In recent years. The incidence of gout in the population of our country continues to increase. There are more patients with asymptomatic hyperuricemia. How to use uric acid-lowering drugs scientifically for gout patients should be known to the majority of patients.
Why does gout “find the door”
Purine metabolism disorder is the root cause of gout attacks. Purine metabolism disorders usually cause increased blood uric acid; hyperuricemia may also be complicated by uric acid kidney stones, hyperuric acid nephropathy, etc., leading to kidney damage, and it is also one of the pathogenic factors of cardiovascular and cerebrovascular diseases.
Uric acid is the end product of purine metabolism. Normal people have 700 to 800 mg of uric acid to be excreted from the body every day, of which about 2/3 is excreted through the kidneys. If there is excessive production of uric acid or excretion disorder, it will cause excessive uric acid in the blood. Clinically, male blood uric acid>416 micromole, liter, female blood uric acid>357 micromole/liter is called hyperuricemia. It should be noted that do not eat too much high-purine foods (such as pork, beef, mutton, offal, mushrooms, beans, nuts, etc.) before the measurement.
The best time to uric acid lowering treatment
of gout can be divided into three stages: the stage of asymptomatic hyperuricemia, acute exacerbation of arthritis, and intermittent episodes of gout (tophi arthritis and chronic phase).
1. Asymptomatic hyperuricemia period: daily prevention is the main thing. Patients in this period have not had a history of gout attacks. If patients have cardiovascular disease or cardiovascular risk factors, they should avoid eating foods with high purine content, smoking bans and limiting alcohol, drinking plenty of water (at least 2000 ml) a day, increasing the intake of fresh vegetables, exercising regularly, and striving to control uric acid for a long time. In the standard range.
2. Acute gouty arthritis attack period: Disable uric acid lowering drugs. Many people take uric acid-lowering drugs as soon as they have an attack of gout. If one medicine does not work, they will take several medicines together, thinking that it will be better to quickly lower the uric acid to the gout. actually not. Maintaining a stable level of uric acid is the basis for preventing gout attacks. The more uric acid-lowering drugs are taken during an acute attack, the greater the fluctuation of uric acid and the more serious joint swelling and pain.
Although uric acid lowering drugs are forbidden during the acute attack of gout, uric acid lowering drugs should be added slowly after the gout remission period. Otherwise, the blood uric acid level will fluctuate drastically, dissolving the tophi in the joint and releasing insoluble needle-like crystals, making the patient feel more painful. At this stage, the main focus should be to relieve the patient’s pain. You can raise the affected limb, apply cold, take non-steroidal anti-inflammatory drugs, colchicine, and use hormones to relieve symptoms when necessary.
3. Intermittent period of gout attacks: Use uric acid-lowering drugs to reduce the number of attacks. At this time, “the wind is calm and the waves are calm”, many patients feel that there is no problem, and they automatically stop the medication. As everyone knows it was wrong again. At this time, uric acid-lowering drugs should be used as soon as possible to control uric acid within the standard range. Patients with a history of gout attacks must keep uric acid below 300 micromol/L for a long time to reduce the number of acute attacks of gout, reduce the deposition of uric acid crystals, and minimize joint tissue damage and kidney damage.
Common uric acid lowering drugs with how
Benzbromarone for good renal function. Patients with urinary tract stones and patients with chronic renal insufficiency should use it with caution. It is forbidden for patients with acute uric acid nephropathy, and for patients with creatinine clearance less than 20 ml. It should not be used if the patient has formed urate stones, or if the daily excretion of urate is >600 mg.
Note Need to drink plenty of water during medication. At the beginning of medication, drink no less than 1500-2000 ml of water every day to maintain a certain amount of urine to avoid the formation of stones. Sodium bicarbonate tablets must be taken to alkalize urine and prevent uric acid from forming stones in the urinary tract.
