In life and work, there are many patients whose quality of life is affected by gout. Gout not only requires drug treatment, but daily diet is also particularly important. This article will briefly introduce the relevant aspects of gout to readers. Knowledge and dietary precautions, I hope to help readers better control the pain caused by gout!
Question 1: What is gout?
Gout (gout) is a disease caused by high blood uric acid levels, which lead to the deposition of uric acid crystals in the joints. The deposited crystals cause painful inflammation in and around the joints.
Tophi is a characteristic clinical manifestation of gout. It is commonly found in the auricles, metatarsal toes, fingertips, metacarpophalanges, elbows and other joints, Achilles tendon, patellar bursa, etc.
This disease is directly related to hyperuricemia caused by purine metabolism disorder and/or reduced uric acid excretion. The main clinical features are elevated blood uric acid, recurrent acute arthritis, and tophi. It can be complicated by kidney disease, and in severe cases, joint destruction and renal function damage can occur. It is often accompanied by hyperlipidemia, hypertension, diabetes, arteriosclerosis, and coronary heart disease.
Question 2: What types of gout are there?
According to different causes, gout can be divided into three categories: primary, secondary, and idiopathic gout, and their clinical manifestations are similar.
Primary gout
accounts for the vast majority and is caused by a combination of genetic factors and environmental factors. It is mostly caused by uric acid excretion disorders and has a certain familial susceptibility.
Secondary gout
is mainly caused by kidney disease, drugs, tumor chemotherapy or radiotherapy
etc.
Idiopathic gout
This type of gout has no known cause.
Question 3: What are the causes of gout?
The cause and specific pathogenesis of gout are not very clear yet. It is relatively certain that gout is closely related to hyperuricemia. At the same time, a misunderstanding needs to be corrected: hyperuricemia does not necessarily cause gout. Clinically, only 5% to 15% of patients with hyperuricemia will develop gout.
Most patients are caused by uric acid excretion disorders, about 10% of patients are caused by excessive uric acid production, and there are also metabolic disorders caused by deficiencies in enzymes related to purine metabolism. These causes are called primary gout. .
Certain genetic diseases, such as Lesch-Nyhan syndrome, type I glycogen storage disease, etc., can lead to abnormal uric acid metabolism; excessive uric acid production after chemotherapy or radiotherapy for blood diseases and malignant tumors; chronic Kidney disease increases uric acid due to reduced renal tubular secretion of uric acid; drugs such as furosemide, pyrazinamide, aspirin, etc. inhibit uric acid excretion and cause hyperuricemia. The resulting disease is called secondary gout.
Question 4: What are the triggering factors for gout?
Drug-induced factors
Some drugs that can affect the kidney’s uric acid excretion capacity, leading to increased blood uric acid levels: such as thiazide diuretics, cyclosporine, pyrazinamide, Ethambutol, niacin, warfarin, low-dose aspirin, etc.
Intake of purine-rich foods
The purine content in the diet of meat, animal offal and some seafood (such as shellfish) is too high, which can be broken down into uric acid by the body. Ingesting a large amount of it Intake leads to increased blood uric acid levels.
Drinking alcohol
Excessive alcohol intake is an independent risk factor for gout attacks. Beer contains a large amount of purine, which has the highest risk of inducing gout.
Other diseases
Suffering from kidney disease, cardiovascular disease, metabolic syndrome, psoriasis, obesity, diabetes, hypothyroidism, insulin resistance, etc. These diseases are all related to high It is related to uric acidemia and is more likely to cause gout attacks when combined with other risk factors.
Question 5: What are the symptoms of gout?
Patients with gout often experience sudden severe pain in one or more joints, often starting suddenly at night. They may also experience joint redness, swelling, increased skin temperature, and red, purple, tense, and irritated skin on the joint surface. Liang et al.
The first few attacks usually involve only one joint, last for a few days, and often resolve spontaneously within 2 weeks, and then the symptoms disappear completely. However, if the condition worsens and is not actively treated after the attack, it will lead to more frequent attacks that can affect multiple joints and can last for 3 weeks or longer.
Repeated attacks of gout can lead to aggravation and chronic development, resulting in diseased joint deformities. Finally, joint movement is gradually limited as urate crystals continue to accumulate around joints and tendons, causing damage.
Question 6: What are the typical symptoms of gout?
The symptoms of gout are introduced according to the natural course of the three stages.
