“Dr. Zhang, do you think that the sooner the uric acid is lowered, the better, is it best to lower it in one day?” An old patient of mine asked me bluntly when he met him. .
Facing the matter of lowering uric acid, strictly speaking, it is not the sooner the better, but it is really not easy to explain to him why it is not the sooner the better. Today, Dr. Zhang will explain the reasons behind this incident to everyone.
Elevated uric acid is too common
Now around us, there are many people with elevated uric acid and even gout. According to our country’s 2019 edition of the “Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout in China”, the overall prevalence of hyperuricemia in China is now at a level of 13.3%. Roughly, there are about 180 million Chinese people. in a state of elevated uric acid. High uric acid is dangerous. Dr. Zhang told everyone before that people with elevated uric acid are prone to diseases such as hypertension, diabetes, kidney disease, cardiovascular and cerebrovascular diseases in addition to gout. So, for people with elevated uric acid, there is nothing to say about lowering uric acid. But isn’t it better to reduce uric acid as fast as possible?
Strictly speaking, people with high uric acid levels and gout should try to bring their uric acid levels down to normal as much as possible, whether by improving their lifestyle or using medications under the guidance of a doctor. However, the speed of reducing uric acid is definitely not as fast as possible, which is really different from everyone’s traditional understanding. However, this point is a bit like high blood pressure. Dr. Zhang has also said many times that it is not better to lower blood pressure as soon as possible in patients with hypertension. It is best to reduce blood pressure steadily. In fact, the same is true for lowering uric acid. It is definitely not the sooner the better, but the best is to gradually reduce it to a reasonable range.
The reason behind this is because the rapid reduction of uric acid can dissolve the urate crystals in the body, and then turn into urate particles, which are then deposited into the body’s Other parts, especially deposits on the joints, can cause gout attacks or recurrences in patients, that is, rapid reduction of uric acid can easily lead to the occurrence of metastatic gout. This is why the attack of gout is not only related to the increase of uric acid in the blood, but also to the huge fluctuation of uric acid in the blood.
Because of this, the 2019 edition of the “Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout in China” specifically pointed out that uric acid-lowering drug therapy should not be started until 2-4 weeks after the acute attack of gout patients is completely relieved. It is also pointed out that for patients with hyperuricemia, when using the two first-line uric acid lowering drugs, febuxostat and benzbromarone, it is necessary to start with a small dose. After 2-4 weeks, if the uric acid does not reach the target, it can be slowed Increase the dose, which is also to make the blood uric acid fall steadily and slowly. Therefore, the process of reducing uric acid must not be rushed, because reducing uric acid too quickly may lead to repeated illness or even at home, but the haste is not enough.
Let’s summarize how to reduce uric acid more reliably:
1. People with high uric acid and no gout attack
First and foremost, improving your lifestyle is something everyone should do. This includes controlling body weight, exercising regularly, limiting alcohol intake, limiting the intake of high-purine foods, limiting the intake of high-fructose foods, encouraging the intake of dairy products and fresh vegetables, and paying attention to drinking more water in moderation and urinating more often.
Secondly,Many people with high uric acid need to take uric acid-lowering treatment under the guidance of a professional doctor, and in the process of using uric acid-lowering drugs, try to start with a small dose, 2-4 After a few weeks, the dose was slowly increased, so that the blood uric acid steadily and slowly decreased. Here is the use of two commonly used drugs:
Febuxeltavir is a first-line drug for lowering uric acid, suitable for hyperuric acid patients with increased uric acid synthesis. The starting dose is generally 20 mg/day. After 2-4 weeks of observation, if the uric acid does not reach the standard, it can be increased by 20 mg/day, and the maximum dose does not exceed 80 mg/day.
Benzbromarone is also a first-line drug for lowering urine, suitable for hyperuric acid patients with impaired uric acid excretion. The starting dose is generally 25mg/day. After 2-4 weeks of observation, if the uric acid does not reach the target, it can be increased by 25mg/day, and the maximum dose does not exceed 100mg/day.
2. People with high uric acid in the acute stage of gout
For patients with elevated uric acid and an acute gout attack, try some anti-inflammatory pain relievers for symptomatic treatment, after the gout attack is controlled for 2-4 weeksStart to use uric acid-lowering drugs for uric acid-lowering treatment, start taking uric acid-lowering drugs in small doses, pay attention to slowly adjusting the drugs, and pay attention to the slow and steady decrease of uric acid. At the same time, it should be noted that patients with gout who have already taken uric acid-lowering drugs are not recommended to stop the drugs during acute attacks.
All in all, for people with elevated uric acid, no matter whether they have gout or not, the process of lowering uric acid should not be too violent or too fast, otherwise the haste will not be achieved. Did you understand this time?
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