According to statistics, the overall prevalence of hyperuricemia in my country is currently 13.3% (over 180 million people), and gout is 1.1% (over 15.4 million people). In addition to high blood pressure, high blood sugar, and high blood lipids, the “fourth highest” health hazards have become increasingly prominent.
The following is a summary and analysis of common clinical misunderstandings of gout, hoping to help readers.
Myth 1: As long as blood uric acid is elevated, it will inevitably cause gout
Hyperuricemia is the material basis for gout. The higher the blood uric acid level, the greater the risk of gout attack.
Studies reported that when serum uric acid was less than 360 μmol/L, 360-480 μmol/L, and greater than 480 μmol/L, the prevalence of gout was 1.3%, 3.2%, and 17.6%, respectively .
However, gout does not necessarily occur due to elevated blood uric acid, because gout attacks are not only related to hyperuricemia, but also related to the body’s internal environment, uric acid fluctuations, and many other factors. Predisposing factors (such as cold, overwork, joint damage, alcoholism, etc.) are related.
To sum up: without hyperuricemia, there will definitely be no gout; the higher the blood uric acid level, the greater the risk of gout; not all patients with hyperuricemia will have gout gout.
Myth 2: High uric acid causes gout
When it comes to the dangers of high uric acid, people first think of it as causing “gout” (ie “gouty arthritis”).
In fact, this is just the tip of the iceberg of the dangers of hyperuricemia. Long-term hyperuricemia can also lead to kidney damage, urinary calculi, atherosclerosis and high blood pressure, and increase the heart and brain. The occurrence of vascular disease and the risk of death, in addition, high uric acid can damage islet beta cells, causing glucose metabolism disorders.
Epidemiological surveys show that:
For every 60 μmol/L increase in blood uric acid levels, the incidence of hypertension increased by 25% and the risk of new-onset diabetes increased by 17%.
Compared with people with normal uric acid, people with high uric acid have a 47% increased risk of stroke and a 26% increased risk of death from stroke.
In the same patients with coronary heart disease, the mortality rate of people with blood uric acid higher than 450 μmol/L is 5 times that of people with blood uric acid lower than 300 μmol/L.
Myth 3: Gout can be completely ruled out by checking the blood uric acid level once.
The blood uric acid level of the human body fluctuates, and the test results have a lot to do with the meal status (is it a low-purine diet?) the day before the test and the stage of the disease course.
Some people with gout have lower-than-usual blood uric acid tests during an acute attack.
This is because during an acute attack, a large amount of uric acid is precipitated from the blood and deposited in the joints. At this time, the content of uric acid in the blood is relatively reduced, and the test results of some patients can even be normal. This can easily lead to missed or misdiagnosed.
Therefore, clinically, for patients with typical gout symptoms and low blood uric acid, the diagnosis of gout should not be dismissed lightly, but blood uric acid should be re-examined after the acute phase to avoid missed diagnosis.
Myth 4: To treat gout, all you have to do is “keep your mouth shut”
Uric acid in our body comes from two sources: 20% comes from the foods we eat that contain purines (exogenous), and 80% is produced by our own metabolism (endogenous).
It can be seen from this that strict control of diet can theoretically reduce blood uric acid by at most 20% (about 100 μmol/L, and an article published in BMJ in 2018 believes that uric acid can be reduced at most by 100 μmol/L or so). 50 μmol/L).
Therefore, keeping your mouth shut is important, but not a complete substitute for uric acid-lowering drugs. In many cases, it is necessary to combine uric acid-lowering drugs at the same time to achieve blood uric acid control.
Clinically, if the patient adjusts his lifestyle through 2 to 3 months (eat less seafood and animal offal, don’t drink big bone soup, avoid alcohol, drink a lot of water, lose weight, etc.), Serum uric acid is still high, and it is necessary to add uric acid-lowering drugs in time.
Myth 5: When symptoms go away, you can stop the medication
Gout is a clinical course of alternating attacks and remissions.
When an acute attack occurs, as long as you take anti-inflammatory painkillers (such as colchicine, non-steroidal anti-inflammatory drugs, etc.) for a few days, most of the symptoms can be relieved quickly, even any medicine No, the pain symptoms can basically relieve themselves within two weeks.
However, pain relief does not mean that gout has been cured, because the high uric acid state in the patient’s body still exists. If it is not corrected, the damage of high uric acid to joints, kidneys and cardiovascular will not be Stop, gout may come back at any time.
If pain relief is compared to “symptom treatment”, then controlling and maintaining normal blood uric acid is “the root cause”. Simply relieving pain is the only cure for the symptoms but not the root cause. Only by controlling the blood uric acid at the target level for a long time , in order to effectively prevent gout attacks.
Unless patients can maintain normal blood uric acid by improving their lifestyle (such as low-purine diet, drinking plenty of water, avoiding alcohol, losing weight, etc.), they need long-term treatment with uric acid-lowering drugs. It should not be discontinued if there are no symptoms during the intermittent period.
Myth 6: The sooner you lower your uric acid, the better
It is now known that gout attacks are not only related to increased serum uric acid, but alsoLarge fluctuations in levels are also an important reason.
This is because with the rapid decline of blood uric acid, the urate crystals in the body will dissolve into urate particles, and the urate particles will deposit on the joints elsewhere in the body, causing gout Another attack is medically called “metastatic gout”.
Therefore, when applying uric acid-lowering drugs, it is necessary to start with a small dose and increase the dose slowly, so that the blood uric acid decreases steadily. If you act too hastily, it may lead to repeated or even recurrence of the disease, and the result is that the haste is not enough.
Myth 7: Everyone’s blood uric acid is the same
The control target of blood uric acid varies from person to person, and the target of blood uric acid control is also different for different groups of people. According to the 2019 edition of “Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout in China”:
(1) In patients with pure hyperuricemia, if there is no comorbidity, the serum uric acid should be controlled at
(2) In patients with gout, if there is no comorbidity, the blood uric acid should be controlled at
Myth #8: Lower blood uric acid levels are better
It has been confirmed that uric acid is a natural antioxidant in the human body, which can scavenge free radicals in the body. The normal physiological concentration of blood uric acid has a certain protective effect on the nervous system.
Low blood uric acid levels may increase the risk of neurodegenerative diseases such as Alzheimer’s, Parkinson’s disease, and multiple sclerosis. Therefore, the lower the blood uric acid is, the better. It is recommended that the blood uric acid level should not be lower than 180 μmol/L.
Planning | Dai Dongjun
Title map | Station Cool Hero