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How to prevent Gout?

Gout is a group of chronic diseases caused by purine metabolism disorder. It is more common in men aged 40-60 years. The ratio of men to women is about 20:1, and women are more likely to develop symptoms after menopause.

Causes

Primary gout is mostly related to heredity, and is closely related to obesity, primary hypertension, dyslipidemia, diabetes, insulin resistance, etc.Secondary gout is mainly caused by kidney disease, blood disease, high purine food or drugs.

Pathogenesis

Gout is reactive arthritis and/or gouty disease caused by the deposition of urate crystals in tissues. Normal daily urate production and excretion in a dynamic balance, such as excessive production or excretion reduction, can cause hyperuricemia.

Signs and Symptoms

The natural course and clinical manifestations of gout can be roughly divided into four stages as follows:

1. Asymptomatic hyperuricemia

Serum uric acid was higher than normal without any symptoms or signs. Hyperuricemia does not necessarily present gout symptoms, but the probability of developing gout is higher than normal.

2. Acute gouty arthritis

Acute arthritis is often the first symptom of gout. The onset of the disease is rapid, typical attack often in the middle of the night because of sharp pain. Pain is progressive and involves redness, swelling, heat, pain and limited function. Gout symptoms generally at the first metatarsal toe joints, followed by heel, ankle, knee, wrist and elbow joints. Gout attacks can last for hours, days or weeks, often with natural relief.

3. Interval period

Gout can be self-relieved after several days to several weeks. Generally, there is no obvious sequelae, and then there is an asymptomatic interval, which lasts for several months, years or more than 10 years. Most patients relapse within one year, with more and more frequent, more and more involved joints and longer and longer duration of symptoms. A few patients without intermittent, the first onset of chronic arthritis after the performance.

4. Tophi and chronic arthritis

Acute gouty arthritis repeated attacks become chronic arthritis with multiple joint involvement and worsening symptoms. It is easy to form tophi at the joints with persistent joint swelling, tenderness, deformity and dysfunction. Deposits of urate crystals in kidney tissue can cause gout nephropathy and in severe cases kidney failure.

Laboratory examination

Hyperuricemia occurs when the uric acid level exceeds 420μmol/L in males and 360μmol/L in females. In addition to blood uric acid test, it can also be combined with urine uric acid test, urate test, imaging examination, ultrasound examination and other tests to clarify the diagnosis.

Treatment

1. General treatment: Avoid high purine food, such as shrimp, crabs, shellfish, sardines and other seafood, animal offal, meat, beer and so on. Maintain a reasonable weight, abstain from alcohol, drink more water, at least 2000ml daily. Avoid overeating, drinking, excessive fatigue and mental tension, wear comfortable shoes, prevent joint injury, and carefully use drugs that affect uric acid excretion, such as some diuretics. Prevent and treat hypertension, diabetes and coronary heart disease.

2. Acute Gouty Arthritis: Common drugs used to relieve acute symptoms are nonsteroidal anti-inflammatory drugs, colchicine and glucocorticoids. The earlier the drug is used, the better. Early treatment can bring about rapid relief of symptoms, while delayed treatment cannot control inflammation easily.

3. Intermission and chronic stage: The initial aim is to control the uric acid level and prevent gout attack. Currently, uric acid lowering drugs are mainly used to inhibit uric acid production and promote uric acid excretion, which should be started from small doses and gradually increased after at least 2 weeks after the end of acute episodes. Adjust to the minimum effective dose within a few months based on the target level of lowering uric acid and maintain it for a long term or even a lifetime.

Prevention

For asymptomatic patients with hyperuricemia, the prevention of gout attack is mainly based on non-drug therapy, which mainly includes diet control and alcohol abstinence, and avoid drugs such as diuretics that increase blood uric acid. Patients with gout arthritis or hyperuricemia after dietary control should take medication. For patients who have suffered from acute gout arthritis during the intermittent period, gout recurrence should be prevented. The key is to control the blood uric acid level through diet and medication. In addition, attention should be paid to avoid strenuous exercise or injury, control weight, and drink more water.