During the Spring Festival
Family reunions, friends together
It's all a common thing
However, there is a class of patients with chronic diseases
This may lead to an "acute" outbreak of the disease
This disease is – gout!
Huang Jianlin, director of the Department of Rheumatology and Immunology of our hospital, received such a patient who had a gout attack and caused a limp and was extremely uncomfortable.
Small pains are turned into big pains, and gout cannot be ignored
Hometown Sichuan, Xiao Wang, who works in Guangzhou, is 36 years old this year, 10 years ago, after a drink, the first toe joint of the foot suddenly swollen and painful, diagnosed as gout after examination, intermittently taking ibuprofen such "small drugs", 1-2 attacks per year.
In the past 3 years, Xiao Wang obviously felt that the number of gout attacks was more frequent, but he still did not pay attention.
Years ago, Xiao Wang's knee suddenly swelled and ached, and the effect of Fenbid, which was commonly used before, was still not ideal for a few days. Although the action was not very convenient, the little king who was like an arrow in his heart still returned to his hometown as originally planned. During the period, in order to "not stop for pain", I even tried to increase the amount of ibuprofen on my own, but the pain still did not subside, which not only affected walking, but also greatly affected sleep.
Troubled, Xiao Wang immediately decided, "After returning to Guangzhou, I will go to the hospital for treatment!" ”
70ml！ One shot relieves pain
Professor Huang Jianlin said, "Seeing him turning and entering the clinic, and his slightly fat and blessed body shape, the first feeling is that this old brother should be gout." ”
After examination, it was found that Xiao Wang's blood pressure reached 185/122mmHg, which was closely related to his poor sleep quality. The right knee joint appears exceptionally swollen and full, not only tender, but also unable to straighten.
Huang Jianlin pointed out that there is more fluid accumulation in the swollen joint cavity, and the first step in treatment is to withdraw these residual fluids. According to past experience, the effusion of the joint cavity due to the pressure in the cavity, a needle full of joint fluid, the joint fluid will automatically emerge from the needle when the needle is replaced, Huang Jianlin laid out the nursing tissue in advance, so as not to replace the needle, the joint fluid will come out and wet the sheet.
While Preparing for the Joint Cavity Operation, Huang Jianlin "praised" Xiao Wang's ability to endure pain. After adequate preoperative preparation, Huang Jianlin successfully extracted a total of 70 ml of joint effusion in two sessions, by which time the upper knee joint (medically known as the suprapatella sac) had collapsed. After drawing the joint fluid, Xiao Wang was also injected with a small amount of triamcinolone.
▲Extraction of joint effusion
Without these effusions that hinder the normal movement of the joints, Xiao Wang was immediately relieved after treatment.
"I can move, and I feel much more relaxed!" Xiao Wang was very happy.
Huang Jianlin said that the way to extract effusions and local joint cavity injection hormones is only used when the joint effusion occurs in the severe attack of gout arthritis, the treatment of gout is mainly based on oral drugs, when the gout attack is taken under the guidance of a doctor, a non-steroidal anti-inflammatory drug (such as celecoxib, eicoxib, ibuprofen, etc.), after the joint is not swollen and painful, carefully and solidly take uric acid-lowering drugs under the guidance of the doctor, long-term standard treatment.
For Xiao Wang, it is still not easy to take lightly, and it is currently necessary to take celecoxib anti-inflammatory treatment, take blood pressure lowering drugs (at that time, the outpatient diastolic pressure measured was as high as 122 mmHg), especially the need to maintain adequate sleep, auxiliary blood draw and liver ultrasound and other medical examinations, check blood sugar, blood lipids, blood uric acid and whether there are kidney stones, in order to guide the next step of the choice of uric acid drugs.
Ten million treatments, prevention of seizures and safe medication of the first
Huang Jianlin pointed out that gout is a chronic disease that needs standardized treatment. He set Xiao Wang a "small goal" for the New Year: blood uric acid should be maintained below 360 mol/L for a long time.
He pointed out that gout patients took uric acid-lowering drugs, does not mean that everything is lucky, whether the blood uric acid is up to standard, to be monitored regularly; it is not recommended to use drugs by themselves or even to increase the amount of medication at will, Xiao Wang felt that the effect of ibuprofen was not good, and increased the dose of the drug without authorization, exceeding the dosage allowed by the instructions, sometimes it is very dangerous; the level of blood uric acid is not up to standard, and gout may recur.
He stressed that in order to reduce gout attacks, or even not attacks, blood uric acid should reach the standard for a long time. At the same time, it is necessary to control diet and weight and strengthen exercise. Patients with hyperuricemia are often accompanied by hypertension, hyperlipidemia, and hyperglycemia, and should also be monitored.
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If you have any questions, ask the sixth jun
This article guides the experts
Director of the Department of Rheumatology and Immunology, Huang Jianlin
Director of Internal Medicine, Director of the Department of Internal Medicine, Director of the Department of Rheumatology and Immunology, Discipline Leader, Professor, Chief Physician, Doctor of Medicine, Doctoral Supervisor. "China's Good Doctor", "Lingnan Famous Doctor", "Yangcheng Good Doctor", "Good Doctor Around the People", national natural science foundation of China peer review expert.
In July 1993, he graduated from the Department of Clinical Medicine of Sun Yat-sen Medical University (six-year undergraduate), and stayed on to work in the school, and after completing the standardized training of internal medicine residents, he has been engaged in clinical, teaching and scientific research in rheumatology since 1998. Years of work as a rheumatologist not only accumulated rich experience in the diagnosis and treatment of rheumatic diseases, but also established sincere doctor-patient feelings with treated rheumatologists.
Academic Appointments:
Vice Chairman of the Rheumatology Branch of Guangdong Medical Association
Vice Chairman of the Rheumatology Committee of Guangdong Hospital Association
Chairman of the Rheumatology Committee of Guangdong Provincial Primary Medical Association
Standing Committee Member of Rheumatology and Immunologist Branch of Guangdong Medical Doctor Association (and Secretary of the 1st Session)
Member of the Standing Committee of the Clinical Immunology Branch of the Guangdong Immunological Society
Visiting hours: Monday and Thursday afternoon, Wednesday morning, Saturday morning, Tuesday morning (Mingyou Clinic)
Editor-in-Charge: Zhang Yuanquan
Preliminary: Daisy.com
Review: Jian Wenyang
Approval release: Zhu Changping