The second is to discuss with the doctor when to start using uric acid-lowering drugs. The prognosis is good as long as you receive patient treatment from specialists for a long time. Don't worry even if gout attacks. At present, there are very effective drugs to treat gout. The key is to insist on regular treatment and follow-up, and never be superstitious about "doctors" on telephone poles.
Gout is a relatively easy disease to treat, but it is based on the guidance and reasonable treatment of specialists. If misdiagnosed for a long time or the treatment is not standardized, it may develop into chronic gouty arthritis, widespread formation of tophi, joint deformity and dysfunction, gouty nephropathy, renal insufficiency, urinary calculi and so on. In the late stage of the disease, the best period of gout treatment is often lost, and the difficulty of cure will be greatly increased, and sometimes even the clinical symptoms are difficult to control. However, if reasonable treatment is carried out in the early stage, people can generally get a good recovery and rarely have serious complications. Serious complications of gout rarely occur in developed countries, but huge tophi is still very common in China, and even disability may occur. There is no other explanation for this situation except misdiagnosis and irregular treatment, which also makes our specialists feel sad.
2. What are the general principles and purposes of treating gout?
The general principles of gout treatment are: reasonable diet control, adequate water intake, regular living system, effective drug treatment and regular follow-up.
The purpose of gout treatment is (1) to reduce uric acid synthesis, promote uric acid excretion and correct hyperuricemia. (2) Prevent acute gout attacks and minimize the number of attacks. (3) Prevention and treatment of tophus, gouty nephropathy and gouty urinary calculi. (4) Prevention and treatment of gout-related diseases, including hypertension, hyperlipidemia, diabetes, obesity, arteriosclerosis and coronary heart disease. (5) Scientific health guidance to improve the quality of life.
3. What are the main aspects of gout treatment?
The treatment of gout should be individualized and phased, and the treatment methods of gout in different stages are also different, including:
(1) general treatment: alcohol consumption must be restricted,
Especially beer and wine. A diet low in purine and fat should be adopted. Drink plenty of water to increase urine volume and promote uric acid excretion. Soda tablets can be used to alkalize urine. Exercise properly to avoid overweight and obesity.
(2) Treatment of initial arthritis attack: When gout attacks, the purpose of treatment is to control the attack. So pain relief is the main thing. Measures that can be taken include stopping the movement of the affected joints and taking anti-gout drugs recommended by doctors. The onset of gout can be controlled within 24 hours at the earliest, and generally not more than 2 weeks at the latest. However, it is difficult to treat patients with extensive tophi. Medication can be used when there are signs of arthritis, and drugs that can quickly control inflammation can be used when gouty arthritis occurs, including non-steroidal anti-inflammatory drugs (including Yingtaiqing, Fenbid, Ruizhili, Dai Fen, etc. ), colchicine and prednisone. For example, take 0.5 mg ~ 1 mg colchicine or 1 ~ 2 tablets of non-steroidal anti-inflammatory drugs. If arthritis is severe, the dosage can be increased appropriately. If you enter the recovery period, you can reduce it to a small dose. Stop taking painkillers after the onset of arthritis is completely controlled.
(3) Initial treatment to control uric acid: It takes about 3 to 6 months. After gouty arthritis subsides, it enters an intermittent period, and hyperuricemia should be controlled at this time. However, in order to prevent the onset of metastatic gouty arthritis induced by the sudden drop of serum uric acid in the early stage of treatment, a small dose should be used first, and then gradually increased to a sufficient amount, and then the serum uric acid should be reduced to the maintenance amount after reaching the ideal level.
(4) lifelong treatment to control uric acid: control uric acid after 6 months of initial treatment. Because hyperuricemia generally does not decline without drug treatment, only taking it can keep blood uric acid at a normal level, so in this sense, lifelong treatment is needed. However, with the extension of treatment time, the uric acid pool in the body will continue to decrease. At this time, the dosage of drugs needs to be guided by a specialist.
(5) Treatment of chronic arthritis and tophi: Most patients who enter the chronic stage are caused by not getting early treatment or irregular treatment. The treatment effect is relatively poor. The treatment principle is still to avoid the recurrence of arthritis and protect joint function.
(6) Treatment of gouty nephropathy and gouty urinary calculi: Controlling hyperuricemia is the key, avoiding unfavorable factors harmful to kidneys, preventing and treating urinary tract infections, and treating complications such as hypertension, arteriosclerosis and diabetes.
