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▎The gout editor of WuXi AppTec's content team is considered by many to be the "first pain in the world".
The famous British cartoonist James Gilley's "Gout" cartoon published in 1799 depicts gout as a black devil who is gnawing on human feet, vividly and deeply showing the suffering of gout patients.
It is possible that some people, although they found elevated uric acid during physical examination, do not usually have any symptoms of joint pain.
Does this situation need to be taken seriously? How to prevent the occurrence and development of gout? Today we will share relevant content.
Image source: What is the relationship between 123RF high uric acid and gout? Hyperuricemia refers to the level of fasting blood uric acid (SUA)> 420 μmol/L on two different days under a normal purine diet.
According to the blood uric acid level and uric acid excretion, HUA is divided into three types: poor uric acid excretion type, excessive uric acid production type and mixed type.
Among them, 90% of primary hyperuricemia is caused by poor excretion of uric acid.
Gout refers to increased blood uric acid levels (hyperuricemia), uric acid accumulates in the body to form needle-like crystals (urate crystal deposition), due to various incentives (such as high uric acid diet, alcohol abuse, joint damage, local temperature drop) , Local pH drop, fatigue, etc.
) cause the deposited crystals to have an acute inflammatory reaction in the body (such as gouty arthritis, uric acid nephropathy and kidney stones), causing gout attacks, sudden pain, tenderness, redness, fever and swelling And other symptoms, often located in the big toe.
The higher the blood uric acid, the greater the probability of gout attacks, but hyperuricemia may not always occur.
Studies have confirmed that the incidence of gout is 30.
5% when blood uric acid is greater than or equal to 600 μmol/L, and the incidence of gout is only 0.
6% when blood uric acid is less than 420 μmol/L.
Therefore, most patients with hyperuricemia are asymptomatic and will not develop gout.
Even among people with severe hyperuricemia (≥600 µmol/L), less than half of them will develop gout in 15 years.
In other words, elevated serum uric acid is an important risk factor for the development of gout, but hyperuricemia does not necessarily cause gout.
Hyperuricemia is closely related to the occurrence of gout, and is also an independent risk factor for the occurrence and development of metabolic syndrome, type 2 diabetes, hypertension, cardiovascular disease, chronic kidney disease, and kidney stones.
Therefore, the harm of gout is far more than simply toe joint pain, and is often related to a variety of diseases.
Patients with hyperuricemia without any symptoms of gout should also pay attention to actively intervene in the event of hyperuricemia to avoid the occurrence of gout or other diseases.
Image source: How does 123RF control uric acid and prevent the occurrence of gout? Recently, a review published in The Lancet suggested that for asymptomatic hyperuricemia patients, it is not currently recommended to prevent gout through urate-lowering drugs or anti-inflammatory drugs.
Life>
Patients with cardiovascular disease risk factors or fasting blood uric acid> 540 μmol/L are recommended for drug intervention.
Conversely, life>
The Chinese Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout (2019) recommend that patients with asymptomatic hyperuricemia start uric acid-lowering drug therapy when the following conditions occur: blood uric acid level ≥540 μmol/L (2B) or blood uric acid level ≥480 μmol /L and one of the following comorbidities: hypertension, abnormal lipid metabolism, diabetes, obesity, stroke, coronary heart disease, cardiac insufficiency, uric acid nephrolithiasis, renal impairment (≥CKD stage 2) (2B).
For those without comorbidities, it is recommended to control blood uric acid to <420 μmol/L; for comorbidities, it is recommended to control it to <360 μmol/L.
Dietary adjustments The Gout Treatment Guidelines (2020 edition) issued by the American College of Rheumatology (ACR) recommends: Regardless of the severity of the disease, patients with gout should strictly limit alcohol (especially purine-rich beer), limit the intake of red meat, seafood, etc.
Purine food, limit the intake of sugary beverages such as high fructose/corn syrup.
Vitamin C supplementation is not recommended (recommended with conditions).
Focus on a low-purine diet (as shown in the figure below), encourage eating foods such as fresh vegetables, low-fat or skimmed milk, eggs, and moderate intake of beans and soy products.
