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    Home > Active Ingredient News > Immunology News > To treat gout, you must be familiar with these 3 "conventional weapons"!

    To treat gout, you must be familiar with these 3 "conventional weapons"!

    • Last Update: 2021-03-22
    • Source: Internet
    • Author: User
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    *It is only for medical professionals to read for reference.
    What weapons do we have to deal with gout? What are the "specialties" and "shortcomings" of these weapons? With the changes in people’s diet and lifestyle, the incidence of hyperuricemia has been increasing year by year, and has now become the "fourth highest" after hypertension, hyperglycemia, and hyperlipidemia.
    The incidence of gout in Chinese has also increased.
    "The sesame blossoms are steadily high.
    "
    It is undeniable that gout is a lifestyle disease, which is related to unhealthy lifestyle habits, but it is far from enough to rely on lifestyle changes (including low-purine diet, alcohol avoidance, weight loss, etc.
    ) to prevent and treat gout.

    In the process of forming high uric acid, dietary factors account for only 30%, and more importantly, it is caused by excessive self-synthesis of uric acid or excretion disorder.

    Therefore, in most cases, the control of gout also requires the help of drugs.

    Healing a disease is like fighting a war.
    Only by knowing yourself and the enemy can you survive a hundred battles.

    So, what weapons do we have to deal with gout? What are the "specialties" and "shortcomings" of these weapons? Under what circumstances will "attack" or "retract"? How to deal with unexpected situations? All these are things we need to understand and master.

    The three "conventional weapons" for controlling gout are painkillers, uric acid lowering drugs, and urine alkalizing drugs.

    Conventional Weapon 01 Anti-inflammatory and Analgesic Drugs The most prominent symptom of gout patients is sudden onset of joint swelling and pain.
    In the face of such an emergency, the top priority is to quickly reduce inflammation and relieve pain.

    There are three main types of anti-inflammatory and analgesic drugs used for gout: drugs "non-steroidal anti-inflammatory drugs", "colchicine", and "glucocorticoids" 01.
    Non-steroidal anti-inflammatory drugs are mainly suitable for those with less severe pain symptoms Patients with gout.

    Commonly used are diclofenac sodium (voltaren), ibuprofen, indomethacin (indomethacin), etoricoxib, etc.
    Among them, etoricoxib has less gastrointestinal adverse reactions.Note that since these drugs can cause gastrointestinal mucosal damage and even gastrointestinal bleeding, gastric mucosal protective agents (such as omeprazole, ranitidine or misoprostol) should be added at the same time.

    In addition, long-term, high-dose non-steroidal anti-inflammatory drugs can also damage the kidneys, leading to "analgesic nephropathy.
    "
    It should be used with caution in patients with the risk of gastrointestinal bleeding and renal insufficiency.

    02.
    Colchicine Colchicine is a specific medicine for relieving acute attacks of gout.
    The earlier it is taken, the better the effect.
    The unsatisfactory effect of some patients is related to the delay of the medication time.

    It is recommended to take it within 12 hours of the onset of pain.
    Generally, the effect will be obvious within 24 to 48 hours.

    The traditional method of taking colchicine is to take 1 mg (2 tablets) by mouth, then 0.
    5 mg (1 tablet) every 1 hour, or 1 mg (2 tablets) every 2 hours until the pain relieves or diarrhea occurs.
    , Stop the drug when vomiting, no more than 6mg (12 tablets) throughout the day.

    Since the "therapeutic amount" of colchicine is very close to the "poisoning amount", the traditional "high-dose usage" is likely to cause drug accumulation and poisoning.
    At present, "low-dose usage" is recommended.

    In small doses, take 1.
    0 mg (2 tablets) at the beginning of the attack, and then take 0.
    5 mg (1 tablet) one hour later; after 12 hours, if necessary, take another 0.
    5 mg.

    After that, take 0.
    5 mg 3 times a day until the pain relieves, usually no more than two weeks.

