According to statistics, the overall prevalence of hyperuricemia in mainland China is 13.3% (more than 180 million people), gout is 1.1% (the number of people is 15.4 million), and high uric acid has become the "fourth highest" in addition to hypertension, hyperglycemia and hyperlipidemia, and the resulting health hazards are becoming increasingly prominent.
The following is a summary and analysis of common clinical gout understanding misunderstandings, hoping to be helpful to the majority of readers.
Myth 1: As long as blood uric acid is elevated, it will inevitably cause gout
Hyperuricemia is the material basis that causes gout, and the higher the blood uric acid level, the greater the risk of gout attacks.
The prevalence of gout was reported to be 1.3%, 3.2%, and 17.6% when blood uric acid was less than 360 μmol/L, 360 to 480 μmol/L, and greater than 480 μmol/L, respectively.
However, gout does not necessarily occur due to elevated hematuric uric acid, because whether gout occurs or not, in addition to being related to hyperuricemia, is also related to the internal environment of the body, uric acid fluctuations, and many precipitating factors (such as cold, overwork, joint injury, alcoholism, etc.).
To sum up: without hyperuricemia, there will certainly be no gout; the higher the level of blood uric acid, the greater the risk of gout; not all patients with hyperuricemia will have gout.
Myth 2: The harm of high uric acid is that it will cause gout
When it comes to the dangers of high uric acid, the first thing that comes to mind is that it causes "gout" (i.e., "gout arthritis").
In fact, this is just the tip of the iceberg of the harm of high uric acid, long-term hyperuricemia can also lead to kidney damage, urinary stones, leading to atherosclerosis and hypertension, increasing the occurrence of cardiovascular and cerebrovascular diseases and the risk of death, in addition, high uric acid will also damage islet β cells, causing glucose metabolism disorders.
Epidemiological investigations have shown that:
For every 60 micromol/L increase in blood uric acid levels, the incidence of hypertension increases by 25% and the risk of new diabetes increases by 17%.
People with high uric acid have a 47% increased risk of stroke and a 26% increased risk of stroke death compared with people with normal uric acid.
In patients with the same coronary heart disease, the mortality rate in people with hematuric uric acid above 450 μmol/L is 5 times higher than in people with hematouric acid below 300 μmol/L.
Myth 3: Checking once the blood uric acid is not high, you can completely exclude gout
Blood uric acid levels in the human body fluctuate, and the test results are related to the detection of the first day's meal status (is there a low-purine diet?). ) and the stage of the course of the disease has a lot to do with it.
Some patients with gout test blood uric acid during the acute onset period are lower than usual.
This is because in the acute attack, a large amount of uric acid precipitated from the blood is deposited in the joint, at this time, the uric acid content in the blood is relatively reduced, and the laboratory results of some patients can even be normal, if this is not understood, it is easy to lead to missed diagnosis or misdiagnosis.
Therefore, clinically, for patients with particularly typical gout symptoms and low blood uric acid, do not rashly deny the diagnosis of gout, but should re-examine blood uric acid after the acute period to avoid missing diagnosis.
Myth 4: To treat gout, you just need to "keep your mouth shut"
The source of uric acid in our body is divided into two parts: 20% comes from the foods we eat that contain purines (exogenous), and 80% is produced by autometabolism (endogenous).
It can be seen that strict dietary control theoretically can only reduce blood uric acid by up to 20% (about 100 μmol/L, and the article published in BMJ in 2018 believes that uric acid can be reduced by up to 50 μmol/L).
Therefore, while it is important to keep your mouth shut, it cannot completely replace uric acid-lowering drugs. In many cases, it is necessary to cooperate with uric acid-lowering drugs at the same time to achieve blood uric acid control standards.
Clinically, if the patient through 2 to 3 months of lifestyle adjustment (eat less seafood and animal offal, do not drink bone broth, avoid alcohol, drink a lot of water, weight loss, etc.), blood uric acid is still high, it is necessary to add uric acid-lowering drugs in time.
Myth 5: When the symptoms disappear, the drug can be discontinued
Gout presents a clinical process that alternates episodes with remission.
When an acute attack occurs, as long as you take anti-inflammatory and analgesic drugs for a few days (such as colchicine, non-steroidal anti-inflammatory drugs, etc.), most of the symptoms can be relieved quickly, and even no medicine is used, and the pain symptoms can basically be relieved within two weeks.
However, pain relief does not mean that gout has healed, because the patient's high uric acid state still exists, if not corrected, the damage of high uric acid to the joints, kidneys and cardiovascular disease will not stop, and gout may come back at any time.
If the relief of pain is compared to the "treatment of symptoms", then the control and maintenance of normal blood uric acid is the "cure", simple pain relief is the treatment of symptoms, only the long-term control of blood uric acid at the target level, in order to effectively prevent gout attacks.
Unless the patient can maintain the normal blood uric acid by improving the lifestyle (such as low purine diet, drinking a lot of water, avoiding alcohol, losing weight, etc.), it is necessary to cooperate with uric acid-lowering drugs for a long time, and there are no symptoms during the intermittent period and it is not advisable to stop using it.
Myth 6: The faster uric acid is lowered, the better
It is now known that in addition to the increase in blood uric acid, gout attacks are also an important reason for the large fluctuation of blood uric acid levels.
This is because with the rapid decline of blood uric acid, the urate crystals in the body will dissolve into urate particles, which are deposited on the joints elsewhere in the body, causing gout to re-attack, medically known as "metastatic gout".
Therefore, when applying uric acid-lowering drugs, it is necessary to start with small doses and slowly increase the dose, which is a steady decrease in blood uric acid. If you are in a hurry, it may lead to repeated or even recurrent diseases, and the result is that the desire is not reached quickly.
Myth 7: All people have the same standard of blood uric acid control
The control goals of hematuric acid vary from person to person, and the control goals of hematuric acid vary from population to population. According to the 2019 edition of the Chinese Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout:
(1) In patients with simple hyperuricemia, if there is no comorbidities, blood uric acid should be controlled
(2) Patients with gout, such as no comorbidities, hematuric uric acid is controlled in
Myth 8: The lower the blood uric acid level, the better
It has been confirmed that uric acid is a natural antioxidant of the human body, which can scavenge free radicals in the body, and the normal physiological concentration of blood uric acid has a certain protective effect on the nervous system.
If blood uric acid levels are too low, it is possible to increase the risk of neurodegenerative diseases such as senile dementia, Parkinson's disease, and multiple sclerosis. Therefore, blood uric acid is not as low as possible, and it is recommended that blood uric acid levels should not be lower than 180 micromol/L.
Planning | Dai Dongjun
Caption | Stand cool Heero
![My feet hurt so much that I couldn't walk and I insisted on drinking, how did gout come about? How to treat it?[fig]](data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACwAAAAAAQABAAACAkQBADs=)