This text discusses gout, a condition characterized by high uric acid levels. Here’s a breakdown of the key points:
What is Gout?
Gout is caused by the body’s inability to properly eliminate uric acid.
High uric acid levels are a prerequisite for diagnosis, but not all high levels led to gout.
A gout diagnosis requires high uric acid, deposition of uric acid crystals in joints, and severe pain attacks.
Asymptomatic Hypertension and Uric Acid:
Asymptomatic hypertension (high blood pressure without symptoms) related to uric acid doesn’t require treatment.
However, if uric acid levels reach 9 mg/dL or higher, preventive management is recommended due to a high risk of gout.
The nature of Gout attacks:
Pain from acute gout attacks can be temporarily relieved by certain medications (like “labour stomach salts”), but this doesn’t cure the underlying issue.
Uric acid crystal deposits remain, leading to recurring attacks.
Over time, these attacks can cause joint damage, deformation, and dysfunction.
Long-term complications can include cardiovascular and kidney problems.
Complications of Uric Acid Crystal Deposition:
While gout often affects joints, uric acid crystals can deposit in other tissues like tendons, soft tissues, blood vessel walls, kidneys, and skin.
Kidney accumulation can lead to urinary stones, impaired renal function, and chronic kidney disease.
The risk of cardiovascular disease substantially increases. Studies show gout patients have more than double the cardiovascular mortality compared to the general population.
Gout is often associated with other metabolic diseases like hypertension, hyperlipidemia, and fatty liver.Dietary Factors Affecting uric Acid:
Alcohol: Beer is high in purines and directly worsens gout. All alcohol inhibits kidney excretion of uric acid and increases its production.
Sweet Drinks: Beverages with liquid fructose, such as fruit juices, mixed coffee, and soft drinks, are major contributors to increased uric acid levels.
Recommendations: Gout patients should limit sweet drinks, eat balanced meals, and drink plenty of water.
Genetic Predisposition:
Gout has a genetic component, with variations in genes like ABCG2 being linked to its advancement.
Having a family history of gout,especially a father with the condition,increases the risk for children.
It’s critically important to get individual uric acid blood tests if there’s a family history, as it’s not routinely checked in national health screenings.
Treatment Strategies:
Dietary control alone is insufficient. Meal therapy can lower uric acid by about 1 mg/dL.
Drug treatment is essential to lower uric acid levels to below 6 mg/dL.
Treatment focuses on medications that inhibit uric acid production (e.g., allopurinol) or promote its excretion.
Lifestyle modifications like meal control, weight loss, and limiting alcohol are also crucial.
long-Term Management:
If uric acid levels remain high and attacks are frequent, long-term medication is usually necessary.
Medication dosage might potentially be adjusted or discontinued under medical supervision if uric acid levels stabilize through weight loss, improved metabolic health, and dietary changes.
However, due to the risk of cumulative joint damage, maintaining medication is often recommended, especially after recurrent attacks.
Lowering uric acid levels through treatment may also help prevent cardiovascular disease.
Professor Kim Se-hee’s Emphasis:
The core treatment strategy is to prevent complications by long-term suppression of blood uric acid levels.
Gout management should focus on long-term uric acid control and preventing complications, rather than just alleviating short-term symptoms.Key Takeaway for Managing Gout:
Consult a specialist.
Adhere to medication to keep uric acid levels below 6 mg/dL.
Implement lifestyle changes,including weight loss if overweight and regular exercise.
