Gout is a recurrent inflammatory disease caused by the increase of purine biosynthesis metabolism, excessive uric acid production or poor uric acid excretion, and urate crystals are deposited in synovium, synovium, cartilage and other tissues of joints. The first attack often involves a single joint, and the first metatarsophalangeal joint is often involved. It is characterized by swelling, burning, tenderness and limited function of the joints. The typical symptoms are as follows: the pain attack reaches its peak within 24 hours; /kloc-relieved within 0/4 days; Acute arthritis generally has no obvious sequelae after remission. This disease is characterized by the presence of birefringent sodium urate monohydrate crystals in joint fluid and tophi. Its clinical features are: hyperuricemia, characteristic acute arthritis, tophi and interstitial nephritis caused by urate crystallization and deposition, joint deformity and dysfunction in severe cases, often accompanied by uric acid urinary calculi. It is more common in obese middle-aged and elderly men and postmenopausal women. With the development of economy and the change of lifestyle, its prevalence rate has gradually increased.
Basic knowledge of gout
Whether it belongs to medical insurance: medical insurance diseases
Alias:? Osteoarthropathy, urate storage disease, foot gout, calendar wind
Onset site:? whole body
Infectious: non-infectious
Multiple population: men over 30 years old
Related symptoms:? 1 pain and swelling of metatarsophalangeal joint? Joint pain? Joint swelling? Joint deformity? Increased urate deposition in joints? [detailed]
Concurrent diseases:? Renal failure? Rheumatoid arthritis? Hypertension? Diabetes? Hyperuricemia? [detailed]
Gout diagnosis and treatment knowledge
Medical department:? Rheumatology department? department of traditional Chinese medicine
Treatment cost:? About (1000-2000 yuan) in the city's top three hospitals.
Cure rate: 60%
Treatment period: 30 days
Treatment:? Drug therapy [details]
Related inspection:? Blood molybdenum? Blood uric acid? Uric acid? Serum uric acid? Bone and joint MRI? [detailed]
Commonly used drugs:? Probenecid tablets, phenylbromarone capsules and allopurinol tablets? [detailed]
Gout must be seen when going to the hospital
Best time to see a doctor:? Nothing special, see a doctor as soon as possible [with details]
Length of visit:? Reserve 2 days for initial visit and 2 days for follow-up visit [with details]
Frequency of follow-up visit/diagnosis and treatment cycle:? Outpatient treatment: it is not suitable to follow up every 2 weeks until the follow-up week is gradually lengthened and the joints are expected to improve. Severe cases need hospitalization.
Preparation before seeing a doctor: It is suggested to fast at 8: 00 p.m. the day before seeing a doctor, and to see a doctor on an empty stomach from 8: 00 to 9: 00 on the day of seeing a doctor.
The guide to gout treatment answers the questions that often appear when gout patients go to the hospital for treatment, such as: What department is the number of gout? Precautions before gout examination? What do doctors usually ask? What tests should gout do? What do you think of gout test results? Wait a minute. The guide to gout treatment aims to facilitate gout patients to seek medical treatment and solve the doubts of gout patients when they seek medical treatment.
characteristic symptoms
Severe joint pain, swelling, erythema, stiffness and fever.
Suggested consultation department
Rheumatology and Chinese medicine
Best time to see a doctor
Nothing special. See a doctor as soon as possible.
Length of visit
The first visit is reserved for 2 days, and the second visit is reserved for 2 days at a time.
Follow-up frequency/diagnosis and treatment cycle
Outpatient treatment: it is not suitable to follow up every 2 weeks until the follow-up week is gradually lengthened and the joints are expected to improve. Severe cases need hospitalization.
Preparation before seeing a doctor
It is suggested to fast at 8: 00 p.m. the day before seeing a doctor, and to see a doctor on an empty stomach from 8: 00 to 9: 00 on the day of seeing a doctor.
