In the summer night, maybe you are craving barbecue, draft beer and food stalls, or maybe you are keen on reducing fat, shaping and living a healthy life. But you know what? Whether you are drinking with a glass in the night wind, or you are sweating on the treadmill to keep fit and self-disciplined, you may be targeted by a disease called gout. The latest data shows that the number of gout patients in China has exceeded 80 million, and it continues to rise, and at the same time it is getting younger and younger. Hyperuricemia has become the "fourth highest" after hypertension, hyperglycemia and hyperlipidemia.
Do you know anything about gout? Who does gout "favor" most? How will the talons of gout affect our lives? Can food supplement "drive away" gout? How can we prevent it? How to treat it? How to exercise?
Are you a gouty person?
□ Dong Lingling, Professor of Rheumatology and Immunology, tongji hospital, Tongji Medical College, Huazhong University of Science and Technology
According to the white paper on gout status report in China in 2017, there are more than 80 million gout patients in China, and gout has become the second largest metabolic disease in China after diabetes.
What kind of disease is gout?
As the saying goes, gout is the arthritis of the rich and rheumatism is the arthritis of the poor. So how was gout discovered?
In 1776, carl scheele, a Swedish chemist, discovered an organic acid in urine stones, which was named litholic acid. More than 20 years later, French chemists found that there was not only lithoid acid in stones, but also in urine, so they changed their names to uric acid. At the same time, British doctors found that the composition of gout patients’ nodules was uric acid. Finally, the doctors finally determined that gout was related to uric acid.
So what is gout? It is a crystal-related arthropathy caused by monosodium urate deposition, which is directly related to hyperuricemia caused by purine metabolic disorder and/or decreased uric acid excretion, and belongs to the category of metabolic rheumatism. Patients often show acute paroxysmal arthritis, tophus formation, tophus chronic arthritis, urate nephropathy and uric acid urinary calculi. Every gout patient must have a period of hyperuricemia before the attack, which is undetected or ignored.
Gout can be complicated with joint disability and renal disease, and in severe cases, joint destruction and renal function damage can occur, often accompanied by other manifestations of metabolic syndrome, such as hyperlipidemia, hypertension, diabetes, arteriosclerosis and cardiovascular diseases.
In which parts of the body does gout occur frequently?
Gout patients often have sudden joint pain at night, and the onset is sudden. Patients will wake up in pain in the middle of the night, and the affected joints may have severe redness and heat pain, showing a local burning sensation. Then the patient’s pain will gradually reduce until it disappears, lasting for several days or weeks.
The most common joint is the big toe, and it is also common in the joints of the hand, knee joint cover, elbow joint and so on. The affected joints will eventually become red, swollen and inflamed, and the tissues will become soft and their activities will be limited after edema, thus affecting daily life.
When does gout usually occur?
Many gout patients have had this experience. In the middle of the night, especially in the middle of the night, when they were sleeping soundly, they were awakened by sudden joint pain. They often felt heartbroken and sweaty, which could not be alleviated for a long time.
Why is gout more common at night? First of all, the glucocorticoid level is low at night, and the ability of anti-inflammatory, analgesic and uric acid excretion is reduced. Secondly, the human body is in a state of relative water shortage at night, and uric acid is easier to deposit. Third, the body temperature is low at night. Fourth, lack of oxygen.
What kind of people does gout prefer?
Men’s data show that the ratio of male to female patients with gout is about 15: 1, so why are men more likely to get gout than women? Women have a congenital advantage because estrogen can promote uric acid excretion and help inhibit the onset of arthritis. Men, on the other hand, have more androgens in the body, and androgens especially love uric acid, which will inhibit the excretion of uric acid by the kidneys, lead to the increase of uric acid content in the body, accelerate the formation and deposition of uric acid crystals, and finally attract gout.
People who love to drink alcohol will produce a lot of lactic acid in our bodies, and these lactic acids will compete with uric acid. When both are excreted, overbearing lactic acid is more easily excreted, and less uric acid is excreted. Over time, it will cause gout.
People who love meat and seafood have high purine content in crustacean seafood such as viscera, shellfish, oysters and lobster, and they are prone to gout if they eat too much. For example, the youngest gout patient in Qingdao is only 13 years old, and he just ate it.
In the impression of most people, gout is a patent for middle-aged and elderly people, which is scientifically based. Postmenopausal women are prone to gout with decreased estrogen and increased androgen. After 60 years old, people are old, joints are aging, coupled with calcium loss, cartilage tissue is also reduced a lot, and in this way, gout began to bully the elderly.
People with a family history of gout will inherit gout.