Asymptomatic period
There is only fluctuating or persistent hyperuricemia, but gout has not yet occurred (manifested by arthritis, tophi and uric acid kidney stones). The time from an increase in blood uric acid to the onset of symptoms can take several years, and some may remain symptom-free for life.
Acute arthritis period and intermittent period
? It usually starts suddenly at midnight or early in the morning, with severe joint pain that reaches its peak within a few hours. The affected joints appear red, swollen, hot, and Pain and dysfunction;
?The first attack involves a single joint, and the unilateral first metatarsophalangeal joint is the most common;
?The attack is self-limiting and resolves spontaneously within more than 2 weeks , the skin of the affected joints desquamates after the redness and swelling subside;
? May be accompanied by hyperuricemia, but the blood uric acid level is normal in some acute attacks;
? In joint fluid or tophi Urate crystals are found;
? May be accompanied by fever.
Tophi and chronic arthritis stage
? Tophi is a characteristic clinical manifestation of gout. The typical location is the auricle. It is also common around joints, olecranon, Achilles tendon, Patellar bursa.
?Tophi appear as raised yellow-white excrescences of varying sizes, with a thin surface. They discharge white powder or paste after ulceration.
?Chronic arthritis is more common in patients who do not receive standardized treatment. The affected joints suffer from asymmetrical, irregular swelling and pain. A large amount of tophi deposited in the joints can cause joint bone destruction, leading to joint deformity in patients. Especially in the hands and feet, and can cause disability.
Symptoms of kidney disease
?Gout patients with a long course of disease may have kidney damage, and their symptoms are also very typical and need to be vigilant.
?Gouty nephropathy: The onset is insidious, and the clinical manifestations include increased nocturia, low specific gravity urine, low molecular weight proteinuria, leukocyteuria, mild hematuria and casts. Renal insufficiency, hypertension, edema, anemia, etc. may occur in the late stage.
?Uric acid kidney stones: can range from no obvious symptoms to symptoms such as renal colic, hematuria, dysuria, hydronephrosis, pyelonephritis or perirenal inflammation.
?Acute renal failure: A large amount of urate crystals block the renal tubules, renal pelvis and even ureters. The patient will suddenly develop oliguria or even anuria, and may develop into acute renal failure.
Question 7: What are the accompanying symptoms of gout?
In addition to common joint-related symptoms, patients sometimes experience other symptoms, including: fever (body temperature can reach above 38.5 C), rapid heart rate (tachycardia), general discomfort, and chills (rarely) )wait.
Question 8: What are the treatment principles for gout?
Early control and relief of acute joint inflammation;
Prevent further deposition of uric acid in tissues by reducing the uric acid content in the blood;
Prevent the formation of uric acid stones and reduce the risk of uric acid stones. This results in severe joint damage and kidney function impairment.
Question 9: What drugs can treat gout?
Acute phase treatment
In the acute attack phase of gout, it is recommended to carry out anti-inflammatory and analgesic treatment as early as possible (usually within 24 hours), non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and sugar. Corticosteroids can effectively provide anti-inflammatory and analgesic effects and improve patients' quality of life. Acid-lowering treatment is not performed during the acute attack period, but those who have already taken acid-lowering drugs do not need to stop taking them to avoid fluctuations in blood uric acid, which may prolong the attack or cause another attack.
1. Nonsteroidal anti-inflammatory drugs are usually effective in relieving joint pain and swelling. Commonly used drugs: indomethacin, diclofenac, etoricoxib, etc. Once the pain and inflammation have subsided, NSAIDs should be continued to prevent symptoms from recurring.
2. Colchicine is a traditional therapeutic drug. During the acute attack of gout, those who have contraindications to non-steroidal anti-inflammatory drugs are recommended to use low-dose colchicine alone. Low-dose colchicine ( 1.5 mg/d~1.8 mg/d) is effective, with few adverse reactions, and the effect is better when used within 48 hours.
3. Glucocorticoids are mainly used for patients who are ineffective or contraindicated in non-steroidal anti-inflammatory drugs, colchicine treatment, or have renal insufficiency. During an acute attack of gout, short-term glucocorticoids (30 mg/ d, 3 days), its efficacy and safety are similar to nonsteroidal anti-inflammatory drugs.
In addition, other analgesics, rest, splinting, and ice may be used to reduce pain.
