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*Only for medical professionals to read and refer to the first issue of "Medical Fate", we followed Director Li Fen and Xiao Wu, a gout patient, into the gout! April 20th is the "National Day for Gout".
Director Li Fen of the Department of Rheumatology and Immunology of the Second Xiangya Hospital of Central South University and her patient Xiao Wu will be a guest on the "Medical Familiarity" program in the medical field, and talk about those things about gout.
! You can scan the QR code of the poster below to view the full version of the first issue of "Medical Familiarity".
If you have any thoughts and suggestions, you can leave a message in the comment section~ Young people are getting more and more gout Xiao Wu: Why the whole people pay attention to gout Is the date set for April 20th? Director Li Fen: The national attention to gout day is set to April 20th and has its origin, because the upper limit of the normal value of uric acid for adult men is 420μmol/L.
In order to make this date easy to remember, the upper limit of the normal value of uric acid is —— 420 as a gout day.
Xiao Wu: How has the development trend of gout changed over the years? Director Li Fen: When I first started as a doctor 20 years ago, there were probably more middle-aged and elderly male patients, but now the biggest feature is that young male patients around 20 years old, and even young female patients have gout.
The prevalence of gout has increased significantly now.
Our country's statistical survey shows that among the population of college students who have no gout attacks, 10% of healthy people have uric acid levels above the normal value.
If the uric acid level exceeds the normal value, they may become gout patients.
At present, the prevalence of gout in China may be around 5% to 6%.
In fact, according to the Chinese population base, this is a very scary figure.
Is high uric acid gout? Xiao Wu: The normal range of uric acid is 420μmol/L.
If uric acid is higher than this value, then it must be gout? Director Li Fen: Actually, there are two ranges of uric acid value.
Because the metabolism of men is slightly stronger, the metabolism of uric acid is higher.
Therefore, the upper limit of uric acid is 420μ/mol for men and 360μ/mol for women.
Both men and women have high uric acid.
It is called hyperuric acid at the critical value. The so-called gout is the onset of arthritis based on high uric acid levels.
What is the onset of arthritis? That is, the joints must suddenly become red, swollen, hot and painful more than once.
The biggest feature of red, swollen, hot and painful is that it develops very fast.
It may reach the peak of the disease within 12~24 hours.
You may be happy with your colleagues when you are off work and go at night.
Drink beer, eat supper, and then the pain is terrible in the middle of the night.
In our clinic, there is a type of patients with high uric acid.
Although they have arthralgias, they do not have acute attacks.
They are often brought into the disease automatically.
They think that they have gouty arthritis, which is actually wrong.
They must be under the guidance of a specialist.
Make an accurate diagnosis of the disease.
Why can't I lower uric acid in the acute phase? Xiao Wu: I believe everyone will have the same questions as me.
Why can't you use uric acid lowering drugs during an acute attack? Director Li Fen: The blood uric acid level must rise during a gout attack, but it must be clear that when blood uric acid cannot be excreted through the kidneys, it must have a place to go.
Its place is often in the joints, which eventually leads to urate.
Crystals are deposited in the joints.
In many patients, uric acid can also be deposited on the ears, intestines and heart valves, which is often misdiagnosed.
You must be very cautious about lowering uric acid in the acute phase.
It is divided into two situations: I have not used uric acid lowering drugs before, and there is no need to lower uric acid in the acute phase.
If you have been taking uric acid lowering drugs for a period of time, you can maintain the treatment or reduce the dose at this time.
If uric acid-lowering drugs are used in the acute phase, the urate crystals in the joints will dissolve and return to the blood.
However, the renal excretion problem is not resolved, so it may aggravate gout and cause more frequent attacks.
Don't care if the pain passes? Xiao Wu: Will the urate crystals dissolve by themselves after a period of time, or just leave it out after an acute attack of gout? Director Li Fen: This problem is actually a clinical confusion.
After a gout attack, many patients feel that their joints are no longer painful, and they think that gouty arthritis is cured.
But this is not the case.
Because the deposition of urate is due to the increased blood uric acid level, it will be deposited on the surface of the articular cartilage if it is not discharged, just like cotton on a tree.
