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▎The prevalence of gout in China, edited by WuXi AppTec's content team, is 1.
1%, but the treatment of gout is generally unsatisfactory, and many patients have repeated attacks
.
Some people did not receive standardized uric acid-lowering treatment; some people did not take the medicine as prescribed by the doctor, and stopped taking uric acid-lowering drugs
.
What happens to my condition if I don’t follow the doctor’s advice? A case recently published in the New England Journal of Medicine (NEJM) described the diagnosis and treatment of a gout patient who took medication irregularly and his condition got worse
.
The corresponding author of the case is Professor Ma Donglai from Peking Union Medical College Hospital
.
The patient was male, 65 years old
.
Due to joint pain and swelling in his hands, feet and knees for 5 years, he went to a dermatology clinic
.
During these 5 years, the patient received intermittent medication for gout, and his symptoms improved in a short period of time
.
But he did not continue to take the medication, so his condition deteriorated
.
Past history: A history of gout and chronic kidney disease (specifically unknown)
.
Physical examination: There are multiple tophi and deformities in the joints of the hands (Figure A), feet and knees
.
He was then referred to the outpatient department of rheumatology and immunology for further evaluation and treatment
.
Laboratory examination: Excessive serum uric acid level: The examination result is 9.
6 mg/dL (570 μmol/L), and the normal reference range is 3.
5-7.
0 mg/dL (210-420 μmol/L); the serum creatinine level exceeds the standard: the result is 1.
8 mg/dL (160 μmol/L), the normal reference range is 0.
7-1.
2 mg/dL (60-110 μmol/L)
.
Underwent a puncture of the first metatarsophalangeal joint of the right foot: a thick white exudate was found in the joint; a large amount of urate crystals can be seen under a polarized light microscope (Figure B)
.
Picture source: References [1] The treatment was given to patients to lower uric acid (the specific treatment plan was not given in the case report)
.
The "Chinese Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout (2019)" pointed out that when choosing uric acid-lowering drugs, the indications, contraindications and types of hyperuricemia should be considered comprehensively
.
Allopurinol, febuxostat, or benzbromarone are recommended as the first-line medication for lowering uric acid in patients with gout
.
Allopurinol is recommended as the first-line medication for lowering uric acid in patients with hyperuricemia and gout.
It is recommended to start with a small dose, and adjust the initial dose, increment, and maximum dose according to renal function
.
Febuxostat is especially suitable for patients with chronic renal insufficiency.
The recommended starting dose of febuxostat is 20 mg/d.
If the blood uric acid level is still not up to the standard after 2-4 weeks, it can be increased by 20 mg/d, the maximum dose It is 80 mg/d
.
Patients whose blood uric acid has not reached the standard can be considered for combined application of two uric acid-lowering drugs with different mechanisms of action
.
It is not recommended to use urate oxidase in combination with other uric acid-lowering drugs
.
After 10 months of follow-up, the patient’s joint pain and swelling were significantly reduced
.
Related reading "The Lancet" sub-issue: How much uric acid can be controlled to reduce gout attacks? The answer given by this research is worth collecting! How to manage the 4 stages of gout well to avoid recurring attacks? The article "The Lancet" clarifies that teeth grow into the nostrils.
How many years did I find out? | US Mount Sinai Medical System NEJM published a case of a girl with long stripes on the nose? It was because of this habit! | Beijing Children's Hospital NEJM announces case contact with small animals, pay attention! Hair loss and rash may be because of it | NEJM case reference materials of Zhejiang University Medical College [1] Tian Chen, and Dong-Lai Ma, 2021.
Untreated Chronic Gout.
NEJM.
DOI: 10.
1056/NEJMicm2112548 [2] Endocrinology Branch of Chinese Medical Association.
Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019).
DOI: 10.
3760/cma.
j.
issn.
1000-6699.
2020.
01.
001 Disclaimer: WuXi AppTec's content team focuses on introducing global biomedical health research progress
.
This article is for the purpose of information exchange only.
The opinions expressed in the article do not represent the position of WuXi AppTec, nor does it mean that WuXi AppTec supports or opposes the views in the article
.
This article is not a treatment recommendation either
.