A former athlete or a fitness expert. Athletes or fitness experts have more activities than ordinary people, and the intensity is greater, which leads to the burning and decomposition of adenosine triphosphate in their bodies and the faster metabolism of cells than ordinary people, thus producing more purines in their bodies. In addition, many athletes have been injured and are more likely to attract gout.
Obese people, especially those who lose weight, may also attract gout, which is similar to drinking. If you lose weight too fast, you will produce a lot of ketone bodies after burning fat, and ketone bodies and uric acid will also have a competitive mechanism. If ketone bodies are overbearing, they will be discharged more, and uric acid will be discharged less. Most obese people love high-calorie foods such as fried chicken and cola, and they eat too much fat. The above drama is repeated again.
Skillful exercise, uric acid control and gout prevention
□ Professor of Orthopaedics, tongji hospital, Tongji Medical College, Huazhong University of Science and Technology Guo Fengjin Li Feng Deputy Chief Physician Hu Weihua
Like a needle! Like a tiger bite! Like a devil’s bite, I can’t wait to cut it off A gust of wind hurts … … This is the description of acute attack by gout patients. Gout is considered as "the first pain in the world", but at present, most patients are "forgetting the pain after getting rid of the scar" and only pay attention to the treatment of acute attack. When the pain was relieved, most people returned to normal life without effective prevention and treatment.
As everyone knows, with the development of time, sodium urate will be deposited on the joints and around them, which will form crystals, that is, tophi. These tophi can cause painful nodules covering the skin. After tophus gradually increases, it may affect joint function, compress nerves and affect organ function, and its external skin may become thinner and ulcerated, forming fistula and discharging white chalk-like urate crystals, which will not heal for a long time. At this point, it can only be treated by surgery.
Can gout patients exercise?
Many small things in life can easily lead to gout if you don’t pay attention to them. You must pay attention to the care of gout patients and cooperate with the doctor’s treatment. Does that mean that gout patients can’t exercise? The answer is no. Life lies in exercise, which is also applicable to gout patients. However, they should pay more attention to some exercise methods. Studies have shown that proper exercise can enhance physical fitness, promote systemic blood circulation, and the utilization of sugar, fat and protein by muscles and tissues, thus reducing blood uric acid and blood sugar concentration, reducing the production of uric acid, and also preventing diabetes and arteriosclerosis, improving heart function, stabilizing blood pressure and reducing cardiovascular complications.
Which exercises are suitable for gout patients?
Tread on the stone barefoot. Treading on stones barefoot refers to walking on cobblestone roads without wearing shoes and socks. Pebbles can stimulate acupuncture points and nerve endings on the soles of feet, cause excitement, activate the functions of autonomic nervous system and endocrine system, accelerate blood circulation, promote metabolism, nourish yin and tonify yang, maintain kidney meridian and adjust blood pressure, improve sleep, relieve fatigue, improve immunity and adaptability to external environmental changes, and have certain preventive and therapeutic effects on gouty arthritis and other diseases.
Swimming. Moderate swimming can rotate all joints, keep them flexible, reduce the friction and extrusion between bones, improve local blood circulation and promote the dissolution and excretion of urate. It should be noted that it is best to control swimming within one hour. Do not increase lactic acid in the body due to excessive exercise and inhibit uric acid excretion by the kidneys.
Jogging. Running is a common and easy sport. For people under pressure, strenuous running is more inclined to vent, but it is not as good as jogging. Before exercise, you can do some warm-up exercises and adjust your breathing. It is recommended to jog for half an hour to an hour every day, and the best time is from 5 pm to 7 pm.
Although physical exercise alone can’t effectively reduce serum uric acid, it can significantly reduce serum uric acid concentration when combined with diet health care, thus playing a role in preventing gout attack and delaying the progress of the disease.
It hurts enough to doubt the rational use of drugs to relieve life.
□ Department of Pharmacy, tongji hospital, Tongji Medical College, Huazhong University of Science and Technology Tang Liying Peng Jingning Fang Jianguo
Gout, pain in the bone, pain in the heart, its ferocity, people doubt life.
The treatment of gout attack should be as urgent as fire fighting. Although there are many strategies to deal with gout, non-drug treatment should be the first choice, pay attention to adjusting the diet structure, and follow the doctor’s advice, take medicine according to the doctor’s advice and review regularly.
The main drugs for gout are colchicine, non-steroidal anti-inflammatory drugs, drugs that promote uric acid excretion (such as probenecid and benbromarone) and drugs that inhibit uric acid synthesis (allopurinol and febuxostat).