If there is no acute attack, it just means that there is no acute inflammation at that time.
After urate crystals have been deposited for a long time, B-mode ultrasound can show a double-track sign on the joints, and the double-track sign indicates that there must be urate crystals.
Therefore, for gout patients, after the acute onset of arthritis, although there is no pain, in fact there are still urate deposits in the joints.
Xiao Wu: Apart from affecting the joints, does the formation of tophi affect other parts of the body? Director Li Fen: If the level of uric acid in patients with gout cannot be effectively controlled, metabolic syndrome will occur first.
Patients will develop hypertension, hyperlipidemia, and hyperglycemia.
If hypertension is not well controlled, cerebral hemorrhage will occur; Atherosclerosis occurs; poor control of high blood sugar can cause diabetic eye disease and diabetic nephropathy, and these three complications can lead to serious consequences.
The most important way of uric acid is excreted from the kidneys.
If the kidneys cannot excrete it, it can also be deposited in the kidneys, leading to gouty nephropathy.
The biggest feature is kidney stones.
Of course, tophi is also deposited in other parts, such as ears, heart valves, and even in the intestines.
It is often deposited in special parts, which are very similar to other diseases.
Sometimes patients even go to surgery by mistake.
The literature found that urate can also be deposited on the cornea, but if you do not provide a medical history with your doctor, the doctor will think that there is a problem with your cornea.
When uric acid is deposited in different places, dysfunction of different organs can occur.
Lower uric acid, not as low as possible! Xiao Wu: Just now, Director Li, you mentioned that gout often has 4 highs, high blood pressure, high blood fat, high blood sugar and high uric acid.
Then I would like to ask gout patients during the treatment process, it will be like the treatment of high blood pressure.
Do you take uric acid medicine for a long time or for life? Director Li Fen: For gout patients, if the uric acid level has been high for ten or twenty years, the time period for taking medicine may be relatively long.
Uric acid-lowering drugs can be reduced, to what extent? It's not enough to drop to a few dozen, because the lower the drop, the risk of getting tumors.
Therefore, the goal of reducing uric acid in gout is to reduce it below 300μmol/L.
Lowering uric acid is not a long-term problem, but treatment must be met, and the method of medication or the interval between medications must be determined according to the conditions that meet the standards.
Diet and work rest are important! Xiao Wu: I am also a gout patient.
I know that gout patients have higher requirements in terms of living habits.
What advice do you have in this regard? Director Li Fen: The diet of gout patients is very important.
Diet accounts for 30% of the factors contributing to elevated uric acid levels, and 70% of the metabolic processes in the body.
What aspects of diet should be paid attention to? 1.
Prohibition: Some active substances in beer can cause the level of uric acid to rise, and we Chinese people must eat and drink when drinking, so while drinking alcohol, the intake of purines will increase, and the metabolism of liquor will Produce acetic acid, it will inhibit the excretion of uric acid, so we must abstain from alcohol! 2.
Diet: Eat less offal.
Of course, there are some daily diets, including pork, beef, and fish.
These foods themselves contain certain purines.
We are more suggesting that patients control the daily total amount.
Pork, beef, dog meat, and fish can be eaten, but the total amount controlled in a week is about 500 grams.
3.
Soy products: At present, there is a lot of controversy, because the content of purines in soy products is relatively high.
If you like to eat them, it is recommended not to eat them every day.
If I eat it once or twice a week, I personally feel that the relationship is not very big.
4.
Vegetables: The normal intestine does not excrete acid, but if it is under stress, the intestine can excrete uric acid.
Under special circumstances, it can excrete up to 30%.
The fibrous diet will increase intestinal acid excretion.
5.
Exercise: Exercise can improve muscles, blood vessels and adjust metabolism, so through exercise and proper diet, the metabolic structure of the entire body can be adjusted.
6.
Work and rest: Now it is found that if the sleeping habits are abnormal, the endocrine hormones will also change.
If you stay up late, the cortisol hormone rhythm in the body will be abnormal, making the cortisol secretion at one to two in the morning and peaking at seven or eight in the morning, so sometimes patients say why they often attack at night? Why doesn't it happen during the day? Therefore, it is very important to make correct scientific adjustments to the living habits and diet of patients with gout!
