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▎Editor of WuXi AppTec's content team According to statistics in 2019, the overall prevalence of hyperuricemia in China is 13.
3%, of which gout is 1.
1%, which has become another common metabolic disease after diabetes
.
However, at present, the Chinese lack sufficient attention to hyperuricemia and gout, and the treatment effect is generally not satisfactory
.
On the one hand, the level of diagnosis and treatment in hospitals in various regions is uneven, and some patients have not received standardized uric acid-lowering treatment
.
On the other hand, many patients have poor compliance.
They didn't listen to the doctor's words carefully.
They stopped taking uric acid medicines and stopped eating them
.
According to the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)", with the update of diagnostic technology and equipment, the wider application of more sensitive, specific and more specific imaging examination methods has made asymptomatic hyperuricemia and gout The boundaries of is becoming blurred
.
Therefore, the management of such diseases should be a continuous process, requiring long-term, or even life-long, disease monitoring and management
.
We should use regular medication and diet management to keep the uric acid level within 240-420umol/L for a long time
.
So if people with high uric acid do not take medicine well and do not control their diet, what will happen to their condition? Image source: What are the consequences of 123RF not controlling uric acid? Recently, a case published in the New England Journal of Medicine (NEJM) described a process in which a gout patient took medication irregularly and his condition gradually worsened
.
This patient is 65 years old this year
.
Five years ago, he developed joint pain and swelling in his hands, feet and knees.
He was diagnosed with gout after going to the hospital
.
Within 5 years of his diagnosis, he would only take medicine for gout when the pain was unbearable
.
After taking the medicine, the symptoms improved in a short period of time, so he stopped the medicine and did not continue to take the medicine
.
After just 5 years, the patient had multiple tophi and deformities in his hands (picture A), feet and knee joints
.
Further examination revealed that there was a viscous white exudate in his joints; a large number of urate crystals can also be seen under a polarized light microscope (Figure B)
.
Image source: Reference material [1] Why not control uric acid, it will produce tophi in the joints, and also cause joint deformities? This is because if the uric acid is increased for a long time, it will cause the urate concentration to be too high, thereby forming monosodium urate crystals
.
This kind of crystals are usually deposited on joints, soft tissues and kidneys, and form tophi over a long period of time
.
Due to poor blood supply to the feet, low skin temperature, low pH of tissue fluid, and the joints of the phalanges are under pressure and are easily damaged, tophi is easy to grow on the joints of the feet
.
If the disease is not treated in time and managed in an all-round way, tophi will affect white blood cells, which will release inflammatory factors after being swallowed
.
The released inflammatory factors will not only cause cell necrosis, but also produce an inflammatory response, releasing more inflammatory factors
.
Such a vicious circle will cause dissolution of articular cartilage and soft tissue damage, leading to joint destruction and deformity
.
Image source: 123RF In fact, gout, known as the “number one pain in the world”, is not the most dangerous.
The complications caused by long-term high uric acid are the most terrifying
.
According to the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)", hyperuricemia and gout are independent risk factors for diseases such as chronic kidney disease, hypertension, cardiovascular and cerebrovascular diseases, and diabetes, and are independent predictors of premature death.
Factor
.
Hyperuricemia and gout are chronic and systemic diseases that can cause damage to multiple target organs and may affect life expectancy.
They also have a clear causal relationship with diseases such as kidney stones, chronic kidney disease, stroke, and coronary heart disease
.
Although the disease is terrible, it is painful and unpleasant; but after systematic scientific treatment, gout can be cured
.
The "2020 American Academy of Rheumatology Guidelines for the Treatment of Gout" also pointed out that gout is a "curable" disease, and the best treatment strategy and plan should be used in the treatment
.
What is the best treatment strategy? Picture source: Uric acid management of 123RF gout patients.
To cure gout, a long-term standardized uric acid-lowering treatment must be carried out under the guidance of a doctor and according to the condition and course of the disease, so that the uric acid value and the time of uric acid control can reach the standard
.
The "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)" gives the following recommendations: 01 General Recommendations recommends that all patients with hyperuricemia and gout maintain a healthy life>
.
Medical nutrition therapy can reduce the intake of exogenous purines, reduce blood uric acid load, reduce the risk of gout, or reduce the number of acute attacks of gout; it can also delay the occurrence and development of related complications; promote and maintain the fitness of the body The nutritional status, prevention and treatment of related diseases, and improve the condition
.