4. Is diet control important? Can it be used as the main treatment?
In the medical field, there is no doubt that gout diet control is the basic treatment of gout. The theoretical basis of diet control is to reduce the intake of purine in the diet, which can reduce the load of purine in the body and is conducive to the reduction of serum uric acid. Strict diet control can reduce blood uric acid by about 60unol/L, and the 24-hour urinary acid excretion can be reduced by about 1/4. It can be seen that diet control can reduce blood uric acid to varying degrees. But it can't be used as the main treatment for gout. Because the increase of serum uric acid is mainly due to endogenous overproduction, uric acid produced by exogenous food only accounts for a small part. The total amount of purine consumed by a normal person every day is about 150 mg ~ 200 mg, while the total amount of purine produced by metabolism in the body is about 600 mg ~ 700 mg, far exceeding the sources in food. In most cases, diet control can not completely correct hyperuricemia. Clinically, it is impossible and unnecessary to tell patients to eat something without purine. Generally speaking, diet control can only be used as adjuvant therapy.
Diet control is not as effective as medication. The answer is no, because long-term high purine diet will make the existing hyperuricemia more serious, which will aggravate and promote the progress of gout. In addition, if overeating can make the blood uric acid suddenly rise in a short time, this obvious fluctuation of blood uric acid in a short time is one of the main reasons for the acute attack of gouty arthritis. Therefore, proper diet control is reasonable and necessary. It is more appropriate to take uric acid-lowering drugs under moderate diet control.
What we encounter is that patients have different attitudes towards diet control. Some people's excessive diet control leads to nutritional imbalance, which in turn aggravates gout. Some people have no scruples about diet. They eat meat and drink. Results Gout progressed rapidly. The author thinks that we should give different diet control according to different situations. For example, when gout attacks, the diet should be strictly controlled. If uric acid is reduced for a long time, blood uric acid can always be maintained at an ideal level, and diet control need not be too strict. Of course, it is best to have the guidance of a nutritionist or a specialist.
5. What should gout patients pay attention to when drinking water?
In order to increase urine output and promote uric acid excretion, gout patients need to drink more water. Proper drinking water can also reduce blood viscosity, which is beneficial to prevent gout complications (such as cardiovascular and cerebrovascular diseases). But we should pay attention to scientific drinking water and reasonable drinking water. The following points are for reference:
(1) Drinking habits: To develop drinking habits, insist on drinking a certain amount of water every day, instead of not drinking at ordinary times and binge drinking temporarily.
(2) Drinking time: Do not drink a lot of water within half an hour before meals and immediately after satiety, which will dilute digestive juice and stomach acid, affect appetite and hinder digestive function. The best time to drink water is between meals and in the evening and early morning. Evening means 45 minutes after dinner to bedtime, and early morning means 30 minutes before breakfast.
(3) Drink water to quench thirst: The habit of ordinary people is to drink water when they are thirsty. Gout patients should take the initiative to drink water, and can't wait for thirst before drinking water, because when thirst is obvious, the body is already in a state of water shortage. At this time, the effect of drinking water on promoting uric acid excretion is poor.
(4) Drinking tea: Many people in China usually like drinking tea. Gout patients can drink tea instead of boiled water, but tea contains tannic acid, which is easy to combine with iron in food to form insoluble precipitate, which affects the absorption of iron. In addition, tannic acid in tea can combine with some protein to form tannic acid protein, which is difficult to absorb. Therefore, if you drink tea immediately after a meal, it will affect the absorption of nutrients and easily cause iron deficiency anemia. A better way is to start drinking tea after meals 1 hour, and light tea is appropriate.
6. Is physical activity beneficial to gout patients? How to choose an exercise method?
Gout patients can exercise properly. Most gout patients have obesity, overweight, hypertension, hyperlipidemia, arteriosclerosis and so on. Many patients are over 50 years old, and their cardiovascular function is not very sound. Therefore, they should take part in proper sports activities to strengthen their physique and improve their cardiovascular function. Physical exercise is also conducive to maintaining an ideal weight and preventing obesity. Therefore, it should be used as a beneficial adjuvant treatment for gout.