"Treat its target first" — — Control acute inflammation. Colchicine and non-steroidal anti-inflammatory drugs are mainly used in the acute onset of gout, and the principle of taking medicine in full at an early stage and gradually stopping after taking effect is generally very obvious. If the pain does not improve obviously after taking the medicine for one week, you should seek medical advice in time. Non-steroidal anti-inflammatory drugs commonly used in clinic include cyclooxygenase -1(COX-1) inhibitors and COX-2 inhibitors, such as indomethacin, ibuprofen, celecoxib, etc. As the first-line drugs for gout, these drugs are effective and relatively safe. However, these two drugs have side effects, mainly gastrointestinal toxicity, which should be paid close attention to in clinical application. The toxic side effects of colchicine tablets in acute phase are great, so it is necessary to monitor blood routine and liver and kidney function regularly during taking the drug. Some patients will have vomiting, diarrhea and other reactions after taking the medicine. At this time, the medicine should be stopped or reduced.
"Slow down and cure its roots" — — Medication in remission should be avoided in acute attack. Patients in remission can start the treatment of allopurinol, an acid inhibitor, 1-2 weeks after joint inflammation is controlled. During the remission period, you should pay attention to drink more water, more than 3000ml per day, supplement sodium bicarbonate when necessary, and alkalize urine to prevent uric acid crystals from depositing in the process of excretion.
In the chronic phase, drugs that inhibit uric acid synthesis and drugs that promote uric acid excretion should be used. Excessive uric acid needs treatment even if it does not cause pain symptoms, and patients can’t ignore it. In addition, patients should pay attention to the interaction between drugs, such as hypoglycemic drugs (biguanides) and antihypertensive drugs (ACEI), which will reduce the excretion of uric acid, and gout patients should be cautious in using such drugs.
As the first choice for reducing uric acid, febuxostat has a strong effect on reducing uric acid. The effect of one tablet of febuxostat is similar to that of three tablets of allopurinol, and patients with impaired renal function do not need to adjust their drug use through liver metabolism. The recommended initial dose of febuxostat tablets is 40mg once a day. If the serum uric acid level is not lower than 6mg/dL after 2 weeks, it is recommended to increase the dosage to 80mg once a day.
At present, febuxostat is the only gout drug whose therapeutic effect is not affected by high-fat diet. However, at the initial stage of taking this product, it may cause gout attack, because the uric acid deposited in tissues is mobilized due to the change of blood uric acid level. It is recommended to take non-steroidal anti-inflammatory drugs or colchicine at the same time.
In short, the treatment of gout is a lifelong process of reducing uric acid, unless intolerance or adverse reactions occur. Patients should pay attention to a low purine diet, maintain a reasonable weight, abstain from drinking, drink more water, avoid overeating, drinking too much, getting cold and getting wet, fatigue and mental stress, wear comfortable shoes to prevent joint injury, and use drugs that affect uric acid excretion with caution, such as some diuretics and low-dose aspirin. In addition, we should pay attention to the prevention and treatment of concomitant diseases, such as hypertension, diabetes and coronary heart disease.
Did you get caught in the eight misunderstandings of gout diet?
□ Ye Ting, Deputy Chief Physician, Department of Clinical Nutrition, tongji hospital, Tongji Medical College, Huazhong University of Science and Technology, Dong Lingling, Professor of Rheumatology and Immunology.
Diet adjustment is an important part of gout treatment. By actively adjusting diet structure and living habits, we can choose different diet methods according to our own condition, which can not only meet the body’s demand for nutrition, but also prevent gout attacks. However, in life, gout patients are often caught in a diet misunderstanding.
First, eat less high-purity foods such as meat, eggs and milk?
Half right and half wrong!
Animal offal, seafood, all kinds of meat including livestock, poultry, most fish and thick broth contain a lot of purine, so it is really necessary to eat less. Purine is soluble in water. When cooking meat, it can be eaten by boiling and stewing.
Milk and eggs, however, are low-purine foods, and are rich in high-quality protein with essential amino acids, which can be eaten by gout patients. Many epidemiological studies show that higher intake of low-fat dairy products is beneficial to prevent gout. For patients with acute gout, milk and eggs can be used as the main sources of high-quality protein in diet. How to eat? We suggest that the daily intake of meat should not exceed 150g, and encourage the intake of low-fat or skim dairy products, 300ml per day.
Second, spinach, cauliflower, mushrooms, asparagus and other vegetables are rich in purine, and gout patients can’t eat them?
Wrong!
Although dark green tender stem and leaf vegetables (such as spinach and asparagus); Flower vegetables (such as cauliflower); Tender bean vegetables (such as edamame and tender peas); Dried fungi (all kinds of fresh mushrooms) are not low-purine foods, but studies show that vegetables rich in purine have no obvious correlation with high uric acid and gout attacks. Eating a lot of vegetables can also play a role in alkalizing urine, which is beneficial to the excretion of uric acid. The recommended daily intake of vegetables for ordinary residents is 300~500 grams, which can be increased to 700~1000 grams if the gastrointestinal function of gout patients can be tolerated.
