In recent years, with the change of people's dietary structure, the incidence of gout has increased year by year and is younger, becoming the second largest metabolic disease after diabetes. Hyperuricemia is the basis and most direct of gout. The prevalence of gout and hyperuricemia in China is 11% and 133%, of which about 10% of patients with hyperuricemia will develop gout.
"There are three stages in the development of gout, but patients often stop insisting on ** after remission in the acute attack period, which can easily lead to the reversal of gout and aggravation of the disease. ”Liu Xinying, the science popularization officer of the Tenth Hospital and the deputy chief physician of the Department of Rheumatology and Immunology of the Shanghai Tenth People's Hospital, reminds patients not to ignore the intermittent and remission phases of gout, and to follow the doctor's instructions and not to stop the drug at will.
The first stage: the acute arthritic phase
The typical manifestation of the acute phase of gout is obvious redness, swelling, heat and pain in the joints of the lower limbs, such as a knife cut or bite. It is more common in the first metatarsophalangeal joint of the foot, which is commonly known as the big toe joint of the foot, but can also occur in other larger joints, especially the ankle and foot joints. The clinical manifestations are mostly monoarticular inflammation, and a small number of patients may have two or more joints at the same time.
Here, there is a large difference between men and women, with alcohol consumption being the most predominant cause in men, followed by a high-purine diet and strenuous exercise. In female patients, a high-purine diet is the most predominantly triggered, followed by cold or strenuous exercise. Liu Xinying said.
Pain in the acute phase of gout is usually self-limited and usually resolves spontaneously within a few days to 2 weeks.
The second stage: the intermittent period
A gout interval is the interval between two episodes of acute gouty arthritis, ranging from weeks to decades.
If uric acid is not well controlled, gout will recur and the intermittent period will become shorter, which can gradually turn into chronic arthritis. At this stage, synovial hyperplasia is obvious, and urate crystals are present in the joints, and gradually increase. Urate crystals are deposited in the joints and are considered to be important nodes in the development of gout.
The third stage: the chronic arthritic stage
A large number of urate crystals appear in the joints, forming tophi. Tophi is the body's chronic, foreign body granulomatous inflammatory response to urate crystals. In the stage of chronic arthritis, the joint ligaments and joint capsule may be eroded and deformed, and bone destruction, joint restriction, joint deformity and even functional impairment may occur. Severely reduces the patient's quality of life.
The goals of the three phases are different.
Acute arthritis phase: pain relief
In an acute attack of gout, stay in bed, avoid activities, maintain a flat lying position, elevate the affected limb, and avoid weight-bearing on the joints. Ice can be applied to the affected area to relieve redness, swelling, heat and pain in the joint and surrounding tissues. Further** NSAIDs, colchicine, or corticosteroids should be taken under the guidance of a doctor.
During a gout attack, foods high in purines must not be eaten. Patients with normal renal function can drink plenty of fluids.
Urate-lowering should not be performed until an acute gout attack has been effectively controlled**. Because gout tends to occur when serum uric acid fluctuates sharply, the addition of urate-lowering drugs can cause gout to worsen. However, uric acid-lowering drugs that were already taken before the attack of gout can be continued.
Intermittent and chronic arthritic phases: avoid**
1) A low-purine diet is essential. Foods high in purines, such as broths, seafood, and organ meats, should be avoided. Eat as many fresh vegetables as possible for balanced nutrition.
2) Drink more water, it is recommended to drink more than 2000ml of water every day to promote uric acid excretion. High-fructose sweetened beverages such as carbonated drinks, fruit juices, and energy drinks should be avoided because fructose can be converted into purines in the liver. It is necessary to abstain from alcohol, which can lead to an increase in blood uric acid, whether it is white wine, rice wine, beer, or red wine.
3) Pay attention to the warmth of the feet, knees, hands and other well-occurring parts, and use drugs that affect uric acid excretion with caution.
4) Exercise moderately and control your weight.
If the above measures still do not meet the target of blood uric acid
Long-term medication should be adhered to under the guidance of a doctor**.
Currently, urate-lowering drugs are divided into the following two categories:
1) Inhibition of uric acid synthesis drugs: mainly allopurinol and febuxostat.
2) Drugs that promote uric acid excretion: benzbromarone.
Tophi has formed in the chronic arthritic phase, which seriously affects the quality of life and can be surgically operated**.
In short, if gout patients can follow the doctor's instructions to standardize, they can achieve the goal of no attacks, and they can also avoid other injuries to the body caused by high uric acid as much as possible, and gain a high-quality healthy life.
Reporter: Luo Xinyue.
Source: Shanghai Tenth People's Hospital.
Editor: Ye Ping.
*: Picture Worm Creative.
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