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Having practiced medicine for more than 10 years, I have encountered many gout patients with poor treatment results.
They are often due to not strict low-purine diet and irregular medication.
Dr.
Huang Runyue encountered some cases of "taking the medication seriously" but the gout is more severe.
Come today Have a chat
.
Case sharing
Case sharingA male patient, 25 years old
.
He likes to drink milk tea cola and eats high-calorie foods such as fried chicken.
2019 year
The patient began to experience swelling and pain in the first metatarsophalangeal joint of his right foot in 2019.
After taking diclofenac sodium by himself, the pain of the metatarsophalangeal joint was relieved but recurring, and it gradually affected both knees, right elbow joints, and both wrist joints
.
When I went to the outpatient clinic, my knees and wrist joints were swollen and painful.
After taking diclofenac sodium, the joint pain was not significantly relieved, and the right elbow was formed as a subcutaneous nodule, which was hard
.
Urine examination: PH5.
0, occult blood 3+
.
Blood uric acid UA590ummol/L, creatinine 110umol/L, CRP77mg/L, blood lipids: TC5.
Color Doppler ultrasound on the abdomen suggests fatty liver
.
The tongue is dark red, the coating is yellow and greasy, and the pulse is slippery
diagnosis
TCM syndrome differentiation belongs to damp-heat stasis
.
Analysis and processing
Analysis and processingThe patient’s unhealthy diet led to excessive intake of fructose and purines, increased uric acid production, and urate deposition in various joints, leading to gouty arthritis.
Uric acid deposition and repeated inflammation also led to kidney damage.
Blood lipids also further affect the metabolism of uric acid, causing repeated attacks of gout
.
The patient had not been treated for lowering uric acid in the past, and had an acute attack of gout.
For the time being, anti-inflammatory and analgesic were the mainstay.
He was given oral colchicine, compound betamethasone intramuscularly for anti-inflammatory and analgesic, and sodium bicarbonate to alkalinize the urine
.
Chinese medicine decoction is added or subtracted to Simiao Pills
.
(Source: Photograph Network)
(Source: Photograph Network)
After the treatment, the joint pain was significantly relieved.
After 2 weeks, he started to use febuxostat to lower uric acid and atorvastatin to lower lipids.
The patient was instructed to have a low-purine, low-fat, low-fructose diet, and appropriate exercise and weight loss
.
After 2 months, the blood uric acid increased to 640 ummol/L, TC6.
3 mmol/L, TG2.
26 mmol/L, LDL4.
7 mmol/L, and CRP22.
2 mmol/L
.
Creatinine 125umol/L
At that time, the patient suffered from multiple joints all over the body, and his movements were aggravated.
The family members pushed the wheelchair to come to see the doctor
.
The patient complained of taking the medication regularly without interruption
(Source: Photograph Network)
(Source: Photograph Network)
Analysis: The patient ingested a lot of incomplete protein, which increased the burden on the kidneys.
Fat metabolism led to the production of a large number of ketone bodies, which reduced the ability of the kidneys to excrete uric acid, significantly increased blood uric acid, and frequent gout
.
Excessive fat intake leads to the deposition of fat in the blood vessels and liver, and aggravates the metabolic syndrome
Analysis: Vascular Metabolic Syndrome
Combining the patient's height, weight, and usual physical activity status, guide the patient to adjust the diet structure, and recommend a high-quality protein, low-fat, low-purine diet
.
Temporary oral administration of prednisone for anti-inflammatory and pain relief, omeprazole to protect the stomach, maintain febuxostat to lower uric acid, use rosuvastatin to lower lipids, valsartan to lower blood pressure and reduce urine protein
One month later, the patient went to see the doctor again, and the blood uric acid was 580 ummol/L, CRP was normal, and urine routine: weakly positive for occult blood and negative for protein
.
No joint pain in the past 3 weeks
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