Director Li Fen of the Department of Rheumatology and Immunology of the Second Xiangya Hospital of Central South University and her patient Xiao Wu will be a guest on the "Medical Familiarity" program in the medical field, and talk about those things about gout.
! You can scan the QR code of the poster below to view the full version of the first issue of "Medical Familiarity".
If you have any thoughts and suggestions, you can leave a message in the comment section~ Young people are getting more and more gout Xiao Wu: Why the whole people pay attention to gout Is the date set for April 20th? Director Li Fen: The national attention to gout day is set to April 20th and has its origin, because the upper limit of the normal value of uric acid for adult men is 420μmol/L.
In order to make this date easy to remember, the upper limit of the normal value of uric acid is —— 420 as a gout day.
Xiao Wu: How has the development trend of gout changed over the years? Director Li Fen: When I first started as a doctor 20 years ago, there were probably more middle-aged and elderly male patients, but now the biggest feature is that young male patients around 20 years old, and even young female patients have gout.
The prevalence of gout has increased significantly now.
Our country's statistical survey shows that among the population of college students who have no gout attacks, 10% of healthy people have uric acid levels above the normal value.
If the uric acid level exceeds the normal value, they may become gout patients.
At present, the prevalence of gout in China may be around 5% to 6%.
In fact, according to the Chinese population base, this is a very scary figure.
Is high uric acid gout? Xiao Wu: The normal range of uric acid is 420μmol/L.
If uric acid is higher than this value, then it must be gout? Director Li Fen: Actually, there are two ranges of uric acid value.
Because the metabolism of men is slightly stronger, the metabolism of uric acid is higher.
Therefore, the upper limit of uric acid is 420μ/mol for men and 360μ/mol for women.
Both men and women have high uric acid.
It is called hyperuric acid at the critical value. The so-called gout is the onset of arthritis based on high uric acid levels.
What is the onset of arthritis? That is, the joints must suddenly become red, swollen, hot and painful more than once.
The biggest feature of red, swollen, hot and painful is that it develops very fast.
It may reach the peak of the disease within 12~24 hours.
You may be happy with your colleagues when you are off work and go at night.
Drink beer, eat supper, and then the pain is terrible in the middle of the night.
In our clinic, there is a type of patients with high uric acid.
Although they have arthralgias, they do not have acute attacks.
They are often brought into the disease automatically.
They think that they have gouty arthritis, which is actually wrong.
They must be under the guidance of a specialist.
Make an accurate diagnosis of the disease.
Why can't I lower uric acid in the acute phase? Xiao Wu: I believe everyone will have the same questions as me.
Why can't you use uric acid lowering drugs during an acute attack? Director Li Fen: The blood uric acid level must rise during a gout attack, but it must be clear that when blood uric acid cannot be excreted through the kidneys, it must have a place to go.
Its place is often in the joints, which eventually leads to urate.
Crystals are deposited in the joints.
In many patients, uric acid can also be deposited on the ears, intestines and heart valves, which is often misdiagnosed.
You must be very cautious about lowering uric acid in the acute phase.
It is divided into two situations: I have not used uric acid lowering drugs before, and there is no need to lower uric acid in the acute phase.
If you have been taking uric acid lowering drugs for a period of time, you can maintain the treatment or reduce the dose at this time.
If uric acid-lowering drugs are used in the acute phase, the urate crystals in the joints will dissolve and return to the blood.
However, the renal excretion problem is not resolved, so it may aggravate gout and cause more frequent attacks.
Don't care if the pain passes? Xiao Wu: Will the urate crystals dissolve by themselves after a period of time, or just leave it out after an acute attack of gout? Director Li Fen: This problem is actually a clinical confusion.
After a gout attack, many patients feel that their joints are no longer painful, and they think that gouty arthritis is cured.
But this is not the case.
Because the deposition of urate is due to the increased blood uric acid level, it will be deposited on the surface of the articular cartilage if it is not discharged, just like cotton on a tree.
If there is no acute attack, it just means that there is no acute inflammation at that time.