(For specific medical nutrition treatment, please click on the blue word: Eat like this if you stay away from gout) It is recommended that all patients with hyperuricemia and gout should understand the possible harms of this disease and always control their blood uric acid levels within the ideal range.
And regularly screen and monitor the damage of target organs to control related comorbidities
.
02 Part of the recommendations When choosing uric acid-lowering drugs, the indications, contraindications and types of hyperuricemia should be considered comprehensively
.
Recommend allopurinol, febuxostat, or benzbromarone as the first-line medication for lowering uric acid in patients with gout (please consult your doctor for specific medication)
.
Alkalizing urine is the main method to prevent and dissolve uric acid kidney stones.
Commonly used drugs are sodium bicarbonate and citric acid preparations (please consult your doctor for specific medications)
.
During the acute attack of gout, it is recommended to use small doses of colchicine or non-steroidal anti-inflammatory drugs as early as possible for anti-inflammatory and analgesic treatment
.
It is recommended to read that an "egg" grows on the neck of a male driver and is risking his life! You may also have this habit | Can't the doctor think of why some people become addicted to drinking? In fact, you are not in love with the top 10 high-incidence cancers in China.
When should you start screening? This article will take you to understand (Part 1) In order to save the father of liver cancer, the 21-year-old guy decided to cut off half of his liver.
Reference materials [1] Tian Chen, and Dong-Lai Ma, 2021.
Untreated Chronic Gout.
NEJM.
DOI: 10.
1056/NEJMicm2112548 [2] Chinese Medical Association Endocrinology Branch.
Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019).
DOI: 10.
3760/cma.
j.
issn.
1000-6699.
2020.
01.
001 [3] Wang Yu, Deng Xuerong, Zhang Zhuoli.
2020 Guidelines for the treatment of gout by the American Academy of Rheumatology[J].
Chinese Journal of Rheumatology, 2020, 24(12): 862-864.
DOI: 10.
3760/cma.
j.
c141217-20200612-00251.
[4] FitzGerald, JD et al .
, (2020).
2020 American College of 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
.
3%, of which gout is 1.
1%, which has become another common metabolic disease after diabetes
.
However, at present, the Chinese lack sufficient attention to hyperuricemia and gout, and the treatment effect is generally not satisfactory
.
On the one hand, the level of diagnosis and treatment in hospitals in various regions is uneven, and some patients have not received standardized uric acid-lowering treatment
.
On the other hand, many patients have poor compliance.
They didn't listen to the doctor's words carefully.
They stopped taking uric acid medicines and stopped eating them
.
According to the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)", with the update of diagnostic technology and equipment, the wider application of more sensitive, specific and more specific imaging examination methods has made asymptomatic hyperuricemia and gout The boundaries of is becoming blurred
.
Therefore, the management of such diseases should be a continuous process, requiring long-term, or even life-long, disease monitoring and management
.
We should use regular medication and diet management to keep the uric acid level within 240-420umol/L for a long time
.
So if people with high uric acid do not take medicine well and do not control their diet, what will happen to their condition? Image source: What are the consequences of 123RF not controlling uric acid? Recently, a case published in the New England Journal of Medicine (NEJM) described a process in which a gout patient took medication irregularly and his condition gradually worsened
.
This patient is 65 years old this year
.
Five years ago, he developed joint pain and swelling in his hands, feet and knees.
He was diagnosed with gout after going to the hospital
.
Within 5 years of his diagnosis, he would only take medicine for gout when the pain was unbearable
.
After taking the medicine, the symptoms improved in a short period of time, so he stopped the medicine and did not continue to take the medicine
.
After just 5 years, the patient had multiple tophi and deformities in his hands (picture A), feet and knee joints
.
Further examination revealed that there was a viscous white exudate in his joints; a large number of urate crystals can also be seen under a polarized light microscope (Figure B)
.
Image source: Reference material [1] Why not control uric acid, it will produce tophi in the joints, and also cause joint deformities? This is because if the uric acid is increased for a long time, it will cause the urate concentration to be too high, thereby forming monosodium urate crystals
.
This kind of crystals are usually deposited on joints, soft tissues and kidneys, and form tophi over a long period of time
.