Treatment between attacks and chronic phase
For patients with frequent attacks of acute gouty arthritis (2 times/year), chronic gouty arthritis or tophi, uric acid lowering should be performed Treatment, stably controlling the patient's blood uric acid level below 358 μmol/L (6 mg/dl) can help relieve symptoms and control the condition.
When gout patients undergo uric acid-lowering treatment, their medication should refer to the mechanism of hyperuricemia and adopt a personalized medication plan. For example, allopurinol or febuxostat is recommended to inhibit uric acid production; to promote uric acid production, allopurinol or febuxostat is recommended. It is recommended to use benzbromarone and probenecid during excretion.
Allopurinol: starting from 50mg/d~100mg/d, the maximum dose is 600mg/d. Adverse reactions include gastrointestinal symptoms, rash, drug fever, elevated liver enzymes, bone marrow suppression, etc.
Febuxostat: It can be used for patients with mild to moderate renal insufficiency, starting from 20mg/d~40mg/d, and the maximum dose is 80mg/d. Adverse reactions mainly include abnormal liver function and diarrhea.
Benzbromarone: initial dose 25mg/d, maximum dose 100mg/d. Adverse reactions include gastrointestinal symptoms, rash, renal colic, neutropenia, etc. Severe hepatotoxicity is rare.
Probenecid: initial dose 0.5g/d, maximum dose 2g/d. Disabled for those allergic to sulfonamides.
At the same time, in the early stage of acid-lowering treatment, it is recommended to use low-dose colchicine (0.5mg/d~1mg/d) for 3 to 6 months to prevent the recurrence of acute gouty arthritis.
If the patient has other underlying diseases, attention should be paid to adjusting the drug selection. If the patient has chronic kidney disease, the renal function needs to be evaluated first, and then uric acid-lowering drugs with little impact on renal function should be used according to the patient's specific conditions. And closely monitor adverse reactions during treatment.
Treatment of associated diseases: Gout is often accompanied by one or more of the metabolic syndromes, such as hypertension, hyperlipidemia, obesity, type 2 diabetes, etc., and should be actively treated. It is recommended to choose losartan or amlodipine as antihypertensive drugs, and fenofibrate or atorvastatin as lipid-lowering drugs.
Gout often affects patients’ daily work and life. In addition to strictly following doctor’s instructions and taking medication on time, patients’ self-management plays an important role in controlling diet and lifestyle.
Question 10: What should gout patients pay attention to in their daily lives?
Diet
Maintain water intake and avoid consuming alcohol, sugary drinks and animal-based high-purine foods such as animal offal and seafood.
Diet recommendations:
?Drink plenty of water, more than 2000 ml per day.
?Increase the intake of fresh vegetables.
?Dietary taboos
?Alcohol is restricted, especially beer.
Reduce the intake of high-purine foods. Common foods with high purine levels include: animal offal, pork, beef, mutton, shellfish, anchovies, sardines, tuna, etc.
?Reduce the intake of fructose-rich beverages.
Lifestyle
?Maintain weight.
?Regular diet and work schedule.
?Regular exercise.
?No smoking.
?Discontinue medications that can cause an increase in uric acid.
Question 11: What should you pay attention to in your daily diet if you have gout?
Diet recommendations for gout
Patients with gout are advised to drink more water in daily life, more than 2000ml per day. You can usually increase your intake of fresh vegetables and fruits, such as cucumbers, tomatoes, apples, oranges, etc. It is recommended to choose low-purine foods, such as potatoes, rice, cassava, etc. For dairy products, you can choose goat milk because it contains lower purine and protein. When cooking, try to choose edible oils rich in unsaturated fatty acids, such as olive oil, which can help reduce the occurrence of inflammation in gout patients.
Dietary taboos for gout
Patients with gout should pay attention to limiting the intake of alcohol, especially beer, in their daily lives. At the same time, pay attention to reducing the intake of high-purine foods such as animal offal, pork, beef, mutton, shellfish, anchovies, sardines, and tuna.
Pay attention to avoid overeating smoked meat and avoid high-salt and high-fat diets. Salt intake should not exceed 6g per day, and fat intake should not exceed 30g per day. It is recommended to choose healthier oil. For example, use vegetable oil instead of solid fatty oil.
At the end of the article, regarding the drug treatment of gout, it is recommended that all patients go to a regular hospital for medication guidance and dosage adjustment, and do not use, reduce or stop medication without permission.
I also hope that gout patients will recover soon and no longer be in pain!
(The article refers to the ninth edition of internal medicine and literature, please note if necessary)