**: Ouyang Yuanming, Department of Orthopedics, Shanghai Sixth Hospital Welcome to share this article, **Please keep the source!
Nowadays, with the improvement of living standards, the incidence of hyperuricemia and gout is getting higher and higher, and the age of onset is getting younger and younger.
Misunderstanding.
1. Hyperuricemia is equivalent to gout.
Hyperuricemia represents the level of uric acid metabolism in the body, and blood uric acid above 420umol L in men and 360umol L in women represents hyperuricemia. However, gout refers to crystal arthritis caused by the deposition of urate crystals in the joints, which is directly related to hyperuricemia, but gout needs to have episodic joint redness, swelling, heat and pain. About 10% of patients with hyperuricemia develop gout. Therefore, hyperuricemia cannot be completely equated with gout.
Misunderstanding.
2. Gout is a disease of old age.
With the improvement of living conditions, the prevalence of hyperuricemia and gout is increasing year by year, and the affected population is getting younger and younger. Gout patients are not all older men, but also young people and postmenopausal women. Primary gout is rare in women during the reproductive years, but secondary gout can occur at all ages and affects women equally.
Overall, the prevalence of hyperuricemia and gout increases with age, with higher prevalence in males than females, higher in urban areas than in rural areas, and higher in coastal areas than inland.
Misunderstanding.
3. Gout is joint pain.
Gout can not only cause painful arthritis, but also tophi, uric acid nephropathy, gouty urinary stones, hyperuricemia, arteriosclerosis, etc.;Gout is often accompanied by hypertension, diabetes, coronary heart disease, dyslipidemia, arteriosclerosis, etc.;Gout is involved in the occurrence and progression of diabetes, arteriosclerosis, hypertension, heart failure and other diseases.
Misunderstanding.
Fourth, gout is not a disease if it does not hurt.
Asymptomatic hyperuricemia, gout remission, intermittent period, may be asymptomatic or the symptoms are not obvious, however, hyperuricemia can still promote gout**, aggravate gouty nephropathy, uric acid stones, hypertension, coronary heart disease, arteriosclerosis, diabetes and other diseases, even if it is "painless gout", it is necessary to lower uric acid through non-drugs and drugs**.
Misunderstanding.
5. Uric acid must be high during gout attacksUric acid levels are not necessarily elevated in gout. During an acute attack of gout, uric acid is deposited in the joints and temporarily lowered as an acute phase reactant. At the same time, the excretion of uric acid by the kidneys in the acute phase increases. In addition, some patients with gout pause some of the factors that cause hyperuricemia, including diuretics,**, or alcohol abstinence, during an acute attack.
Misunderstanding.
6. Medication is only needed during the gout attack**
During the onset of joint redness, swelling, heat and pain, patients with gout take allopurinol or benzbromarone** gout, and the symptoms are aggravated. There are two misunderstandings here, on the one hand, in the acute attack of gout, it is necessary to take anti-inflammatory painkillers, colchicine or hormones and other drugs to control the onset of joint redness, swelling and heat pain, rather than directly taking uric acid-lowering drugs. On the contrary, in the acute attack stage, taking urate-lowering drugs will aggravate the fluctuations of uric acid in the body, and the joint swelling and pain will worsen or be difficult to control. On the other hand, urate-lowering drugs require long-term use to control uric acid levels to reduce the incidence of recurrent acute arthritis.
Misunderstanding.
7. Relief after a gout attack is **.
Gouty arthritis has a characteristic, that is, it can be reversed, the current medical technology can not completely ** gout, it is necessary to control the blood uric acid in the normal range for a long time, avoid risk factors, and prevent gout.
Misunderstanding.
8. The lower the blood uric acid level, the better.
The lower the blood uric acid level, the better, uric acid is an important biochemical substance in the human body, has an important physiological role, the appropriate blood uric acid concentration is conducive to antioxidant, balance immune function, increase the ability to resist infection in the body, etc., too low blood uric acid is related to many neurological diseases.
Misunderstanding.
9. Uric acid-lowering drugs should be taken immediately during gout attacks.
Urate-lowering drugs should not be used during an acute attack of gout, and if urate-lowering drugs have just started**, they also need to be temporarily stopped, and long-term urate-lowering drugs can be decided according to the condition and dosage to avoid gouty arthritis aggravation and prevent metastatic gout. Urate-lowering drugs should be started at a low dose and gradually increased until the serum uric acid level is normal and the low dose is maintained after the acute gout has resolved**.
