If not treated in time, the consequence of delay is that the pain will become more and more severe and unbearable. If you have a fever at this time, it means that there is already inflammation. Not only that, the joints themselves will be damaged, the bones will be corroded, which will lead to joint deformation (see the atlas), and the kidneys will also be damaged during the whole illness, which will lead to kidney calculi's disease and even renal failure, which is life-threatening.
The essential cause of gout is the increase of uric acid level in the body, which leads to the deposition of urate in joints and kidneys. Generally speaking, the main causes of gout include but are not limited to: ① diet. After eating too much meat and seafood and drinking too much beer, the uric acid level of human body rises, which may cause urate deposition; ② Obesity. The consequence of obesity is that uric acid in the body increases, and the kidneys cannot completely metabolize excess uric acid; (3) take some drugs. These drugs will lead to an increase in uric acid levels in the body; ④ Family history. If your family has gout, your chances of getting sick will also increase greatly.
The first metatarsal bone (big toe), knuckles, knee joints and elbow joints are common causes in many groups of male patients in the Department of Rheumatology, Immunology and Internal Medicine of gout clinic, which lead to high serum uric acid levels, causing common symptoms such as urate deposition, joint pain, edema, inflammation, joint deformation, kidney calculi, infectious renal failure, etc. Whether medical insurance can cure it, whether it recurs, whether heredity is a common treatment method, and whether surgical treatment is life-threatening if necessary.
Gout is a kind of crystal-related arthropathy caused by the deposition of monosodium urate (MSU), which is directly related to hyperuricemia caused by purine metabolic disorder and/or decreased uric acid excretion, and belongs to the category of metabolic rheumatism. Gout can be complicated with kidney diseases, and in severe cases, joint damage and renal function damage can occur, often accompanied by hyperlipidemia, hypertension, diabetes, arteriosclerosis and coronary heart disease.
As a chronic crystalline arthritis-gout, hyperuricemia is the basis of gout. Genetic factors affect the whole process of gout and hyperuricemia. Single-gene genetic diseases may affect key enzymes in uric acid metabolism pathway, while SNP may lead to differences in uric acid transporter and inflammatory response. Hyperuricemia and supersaturation of uric acid in urine make urate deposit in the lumen or interstitium of renal tubules, leading to acute inflammatory reaction.
Gout can be accompanied by obesity, hypertension, diabetes, lipid metabolism disorder and other metabolic diseases. Obesity is one of the main risk factors of gout. Gout patients with different body mass index (BMI) have different clinical characteristics, so individualized treatment should be given to different patients.
Gout patients often have tophi. It can be seen under the skin, joints, tendons and soft tissues around the patient's ear. Tophoresis is a kind of yellowish or white protuberance or vegetation of different sizes, which is hard and similar to stone. The tophi formed in all parts of the body, especially the limbs, not only seriously affects the shape of the limbs, but also leads to joint deformity, dysfunction, nerve compression, skin ulceration and prolonged sinus healing time, which requires surgical treatment.
The development of history
As early as the 5th century BC, Hippocrates recorded the clinical manifestations of gout. The word gout comes from Latin Guta, which means that a drop of harmful liquid causes joint damage, and the pain is like a gust of wind, so it is named gout. In ancient times, gout was common in emperors and princes, but with the improvement of living standards, the prevalence of gout/hyperuricemia (China) increased year by year. Increased uric acid production and/or decreased excretion can lead to the occurrence of HUA.
Definition of gout/hyperuricemia
The international definition of China is: under the normal purine diet, the fasting blood uric acid level on different days is twice: male blood uric acid >; 420 μmol/L, female serum uric acid >: 360 μ mol/L. When the level of serum uric acid exceeds the saturation of monosodium urate in joints, it is called gout. China without gout attack is called asymptomatic China, which has not attracted enough attention because it has no obvious clinical symptoms.
Risk factor
First of all, obesity
Obesity is a risk factor for gout. Obesity will not only increase the risk of gout, but also lead to gout in obese patients at an earlier age. With the increase of body mass index, the incidence of gout increases obviously, and visceral fat is closely related to the occurrence of gout.
Hypertriglyceridemia and obesity are both risk factors for gout. Obesity will lead to insulin resistance, and eventually lead to the reduction of uric acid excretion in the kidney through various channels. Obesity can increase the free fatty acids and the synthesis of uric acid by affecting the activity of xanthine oxidase.
Second, drinking.
Excessive drinking and alcohol intake are independent risk factors for gout attack. Beer contains a lot of purine components, so the risk of gout is the greatest.
Possible reasons for the increase of serum uric acid level caused by drinking;
(1) ethanol stimulates human body to synthesize lactic acid, and lactic acid competitively inhibits renal tubular uric acid excretion.