After urate crystals have been deposited for a long time, B-mode ultrasound can show a double-track sign on the joints, and the double-track sign indicates that there must be urate crystals.
Therefore, for gout patients, after the acute onset of arthritis, although there is no pain, in fact there are still urate deposits in the joints.
Xiao Wu: Apart from affecting the joints, does the formation of tophi affect other parts of the body? Director Li Fen: If the level of uric acid in patients with gout cannot be effectively controlled, metabolic syndrome will occur first.
Patients will develop hypertension, hyperlipidemia, and hyperglycemia.
If hypertension is not well controlled, cerebral hemorrhage will occur; Atherosclerosis occurs; poor control of high blood sugar can cause diabetic eye disease and diabetic nephropathy, and these three complications can lead to serious consequences.
The most important way of uric acid is excreted from the kidneys.
If the kidneys cannot excrete it, it can also be deposited in the kidneys, leading to gouty nephropathy.
The biggest feature is kidney stones.
Of course, tophi is also deposited in other parts, such as ears, heart valves, and even in the intestines.
It is often deposited in special parts, which are very similar to other diseases.
Sometimes patients even go to surgery by mistake.
The literature found that urate can also be deposited on the cornea, but if you do not provide a medical history with your doctor, the doctor will think that there is a problem with your cornea.
When uric acid is deposited in different places, dysfunction of different organs can occur.
Lower uric acid, not as low as possible! Xiao Wu: Just now, Director Li, you mentioned that gout often has 4 highs, high blood pressure, high blood fat, high blood sugar and high uric acid.
Then I would like to ask gout patients during the treatment process, it will be like the treatment of high blood pressure.
Do you take uric acid medicine for a long time or for life? Director Li Fen: For gout patients, if the uric acid level has been high for ten or twenty years, the time period for taking medicine may be relatively long.
Uric acid-lowering drugs can be reduced, to what extent? It's not enough to drop to a few dozen, because the lower the drop, the risk of getting tumors.
Therefore, the goal of reducing uric acid in gout is to reduce it below 300μmol/L.
Lowering uric acid is not a long-term problem, but treatment must be met, and the method of medication or the interval between medications must be determined according to the conditions that meet the standards.
Diet and work rest are important! Xiao Wu: I am also a gout patient.
I know that gout patients have higher requirements in terms of living habits.
What advice do you have in this regard? Director Li Fen: The diet of gout patients is very important.
Diet accounts for 30% of the factors contributing to elevated uric acid levels, and 70% of the metabolic processes in the body.
What aspects of diet should be paid attention to? 1.
Prohibition: Some active substances in beer can cause the level of uric acid to rise, and we Chinese people must eat and drink when drinking, so while drinking alcohol, the intake of purines will increase, and the metabolism of liquor will Produce acetic acid, it will inhibit the excretion of uric acid, so we must abstain from alcohol! 2.
Diet: Eat less offal.
Of course, there are some daily diets, including pork, beef, and fish.
These foods themselves contain certain purines.
We are more suggesting that patients control the daily total amount.
Pork, beef, dog meat, and fish can be eaten, but the total amount controlled in a week is about 500 grams.
3.
Soy products: At present, there is a lot of controversy, because the content of purines in soy products is relatively high.
If you like to eat them, it is recommended not to eat them every day.
If I eat it once or twice a week, I personally feel that the relationship is not very big.
4.
Vegetables: The normal intestine does not excrete acid, but if it is under stress, the intestine can excrete uric acid.
Under special circumstances, it can excrete up to 30%.
The fibrous diet will increase intestinal acid excretion.
5.
Exercise: Exercise can improve muscles, blood vessels and adjust metabolism, so through exercise and proper diet, the metabolic structure of the entire body can be adjusted.
6.
Work and rest: Now it is found that if the sleeping habits are abnormal, the endocrine hormones will also change.
If you stay up late, the cortisol hormone rhythm in the body will be abnormal, making the cortisol secretion at one to two in the morning and peaking at seven or eight in the morning, so sometimes patients say why they often attack at night? Why doesn't it happen during the day? Therefore, it is very important to make correct scientific adjustments to the living habits and diet of patients with gout!