Misunderstanding.
10. Don't eat meat and eat fruits and vegetables casually.
Dietary restrictions on alcoholic beverages, especially beer and distilled spirits (liquor), are strictly restricted, with an overall alcohol unit of 2 alcohol units per day for men and 1 alcohol unit per day for women. (1 alcohol unit is about 14g of pure alcohol, equivalent to 145ml of 12° red wine, 3.)5° beer 497ml, 40° distilled spirits 43ml), the diet should be balanced, limit the total daily calorie intake, focus on a low-purine diet, limit the intake of high-purine foods such as animal offal, seafood and meat, encourage the consumption of fresh vegetables, low-fat or skimmed milk, eggs and other foods, and moderate intake of beans and soy products. Some vegetables are higher in purines, including lettuce, spinach, mushrooms, cauliflower, etc. In addition, establish good eating Xi and avoid overeating or eating a lot of meat in one meal. Seafood, meat and high-purine plant foods are advised to discard soup after cooking to reduce purine content. Drinking plenty of water can shorten the duration of gout attacks and reduce symptoms. It is recommended that people with normal heart and kidney function drink more water and maintain a daily urine output of 2000 3000ml. Avoid drinks high in fructose (e.g. orange juice, apple juice, etc.) and sugary soft drinks (cola, etc.). It can be replaced with fresh fruits with lower fructose content, such as cherries, strawberries, pineapples, peaches, etc. At the same time, it is necessary to alkalize the urine properly and maintain the urine pH at 62~6.9. It is conducive to the dissolution and excretion of urate crystals in urine.
Misunderstanding.
Ten. 1. The more intense the exercise, the better.
Exercise can reduce the number of gout attacks, but the more intense the better, and moderate exercise should be adhered to, and activity should be reduced during acute gout attacks, and immobilization should be required if necessary. In terms of exercise intensity and time, it is recommended to do at least 150 minutes (30 min d, 5 d w) of moderate-intensity aerobic exercise per week, which refers to the range of heart rate = (220-age) (50 70%) during exercise. Note: Strenuous exercise or sudden exposure to a cold can trigger an acute attack of gout. In addition to diet control and appropriate exercise, lifestyle interventions include weight control and smoking cessation.
Misunderstanding.
Ten. Second, it is okay for uric acid to drop to normal.
Patients with isolated hyperuricemia generally require blood uric acid control within 420 mol LIf there is a gout attack, serum uric acid is generally controlled within 360 mol L;If a patient with gout also has tophi, it is required to control the serum uric acid within 300 mol L.
Ouyang YuanmingChief Physician of the Department of Orthopedics and Joint Surgery, Shanghai Sixth People's Hospital, MDBoGraduate Supervisor
Shanghai Jiao Tong UniversityGraduated from medical school and engaged in clinical workMore than 20 yearsThe main focus is on joint surgery。He has studied Xi in Seoul, South Korea, Munich, Germany, Canada and Hong Kong, mastering advanced joint replacement surgery and arthroscopic techniques. The average annual surgical volume is about 1,000
Good at:
1. Artificial knee joint, hip replacement and prosthetic infection loose revision surgery (osteoarthritis, rheumatoid, gouty arthritis, traumatic arthritis, ankylosing spondylitis, bone hyperplasia, bone spurs, joint wear, knee joint inward and valgus deformity, femoral head necrosis, congenital hip dysplasia);
2. Knee protection, hip protection, hip arthroscopic surgery;
3. Arthroscopic minimally invasive ** knee effusion, synovitis, cartilage injury, meniscus injury, meniscus tear, frozen shoulder, rotator cuff injury;
4. Total shoulder and total elbow replacement;
5. Severe elbow, knee and hip joint heterotopic ossification joint stiffness and release surgery.
Position:
He is a member of the Hand Surgery Branch of the Chinese Medical Association, a member and secretary of the Hand Surgery Society of the Shanghai Branch of the Chinese Medical Association, a member of the Shanghai Sports Medicine Joint Minimally Invasive Group, a member of the Trauma Professional Youth Committee of the Shanghai Association of Integrative Traditional and Western Medicine, a review expert of the Shanghai Science and Technology Expert Database, a member of the Asia-Pacific Association of Knee-Arthroscopy-Sports Medicine (APKASS), an editorial board member of the international journal Frontiers in Neuroscience, and an American journal "Orthopedics" Lead reviewer.