With the continuous development of social economy and changes in people’s lifestyle and dietary structure, my country continues to have three high levels of “hypertension”, “hyperglycemia” and “hyperlipidemia”. The fourth highest level – “hyperuricemia” has appeared again, and the incidence of hyperuricemia and gout is increasing year by year, showing a younger trend. AndAccording to statistics, the incidence of hyperuricemia in my country is about 13.3%, and the incidence of gout is about 1.7%.
In 2017, the 4th Cross-Strait Medical and Health Exchange Association Rheumatology and Immunology Gout Group issued an initiative, April 20th is designated as National Gout Day.
Hyperuricemia and gout are multisystem systemic diseases, and their diagnosis and treatment require multidisciplinary participation. At the same time, it is also a chronic disease that requires long-term or even lifelong monitoring and management. The treatment of gout is the management of chronic diseases.
I. What is hyperuricemia and gout
< p data-track="5">Hyperuricemia refers to the detection of fasting blood uric acid levels at different times. Generally, males>420umol/L and females>360umol/L, which is considered to be hyperuricemia. Gout is a metabolic disease that causes arthritis, skin lesions, and kidney damage due to the deposition of urate crystals in the joints, soft tissues, and kidneys. Hyperuricemia and gout are different states of the same disease. In the 2018 Evidence-Based Evidence-Based Diagnosis of Gout updated by the European League Against Rheumatism, experts suggested that the course of gout is divided into early clinical stage (asymptomatic hyperuricemia and asymptomatic uric acid crystal deposition) and gout stage (ie clinical period, gouty arthritis flare, and flare). Staged treatment is required for these two different periods, and different symptoms correspond to different treatment plans.
2. Are hyperuricemia and gout hereditary?
Hyperuricemia and gout are complex genetic and environmental factors, and are a polygenic disease. There is a certain phenomenon of family gathering. The study found that the possibility of hereditary blood uric acid level is 27%-41%, the possibility of hereditary gout is 30%, and 20% of gout patients have a family history. Hereditary and environmental factors account for about 55%:45%, and and the onset of gout is closely related to environmental factors.
4. What are the causes of hyperuricemia and gout?
There are three main reasons for hyperuricemia and gout:
(1) Diseases with obvious secondary hyperuricemia such as congenital genetic diseases, chronic kidney disease, drugs, blood system diseases, malignant tumors;
( 2) Lifestyles such as a lot of alcohol, high purine diet, high carbonated/fructose drinks;
(3) Obesity, hypertension, ischemic heart disease, heart failure, diabetes , hyperlipidemia and other concomitant diseases.
5. Why is dual-energy CT examination recommended for hyperuricemia and gout patients?
Dual energy CT can accurately and specifically identify components such as urate crystals, quantify crystal size, and even detect early The urate deposition site and content of clinical symptoms, can be used for early diagnosis of gout and detection of gout treatment effect.
6. How is gout diagnosed?
In 2018, the European League Against Rheumatism recommended a three-step approach to the diagnosis of gout< /strong>.
The first step is to look for urate crystals in synovial fluid or tophi aspirate.
The second step, if joint fluid microscopy cannot be performed, clinical diagnosis of gout can be made when the following typical clinical manifestations occur, including: monoarthritis of the foot or ankle (especially 1st metatarsophalangeal joint); acute arthritis-like attack; acute joint swelling and pain symptoms (peak within 24 hours); localized joint erythema; cardiovascular disease and hyperuricemia in men.
In the third step, when the clinical diagnosis of gout is uncertain and crystals cannot be confirmed, it is recommended to look for imaging evidence of urate crystal deposition, especially ultrasound or dual-energy CT.
VII. Do patients with asymptomatic hyperuricemia need uric acid-lowering therapy?
Patients with asymptomatic hyperuricemiashould firstly take non-pharmacological measures to control serum uric acid levels , i.e. adjusting your diet, exercising more, and controlling your weight.
Eighth, is the blood uric acid high in gout?
Although the basis of gout attack is hyperuricemia, serum uric acid may be normal during gout attack, except for the diagnosis of gout , the diagnosis of gout is impossible. About 10% of gout patients have flares during acute arthritis. If the serum uric acid level is normal, the diagnosis of gout cannot be completely ruled out, but it also indicates that the possibility of gout is very low.
9. What is the timing of lowering uric acid?
The best time to lower uric acid is mostly at the onset of gout, most Uric acid-lowering drugs are not recommended at the beginning, and must be used as appropriate after 2 weeks of anti-inflammatory and analgesic treatment.
If a gout flare occurs during stable urate-lowering therapy, it is not necessary to discontinue urate-lowering drugs. At the same time, anti-inflammatory and analgesic treatment was performed.
10. How to choose uric acid-lowering drugs?
The choice of urate-lowering medication needs to be individualized. At present, commonly used uric acid-lowering drugs in my country include inhibiting uric acid synthesis (allopurinol and febuxostat) and promoting uric acid excretion (benbromarone).
Allopurinol, febuxostat, and benzbromarone can be the first-line drugs of choice. Since the positive HLA-B*5801 gene is a risk factor for the adverse reactions of allopurinol, it is recommended to perform HLA-B*5801 gene detection before allopurinol treatment.
Febuxostat does not require dose adjustment in patients with EGFR≥30ml/min. Benzbromarone is contraindicated in patients with uric acid nephrolithiasis.
420 people in the world fight against gout. When everyone suffers from gout, they must first make psychological suggestions and go to a specialist hospital for examination and treatment in time. There is no need for treatment if the hair is cured, but in fact, as long as you go to the doctor in time and cooperate with the doctor, the condition can still be controlled.