If you need guidance on the treatment plan, please go to a regular hospital for treatment
.
1%, but the treatment of gout is generally unsatisfactory, and many patients have repeated attacks
.
Some people did not receive standardized uric acid-lowering treatment; some people did not take the medicine as prescribed by the doctor, and stopped taking uric acid-lowering drugs
.
What happens to my condition if I don’t follow the doctor’s advice? A case recently published in the New England Journal of Medicine (NEJM) described the diagnosis and treatment of a gout patient who took medication irregularly and his condition got worse
.
The corresponding author of the case is Professor Ma Donglai from Peking Union Medical College Hospital
.
The patient was male, 65 years old
.
Due to joint pain and swelling in his hands, feet and knees for 5 years, he went to a dermatology clinic
.
During these 5 years, the patient received intermittent medication for gout, and his symptoms improved in a short period of time
.
But he did not continue to take the medication, so his condition deteriorated
.
Past history: A history of gout and chronic kidney disease (specifically unknown)
.
Physical examination: There are multiple tophi and deformities in the joints of the hands (Figure A), feet and knees
.
He was then referred to the outpatient department of rheumatology and immunology for further evaluation and treatment
.
Laboratory examination: Excessive serum uric acid level: The examination result is 9.
6 mg/dL (570 μmol/L), and the normal reference range is 3.
5-7.
0 mg/dL (210-420 μmol/L); the serum creatinine level exceeds the standard: the result is 1.
8 mg/dL (160 μmol/L), the normal reference range is 0.
7-1.
2 mg/dL (60-110 μmol/L)
.
Underwent a puncture of the first metatarsophalangeal joint of the right foot: a thick white exudate was found in the joint; a large amount of urate crystals can be seen under a polarized light microscope (Figure B)
.
Picture source: References [1] The treatment was given to patients to lower uric acid (the specific treatment plan was not given in the case report)
.
The "Chinese Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout (2019)" pointed out that when choosing uric acid-lowering drugs, the indications, contraindications and types of hyperuricemia should be considered comprehensively
.
Allopurinol, febuxostat, or benzbromarone are recommended as the first-line medication for lowering uric acid in patients with gout
.
Allopurinol is recommended as the first-line medication for lowering uric acid in patients with hyperuricemia and gout.
It is recommended to start with a small dose, and adjust the initial dose, increment, and maximum dose according to renal function
.
Febuxostat is especially suitable for patients with chronic renal insufficiency.
The recommended starting dose of febuxostat is 20 mg/d.
If the blood uric acid level is still not up to the standard after 2-4 weeks, it can be increased by 20 mg/d, the maximum dose It is 80 mg/d
.
Patients whose blood uric acid has not reached the standard can be considered for combined application of two uric acid-lowering drugs with different mechanisms of action
.
It is not recommended to use urate oxidase in combination with other uric acid-lowering drugs
.
After 10 months of follow-up, the patient’s joint pain and swelling were significantly reduced
.
Related reading "The Lancet" sub-issue: How much uric acid can be controlled to reduce gout attacks? The answer given by this research is worth collecting! How to manage the 4 stages of gout well to avoid recurring attacks? The article "The Lancet" clarifies that teeth grow into the nostrils.
How many years did I find out? | US Mount Sinai Medical System NEJM published a case of a girl with long stripes on the nose? It was because of this habit! | Beijing Children's Hospital NEJM announces case contact with small animals, pay attention! Hair loss and rash may be because of it | NEJM case reference materials of Zhejiang University Medical College [1] Tian Chen, and Dong-Lai Ma, 2021.
Untreated Chronic Gout.
NEJM.
DOI: 10.
1056/NEJMicm2112548 [2] Endocrinology Branch of Chinese Medical Association.
Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019).
DOI: 10.
3760/cma.
j.
issn.
1000-6699.
2020.
01.
001 Disclaimer: WuXi AppTec's content team focuses on introducing global biomedical health research progress
.
This article is for the purpose of information exchange only.
The opinions expressed in the article do not represent the position of WuXi AppTec, nor does it mean that WuXi AppTec supports or opposes the views in the article
.
This article is not a treatment recommendation either
.
If you need guidance on the treatment plan, please go to a regular hospital for treatment
.
