Gout patients are so serious after 5 years if they don't take medicine?

The prevalence of gout in China is 1.

If you don't follow the doctor's advice, what will happen to your condition? A case recently published in the "New England Journal of Medicine" (NEJM) describes the diagnosis and treatment of a gout patient who took medication irregularly and his condition worsened

The patient is male, 65 years old

She presented to the dermatology clinic with joint pain and swelling in her hands, feet, and knees for 5 years

During these 5 years, the patient received intermittent gout medication, with short-term improvement in symptoms

Past medical history: history of gout and chronic kidney disease (unspecified)

Physical examination: There were multiple tophis and deformities in the joints of the hands (Panel A), feet, and knees

Laboratory tests:

Serum uric acid level exceeds the standard: the test result is 9.

Serum creatinine level exceeded: the test result was 1.

Arthrocentesis of the first metatarsophalangeal joint of the right foot was performed: a thick white exudate was found in the joint; a large number of urate crystals were seen under a polarizing microscope (Figure B)

Image source: Reference [1]

treat

The patient was given uric acid-lowering therapy (no specific treatment plan was given in the case report)

The "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)" pointed out that the indications, contraindications and types of hyperuricemia should be comprehensively considered when selecting uric acid-lowering drugs

Allopurinol is recommended as the first-line drug for lowering uric acid in patients with hyperuricemia and gout.

Febuxostat is especially suitable for patients with chronic renal insufficiency.

For patients whose blood uric acid is still not up to the standard after a single drug with sufficient dose and a full course of treatment, a combination of two uric acid-lowering drugs with different mechanisms of action can be considered

prognosis

At follow-up 10 months later, the patient's joint pain and swelling were significantly reduced