“The pain is excruciating, coming and going like wind,” is how someone describes gout. Studies have shown that gout, once considered a “senile disease”, is now plaguing more and more young people. What is gout? What are the causes of gout attacks? How to prevent, relieve and treat gout? Meng Juan, chief physician of the Rheumatology and Immunology Department of Beijing Chaoyang Hospital, gave a detailed answer.
Excessive uric acid, gout and arthritis “uninvited”
17-year-old Liangliang was carefully pushed into the rheumatology and immunology department of the hospital by her parents in a wheelchair.
“This is the youngest gout patient I have ever treated, only 17 years old.” Meng Juan said that Liangliang was a sophomore in high school. After the winter vacation, he had a hot pot dinner with his classmates. At night, he suddenly suffered from severe pain in his toes and could not stop eating. Pain medication had little effect, and he was eventually diagnosed with gout.
The examination found that Liangliang was 1.85 meters tall, weighed 105 kilograms, and had a body mass index (BMI) of more than 30, making him obese. His blood uric acid value was far beyond the normal level. “Parents said that Liangliang usually eats more meat, does less exercise, drinks drinks like water, and likes to stay up late.” Meng Juan said that due to the intense study in the second year of high school, Liangliang’s parents often stewed meat soup to replenish his body. Little did they know that this would On the contrary, it increased the level of blood uric acid in the blood. Under the long-term effect of various factors, it eventually led to gout.
The “2021 White Paper on High Uric Acid and Gout Trends in China” shows that the number of people suffering from hyperuricemia in my country is about 177 million, of which about 14.66 million are gout patients, and they have shown an obvious trend of getting younger in recent years.
“The youngest gout patient reported in domestic literature is only 11 years old. In clinical practice, adolescent gout patients like Liangliang are not uncommon.” Meng Juan found that gout in young people is often related to bad living habits, such as liking seafood and Eating meat and other high-purine non-vegetarian foods, loving to drink beverages, smoking, irregular work and rest schedule, obesity, etc.
“Gout is a metabolic rheumatism caused by abnormal purine metabolism leading to an increase in blood uric acid and the deposition of uric acid crystals in the joints.” Meng Juan said that typical gout often attacks at night and has a sudden onset. Patients often have a sudden onset. Or severe pain in multiple joints, redness, swelling, heat and pain in the first metatarsophalangeal joint (big toe), ankle joint, etc. are more common. Generally, gout symptoms usually resolve on their own within a few days or 2 weeks. If the disease worsens or relapses without active treatment, it may cause diseased joint deformities and gradual limitation of joint movement. In severe cases, renal function damage may occur, often accompanied by hyperlipidemia, hypertension, diabetes, coronary heart disease, etc.
Meng Juan introduced that hyperuricemia is the basis and most direct cause of gout. Fasting blood uric acid is measured twice on different days. If the blood uric acid in men and postmenopausal women is >420 micromol/L, and the blood uric acid in premenopausal women is >360 micromol/L, it is called hyperuricemia. About 1/3 of patients with hyperuricemia will develop gout, and about 2/3 of people may remain asymptomatic. However, hyperuricemia can affect various organs in the body and cause various serious complications. Therefore, regardless of With or without gout, as long as the blood uric acid level reaches a certain level, lifestyle adjustments and/or uric acid-lowering treatment should be actively carried out.
“Preferring” men, “deep pain” can be prevented and cured
“A gout attack has a ‘level ten’ pain, it’s really painful.” “It’s like ants gnawing at the seams of bones.” “Every attack makes me cry.” When it comes to gout, many “sufferers” describe it like this. Severe pain when it attacks.
“Severe joint pain is a typical manifestation of gout. We often hear gout patients saying, ‘Who knows the pain?'” Meng Juan said that in China, the incidence and awareness rates of gout are generally high, but the treatment and control rates are It is relatively low, which is related to people’s lack of understanding of gout.
Meng Juan introduced that according to the natural course of gout, it can be divided into asymptomatic hyperuricemia stage, acute attack stage, inter-attack stage and chronic tophi stage. The asymptomatic hyperuricemia stage is in the preclinical stage and is often insidious. It is generally difficult to detect elevated uric acid levels without a blood uric acid test. In the clinical stage, some patients’ gouty nephropathy is also relatively insidious, often with increased nocturia. , hematuria or uric acid kidney stones (such as difficulty urinating, renal colic, etc.).
“If elevated uric acid is detected early, such as in the preclinical stage, it can be reversed by adjusting lifestyle, receiving treatment, etc.; gouty arthritis is also currently considered a curable joint disease.” Meng Juan emphasized that the key is to control blood circulation If uric acid reaches the target for a long time, the number of gout attacks in patients will be reduced or even no more.
What are the risk factors for gout? “Risk factors for gout include obesity, alcohol consumption, high blood pressure, high blood sugar, regular use of drugs that affect uric acid metabolism, preference for eating purine-rich foods, drinking sugary drinks as water, etc.” Meng Juan said that people who are overweight More “preferred” by gout. Clinical studies have found that obesity is an independent risk factor for gout attacks and is closely related to the occurrence of gout.
Generally speaking, men over 40 years old are the most common group affected by gout. It should be noted that people with a family history of gout or gout family aggregation will have gout onset earlier and with more severe symptoms. Meng Juan said that if one parent suffers from gout, 40% to 50% of their children will suffer from gout due to the same lifestyle. “For example, Liangliang’s father is a gout patient, and it is easy for Liangliang to copy his father’s lifestyle.” , leading to an increased risk of gout.”