Allopurinol can be used in patients with mild to moderate renal insufficiency, but it is contraindicated in patients with creatinine clearance <15 ml/min. Most Asians have genes that may cause serious skin reactions to allopurinol. Therefore, before using allopurinol, it is recommended to go to a regular hospital for genetic testing. Patients with positive results are prohibited from using it, and patients with negative results can only use it. Otherwise, serious adverse reactions may result.
Note (1) Allopurinol should be taken from a small dose and gradually increased. (2) Because allopurinol may induce hypersensitivity reactions, once it occurs, the fatality rate is extremely high, so patients who cannot use allopurinol can switch to febuxostat.
Febuxostat is mainly suitable for the long-term treatment of hyperuricemia in patients with gout, and it is not recommended for hyperuricemia without clinical symptoms. Generally, there is no need to adjust the dosage for patients with renal insufficiency.
Matters needing attention In the initial stage of taking febuxostat, there may be an increase in gout attacks. This is because the blood uric acid concentration decreases, which leads to the mobilization of urate deposited in the tissues. To prevent the onset of gout in the early stage of treatment, it is recommended to take colchicine or non-steroidal anti-inflammatory drugs at the same time.
Why is the wrong treatment following
cases 140-year-old Wu, nearly five years of medical reports showed increased blood uric acid, but he had no discomfort, no care. Recently, every night after socializing and drinking, the first joint of his foot would become red, swollen and painful. When I went to the local clinic, the doctor told him that it was just an unnamed swelling, and gave him an intravenous drip of penicillin. After three or five days, it really got better. However, the symptoms of foot pain recurred. Later, the effect of penicillin was not obvious.
Comments In fact, this is a more typical gout. At the beginning of the onset, significant redness, swelling, heat, pain, and dysfunction appear in the affected joints (such as the big toe, the part of the back of the foot). This is the acute phase, and it is easy to be misdiagnosed as a local infection, so penicillin treatment is wrongly used. Gout is a kind of aseptic inflammation, and antibiotic treatment is ineffective. After the patient started taking antibiotics, the pain was relieved, and he thought the medicine was effective. In fact, he was "fudged". Because the early onset of gout is self-limiting, even if it is not treated, it will resolve itself in about a week.
Case 2 On the night when 32-year-old Mr. Liu ate seafood, his big toe suddenly became swollen and painful, which gradually worsened, and stayed awake all night. The next day, he went to the hospital for treatment. A blood test showed that uric acid reached 720 micromol/l, and he was diagnosed with gout. So he was treated with gout drugs diclofenac and allopurinol, but it still didn't work for more than a month.
Comments Some doctors and patients will eagerly hope to reduce the elevated blood uric acid to the normal range quickly, thinking that after the blood uric acid is normal, the gout attack will stop. In fact, the sudden drop in uric acid level can sometimes aggravate the onset of gout. The sudden decrease in blood uric acid will cause the insoluble urate crystals that have been deposited in the joints and surrounding tissues to fall off, causing acute gouty arthritis, also called metastatic arthritis. Therefore, do not use uric acid lowering drugs at the beginning of the acute phase of gout (if the patient has been taking uric acid lowering drugs, continue to take the original dose), and start taking uric acid lowering drugs after 2 to 4 weeks after the joint swelling and pain is relieved.
Case 3 Da Liu, who is in his prime, loves to drink and eat meat most, and every time he drinks, he will have arthritis. As long as he goes to a small clinic for an injection (glucocorticoid), it will be effective. He feels very convenient. In the past year, he has become fatter and fatter, with nodules on his finger joints and feet, which have gradually enlarged and ulcerated.
Comment on the correct treatment of gout. Generally, colchicine, non-steroidal anti-inflammatory drugs (such as diclofenac) and some Chinese patent medicines (such as Tongfengding Capsules) are used to control symptoms, and Liu's injections are glucocorticoids. Hormones can indeed alleviate temporary pain, but it is only suitable for severe recurrent acute gout when conventional drugs are ineffective or intolerable. Long-term use of hormones can cause obesity, osteoporosis, hyperlipidemia and diabetes. Moreover, hormones have no effect on blood uric acid. Long-term use may increase blood uric acid.