    Compared with "traditional usage", "low-dose usage" is not bad in curative effect, and has higher safety, which can avoid side effects such as diarrhea.

      Note that the toxic and side effects of colchicine are relatively large.
    Excessive dosage can cause severe gastrointestinal reactions such as nausea, vomiting, and diarrhea.

    In addition, long-term use of colchicine can cause bone marrow suppression and liver and kidney damage.
    Therefore, once adverse reactions such as diarrhea occur during treatment, the drug should be stopped immediately.

    In addition, pay attention to review blood routine, liver and kidney function.

    03.
    Glucocorticoids clinically, when the effects of conventional analgesics such as non-steroidal anti-inflammatory drugs and colchicine are not good or there are contraindications (such as patients with renal insufficiency), glucocorticoids can be used for a short time, such as strong Loose 20-30mg/day, gradually reduce the dose and stop the drug after the symptoms are relieved.
    The total course of treatment is 7-10 days.

      Note that although the effect of glucocorticoid treatment is obvious, even faster than colchicine, its side effects should not be underestimated.
    It can cause peptic ulcer bleeding, blood sugar and blood pressure increase, secondary osteoporosis and so on.

    Therefore, glucocorticoids are usually not the first choice as analgesics and are limited to short-term use.

    Also note: It is not advisable to combine glucocorticoids with non-steroidal anti-inflammatory drugs to avoid increasing the risk of gastrointestinal bleeding.

    In order to prevent "rebound" after glucocorticoid reduction or withdrawal, glucocorticoids can be used in combination with low-dose colchicine.
    After the hormone is stopped, the low-dose colchicine will continue to be maintained for a period of time.

    Conventional weapons 02 Uric acid-lowering drugs The increase in blood uric acid is the main pathological basis for gout.
    According to the different links of the increase in blood uric acid, uric acid-lowering drugs can be divided into two categories: uric acid-lowering 1) "drugs that inhibit uric acid production", representative The drugs include allopurinol and febuxostat; 2) "drugs that promote uric acid excretion", representative drugs include benzbromarone and probenecid.

    01.
    Drugs that inhibit uric acid production 1) Allopurinol is suitable for primary and secondary hyperuricemia, especially in patients with hyperuricemia caused by excessive uric acid production; in addition, mild renal insufficiency and Gout patients with kidney stones can also take it, but it is contraindicated when the glomerular filtration rate (GFR) is ≤30ml/min.

    The drug should be started from a small dose (50-100mg/d) and gradually increased.
    The conventional dose is 100mg each time, 3 times a day, and the maximum dose should not exceed 600mg/d.

      Note that the main side effects of allopurinol are: ① gastrointestinal reactions, such as nausea, vomiting, loss of appetite, etc.
    ; ② skin allergic reactions, such as rash and itching, which can lead to "exfoliative dermatitis" in severe cases; ③ bone marrow suppression; ④ liver Renal function damage.

    In addition, patients with mild renal insufficiency and gout with kidney stones can also take it.

    Those who are allergic to allopurinol or those with glomerular filtration rate (GFR) ≤ 30ml/min are contraindicated.

    Prohibited for breastfeeding women.

    What needs extra vigilance is exfoliative dermatitis caused by allopurinol allergy.
    Although the incidence is not high (only 0.
    1% to 0.
    4%), the consequences are extremely serious, with a fatality rate of 20% to 25%.

    It has been found that the occurrence of allopurinol hypersensitivity is related to a gene called HLA-B*5801 carried in the body.
    For the sake of caution, patients with gout must check HLA-B5801 before taking allopurinol.
    Allopurinol is forbidden for those with positive results.

    2) Febuxostat is a new drug that inhibits the synthesis of uric acid.
    Compared with allopurinol, the advantages of this drug are mainly reflected in four aspects: ①The effect of lowering uric acid is more powerful than that of allopurinol; ②It is safer than other drugs.
    Purinol is higher, and allergic reactions rarely occur; ③Dual-channel excretion of liver and kidney, so patients with mild to moderate renal insufficiency and kidney stones can also be used, but severe renal insufficiency (GFR≤30ml/min) needs to be used with caution; ④ Only need to take the medicine once a day (Note: the initial dose is 20 mg/day), and the patients have high treatment compliance.