Epidemiological surveys show that the male-to-female ratio of gout patients in my country is about 15:1, showing an obvious “son preference” phenomenon. Why does gout “prefer” men more?
Meng Juan introduced that both men and women secrete hormones in their bodies. Men mainly produce male hormones, while women produce more estrogen. Androgens inhibit the excretion of uric acid by the kidneys, causing the content of uric acid in the body to increase, thereby accelerating the formation and deposition of uric acid crystals; estrogen does the opposite, promoting the excretion of uric acid and inhibiting the excretion of urate. Formation, relatively speaking, the risk of gout is reduced. The incidence of gout in postmenopausal women is similar to that in men, which is caused by the decrease in estrogen.
Keep your mouth shut, open your legs, control your weight, and drink more water
“Doctor Meng, do you still know me?”
A few years ago, Meng Juan treated a young gout patient, Xiao Fei. When she saw him again, it was difficult for Meng Juan to connect the energetic and confident young man in front of her with the man who came to see a doctor on crutches half a year ago.
Xiaofei is a pastry chef in a Western restaurant. He came to the outpatient clinic for consultation because he found elevated blood uric acid during a physical examination. “At that time, he was 1.75 meters tall and weighed 100 kilograms. He was also obese, and his blood uric acid reached 650 micromol/L. After understanding his medical history, living habits, etc., and considering that this was his first attack of gout, I suggested that he First, change your lifestyle, control your weight, and review regularly. The young man was very cooperative. Half a year later, his weight has dropped to 82 kilograms, and the review found that the blood uric acid level has also reached the standard.” Meng Juan said that Xiao Fei’s mental outlook has changed a lot since he lost weight. Big change, “I feel like I have become more handsome.”
Meng Juan reminded that in daily life, attention should be paid to regular physical examinations, early detection of hyperuricemia, control of asymptomatic hyperuricemia, and removal of high-risk factors. If you experience redness, swelling, heat and pain in your big toe or ankle joint, especially after eating a high-purine diet, be alert to a gout attack and seek medical attention promptly.
“Developing good habits can effectively help stay away from gout. I often tell patients a jingle: keep your mouth shut, open your legs, control your weight, and drink more water.” Meng Juan emphasized that controlling blood uric acid levels is the key to preventing the worsening of gout. The key is to treat it by taking uric acid-lowering drugs and adjusting your lifestyle. Uric acid-lowering drugs require doctors to decide on individual circumstances. In terms of lifestyle adjustments, the following measures can be taken –
Diet adjustment: Limit the intake of high-purine foods, such as animal offal, seafood, especially shellfish, and eat more low-purine foods such as fruits, vegetables, and whole grains. Cooking methods such as making thick soups and hot pots can significantly increase uric acid. Gout patients should try to avoid such cooking methods.
Moderate exercise: Moderate aerobic exercise can help reduce uric acid levels in the body, but it should not be excessive or strenuous exercise. It is recommended to do moderate aerobic exercise regularly, such as walking, swimming, cycling, etc. When gout attacks, you should stop exercising and take a good rest to avoid aggravation of gout.
Maintain a healthy weight: People with obesity need to lose weight and maintain a healthy weight to reduce the risk of gout attacks.
Limit alcohol consumption: The more alcohol you consume, the greater your risk of gout attacks. Beer and spirits (such as white wine, foreign wine, and rice wine) can increase the risk of gout attacks, so drinking should be limited or abstained from.
Drink enough water: Drinking more water can promote the excretion of uric acid, thereby reducing blood uric acid levels. The Dietary Guidelines recommend that adults should drink around 1,500-1,700 milliliters of water per day, which can be increased or decreased appropriately based on the actual situation. If you have hyperuricemia, it is recommended that you drink more than 2000 ml of water every day.
Avoid excessive fatigue and excessive mental stress: Excessive fatigue and excessive mental stress may lead to gout attacks, so pay attention to regulating your emotions and maintaining adequate rest.
Common misunderstandings about gout
Question 1: Does gout require treatment only when the joints are painful, but not when the joints are not painful?
Answer: No. If you no longer adhere to treatment after the acute attack is relieved, it can easily lead to recurring gout attacks and worsening of the condition. Therefore, patients should not ignore the treatment of gout intermittent and remission periods, and should not stop taking medication at will.
Question 2: Gout is a “disease of wealth” and only happens to rich people, right?
Answer: No. Gout is related to eating habits and lifestyle. Modern people’s living standards have improved, their dietary structure has changed, excessive intake of high-calorie, high-fat and high-purine foods, and lack of exercise can easily lead to gout. Therefore, gout has become a common disease, regardless of rich or poor.
Question 3: Is gouty arthritis incurable and can only relieve symptoms?
Answer: No. Gouty arthritis is a treatable joint disease. Through reasonable treatment and lifestyle adjustments, patients can control uric acid levels within a reasonable range, arthritis will no longer recur, and gouty arthritis can be considered cured.
Question 4: Is it necessary to lower uric acid immediately after a gout attack?
Answer: No. Patients with an acute attack of gouty arthritis for the first time should mainly take anti-inflammatory and analgesic measures. Immediate uric acid-lowering treatment is not recommended. Excessive fluctuations in blood uric acid levels will prolong the onset of gout or worsen the symptoms.