also have redness, swelling, skin temperature rising, and the skin on the joint surface is red, purple, tight and shiny.
The first few attacks usually involve only one joint, last for several days, usually relieve themselves within 2 weeks, and then the symptoms disappear completely. However, if the disease gets worse and is not treated actively after the attack, it will lead to more frequent attacks and spread to multiple joints, which can last for 3 weeks or longer.
Repeated attacks can lead to gout aggravation, chronic development and pathological joint deformity. Finally, due to the continuous deposition of urate crystals around joints and tendons, joint activity is gradually limited.
Question 6: What are the typical symptoms of gout?
According to the natural course of gout in three stages, the symptoms are introduced respectively.
Asymptomatic period
There is only fluctuating or persistent hyperuricemia, and gout (arthritis, gout stone, uric acid kidney calculi) has not appeared. The time from the rise of serum uric acid to the appearance of symptoms can reach several years, and some can be asymptomatic for life.
Acute arthritis and intermittent period
? It often occurs suddenly at midnight or early morning, and the joint pain is severe, reaching a peak within a few hours, and the affected joints appear red, swollen, hot, painful and dysfunctional;
? The first attack involves a single joint, and 1 metatarsophalangeal joint is the most common.
? The seizure was self-limited and relieved spontaneously within more than 2 weeks. After the redness subsided, the skin at the affected joints fell off.
? It may be accompanied by hyperuricemia, but the blood uric acid level is normal in some acute attacks;
? Uric acid salt crystals were found in joint fluid or tophi;
? May be accompanied by fever.
Tophus and chronic arthritis stage
? Gout calculus is a characteristic clinical manifestation of gout, usually located in auricle, but also around joints, olecranon, achilles tendon and patellar bursa.
? The appearance of tophi is uneven yellow-white vegetation with thin surface, and white powder or paste is discharged after crushing.
? Chronic arthritis is more common in patients without standardized treatment, and the affected joint is asymmetric, irregular swelling and pain. A large number of tophi are deposited in joints, which can cause joint bone destruction, lead to joint deformity, especially hands and feet, and can cause disability.
Renal pathological symptoms
? Patients with gout with a long course of disease may have kidney damage, and their symptoms are very typical, so they need to be vigilant.
? Gouty nephropathy: the onset is hidden, and the clinical manifestations are increased nocturia, low specific gravity urine, low molecular weight proteinuria, leukocytosis, mild hematuria and cast. Renal insufficiency, hypertension, edema and anemia may occur in the late stage.
? Uric acid kidney calculi: From no obvious symptoms to renal colic, hematuria, dysuria, hydronephrosis, pyelonephritis or perinephrosis.
? Acute renal failure: a large number of urate crystals block renal tubules, renal pelvis and even ureters, and patients will suddenly appear oliguria or even anuria, which can develop into acute renal failure.
Question 7: What are the symptoms associated with gout?
In addition to the common joint-related symptoms, patients sometimes have other symptoms, including fever (body temperature can reach above 38.5℃), increased heart rate (tachycardia), general malaise, chills (rare) and so on.
Question 8: What is the treatment principle of gout?
Control and relieve acute joint inflammation as soon as possible;
By reducing the content of uric acid in blood, further deposition of uric acid in tissues can be prevented;
Prevent the formation of uric acid stones and reduce the serious joint injury and renal function damage caused by them.
Question 9: What medicine can gout be treated with?
Acute treatment
It is suggested that anti-inflammatory and analgesic treatment should be carried out as soon as possible (usually within 24 hours) when gout is acute. Non-steroidal anti-inflammatory drugs, colchicine and glucocorticoid can effectively relieve inflammation and pain, and improve the quality of life of patients. No acid-lowering treatment is given during acute attack, but those who have taken acid-lowering drugs do not need to stop taking them, so as not to cause blood uric acid fluctuation and lead to prolonged attack time or recurrence.
1. NSAIDs are usually effective in relieving joint pain and swelling. Commonly used drugs are indomethacin, diclofenac and etoricoxib. After the pain and inflammation are relieved, we should continue to use non-steroidal anti-inflammatory drugs to prevent the symptoms from recurring.
Colchicine is a traditional therapeutic drug. During the acute attack of gout, if non-steroidal anti-inflammatory drugs are contraindicated, it is recommended to use small doses of colchicine alone. Low dose of colchicine (1.5mg/d~ 1.8 mg/d) is effective, with few adverse reactions, and the effect is good within 48 hours.
3. Glucocorticoids are mainly used for non-steroidal anti-inflammatory drugs, colchicine treatment is ineffective or contraindicated, and renal insufficiency. Glucocorticoid (30mg/d, 3 days) alone for a short time in acute attack of gout has similar efficacy and safety as non-steroidal anti-inflammatory drugs.
