Recently, Lao Chen met such a patient in the outpatient clinic, Lu, tophi has been for many years, and the tophi on the knee joint and ankle is as small as peanut grains and as large as eggs. When he came to the clinic, he was on crutches, and tophi significantly limited joint flexion and extension.
In the outpatient clinic, through the understanding of Lu's living habits and family history, Lu told me that he usually does not eat beef and mutton, hot pot and rarely eat, does not drink carbonated drinks and sugary drinks, and there are no gout patients at home.
A patient who never smokes and drinks, does not drink sugary drinks, usually eats healthily, has a suitable combination of meat and vegetables, asks about family history, and does not suffer from gout at home, how can there be such a serious gout, I am a little puzzled, what is the reason?
There are many clinical factors that cause hyperuricemia and induce tophi
Lu has a healthy diet, a regular life, and there are no gout patients at home, but he still induced tophi because of hyperuricemia, and I asked Lu about his disease history.
Lu told me that five years ago, Lu had a coronary heart disease, at that time, he had recurrent retrosternal crushing pain for a long time, and his family accompanied him to the hospital for examination, and found that troponin was elevated, and the doctor considered it to be acute coronary syndrome.
Because acute coronary syndrome is a serious type of coronary heart disease, doctors have focused on coronary heart disease, so they did not care about Lu's other symptoms. At that time, he also had symptoms, namely red and swollen joints in his right lower limb, pain and fever in the thumb toe and first metatarsophalangeal joints of his left foot. Neither Lu nor the doctor realized that coronary heart disease had induced gout.
Found the root of the problem, I told Lu that your gout has nothing to do with diet, although many people believe that high-purine food is a factor that causes tophi to appear in gout, but it is not the main factor, you have been plagued by tophi for many years, and one of the main reasons is coronary heart disease.
Coronary heart disease, high blood pressure, and diabetes can all induce tophi
I found in the outpatient clinic that many patients have the possibility of hyperuricemia, hyperuricemia, tophi is also related to long-term high blood pressure, high blood cholesterol, high blood sugar, these underlying diseases are risk factors for tophi.
For example, long-term hypertension can make the glomerular hypoxia, increase lactic acid production, and compete with uric acid for excretion, and long-term hypertension should stabilize blood pressure through antihypertensive drugs to avoid complications, but long-term use of antihypertensive drugs such as diuretics can also reduce uric acid excretion. In turn, long-term elevated uric acid can also increase the progression of coronary heart disease, hypertension, diabetes and other conditions.
In another case, in people with coronary heart disease, patients who received coronary angiography or interventional therapy had a higher probability of inducing an acute attack of gout than people who did not receive coronary intervention.
Studies have found that coronary angiography and coronary intervention, as risk factors for gout attacks, have a 2.7-fold and 5.5-fold higher risk of inducing tophi than people who have not undergone these two procedures.
Gout is harmful, and people with underlying diseases should pay more attention
When it comes to gout, people are usually scared. In particular, tophi can harm joints and even kidneys. Because of the urate deposition caused by gout, patients can produce chronic inflammatory reactions and form foreign body nodules, which is what we usually call tophi, which is common in joint cartilage, bursa, auricles, tendon sheaths, periarticular tissues and renal interstitium and other parts, easy to cause degenerative lesions of cartilage, can gradually develop into joint rigidity or deformity. It even causes gouty nephropathy, eventually progressing from chronic azotemia to uremia and even death.
Gout patients often have obesity, hyperlipidemia, diabetes, hypertension, coronary heart disease, etc. and aggravate metabolic dysfunction, such as diabetes, can aggravate insulin resistance, form metabolic syndrome, hyperuricemia and tophi are a manifestation of this metabolic syndrome. In the causes of death of gout patients, these underlying diseases greatly exceed renal insufficiency, so it is said that clinically, people with underlying diseases such as hypertension, diabetes, and coronary heart disease must pay attention to hyperuricemia and tophi.