Of course, for parents, the more concerned question is: Should adolescent gout be treated? In fact, both clinicians and parents and friends have always had different views on this issue. Dr. Liu summarized these opinions, mainly including the following points:
In fact, based on the consideration of drug safety, Dr. Liu usually does not recommend the use of uric acid-lowering drugs for adolescent gout patients; However, some parents think that doctors are unreliable and will use drugs to lower uric acid for their children. There are also cautious parents who are afraid of the adverse reactions of drugs and the side effects of long-term use, so that children's hyperuricemia and gout are ignored. Dr. Liu believes that these ideas have some truth, but they are not sufficient. Today, we will talk about whether adolescent gout should be treated and how to treat it from the experience of a small patient.
It was the mother who brought the child to see the doctor. The child is 13 years old today, and has just entered junior high school. He is 157 cm tall and weighs 85 kg. Children like playing basketball, but they haven't even touched it in the last month.
One night a few months ago, the child suddenly had a sore toe and a little fever. Mother usually cares about her son, so she said she would take her son to the hospital for examination. My father looked indifferent: "Why go to the hospital when you have nothing to do?"? Maybe you sprained your ankle playing basketball. "
The mother believed half of her father's words, looked it up on the Internet and asked about her son. She thinks it's not like a foot injury, but more like growing pain, because I heard that growing pain can also cause low fever. It's not that the mother didn't treat her child, but gave her some antipyretics.
However, the child's foot pain has continued, and it has been intermittent pain for several months. The mother thinks that the child has really reached the stage of long body, and the pain of growth will probably last for some time; She believes that the child's health will be good after a while and should grow taller.
But what parents didn't expect was that instead of relieving their son's foot pain, they often called their parents in pain. When a father thinks of his father, that is, the grandfather of the child, it often hurts like this; Be diagnosed with gout. The father panicked and quickly took the child to the rheumatology immunology department of the hospital to see a doctor.
When I came to see a doctor, my mother was worried, but my child was stubborn. When checking uric acid, the blood uric acid is as high as 793 μ mol/L; There is indeed urate crystal deposition at the painful joint. Acute gout attacks in adolescents and children are different from those in adults: they often lack the typical manifestations of gouty arthritis. If an acute gout attack occurs, accompanied by redness, swelling, heat and pain, it often lasts for a long time.
The child's grandfather is a direct relative, and his grandfather has gout, so the probability of his grandson suffering from gout will be higher, because gout has a certain relationship with genetic inheritance, and the onset age will be earlier. However, genetic inheritance does not mean that children will definitely have gout. Some children have no history of gout in their families, and their parents are not hyperuricemia patients. Children are not allowed to eat hot pot and barbecue. And the child will still have gout.
Among the gout patients treated by Dr. Liu, the number of adolescent gout patients treated in 2020 doubled compared with 20 19, and the onset age was also advanced. /kloc-It is not uncommon for children under 0/3 to come to see a doctor under the guidance of their parents. Among adolescent gout patients, as mentioned above, there are not many children with family history of gout, but most of the children diagnosed with gout have obvious symptoms: blood uric acid is mostly higher than 540μmol/L, and gout attacks twice.
After gouty arthritis is usually diagnosed, we need to find out the causes of gouty arthritis in adolescents and adults. Generally speaking, gout in children has the following characteristics:
①30% had family history, and the positive rate was high; ② The serum uric acid level is higher than that of adults; ③24-hour uric acid excretion increased, mainly hyperuricemia with increased uric acid production; ④ 50% of patients are accompanied by gouty kidney or uric acid kidney calculi, which is prone to urinary system infection. ⑤ After the onset of gouty arthritis, the pain is severe, the attacks are frequent, the interval is short, and even the attacks continue.
Among adolescent gout patients, some children are picky eaters, do not like vegetables, and like hamburgers and fried chicken; Some children love snacks and drinks; Some children are overweight. In other words, the main causes of gout in children are: part of it is family genetic tendency; Some people have an unhealthy lifestyle and unbalanced nutrition since childhood; Partial lack of exercise leads to obesity; Or both.
Bad diet and living habits are the main causes of gout in adolescents. So do you need treatment? Since we can find out the cause, why not treat it promptly and effectively? By "timely", we mean to prevent young gout patients from recurring acute gouty arthritis due to high uric acid concentration, which will last for a long time, thus leading to gouty stones and gouty nephropathy in their twenties.
The inducement of adolescent gout mentioned by Dr. Liu is also because of unhealthy lifestyle, which not only leads to high levels of gout and serum uric acid, but also usually causes other metabolic disorders, such as hypertension, hyperlipidemia, fatty liver and diabetes. For example, glycogen storage disease, because congenital defects can not decompose glycogen, so uric acid will be born too much and higher and higher.
Even if some adolescent gout patients only have symptoms of gout attack and no other metabolic abnormalities, the risk of cardiovascular and cerebrovascular diseases such as type 2 diabetes, hypertension, coronary heart disease and stroke will be much higher for these children who have suffered from gout in adulthood.
Don't think that the cause of adolescent gout analyzed by Dr. Liu above is alarmist. In fact, my opinion is that most of the causes of gout in adolescents are caused by unhealthy lifestyles. So, should adolescent gout be treated? How to treat it? Let's look down again.
Some parents will have questions: "Dr. Liu, you don't recommend the use of uric acid-lowering drugs for ordinary gout patients. How can you reduce uric acid?" My suggestions are: first, cultivate children's healthy eating habits, especially parents to set a good example for their children; It is suggested that young patients should strictly control their diet, strengthen exercise and stick to it.
For adolescent gout, Dr. Liu does not recommend using uric acid-lowering drugs at the beginning, but adopting "non-drug treatment", and should pay attention to lifestyle intervention and remodeling, and adjust diet and exercise patterns; Especially the obese or overweight adolescent gout patients need weight intervention and scientific weight loss.
In fact, if adolescent gout is actively treated under the reasonable and standardized lifestyle adjustment, it can still reduce the pain degree and frequency of acute gout attack, and can also avoid other gout stones, gout kidneys and metabolic diseases caused by long-term hyperuricemia. When you think about your child, please don't rush to take drugs to reduce uric acid, see if your child's lifestyle is healthy, learn to adjust bit by bit, and don't rush for success.