(2) Ethanol can be degraded into adenosine monophosphate by increasing ATP, thus promoting uric acid production.
(3) Some alcoholic beverages, especially fermented beverages such as beer, will produce a lot of purines during their fermentation. Long-term heavy drinking can promote the occurrence of China and even gout.
(4) Drinking alcohol is often accompanied by high purine food intake, which increases the risk of gout.
(5) Chronic alcohol-related liver disease caused by long-term heavy drinking is related to the increase of insulin level, which can inhibit insulin signaling pathway, increase the risk of insulin resistance, increase uric acid reabsorption and increase serum uric acid level.
Third, hypertension.
The serum uric acid level and HUA prevalence rate in hypertensive patients were significantly higher than those in non-hypertensive patients. Hypertension is an independent risk factor for gout attack. After 9-year follow-up of American residents, it was found that participants with hypertension had a significantly higher risk of gout than those without hypertension. The possible reasons are: hypertension leads to microangiopathy, leading to tissue hypoxia, and then the blood lactic acid level increases, inhibiting the secretion of urate in renal tubules, and finally leading to uric acid retention and HUA；; In addition, long-term use of diuretics, loop diuretics and thiazide diuretics in many patients with hypertension can promote the increase of serum uric acid level.
Fourth, hyperglycemia.
Hyperglycemia is a risk factor for China. In diabetic patients, purine catabolism is enhanced, uric acid production is increased, and blood uric acid level is increased. HUA can aggravate renal damage, reduce renal uric acid excretion, and further aggravate the occurrence and development of HUA. However, there is no nonlinear correlation between blood glucose and serum uric acid level.
5. Foods rich in purine
Purine-rich foods (such as meat and seafood) can increase the risk of gout. Fructose is the only carbohydrate that can increase blood uric acid level, which can promote uric acid synthesis and inhibit uric acid excretion. Therefore, a large intake of fructose-containing beverages can increase the level of serum uric acid.
Six, some drugs
Many drugs are closely related to China. The relative risk of gout for loop diuretics and thiazide diuretics is 2.64 and 1.70, respectively. Low dose aspirin (75 ~ 150 mg/d), cyclosporine, tacrolimus and pyrazinamide can promote the increase of serum uric acid and increase the risk of gout.
epidemiology
There is no national epidemiological survey data of gout in China, but according to the reported gout prevalence rates in different time and regions, the current gout prevalence rate in China is 1% ~ 3%, and it is increasing year by year.
According to the periodical data of online registration and follow-up study in China Rheumatology Data Center (CRDC), as of February 20 16, 68 14 gout patients were found in 100 hospitals in 27 provinces, municipalities and autonomous regions, with an average age of 48.28 years (male 47.95 years). More than 50% of gout patients are overweight or obese.
Globally, the prevalence of HUA/ gout in developed countries is higher than that in developing countries. Gout is common in North America and Western Europe, with a prevalence rate of 1% ~ 4%, and the former Soviet Union, Iran, Malaysia and other regions have lower prevalence rates.
Epidemiological studies show that hyperuricemia is related to the progression of CKD to end-stage renal disease.
Reasons for seeing a doctor
According to 20 16 China gout diagnosis and treatment guidelines, the main cause of gout patients is joint pain (4 1.2% for men and 29.8% for women), followed by fatigue and fever. There are great differences between men and women. Among male patients, drinking is the main reason (25.5%), followed by high purine diet (22.9%) and strenuous exercise (6.2%). Female patients were mainly induced by high purine diet (17.0%), followed by sudden cold (1 1.2%) and strenuous exercise (9.6%).
At the time of seeing a doctor, the doctor will evaluate the patient's clinical manifestations, and if necessary, X-ray examination and laboratory examination (that is, biochemical examination) will be used for diagnosis.
treat cordially
Healthy lifestyle, adjust the diet structure: give priority to a light diet, eat more vegetables, limit oil with less salt, and eat less foods with high purine content (such as animal viscera and bean products); Quit smoking and limit alcohol; Weight loss: through yoga, fitness, jogging and other aerobic exercise, or massage, dredge meridians and control weight; Preventive gout treatment: We can prevent the excessive production of uric acid by eating and drinking tea with emperors, promote the excretion of uric acid by kidneys, and achieve the purpose of preventing gout. Gout will lead to organ microcirculation disorder due to uric acid deposition in various organs, and cardiovascular and cerebrovascular complications and renal complications should be actively prevented.
At present, the treatment of gout mainly includes two aspects-the treatment of pain and inflammatory reaction during gout attack. Prevent gout attack and reduce serum uric acid.