Exercise can be divided into anaerobic exercise and aerobic exercise. Anaerobic exercise is mainly strenuous exercise and cannot last for a long time. It can't consume a lot of heat energy as imagined. Mainly consumes sugar, almost no fat. Aerobic exercise is an exercise that effectively inhales and utilizes oxygen and generates heat through breathing during exercise. Aerobic exercise is characterized by long duration, which can enhance endurance, consume excess fat and not accumulate fatigue.
At present, there is no special exercise to reduce blood uric acid value and prevent gout attack, and only several exercises that can lose weight and enhance general endurance can be recommended. Gout is suitable for aerobic exercise, not anaerobic exercise. Specific methods such as: walking, brisk walking, jogging, aerobics, fitness dance, cycling, swimming and so on.
7. I am being treated with drugs to reduce uric acid. Why is there an arthritis attack?
This is the problem of metastatic arthritis. The serum uric acid level drops sharply at the initial stage of treatment with uric acid reducing drugs, which can release insoluble needle-like sodium urate from joint tissues and significantly increase the concentration of uric acid in joint cavity, thus stimulating inflammatory reaction.
Generally speaking, it takes 1 ~ 3 months to balance the concentration of uric acid inside and outside the joint. After this balance is basically established, arthritis rarely occurs again after continuing to use uric acid-lowering drugs. At the initial stage of treatment with uric acid-lowering drugs, many patients mistakenly thought that uric acid-lowering drugs were ineffective because of acute arthritis, and even suspected or denied the diagnosis of gout and stopped treatment, thus delaying their illness.
8. When blood uric acid drops to normal, can I stop using uric acid-lowering drugs?
After the first attack of gout, if it is not treated, the following situations will occur: First, it will occur frequently in the future and the condition will get worse and worse. Second, although there are seizures in the future, they are not very frequent. Third, it rarely happens again. The first two cases are more common, accounting for the vast majority. In addition, the onset of arthritis is not consistent with visceral injury. Sometimes arthritis is mild, but visceral injury may be serious. Therefore, as long as hyperuricemia exists, we must adhere to the treatment of reducing uric acid. For primary gout, because the cause is unknown, it is difficult to remove the cause of elevated blood uric acid, which can be said to exist for life. As long as the uric acid-lowering drugs are stopped, the blood uric acid of most patients will rise again, which is very unfavorable for completely controlling the disease. The reasonable measure is to continue to take the maintenance dose of uric acid-lowering drugs after the blood uric acid drops to normal. It is also necessary to regularly check blood uric acid and pay attention to whether there is renal damage and urinary calculi, because gout renal damage is often unconscious and easy to be ignored, and it is too late to develop into renal failure.
9. Can colchicine prevent acute attack of gouty arthritis?
There are two different views on this issue. First, taking a small dose of colchicine (0.5mg ~ 1mg/ day) can prevent the onset of gouty arthritis, and second, it can't effectively prevent the onset of gouty acute arthritis. The authors believe that colchicine can prevent the onset of metastatic arthritis in the early stage of uric acid-lowering drug treatment, and the maximum use time is 1 ~ 2 months. In addition, the advantages of colchicine in preventing acute gouty arthritis outweigh the disadvantages. Colchicine must be used under the guidance of experts.
10, gouty arthritis attack, do you need local treatment?
The attack of gout is an acute inflammation induced by phagocytosis of urate microcrystals by white blood cells. External acupuncture, local cold compress and hot compress are not helpful to control gouty arthritis, but external ointment with anti-inflammatory and analgesic effects is helpful to control inflammation, especially suitable for those who are not suitable for oral drugs or have contraindications to oral drugs.
It is not advisable for folk doctors to use acupuncture to break tophi to squeeze out urate crystals. Because the treatment of tophi is expected to use uric acid-lowering drugs to make tophi subside and then form a package, but it will take a long time. If the package has been formed, it needs to be taken out surgically. Because the deposition of uric acid crystals is diffuse, the method of squeezing uric acid crystals by needling the skin can not completely remove tophi.
1 1. What should I do after the tophus is broken?
If tophus is not treated properly, it is difficult to heal and bacterial infection is prone to occur. Treatment measures include: (1) keeping the local wound clean, cleaning the wound with normal saline and disinfectant every day, and removing urate in the nodule as much as possible, which can accelerate the wound healing. (2) The tophi has a large rupture range and a long rupture time, so it is difficult to heal itself and needs surgical removal. (3) If you have complicated infection, fever and leukocytosis, you should be admitted to hospital in time to avoid delaying the illness and causing adverse consequences. For those who have pus locally, take it for bacterial culture and drug sensitivity test to guide the selection of antibiotics.
