These 4 knowledge points of uric acid-lowering drugs, be careful that the director will ask about ward rounds!

*For medical professionals to read and reference clinicians should keep in mind that the current clinical methods to reduce uric acid, in addition to low-purine diet, restricting tobacco and alcohol, insisting on exercise and weight control, drug treatment is one of the commonly used methods
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However, there are many kinds of uric acid-lowering drugs commonly used in clinical practice.
Are the principles and timings of the use of these drugs the same? For patients with high uric acid and gout, what precautions should doctors explain to patients? Today, the author will talk with you about the four major knowledge points that should be mastered in the rational use of uric acid-lowering drugs in combination with relevant references, hoping to help you in clinical medication
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 01 Principles of use of uric acid-lowering drugs When choosing uric acid-lowering drugs, the indications, contraindications and types of the drugs should be comprehensively considered
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For the first acute gout attack, it is recommended to start uric acid-lowering drug treatment 2 to 4 weeks after the gout attack is relieved; if a gout attack occurs during the treatment of uric acid-lowering drugs, it is not recommended to stop uric acid-lowering drugs
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Avoid excessive fluctuations in blood uric acid levels in the short term to induce gout attacks again
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All uric acid-lowering drugs should start with a low dose, and slowly increase the dose according to blood uric acid until the blood uric acid reaches the standard; long-term medication should be followed up regularly, and the blood uric acid level should be checked regularly (3-6 months), and when the blood uric acid is stable at a normal level On the basis of dietary intervention, the dose can be gradually reduced
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 02 Timing of the use of uric acid-lowering drugs 103 After the blood uric acid of the uric acid-lowering drugs reaches the standard, can the drug be discontinued? Uric acid-lowering drugs should be started with a small dose and slowly increased, so that the blood uric acid level gradually reaches the standard and reaches the standard for a long time
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It is contraindicated that the drug should be discontinued as soon as the serum uric acid reaches the target
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Because even if the blood uric acid is normal, uric acid-lowering treatment is still needed, because it takes time for the uric acid deposited in the tissue to dissolve into the blood, so the normal blood uric acid does not mean that the total amount of uric acid in the body has been reduced to the normal range
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Clinically, the blood uric acid level is less than 300μmol/L for more than 6 months, and the tophi can gradually dissolve and shrink.
Therefore, the long-term blood uric acid level can significantly reduce the frequency of gout attacks, prevent the formation of tophi, prevent bone destruction, reduce the risk of death and improve patient quality of life
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It is recommended for all patients to control the serum uric acid level at 240-420 μmol/L for life.
For some patients, if low-dose drugs can maintain the long-term uric acid standard and there is no evidence of tophi, they can try to stop the uric acid-lowering drugs, but the blood uric acid level needs to be monitored regularly.
, keep it within the target range
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 04 Confessions about taking uric acid-lowering drugs (1) How to make up after missed doses Once you start taking uric acid-lowering drugs as prescribed by your doctor, you need to take them on a long-term and continuous basis
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If you forget to take the medicine, you do not need to take the medicine, and you cannot take the medicine for two days a day
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(2) Regularly check liver and kidney function Uric acid-lowering drugs are mostly metabolized by liver and kidney, and long-term use may affect liver and kidney function.
During drug use, liver and kidney function should be checked regularly, and if any abnormality is found, the drug should be discontinued in time
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(3) It is necessary to pay attention to reducing uric acid at different stages to prevent gout attacks, but patients with hyperuricemia who take uric acid-lowering drugs for the first time will lead to a rapid decrease in the level of uric acid in the body, so that the surface of tophi will dissolve, and local irritation may be induced, which may induce gout.
Or make the original gout symptoms worse
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Therefore, it is recommended to use low-dose colchicine for the first time taking uric acid-lowering drugs to avoid gout
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It is not advisable to take uric acid-lowering drugs during an acute attack of gout, and uric acid-lowering therapy should be performed 2 to 4 weeks after the acute attack of gout is completely relieved
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However, in patients with acute gout who are taking uric acid-lowering drugs, if the dose of the drug is changed, the level of uric acid in the blood can also fluctuate, so it is not recommended to stop uric acid-lowering drugs
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What are the commonly used uric acid lowering drugs? What do different groups of people need to pay attention to when using these drugs? If you want to know the answer, please continue to pay attention to the "Medical Endocrinology Channel" and present exciting content to you at the same time next week! References: [1].
Practice Guidelines for Diagnosis and Treatment of Hyperuricemia in Renal Diseases in China (2017 Edition) [J].
Chinese Medical Journal, 2017, 97(25): 1927-1934.
[2].
Gout and Hyperuricemia Guidelines for Primary Diagnosis and Treatment of Symptoms (2019)[J].
Chinese Journal of General Practitioners,2020,19(4):293-300.
[3].
China Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout (2019)[J].
Zhonghua Journal of Endocrinology and Metabolism, 2020, 36(1): 1-13.
[4].
Guidelines for rational drug use at grassroots level for gout [J].
Chinese Journal of General Practitioners, 2021, 20(6): 631-637.
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