Third, gout patients can’t eat coarse grains?
Wrong!
Like vegetable selection, although the purine content of some whole grains is higher than that of polished rice flour, it is not accurate to evaluate whether a food is suitable for gout patients only by considering the purine content. At present, no research has found that whole grains increase the risk of gout, and the purine content of millet, corn and other grains is equivalent to that of rice and white flour, or even lower. Moreover, miscellaneous grains are also a good food source of B vitamins, potassium and dietary fiber, which is beneficial to uric acid excretion, inflammatory reaction and weight control in patients with gout and hyperuricemia.
Fourth, soy products can’t be eaten?
Wrong!
Although soybean is a high purine food, the latest research shows that beans, especially bean products, can not only reduce the level of serum uric acid, but also reduce it. The mechanism is mainly because beans can increase blood uric acid and promote uric acid excretion at the same time, and the latter is more significant.
The cooking method of food has a great influence on the purine content of bean products. After soaking and grinding, the purine content is diluted. When tofu is made, part of the slurry water is squeezed out, and the purine content is further reduced due to the loss of water. The purine content of soybean products is greatly reduced, and it is rich in high-quality protein, which can make up for the reduction of protein intake caused by the restriction of red meat intake and reduce the risk of coronary heart disease. Therefore, gout patients can eat soy products in moderation.
Five, fruit contains fructose, gout patients can’t eat?
Wrong!
Although many fruits contain a lot of fructose, they are also rich in dietary fiber, potassium and vitamin C, which is beneficial to the excretion of uric acid and the reduction of blood uric acid level. At the same time, polyphenols in fruits are beneficial to reduce the level of inflammatory reaction, which are beneficial to gout patients. Studies have shown that fruits can reduce the risk of gout attacks.
But after all, fruit contains a lot of sugar, so it is not recommended for all gout patients to eat a lot of fruit. Fruits with less fructose can be eaten, such as cherries, strawberries, pineapples, watermelons, peaches, etc. It is no problem to eat 200~300 grams according to the normal quantity of healthy people.
Sixth, fat has no effect on uric acid?
Wrong!
Although fat itself does not contain purine, it will not increase uric acid production, but it will reduce uric acid excretion. At the same time, the high energy density of fat is not conducive to weight control. Therefore, we should try to reduce fat intake, such as fat meat and poultry with skin; Avoid frying high-fat foods.
Drinking beer, tea, coffee and fruit juice can increase the amount of drinking water and help to excrete uric acid?
Not quite right!
For the prevention and control of hyperuricemia and gout, what you eat is important, and what you drink is also important. Purine is easily soluble in water. Drinking more water for gout patients is beneficial to uric acid excretion, and it can also prevent kidney calculi of uric acid and delay the damage of kidney caused by the disease. Drinking plenty of water can shorten the duration of gout attack and relieve symptoms. People with normal heart and kidney function can drink more water and maintain a daily urine volume of 2000~3000ml.
However, it is not good to drink more beer, because alcohol metabolism can increase the concentration of lactic acid in the blood, and lactic acid can inhibit the secretion of uric acid by renal tubules and reduce the ability of kidney to excrete uric acid; Fruit juice drinks are rich in fructose, which can promote the production of endogenous uric acid. Excessive sugar intake accompanied by excessive fruit juice intake will promote obesity and metabolic disorders, which are themselves factors that promote gout. The relationship between coffee and high urea and gout is still inconclusive. Some studies show that coffee does not increase the risk of high uric acid, and may reduce the risk of gout. We believe that the best drink for gout patients is boiled water, which should be more than 2 liters per day.
Eight, gout patients only need to pay attention to the purine content of food?
Wrong!
Gout patients often pay too much attention to the purine content of food, and are entangled in whether this food can be eaten or not. There are two sources of uric acid in human body. The one decomposed from purine-rich foods (exogenous) accounts for about 20% of the total uric acid in the body, while the one synthesized in the body or metabolized by nucleic acids (endogenous) accounts for about 80% of the total uric acid in the body. In addition to reducing the intake of purine in diet, we should also control weight, reasonable diet and improve the metabolic disorder of the body. Obesity increases the risk of gout in patients with high uric acid, and weight loss can effectively reduce the level of serum uric acid. It is suggested that patients with hyperuricemia should control their weight in the normal range. However, you should avoid dieting and losing weight too fast, and ketone body production will interfere with uric acid excretion.
Li Jianfa [2019] No.225 Annex. doc