12. Can gouty kidney calculi be treated with laser lithotripsy?
Laser lithotripsy has the advantages of little damage, no pain, simplicity and economy. As long as the case is chosen properly, the effect is very good. The indications of laser lithotripsy are: (1) The diameter of the stone is less than 20mm, and the oversized stone is not fragile. (2) The most suitable number of stones is a single stone. Too many stones and too many lasers can easily cause kidney damage. (3) Renal function should be normal.
13. How can gout patients detect and adjust the pH of urine?
The simple way to know the pH of urine is to use pH test paper, and you can choose pH precision test paper 5.0 ~ 7.0, which is produced by Shanghai Third Reagent Factory. The pH values of standard bands are below 5.4, 5.4, 5.8, 6.2, 6.4, 6.7, 7.0 and above 7.0 respectively. Usage: put a small amount of urine into a test tube or other utensils, and then take the test paper and immerse it in the solution to be tested. Take it out after half a second and compare it with the standard color plate to get the pH value. Generally, it is more appropriate to control it between 6.2 and 6.8. If the urine is acidic, you can take drugs to alkalize the urine orally. Commonly used are baking soda tablets and 10% potassium citrate solution. Start with a small dose and adjust the dose according to the pH of urine.
14. Can drugs promoting uric acid excretion make kidney calculi disappear and dissolve?
The main function of uric acid excretion promoting drugs is to promote renal excretion of uric acid and increase uric acid content in urine. Therefore, it is unfavorable for patients with gouty nephropathy and gouty kidney calculi. Taking drugs to promote uric acid excretion often requires alkalizing urine and drinking more water to increase the solubility of uric acid in urine. If there is urinary tract obstruction, hydronephrosis, or urine volume is reduced due to insufficient drinking water, and the urine is acidic, drugs that promote uric acid excretion will help to form kidney calculi and aggravate gouty nephropathy. Therefore, the use of drugs to promote uric acid excretion requires a prerequisite, that is, the patient's renal function must be normal. If there are three kinds of renal dysfunction, it is not appropriate to use drugs to promote uric acid excretion: (1) Patients have azotemia; (2) The creatinine clearance rate is lower than 30ml/min; (3) The glomerular filtration rate is less than 20ml/min. In this case, allopurinol can only be used as the main treatment.
15. How can gout patients prevent kidney damage?
The most easily damaged internal organs of gout patients are kidneys, which can lead to uremia and even death in severe cases. Therefore, it is very important to take active and effective measures to protect the kidney. The specific methods mainly include: (1) controlling hyperuricemia. (2) Actively prevent and treat urinary system infections. (3) Patients with hypertension should control their blood pressure at a normal level. (4) Avoid using drugs and contrast agents that are harmful to the kidneys.
16, what are the indicators to judge whether gout treatment is effective?
After active comprehensive treatment, if the following indicators can be achieved, the treatment effect is good. (1) Gouty arthritis stopped and joint function and morphology remained normal. (2) No tophi and urinary calculi. (3) Common complications (hypertension, hyperlipidemia, obesity, diabetes, arteriosclerosis and coronary heart disease) can be effectively controlled. (2) Serum uric acid is stable in the normal range for a long time (preferably below 360umol/L), urine routine and renal function are normal, and combined X-ray examination is normal.
17, how to prevent gout attacks?
After suffering from gout, measures should be taken to actively prevent gout recurrence. The specific methods are as follows: (1) First, we should control our diet, avoid eating a lot of high-purity food, strictly abstain from alcohol and drink more alkaline drinks. (2) Drink plenty of water to help uric acid excretion. (3) prevent obesity. (4) Keep cheerful and avoid inducing factors such as overwork, mental stress, cold and humidity, and joint injury. (5) It is not advisable to use drugs that inhibit uric acid excretion, such as dihydrogram urine plug and furosemide. (6) Take medicine to reduce serum uric acid and actively prevent and treat complications. (7) Regular follow-up, regular review of blood uric acid. (8) The prevention of secondary gout is mainly to actively treat primary diseases such as leukemia, multiple myeloma and chronic kidney disease.