Image source: WuXi AppTec's content team created good eating habits to avoid overeating or eating a lot of meat in one meal; the diet should be balanced and limit the total daily calorie intake.
Seafood, meat and high-purine plant foods are recommended to be boiled and discarded for consumption in order to reduce the purine content in the food.
Studies have also suggested that DASH diet and weight loss can help achieve a moderate reduction in serum uric acid levels.
DASH diet: advocate low fat, low salt, low sugar, and provide balanced nutrition.
Use refined meat, poultry, and fish as the main protein sources, and a balanced intake of fruits and vegetables, dairy products, grains, soy products, nuts, a small amount of fat and sweets; at the same time reduce the intake of salt and saturated fat, such as drinking low-fat milk , Do not eat or eat less fat.
Regardless of the severity of the disease, overweight gout patients/hyperuricemia patients should lose weight.
Studies have shown that 31% of gout attacks can be attributed to overweight and obesity itself.
Image source: 123RF For patients with hyperuricemia without any symptoms of gout, it is recommended to maintain a healthy weight, adopt a low-purine diet combined with a DASH diet to control uric acid and avoid gout or other diseases.
Related reading Edamame with beer actually deformed joints? How should gout patients eat? worth collecting! How to manage the 4 stages of gout well to avoid recurring attacks? The article "The Lancet" clarifies the Harvard study of JAMA sub-Journal: Nearly 80% of gout can be prevented, and this is the key! Data of nearly 40,000 people: Not only gout, but low or elevated uric acid is related to the risk of death.
Reference materials [1] Chinese Society of Endocrinology (CSE, Chinese Society of Endocrinology) (2019).
Hyperuricemia and gout Consensus of Chinese experts on treatment.
Chinese Journal of Endocrinology and Metabolism, 29(11):913-920.
[2] Nicola Dalbeth, et al.
, (2021).
Gout.
The Lancet, DOI: https://doi.
org/10.
1016/ S0140-6736(21)00569-9[3] McCormick N,, et al.
, (2020).
Estimation of Primary Prevention of Gout in Men Through Modification of Obesity and Other Key Life>
If you need guidance on treatment plans, please go to a regular hospital for treatment.
The famous British cartoonist James Gilley's "Gout" cartoon published in 1799 depicts gout as a black devil who is gnawing on human feet, vividly and deeply showing the suffering of gout patients.
It is possible that some people, although they found elevated uric acid during physical examination, do not usually have any symptoms of joint pain.
Does this situation need to be taken seriously? How to prevent the occurrence and development of gout? Today we will share relevant content.
Image source: What is the relationship between 123RF high uric acid and gout? Hyperuricemia refers to the level of fasting blood uric acid (SUA)> 420 μmol/L on two different days under a normal purine diet.
According to the blood uric acid level and uric acid excretion, HUA is divided into three types: poor uric acid excretion type, excessive uric acid production type and mixed type.
Among them, 90% of primary hyperuricemia is caused by poor excretion of uric acid.
Gout refers to increased blood uric acid levels (hyperuricemia), uric acid accumulates in the body to form needle-like crystals (urate crystal deposition), due to various incentives (such as high uric acid diet, alcohol abuse, joint damage, local temperature drop) , Local pH drop, fatigue, etc.
) cause the deposited crystals to have an acute inflammatory reaction in the body (such as gouty arthritis, uric acid nephropathy and kidney stones), causing gout attacks, sudden pain, tenderness, redness, fever and swelling And other symptoms, often located in the big toe.
The higher the blood uric acid, the greater the probability of gout attacks, but hyperuricemia may not always occur.
Studies have confirmed that the incidence of gout is 30.
5% when blood uric acid is greater than or equal to 600 μmol/L, and the incidence of gout is only 0.
6% when blood uric acid is less than 420 μmol/L.
Therefore, most patients with hyperuricemia are asymptomatic and will not develop gout.
Even among people with severe hyperuricemia (≥600 µmol/L), less than half of them will develop gout in 15 years.
In other words, elevated serum uric acid is an important risk factor for the development of gout, but hyperuricemia does not necessarily cause gout.