Due to poor blood supply to the feet, low skin temperature, low pH of tissue fluid, and the joints of the phalanges are under pressure and are easily damaged, tophi is easy to grow on the joints of the feet
.
If the disease is not treated in time and managed in an all-round way, tophi will affect white blood cells, which will release inflammatory factors after being swallowed
.
The released inflammatory factors will not only cause cell necrosis, but also produce an inflammatory response, releasing more inflammatory factors
.
Such a vicious circle will cause dissolution of articular cartilage and soft tissue damage, leading to joint destruction and deformity
.
Image source: 123RF In fact, gout, known as the “number one pain in the world”, is not the most dangerous.
The complications caused by long-term high uric acid are the most terrifying
.
According to the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)", hyperuricemia and gout are independent risk factors for diseases such as chronic kidney disease, hypertension, cardiovascular and cerebrovascular diseases, and diabetes, and are independent predictors of premature death.
Factor
.
Hyperuricemia and gout are chronic and systemic diseases that can cause damage to multiple target organs and may affect life expectancy.
They also have a clear causal relationship with diseases such as kidney stones, chronic kidney disease, stroke, and coronary heart disease
.
Although the disease is terrible, it is painful and unpleasant; but after systematic scientific treatment, gout can be cured
.
The "2020 American Academy of Rheumatology Guidelines for the Treatment of Gout" also pointed out that gout is a "curable" disease, and the best treatment strategy and plan should be used in the treatment
.
What is the best treatment strategy? Picture source: Uric acid management of 123RF gout patients.
To cure gout, a long-term standardized uric acid-lowering treatment must be carried out under the guidance of a doctor and according to the condition and course of the disease, so that the uric acid value and the time of uric acid control can reach the standard
.
The "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)" gives the following recommendations: 01 General Recommendations recommends that all patients with hyperuricemia and gout maintain a healthy life>
.
Medical nutrition therapy can reduce the intake of exogenous purines, reduce blood uric acid load, reduce the risk of gout, or reduce the number of acute attacks of gout; it can also delay the occurrence and development of related complications; promote and maintain the fitness of the body The nutritional status, prevention and treatment of related diseases, and improve the condition
.
(For specific medical nutrition treatment, please click on the blue word: Eat like this if you stay away from gout) It is recommended that all patients with hyperuricemia and gout should understand the possible harms of this disease and always control their blood uric acid levels within the ideal range.
And regularly screen and monitor the damage of target organs to control related comorbidities
.
02 Part of the recommendations When choosing uric acid-lowering drugs, the indications, contraindications and types of hyperuricemia should be considered comprehensively
.
Recommend allopurinol, febuxostat, or benzbromarone as the first-line medication for lowering uric acid in patients with gout (please consult your doctor for specific medication)
.
Alkalizing urine is the main method to prevent and dissolve uric acid kidney stones.
Commonly used drugs are sodium bicarbonate and citric acid preparations (please consult your doctor for specific medications)
.
During the acute attack of gout, it is recommended to use small doses of colchicine or non-steroidal anti-inflammatory drugs as early as possible for anti-inflammatory and analgesic treatment
.
It is recommended to read that an "egg" grows on the neck of a male driver and is risking his life! You may also have this habit | Can't the doctor think of why some people become addicted to drinking? In fact, you are not in love with the top 10 high-incidence cancers in China.
When should you start screening? This article will take you to understand (Part 1) In order to save the father of liver cancer, the 21-year-old guy decided to cut off half of his liver.
Reference materials [1] Tian Chen, and Dong-Lai Ma, 2021.
Untreated Chronic Gout.
NEJM.
DOI: 10.
1056/NEJMicm2112548 [2] Chinese Medical Association Endocrinology Branch.
Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019).
DOI: 10.
3760/cma.
j.
issn.
1000-6699.
2020.
01.
001 [3] Wang Yu, Deng Xuerong, Zhang Zhuoli.
2020 Guidelines for the treatment of gout by the American Academy of Rheumatology[J].
Chinese Journal of Rheumatology, 2020, 24(12): 862-864.
DOI: 10.
3760/cma.
j.
c141217-20200612-00251.
[4] FitzGerald, JD et al .
, (2020).
2020 American College of 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
.