18, penicillin and other antibiotics are effective in treating gout?
Penicillin or other antibiotics have no therapeutic effect on gout, but why do many patients have effective experience? This is because early gout attacks are often self-limited. Early gout attacks will be relieved within a few days even if they are not treated, which can easily be mistaken for the efficacy of antibiotics. Actually, this is just a coincidence. With the extension of gout attack time, penicillin is no longer "effective". However, if there is gout stone rupture complicated with infection, antibiotics can be used as appropriate, which is different from the treatment of acute gouty arthritis. When choosing antibiotics, gout patients should try to choose preparations that have no side effects on the kidneys.
19, can Chinese medicine treat gout?
Chinese medicine's understanding of gout as a disease is only a recent thing. According to the author's statistics, hundreds of scholars have reported the traditional Chinese medicine prescription for treating gout in recent ten years, but this prescription lacks prospective research and purification of effective components without exception. This empirical medication is undoubtedly difficult to be widely recognized by modern medical circles and patients. I also hope that Chinese medicine can make a breakthrough in the treatment of gout, so that it can go to the international market. Unfortunately, so far, there is no pure Chinese medicine with intellectual property rights that can be used to treat gout. We have noticed that some scholars have done some useful work in treating gout with traditional Chinese medicine, such as pharmacological research and animal experiments, but further large-scale clinical research is unknown. Encouragingly, in recent years, Tongfengling, a Yi medicine in Guizhou Plateau, has been approved for formal production and can be used for clinical selection, which shows the potential development value of traditional Chinese medicine in treating gout. We also have a series of traditional Chinese medicine decoction for treating gout for clinical application, and are doing some basic research work. At present, no matter Chinese medicine or western medicine, there is no internationally recognized standard for curing gout, so gout cannot be cured. In fact, the pursuit of the so-called "cure" is worthless. Is gout cured if it doesn't attack or never attacks for three years? From the pathogenesis, it is a worldwide problem that children should be cured only if the purine metabolic disorder is completely corrected, or if the polygenic genetic defect is corrected from the genetic point of view. No one in the medical field can say that gout has been completely conquered, and advertisements, newspaper reports and individual doctors' promises are not really countable cure standards.
In addition, it is also common for tabloids to publicize the "secret recipe of Chinese medicine", and the author has also encountered many cases. Most of these "secret recipes handed down from ancestors" are the "fruits" of inventors' personal study of ancient books and trial use of herbs, and the reliability of their curative effects is very doubtful, so it is difficult to stand the scientific test. In order to make up for this deficiency, propaganda had to be "filled with water", and the result spread more and more "God". What's more, grinding hormone western medicine into powder and adding it to Chinese medicine has become a "folk prescription" and a "secret recipe", claiming that pure Chinese medicine does not contain hormones to deceive patients. Results Long-term drug use caused dependence. Once the drug was stopped, symptoms worsened, weight increased and facial fat appeared. Therefore, this "secret recipe from the ancestors" is not credible and can't be eaten any more.
20. What is the prognosis of gout patients?
The prognosis of gout patients is generally optimistic. As long as there is no obvious renal dysfunction, no serious complications, no obvious joint injury and deformity, gout patients can live a normal life and have a good prognosis. Even if there are multiple subcutaneous tophi, as long as it does not develop, it will not have much adverse effect on the prognosis. However, the prognosis is not good if:
(1) The therapeutic effect of uric acid-lowering drugs is not ideal, or uric acid-lowering drugs cannot be used due to adverse reactions, and hyperuricemia cannot be effectively controlled.
(2) Gouty arthritis occurs frequently, with 5-6 episodes over a year.
(3) There are more and more tophus stones, some of which are broken.
(4) Patients with severe gouty nephropathy, renal insufficiency and bilateral extensive gouty kidney calculi.
(5) Patients with various complications, such as cardiovascular and cerebrovascular diseases (cerebral arteriosclerosis, stroke and coronary heart disease). ) and other metabolic disorders such as obesity, hyperlipidemia and diabetes. )
Gout patients are generally not life-threatening, but may die if:
(1) Gouty nephropathy develops into uremia.
(2) Sepsis or septicemia caused by the rupture of tophus.
(3) Gouty kidney calculi, bladder stones, hydronephrosis, etc. Cause intractable urinary system infection, especially nephritis.
(4) those with serious complications.