For obese gout patients, while paying attention to blood uric acid, we should pay attention to guiding patients to exercise regularly, monitoring blood pressure, blood sugar, blood lipid, liver transaminase and other indicators, giving comprehensive treatment, maintaining blood uric acid up to standard, and reducing the number of affected joints as much as possible.
Eat a low purine diet, maintain a reasonable weight, give up drinking, drink more tea, and drink more than 2000ml of water every day. Avoid overeating, excessive drinking, cold and dampness, fatigue and mental stress, wear comfortable shoes to prevent joint damage, and use drugs that affect uric acid excretion with caution, such as some diuretics and low-dose aspirin. Prevention and treatment of accompanying diseases such as hypertension, diabetes and coronary heart disease.
Colchicine colchicine can relieve symptoms quickly when used in the early stage of gout attack. 20 12 American Rheumatology Association (ACR) guidelines point out that taking colchicine within 36 hours of acute gout attack can prevent gout attack. Renal insufficiency is still the first-line drug, but it should be reduced, because renal insufficiency will obviously reduce its clearance rate and increase drug toxicity. Up to 20% of oral drugs are excreted through the kidney, and the half-life of colchicine in patients with severe renal failure is 2 ~ 3 times that in patients with normal renal function. At the same time, colchicine can not be removed by dialysis, so its toxicity is aggravated in CKD patients.
The surgical indications of tophi mainly involve the following aspects:
(1) tophi leads to limb deformity and dysfunction, which affects daily life;
(2) pressing the skin, which has formed or is about to appear skin ulceration;
(3) Sinus formation, chalky substance exudation or infection in different degrees;
(4) joint movement disorder and nerve compression symptoms.
Diameter of tophus: 1.5 cm. Surgery should be performed as soon as possible.
Most gout patients can control the development of the disease through drugs, but a few patients have poor or even ineffective efficacy after drug treatment. Uric acid crystals are deposited on joints and tendons, gradually forming gout stones. 12%- 15% of gout patients have tophi. Finally, the superficial skin ruptures, forming ulcers or sinuses. Studies have shown that the incidence of gout wound nonunion is as high as 23%, and the dressing change time can reach 6 ~ 8 weeks. The average healing time is as long as 4 months, which has great influence on the daily life, psychology and limb function of patients.
If the control of uric acid in gout patients is not ideal, acute gout will recur, which is not conducive to wound healing. Gout wounds often last for a long time because of poor blood supply and weak cell regeneration ability. [10] The basic conditions of this group of patients were poor when they were admitted to hospital, and they often had different degrees of infection, with obvious inflammation such as redness, swelling, heat and pain in some areas. Before the operation, the wound should be changed daily. According to the results of drug sensitivity test, sensitive antibiotics were used to wet compress the wound and red light therapeutic instrument was used for physical therapy. If necessary, combined with a simple negative pressure drainage device with low medical cost, the wound foundation can be improved.
prevent
Although the influence of dietary factors on gout has been confirmed by a large number of studies, it is found that the awareness rate of gout patients and doctors about gout diet knowledge is only 22% and 37.2% respectively. The following are specific suggestions related to diet:
First, encourage the intake of soy products.
Soybean food is rich in protein, soybean isoflavones and polyunsaturated fatty acids. Six epidemiological surveys show that soybean food intake has nothing to do with blood uric acid level, hyperuricemia and gout; Five intervention experiments found that although soybean protein increased the serum uric acid level, compared with the intake of Asians, the clinical impact of the increase in serum uric acid level was negligible. A recent study in China found that the level of serum uric acid decreased significantly after giving patients with hyperuricemia a high-protein diet of beans for 3 months.
Second, encourage the intake of low-fat milk and yogurt.
A study confirmed that both short-term and long-term intake of dairy products, especially skim milk and low-calorie yogurt, will reduce uric acid levels. In addition, glycomacropeptide and G600 in milk have anti-inflammatory effects, which may reduce the acute attack of gout by reducing the inflammatory reaction of monosodium urate in joints.
Third, encourage the consumption of fruits and vegetables.
Dietary surveys in China and South Korea found that eating vegetables and fruits rich in purine did not increase serum uric acid levels. Vegetables-based diet can reduce uric acid level, even if spinach is eaten, the same effect is observed. Anthocyanins contained in cherries have the effects of reducing uric acid, anti-inflammatory and anti-oxidation, and can prevent gout.
Fourth, limit the total intake of protein.
Fifth, limit sugary drinks.
Emphasize to gout patients not to drink or drink less sugary drinks, and not to eat or eat less packaged foods such as cakes, desserts and cold drinks. And pay attention to adding as little sugar as possible when cooking to reduce the intake of fructose-rich fruits; At the same time, vigorously publicize the health hazards of excessive intake of sugar products to the society.