Gouty arthritis

Gouty arthritis is a crystal-related arthropathy caused by monosodium urate deposition, which is associated with hyperuricemia caused by purine metabolism disorders and decreased urate excretion, and belongs to the metabolic rheumatism range, more common in men aged 40-60 years, with a male-to-female ratio of 15:1
.

Depending on the course of the disease, gouty arthritis can be divided into 4 stages: the period of asymptomatic hyperuricemia, the acute exacerbation of gouty arthritis, the intermittent period of gouty arthritis attacks, and the stage
of chronic gouty arthritis.
When the blood uric acid is higher than 420 μml/L but there are no other symptoms, it is hyperuricemia
.

Acute attacks of gout are usually redness, swelling, heat and pain of a single joint with dysfunction, which resolves
within most hours to 2 days.
Remission is called the episodic phase, and the chronic phase includes tophi formation, joint destruction, and kidney damage
.
Most patients have insufficient understanding of gout and irregular treatment, which is an important cause of recurrent gout, and the following answers to several common clinical problems
.

1.
Does hyperuricemia necessarily have gout?

Not patients with hyperuricemia will definitely get gout, gout is because uric acid in the form of crystals precipitated, gathered in the joints and other places, resulting in joint redness, swelling, heat and pain of the inflammatory reaction, in hyperuricemia patients only 5%-12% of patients will become gouty arthritis, but long-term high uric acid on the cardiovascular and cerebrovascular and kidney burden can not be ignored
.

2.
Uric acid has come down, why does it still hurt?

In the treatment process of gout, it is not that uric acid can cure gout, gout is because of the deposition of urate crystals in the joints, blood uric acid decreases but uric acid crystals are not dissolved, gout
will still occur.
For patients with long-term hyperuricemia, a large amount of uric acid is deposited in its muscles, skin, blood vessels, organs and bones, if the uric acid is lowered too quickly, the uric acid in the blood is reduced, and the uric acid in the tissues will inevitably transfer to the blood, then it is easy to break the concentration balance of uric acid in the joints, and it is easier to produce crystals, thereby inducing the attack
of acute gout.

3.
Will tophi disappear after uric acid lowering treatment?

Tophi is a large amount of urate long-term accumulation, local tissue fibrosis, calcification, although the drug can dissolve tophi and urate deposition, but the diameter of more than 2 mm, or more than two years of tophi is more stubborn, taking medicine to dissolve it is more difficult, in addition, liver and kidney function abnormal patients, not suitable for long-term use of urate-lowering drugs
.
For refractory tophi, it is recommended to use needle knife scopic surgical resection, and then cooperate with uric acid lowering therapy to reduce uric acid to about 300, and the final metabolism adjustment therapy is the top priority, metabolism is adjusted to recur in the late stage of gout, including the probability of long tophi will be greatly reduced
.

4.
Why can't uric acid come down if I avoid it?

High uric acid is not all eaten
.
In the treatment of gout, dietary control is not a substitute for medication
.
80% of uric acid in the human body comes from nucleic acids and other purine chemicals metabolized by cells, and 20% comes from food
.
Under normal circumstances, most of uric acid can be excreted through kidney metabolism, and when the kidney has lesions, uric acid excretion will be affected
.
Urate is deposited in the joints, and gout
is easy to occur under the triggers of overeating, drinking, colds, and joint injuries.

5.
Can gout be cured?

Many people think that gout is relieved is cured, and then uric acid is not continued to be controlled, and gout often occurs
repeatedly.
In fact, if the treatment is actively cooperated, the cure under the concept of
drug-free clinical remission can be achieved.
Patients with gout must adhere to urate-lowering therapy after gout is relieved and control blood uric acid within the standard range (with tophi, blood uric acid level is controlled below 300μmol/L; In patients without tophi, blood uric acid is controlled below 360μmol/L), and while starting to take corresponding urate-lowering drugs, preventive medication is also required to prevent rapid reduction of blood uric acid and induce acute arthritis
.