Frequently asked questions
1, describe the reason for seeing a doctor (since when, what's wrong with you? )
2. Are there any joint symptoms such as severe pain, swelling, erythema, stiffness and fever?
3. Have you been to the hospital, have you done those tests, and what are the results?
Key inspection items
1, blood and urine routine and erythrocyte sedimentation rate
Blood routine and erythrocyte sedimentation rate examination? During acute attack, the white blood cell count in peripheral blood is increased, usually (10 ~ 20 )×109/L, and rarely exceeds 20×109/L.. Neutrophils increased correspondingly. Those with decreased renal function may have mild or moderate anemia. The erythrocyte sedimentation rate increases rapidly, usually less than 60 mm/h. Routine urine examination generally does not change in the early course of the disease, and those who involve the kidney may have proteinuria, hematuria, pyuria, and occasionally tubular urine; In patients with kidney calculi, obvious hematuria can be seen, and acidic urolithiasis can also be seen.
2. Determination of serum uric acid
The content of serum uric acid increased in most patients during acute attack. It is generally believed that the uricase method is 4 16μmol/L(7mg/dl) for male and >: 357μmol/L(6mg/dl), which has diagnostic value. If uric acid excretion drugs or adrenocortical hormones have been used, the serum uric acid content may not be high. The remission period can be normal. There are 2% ~ 3% patients with typical gout attack and the serum uric acid content is less than the above level. There are three explanations: ① the gradient difference between central body temperature and peripheral joint temperature is large; ② The body is under stress, secreting more adrenocortical hormones, which promotes the excretion of serum uric acid, while the content of sodium urate in the distal joint is still relatively high; ③ The effect of uric acid excretion drugs or corticosteroids.
3, urine acid content determination
Under the condition of no purine diet and no drugs affecting uric acid excretion, the total urine acid in 24 hours of normal male adults does not exceed 3.54mmol/(600mg/24h). 90% of patients with primary gout have urinary acid excretion less than 3.54mmol/24h. Therefore, urine uric acid excretion is normal, and gout cannot be ruled out, while urine uric acid is more than 750mg/24h, suggesting that uric acid is produced too much, especially in non-renal secondary gout, blood uric acid is increased, and urine uric acid is also significantly increased.
4, joint cavity puncture examination
At the onset of acute gouty arthritis, there may be effusion in the swollen joint cavity, so it is of great diagnostic significance to extract synovial fluid with an injection needle. The white blood cell count of synovial fluid is generally (1~ 7 )×109/l, mainly lobulated granulocytes. Whether receiving treatment or not, the vast majority of patients in intermittent period still have sodium urate crystals after joint synovial fluid examination.
5, gout nodule content inspection
For gout nodules, the positive rate of specific urate is extremely high by biopsy or puncture to absorb its contents, or by taking chalk sticky material smear from skin ulcer.
6. X-ray examination
Acute arthritis in stage I only showed swelling of soft tissues and normal joint development. With the progress of the disease, irregular or lobulated defects may appear in the bone adjacent to tophi, and the edge is warped; The articular cartilage margin is destroyed and the articular surface is irregular.
7. CT and MRI examination
The tophi deposited in the joint appears as speckled images with different gray levels in CT scan according to the different degree of ashing. In T 1 and T2 images of MRI, tophi showed low to medium density of massive shadows. Intravenous gadolinium injection can enhance the density of tophi shadows. The combination of the two examinations can make an accurate diagnosis of most intra-articular tophi.
diagnostic criteria
1. Specific urate crystals were found in synovial fluid; 2. The tophi was confirmed to contain sodium urate crystals by chemical methods or polarized light microscopy; 3. Having 6 of the following clinical, laboratory and X-ray signs 12. (1) 1 more acute arthritis attacks; (2) Inflammation peaked in 1d; (3) Monoarthritis attack; (4) The skin of diseased joints is dark red; (5) Pain or swelling of the first metatarsal joint; (6) Unilateral attack involving the first metatarsophalangeal joint; (7) unilateral attack involving tarsal joint; (8) There are suspicious tophi; (9) hyperuricemia; (10)X-ray showed asymmetric swelling of joints; (1 1)X-ray film showed that the subcortical cyst was not accompanied by qualitative erosion; (12) The microbial culture of joint fluid was negative during the onset of joint inflammation. The criteria for clinical diagnosis of acute gout: Recurrent acute arthritis accompanied by increased serum uric acid, colchicine test treatment is effective, that is, within a few hours of acute arthritis, colchicine is 0.5 ~1mg every ~ 2 hours. If it is acute gout, generally, after taking medicine for 2 ~ 3 times, the joint will be painless immediately, and it will be difficult to walk.