In addition, other analgesics, rest, splint fixation and ice compress can be used to relieve pain.
Intermittent and chronic treatment
Patients with acute gouty arthritis (twice a year) and chronic gouty arthritis or tophus should be treated with uric acid reduction, and the serum uric acid level of patients should be controlled below 358μmol/L(6 mg/dl), which is helpful to relieve symptoms and control the disease.
Patients with gout should refer to the pathogenesis of hyperuricemia and adopt personalized medication scheme when they are treated for reducing uric acid. For example, it is suggested to use allopurinol or budesonide to inhibit uric acid production; Benzbromarone and probenecid are recommended to promote uric acid excretion.
Allopurinol: from 50 mg/day to 100 mg/day, the maximum dose is 600 mg/day, and the adverse reactions include gastrointestinal symptoms, rash, drug fever, elevated liver enzymes and bone marrow suppression.
Febusotan: It can be used for patients with mild to moderate renal insufficiency, starting from 20 mg/d to 40 mg/d, with a maximum dose of 80 mg/d. The main adverse reactions are abnormal liver function and diarrhea.
Benzbromarone: The initial dose is 25mg/day, and the maximum dose is100mg/day ... Adverse reactions include gastrointestinal symptoms, rash, renal colic, granulocytopenia and rare and severe hepatotoxicity.
Probenecid: the initial dose is 0.5g/d, and the maximum dose is 2g/d. It is forbidden for people who are allergic to sulfanilamide.
At the same time, it is suggested that low-dose colchicine (0.5 mg/d ~1mg/d) should be used for 3 ~ 6 months in the initial stage of acid-lowering treatment to prevent the recurrence of acute gouty arthritis.
If the patient has other basic diseases, it is necessary to adjust the drug choice. If the patient has chronic kidney disease, it is necessary to evaluate the renal function first, and then use uric acid-lowering drugs that have little effect on the renal function according to the specific situation of the patient, and closely monitor the adverse reactions during the treatment.
Treatment of accompanying diseases: Gout is often accompanied by one or more metabolic syndromes, such as hypertension, hyperlipidemia, obesity, type 2 diabetes, etc. , should be actively treated. Losartan or amlodipine is recommended for antihypertensive drugs, fenofibrate or atorvastatin is recommended for lipid-lowering drugs.
Gout often affects the daily work and life of patients. In addition to taking medicine on time in strict accordance with the doctor's advice, self-management of patients also plays an important role in controlling diet and lifestyle.
Question 10: What should gout patients pay attention to in their daily life?
prescribe a diet
Keep drinking water, and avoid drinking alcohol, sugary drinks, animal offal, seafood and other high-purine foods.
Dietary advice:
? Drink more water, more than 2000 ml per day.
? Increase the intake of fresh vegetables.
? Dietary taboo
? Limit drinking, especially beer.
? Reduce the intake of high purine food. Common foods with high purine content are: animal viscera, pork, beef, mutton, shellfish, anchovies, sardines, tuna and so on.
? Reduce the intake of fructose-rich beverages.
way of life
? Keep your weight.
? Eat regularly and combine work and rest.
? Exercise regularly.
? No smoking.
? Stop taking drugs that can cause uric acid to rise.
Question 1 1: What should we pay attention to in the daily diet of gout?
Dietary advice for gout
Gout patients are advised to drink more water in daily life, more than 2000ml per day. Usually you can increase the intake of fresh vegetables and fruits, such as cucumbers, tomatoes, apples, oranges and so on. It is suggested to choose foods with low purine content, such as potatoes, rice and cassava. Goat milk can be used as a dairy product because of its low content of purine and protein. When cooking, try to choose edible oil rich in unsaturated fatty acids, such as olive oil, which is helpful to alleviate the inflammation of gout patients.
Dietary taboo of gout
Gout patients should pay attention to limit alcohol intake, especially beer. At the same time, we should pay attention to reducing the intake of high-purity foods such as animal viscera, pork, beef, mutton, shellfish, anchovies, sardines and tuna.
Usually pay attention to avoid overeating bacon and avoid a high-salt and high-fat diet. The intake of salt should not exceed 6g, and the intake of fat should not exceed 30g. It is recommended to choose a healthier oil. Such as vegetable oil instead of solid fatty oil.
Finally, for the drug treatment of gout, it is recommended that patients go to regular hospitals for medication guidance and dose adjustment, and do not use drugs, reduce drugs or stop drugs privately. I also hope that gout patients will get up early and recover soon!
(Refer to the ninth edition of Internal Medicine and Literature, and comment if necessary.)