As the weather turned colder, hot pot became more and more popular. Mr. Wang, in his forties, had a hot pot meal for two consecutive days at a weekend gathering with relatives and friends. The next morning he suddenly woke up with pain, and his right big toe joint again It was swollen and painful, so I had to get out of bed to take painkillers, but the moment his right foot stepped on the floor, it made him sore in cold sweat. After some tossing, Mr. Wang had to take a ride to the emergency room for help.
Mr. Wang’s uric acid has exceeded the standard for many years. After the acute attack is relieved, the doctor suggested to use drugs to reduce uric acid and reduce futuregoutThe chance of an acute attack, but Mr. Wang’s kidney function is not good. After discussion, he started to use a new generation of uric acid-lowering preparations to reduce the production of uric acid.
Dr. Chen Guanxing from the Department of Nephrology, Chang Gung Memorial Hospital in Linkou, pointed out that gout is closely related to “hyperuricemia,” and the source of uric acid is “Pulin.” All tissues in our body contain the substance “purin”. When cells are replacing old ones, they will decompose purin to produce uric acid.
How does our body eliminate uric acid? Dr. Chen Guanxing explained: “About one-third depends on the gastrointestinal tract, and the other two-thirds depend on the kidneys, which are eliminated in feces and urine.” But if you take too much high-premium food, or your kidneys are not functioning If it is good and difficult to rule out, uric acid will accumulate in the blood and form “hyperuricemia”, which is clinically defined as blood uric acid concentration> 7.0mg/dl.
When the blood uric acid content is too high, uric acid crystals may be formed in the body. These long and thin uric acid crystals are easy to accumulate in the joint cavity, causing joint inflammation and redness, swelling, heat, and pain. This is known as “gout”.
Gout not only causes joint pain, but also forms “tophi”
Dr. Chen Guanxing said that gout usually occurs paroxysmal. The joint most prone to gout is the big toe. Many patients will feel severe joint pain in their sleep in the middle of the night and early morning and wake up. The toe joints have become red and red. Swollen, hot, and painful. After an attack of gout, it often takes a few days to get better, but it may also recur soon after. Patients with hyperuricemia will gradually find that even knees, ankles, and wrists may have gout attacks.
“If gout attacks repeatedly, after five or ten years, uric acid crystals will damage and erode the joints,” Dr. Chen Guanxing reminded: “These crystals accumulated in the joints will form tophi and cause joint deformation.”
Gout occurs in men between 30 and 50 years old. However, with changes in eating habits, more and more young patients are also experiencing gout problems. The prevalence of hyperuricemia in the aborigines of Huadong area may be as high as 90%.
Chronic inflammation leads to a variety of comorbidities, and the whole body suffers from gout.
Dr. Chen Guanxing said that it is worth noting that gout not only causes joint pain, but may also damage other organs. In addition to deposits in joints, uric acid crystals can also deposit in blood vessels and kidneys, causing chronic inflammation.
“Gout is actually a chronic inflammation, and it is associated with many diseases. For example, hypertension, diabetes, cardiovascular disease, etc. are all related to gout. Even Taiwan’s national disease “kidney disease” is also related to gout.” Dr. Chen Guanxing Emphasize: “Treat gout and control uric acid as soon as possible to reduce the chance of various complications.”
Uric acid is mainly metabolized by the kidneys. If the concentration of uric acid in the body continues to be too high, the burden on the kidneys will be great. When the urate crystals are too large to be excreted smoothly by the kidneys, it will block the renal tubules and cause inflammation of the renal interstitium; urate crystals will also get stuck in the ureter and form urinary stones. In addition, when uric acid crystals settle on the walls of the capillaries of the kidneys, the glomeruli will gradually harden, causing kidney dysfunction.
Therefore, if patients with gout do not receive proper treatment, they can only buy powerful non-steroidal anti-inflammatory painkillers at the time of the attack. Long-term use of large amounts may damage the kidney function and gradually lead to renal failure, even to the extent that dialysis and dialysis are required.
In the face of gout, long-term control of uric acid is the key
Dr. Chen Guanxing analyzed: “When treating gout, it can be divided into two parts. In the acute attack of gout, anti-inflammatory analgesics can be used to improve the patient’s pain; in the chronic phase, it is to try to reduce the blood uric acid concentration.”
If the patient will have two or more gout attacks a year, or have comorbidities such as hypertension, diabetes, etc., it is necessary to consider long-term use of uric acid-lowering drugs to stably control the blood uric acid concentration to less than 6.0 mg/dL. In a state of chronic inflammation.
Dr. Chen Guanxing explained that there are currently two mechanisms for controlling uric acid, one is to “promote the elimination of uric acid” and the other is to “reduce the production of uric acid.”
Drugs that “promote uric acid elimination” can increase the amount of uric acid excreted by the kidneys. However, if the patient’s kidney function is poor and more uric acid is excreted from the kidneys, it may increase the burden on the kidneys, and the therapeutic effect of the drugs is not good. In addition, the more uric acid excreted from the urinary tract, it will actually increase the risk of urinary stones.
Drugs that “reduce uric acid production” can inhibit uric acid synthesis. A new generation of uric acid-lowering preparations developed in recent years are metabolized by the liver and can be used even in patients with poor kidney function. Dr. Chen Guanxing said: “Taiwanese patients usually only need to take half a capsule a day to reduce the blood uric acid concentration.”
Studies have pointed out that when gout patients regularly take a new generation of uric acid-lowering preparations and maintain the uric acid value below 6.0mg/dL, it can be observed to delay the deterioration of the patient’s renal function, significantly eliminate tophi, and reduce the chance of recurrence of gout, and improve the life of patients quality.
Compared with traditional medicines, there is a risk of allergies, ranging from rashes on the skin to Stevens-Johnson Syndrome (SJS), which is a serious systemic allergic reaction that can lead to death and disability, which is very difficult. The new generation of uric acid-lowering preparations have less skin allergic reactions and are highly safe.
Dr. Chen Guanxing recalled that once a gout patient suffered from hypertension and diabetes at the same time. When he first came to the clinic, uric acid exceeded 9.0 mg/dL, and he had gout 2-3 times a year. His kidney function is poor and he has entered stage 3b of chronic kidney disease (eGFR 30~44 ml/min/1.73m2), so he chose to use a new generation of uric acid-lowering preparations.
Under continuous and stable medication, his uric acid gradually dropped below 6.0 mg/dL and returned to normal. During the follow-up process, it was found that his kidney function had progressed from stage 3b to stage 3a (eGFR 45~59 ml/min/1.73m2), and his gout attacks were no longer frequent.
Gout is a disease of wealth and wealth
Dr. Chen Guanxing said, I wantAvoid gout, We also have to work on food. First of all, meat, seafood, hot pot soup, high-fructose syrup, and beer are all high-purin foods, so be sure to control the amount of intake.
Sufficient water should be provided every day. Sufficient water can help eliminate uric acid and reduce the chance of urinary stones. Appropriate weight loss can also reduce the chance of gout attacks. In addition, gout and many chronic diseases have comorbidities, so chronic diseases such as high blood pressure and diabetes must be well controlled.
“Don’t think that gout is just joint pain. Take painkillers after an acute attack!” Dr. Chen Guanxing exhorted: “Excessive uric acid is a chronic problem. It is not good for the kidneys and cardiovascular in the long run. It is best to take the medicine regularly. Controlling uric acid can reduce the chance of kidney failure and dialysis in the future.”
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