[Large class]
Not long ago, a male patient over 60 years old came to see a doctor. I was amazed when he showed his finger. I saw that his middle finger, forefinger and other joints were deformed and thick. This is what we often call tophi, also known as gout nodule.
In fact, there have been many typical cases caused by uric acid metabolic disorder since the clinic of high uric acid and gout was opened in the clinical nutrition department. According to the patient’s self-report, he has a history of gout for more than 30 years. At the beginning of his illness, he felt pain and would take medicine to control it. However, in the past 10 years, because he had no pain symptoms, he didn’t take it seriously, neither seeing a doctor nor taking medicine. As a result, his condition further developed, spreading from his hands and feet to his knee joint and ankle joint, and more and more tophi became bigger and bigger, which led to limited walking and activities and seriously affected his normal life.
Uric acid is the final product of purine metabolism in human body. Normal adults produce about 700 mg of uric acid every day, of which about 500 mg is excreted by the kidney and 200 mg by the intestine, thus maintaining the balance of uric acid in the body. If uric acid is produced too much or excreted poorly, it will lead to the increase of uric acid in blood. In general, when the serum uric acid concentration is greater than 416umol/L (micromoles per liter), it can be clinically diagnosed as hyperuricemia. Uric acid salt crystals in patients with hyperuricemia are deposited in joint synovium, synovial bursa, cartilage and other tissues, causing recurrent inflammatory diseases, which are called gout, manifested as gouty acute arthritis, chronic arthritis, tophi and joint deformity, gouty nephropathy and so on. The higher the serum uric acid level, the greater the possibility of gout in the next five years. However, due to the different conditions of patients with hyperuricemia, some people still have no symptoms when their urine acid is as high as 700umol/L, and some people are close to 400umol/L, so their toes are too painful to walk. Therefore, most patients without obvious symptoms, even if hyperuricemia is found in physical examination, often do not go to the doctor, thus delaying their condition.
Where does uric acid in the human body come from? Generally, there are two sources: endogenous is the continuous renewal and decomposition of nucleic acids in the body, and the renewal route is nucleic acid → Purine-→ Uric acid, about 80% of uric acid comes from the decomposition of nucleic acid in the body; Another 20% comes from foods rich in purine in the diet. But don’t underestimate this 20% purine from food, because patients with high uric acid and gout have a common feature, that is, they like to eat purine-rich foods, such as seafood, viscera, pork, beef and mutton, chicken, duck and fish, various gravy and bean products. People with a family history of gout, obesity, male, excessive drinking and eating a high purine diet are all susceptible to gout. Clinically, it is found that every attack of gout patients is induced. For example, every year when crabs are on the market, the number of gout patients will increase; In various holidays, due to continuous dinner, drinking, overeating, etc., uric acid may also increase and gout may be induced.
So what should I do once I find that uric acid exceeds the standard?
First, we should see a doctor in time. Once hyperuricemia is detected, you should go to the hospital in time, and don’t wait until the condition is serious. Only by reducing uric acid to a normal level and maintaining it within the normal range can health be guaranteed.
Second, pay attention to diet control. Because hyperuricemia is one of the "affluence diseases" eaten, adjusting diet is the first choice to control hyperuricemia and gout. For patients who come to see a doctor, the doctor will calculate the personalized energy requirement according to the patient’s height, weight and activity, and give them a low purine diet to guide the patient to eat correctly.
Third, cooperate with drug treatment. In the acute attack period of gout, in addition to rest, raising the affected limb and avoiding the burden on the affected joints, drugs should be given in a targeted manner every day to effectively relieve symptoms.
Fourthly, in addition to the low purine diet, drugs that inhibit uric acid production should be used reasonably according to the patient’s uric acid level and gout symptoms, and the blood uric acid level should be reviewed regularly.
What needs to be emphasized in particular is that some patients "forget the pain after healing the scar". When there are symptoms, they can shut up and take medicine together. Once the symptoms are relieved, they will stop taking drugs and start eating and drinking, which will not only lead to repeated illness, but also bring more damage to the body. Here, I would like to remind the patients that we must "learn from a painful experience", and even in the remission period, we should manage the uric acid level to make it in a state of "reaching the standard".
(Author: Xu Yingxia, deputy chief physician of Clinical Nutrition Department of Beijing Tiantan Hospital, organized by Kuang Yuanshen)