    The main adverse reaction is that it may increase the risk of heart failure.
    Patients with severe heart disease should use it with caution.

    The drug is suitable for the long-term treatment of hyperuricemia in patients with gout and is the first choice for patients with gouty nephropathy, but it is not recommended for hyperuricemia without clinical symptoms.

    02.
    Drugs that promote uric acid excretion are suitable for patients with primary and secondary hyperuricemia, especially hyperuricemia caused by uric acid excretion disorders.

    Its representative drug is benzbromarone (Ligalixian).
    Because of its long half-life, it only needs to be taken once a day, after breakfast.

    It must also be used with a small dose (25mg/day).
    The conventional treatment dose is 50-100mg/day, and the dose for patients with tophi can be increased to 150mg/day.

      Note that the main adverse reaction of the drug is to increase the risk of kidney urate stones formation, occasional gastrointestinal reactions, skin rashes, etc.
    , rare (1/10000) liver damage.

    People with kidney stones or severe renal impairment (the glomerular filtration rate is less than 20ml/min) should not be used.

    During medication, patients must drink a lot of water (more than 2000ml per day) to increase urine output, and at the same time take alkaline drugs (baking soda, etc.
    ) to prevent urate from depositing in the kidneys and forming urinary tract stones.

    03.
    Reasonable selection of uric acid-lowering drugs can cause the increase in blood uric acid to be nothing more than three conditions: increased blood uric acid, uric acid production, decreased uric acid excretion, or both ▶If the patient’s 24-hour uric acid excretion exceeds 800mg (4.
    8mmol) ) Belongs to the "excessive uric acid production type".
    At this time, you can choose drugs that inhibit the production of uric acid, such as allopurinol and febuxostat; ▶If the patient's 24-hour uric acid excretion is less than 600mg (3.
    6mmol), it is classified as "uric acid" Reduced excretion type", you can choose drugs that promote uric acid excretion, such as benzbromarone and probenecid.

    Generally speaking, one of the above-mentioned uric acid-lowering medicines is sufficient.

    ▶If a drug cannot make blood uric acid up to the standard (standard standard: general patients with blood uric acid <360µmol/L; patients with recurrent gout or tophi, blood uric acid <300µmol/L), two types of uric acid-lowering drugs can be considered Combined use, such as "febuxostat + benzbromarone".

    Conventional Weapon 03 Alkalizing urine drug uric acid has higher solubility in alkaline urine than in acidic urine.
    By alkalizing urine, it can promote the dissolution and excretion of urate and prevent the formation of urinary stones.
    Reduce the damage of urate to the kidneys.

    Therefore, it is necessary to use alkaline drugs when the urine pH is lower than 5.
    5 during the period of high blood uric acid concentration or taking uric acid excretion drugs (such as benzbromarone).

    Sodium bicarbonate (baking soda) is currently the most commonly used drug to alkalinize urine.
    Specific usage: baking soda 0.
    5 to 1 g (1 to 2 tablets) each time, 3 times a day.

    "Alkalized urine" does not mean that the higher the pH, the better.
    Excessive alkalization of urine (urine pH>7.
    0) can not only cause alkalosis, but also easily form calcium salt stones.

    It is generally believed that it is more appropriate to maintain the pH value between 6.
    2 and 6.
    9, not more than 7.
    0.

    Therefore, during the period of taking uric acid excretion drugs, attention should be paid to regular monitoring of urine pH, and the amount of sodium bicarbonate should be adjusted in time according to the test results to control the urine pH in an appropriate range.

    Clinically, I often hear patients complain: "Gout is difficult to treat, but the disease recurs.

    " In fact, the problem lies in two aspects: one is that he is not self-disciplined in his daily life;
    As long as these two points are done well, staying away from gout will no longer be a difficult dream.

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