Hyperuricemia is closely related to the occurrence of gout, and is also an independent risk factor for the occurrence and development of metabolic syndrome, type 2 diabetes, hypertension, cardiovascular disease, chronic kidney disease, and kidney stones.
Therefore, the harm of gout is far more than simply toe joint pain, and is often related to a variety of diseases.
Patients with hyperuricemia without any symptoms of gout should also pay attention to actively intervene in the event of hyperuricemia to avoid the occurrence of gout or other diseases.
Image source: How does 123RF control uric acid and prevent the occurrence of gout? Recently, a review published in The Lancet suggested that for asymptomatic hyperuricemia patients, it is not currently recommended to prevent gout through urate-lowering drugs or anti-inflammatory drugs.
Life>
Patients with cardiovascular disease risk factors or fasting blood uric acid> 540 μmol/L are recommended for drug intervention.
Conversely, life>
The Chinese Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout (2019) recommend that patients with asymptomatic hyperuricemia start uric acid-lowering drug therapy when the following conditions occur: blood uric acid level ≥540 μmol/L (2B) or blood uric acid level ≥480 μmol /L and one of the following comorbidities: hypertension, abnormal lipid metabolism, diabetes, obesity, stroke, coronary heart disease, cardiac insufficiency, uric acid nephrolithiasis, renal impairment (≥CKD stage 2) (2B).
For those without comorbidities, it is recommended to control blood uric acid to <420 μmol/L; for comorbidities, it is recommended to control it to <360 μmol/L.
Dietary adjustments The Gout Treatment Guidelines (2020 edition) issued by the American College of Rheumatology (ACR) recommends: Regardless of the severity of the disease, patients with gout should strictly limit alcohol (especially purine-rich beer), limit the intake of red meat, seafood, etc.
Purine food, limit the intake of sugary beverages such as high fructose/corn syrup.
Vitamin C supplementation is not recommended (recommended with conditions).
Focus on a low-purine diet (as shown in the figure below), encourage eating foods such as fresh vegetables, low-fat or skimmed milk, eggs, and moderate intake of beans and soy products.
Image source: WuXi AppTec's content team created good eating habits to avoid overeating or eating a lot of meat in one meal; the diet should be balanced and limit the total daily calorie intake.
Seafood, meat and high-purine plant foods are recommended to be boiled and discarded for consumption in order to reduce the purine content in the food.
Studies have also suggested that DASH diet and weight loss can help achieve a moderate reduction in serum uric acid levels.
DASH diet: advocate low fat, low salt, low sugar, and provide balanced nutrition.
Use refined meat, poultry, and fish as the main protein sources, and a balanced intake of fruits and vegetables, dairy products, grains, soy products, nuts, a small amount of fat and sweets; at the same time reduce the intake of salt and saturated fat, such as drinking low-fat milk , Do not eat or eat less fat.
Regardless of the severity of the disease, overweight gout patients/hyperuricemia patients should lose weight.
Studies have shown that 31% of gout attacks can be attributed to overweight and obesity itself.
Image source: 123RF For patients with hyperuricemia without any symptoms of gout, it is recommended to maintain a healthy weight, adopt a low-purine diet combined with a DASH diet to control uric acid and avoid gout or other diseases.
Related reading Edamame with beer actually deformed joints? How should gout patients eat? worth collecting! How to manage the 4 stages of gout well to avoid recurring attacks? The article "The Lancet" clarifies the Harvard study of JAMA sub-Journal: Nearly 80% of gout can be prevented, and this is the key! Data of nearly 40,000 people: Not only gout, but low or elevated uric acid is related to the risk of death.
Reference materials [1] Chinese Society of Endocrinology (CSE, Chinese Society of Endocrinology) (2019).
Hyperuricemia and gout Consensus of Chinese experts on treatment.
Chinese Journal of Endocrinology and Metabolism, 29(11):913-920.
[2] Nicola Dalbeth, et al.
, (2021).
Gout.
The Lancet, DOI: https://doi.
org/10.
1016/ S0140-6736(21)00569-9[3] McCormick N,, et al.
, (2020).
Estimation of Primary Prevention of Gout in Men Through Modification of Obesity and Other Key Life>
If you need guidance on treatment plans, please go to a regular hospital for treatment.
