Case review: Recently, I met such a patient in an outpatient clinic.
Mr. Wang, 27, was found to have blood uric acid levels fluctuating between 450 and 520 μmol/L (normal ≤420 μmol/L) during two consecutive years of physical examination. He was in good health and had no history of acute episodes of joint swelling and pain.
Mr. Wang became very anxious about this, worried that he had gout, and asked if he should take a drug to reduce uric acid.
Like Mr. Wang, in the physical examination found blood uric acid on the high side of the patient is not a few, so high uric acid is suffering from gout?
Should I take the medicine right away?
Now, let’s listen to what the doctor had to say.
Hyperuricemia ≠ gout
The first thing to be clear about is that hyperuricemia is not gout.
Hyperuric acid, or hyperuricemia, is defined as fasting blood uric acid levels in men on a normal purine diet that do not occur twice a day.
420 μmol/L, female >
360 mu mol/L.
Gout is a crystalline-related joint disease caused by urate deposition into joints, which is directly related to hyperuricemia caused by purine metabolism disorder and/or reduced uric acid excretion, and belongs to the category of metabolic rheumatism.
Theoretically, hyperuricemia is the pathophysiological basis for the occurrence of gout. However, when the body only has elevated blood uricemia without clinical manifestations such as swelling and pain of joints, we call it asymptomatic hyperuricemia and cannot judge it as gout.
So hyperuricemia does not equal gout.
However, the long-term increase of blood uric acid can lead to the precipitation and deposition of urate crystals in joints and surrounding soft tissues, renal tubules and blood vessels, and lead to acute and chronic inflammatory injuries such as articular cartilage, bone, kidney and intima of blood vessels over time.
In recent years, with the continuous improvement of people’s living standards, the prevalence of asymptomatic hyperuricemia has been increasing year by year.
The prevalence rate increases with age, generally higher in cities than in rural areas and higher in coastal areas than in inland areas.
According to statistics, the prevalence of hyperuricemia in Chinese men ranges from 9.2% to 26.2%.
Uric acid is high. Don’t rush to take the medicine
According to the multidisciplinary expert consensus on the diagnosis and treatment of hyperuricemia related diseases in China published in 2017, it is pointed out that hyperuricemia patients need comprehensive and long-term whole-process management. According to the blood uric acid level and combined clinical symptoms and signs, the timing of drug initiation treatment is determined, and corresponding treatment targets are formulated, and hierarchical management is carried out:
Patient management is based on knowledge of hyperuricemia and individualized lifestyle interventions.
If there are comorbidities, it is necessary to work with a specialist to develop a treatment plan for comorbidities and avoid drugs that affect uric acid metabolism.
Non-pharmacological therapy is the key to advocating a balanced diet, mainly a low-purine diet.
Drink plenty of water and maintain a daily urine volume of 2000 to 3000ml;
Milk and dairy products, especially skimmed milk and low-calorie yoghurt;
At the same time, avoid cola, orange juice, apple juice and other fructose drinks or sugary soft drinks;
Insist on regular exercise, lose weight can effectively reduce blood uric acid level.
Medication is a supplement for patients with hyperuricemia who have not responded well to non-pharmacological interventions. Medication may be considered as appropriate.
Especially for patients with long-term blood uric acid level greater than 480μmol/L and combined with metabolic syndrome, cardiovascular disease, chronic kidney disease and kidney stones, multidisciplinary cooperation should be made to develop a reasonable treatment plan for reducing uric acid.
Finally, take a look at the situation of Mr. Wang, whether to use drugs to reduce uric acid treatment?
According to the medical history, considering that Mr. Wang has not paid attention to diet in his daily life, and Mr. Wang does not have any symptoms and complications at present, it is suggested that Mr. Wang should first intervene in accordance with the patient management and non-drug treatment methods mentioned above, and the initial drug therapy for lowering uric acid is not recommended for the time being.
Gouty arthritis anti – inflammatory analgesic important
Occurs gout sex arthritis, should use immediately drop uric acid medicine?
Wrong again. That’s counterproductive.
If gouty arthritis occurs, aggressive anti-inflammatory and analgesic therapy should be given in the acute phase, rather than rushing to add uric acid lowering drugs.
Because if in the acute phase of the use of hypouric acid drugs, will prolong the acute period of joint swelling pain duration, aggravate the painful process of gout patients.
After the acute phase, for these patients with clear indications of lowering uric acid, it is recommended to initiate therapy with lowering uric acid drugs, in combination with non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose colchicine to prevent the onset of gout.
The process of reducing uric acid should be stable, not fast.
After the beginning of lowering uric acid, the blood uric acid level should be rechecked regularly to observe whether the current dosage of lowering uric acid drugs can reduce the level of uric acid to the target range (blood uric acid < 360μmol/L), and titrate the dosage of lowering uric acid drugs.
After the level of uric acid can not be arbitrarily stopped using drugs to reduce uric acid, or it is recommended that patients take it for a long time to maintain the level of blood uric acid continued to reach the level of the state.
I hope you can do the above points, keep your mouth shut, move your legs, drink more water, take medicine regularly, and stay away from gout.