Why does gout keep coming and going? How can I prevent the recurrence of gout?

Gout is a common joint inflammation, but also a metabolic disorder of the disease, very easy to recur, so that patients are miserable, there are many treatments for gout disease, and gout can also be cured, so, why does gout always come and go? How can I prevent the recurrence of gout? This is the question that patients are most concerned about, so let's take a look.

1. Causes of easy recurrence

Myth 1: Hormones are fiercer than tigers, and you need to be cautious in your selection

1) Many people talk about hormone discoloration, and there are many side effects of hormones, such as obesity, high blood pressure, hyperlipidemia, diabetes, osteoporosis, cataracts, gastric bleeding, etc. Therefore, many people think that "hormones are fiercer than tigers", and they can not use them.

It is important to note that these side effects of hormones are caused by long-term use. In the acute phase of gout, if you need to use hormones, you should use them for a short time under the guidance of a rheumatologist, and at the same time use drugs to prevent hormone side effects, generally speaking, it will not have much effect on our body, so there is no need to worry about it.

2) Hormones are not a conventional weapon for anti-inflammatory and pain-relieving pain in the acute phase of gout, but are used as the ultimate weapon, just like the atomic bomb. So what kind of gout patients need to use hormones?

In general, short-term corticosteroids are appropriate in patients who are ineffective or intolerant of NSAIDs or colchicine, or who have severe recurrent episodes of acute gout, or who are advanced and already compromised in their body function, such as renal impairment (when colchicine and NSAIDs are no longer available).

Myth 2: About the use of colchicine

1) At present, it is believed that the use of low-dose colchicine in the acute stage of gout is as effective as that of high-dose colchicine and has significantly reduced side effects (the guidelines for the diagnosis and treatment of gout at home and abroad recommend the use of colchicine 0.5mg in the acute stage, 3 times a day).

2) Do I need colchicine in the non-acute phase?

It is true that the first task in remission of gout is urate-lowering therapy, but in remission of gout, colchicine prophylactic anti-inflammatory treatment is required. The so-called prophylactic anti-inflammatory is to take 0.5mg (1 tablet) of colchicine every day while taking uric acid-lowering drugs, and the guidelines recommend that the course of treatment should not be less than half a year.

Because, after taking uric acid-lowering drugs, the blood uric acid level drops sharply, which is easy to induce an acute attack of gout, adding a small dose of colchicine can not only reduce the acute attack of gout, but also reduce the repeated fluctuations of uric acid, which is more conducive to the continuous and stable reduction of uric acid.

Myth 3: Pain is not cured

In clinical practice, it is common to encounter such a type of patient who "forgets the pain after the scar is good", and will actively cooperate with the treatment during the acute attack of gout, but stop the drug immediately during the remission period, forget the doctor's instructions to the "nine clouds", and continue to eat and drink.

In addition to the acute attack treatment, the key to gout treatment lies in the chronic maintenance treatment, and only when the blood uric acid is controlled can the recurrence of gouty arthritis be fundamentally controlled and related diseases caused by hyperuricemia can be prevented.

If it is only "pain treatment, no pain treatment" is completely "treating the symptoms but not the root cause", and cannot fundamentally control the uric acid level, gout attacks will become more and more frequent in the future, and the long-term harm brought by this is often very serious, such as joint deformity, uric acid nephropathy, stroke, myocardial infarction, etc., so the treatment of gout is a long-term project with a long way to go.

Myth 4: Gout attacks in the process of lowering uric acid

1) There is such a common phenomenon: gout patients in the process of lowering uric acid have a gout attack after taking uric acid-lowering drugs, at this time, many patients will think that the uric acid-lowering drugs are "causing trouble", so they "angrily" stop the uric acid-lowering drugs, in fact, this is completely wrong, and the consequence is that gout continues to attack for a long time and cannot be cured.

2) Gout recurrence or aggravation during urate-lowering treatment, which is an effective response to urate-lowering drugs. After gout patients use urate-lowering drugs, uric acid drops quickly, and the urate crystals in the patient's body will dissolve into urate particles, like "snowman dissolving".

Urate particles that fall from urate crystals are deposited on other joints in the body, causing pain, which is also a process in which the drug works.

At this time, what we should do is to use a combination of colchicine or anti-inflammatory and analgesic drugs to prevent gout recurrence. If the blood uric acid level can be maintained below 360umol/L (patients with obvious tophi are recommended to control the blood uric acid level to maintain below 300umol/L), the tophi deposited in the body can gradually dissolve and disappear, and it will no longer attack, so as to achieve the possibility of curing gout.

Myth 5: Antibiotics are used for acute attacks of gout

1) Many gout patients, and even some non-specialist doctors, will choose to use antibiotics for treatment during an acute attack of gout, such as intravenous infusion of penicillin, cephalosporin antibiotics, etc., based on the belief that if the joint is red, swollen, hot and painful, then there must be a bacterial infection.

The most important thing is that the joint swelling and pain in gout patients can be relieved for a period of time after taking antibiotics. Why？！

2) To get back to the point, do I need antibiotics for an acute attack of gout? The answer is no. Because an acute attack of gout is a sterile inflammatory response caused by the deposition of urate crystals in the joints and surrounding tissues, antibiotics are generally not needed unless the gout patient has secondary infection or other site infection, and there is obvious evidence of infection and laboratory indicators.

So why do many gout patients be relieved of joint swelling and pain after taking antibiotics in the acute phase for a period of time? In fact, this is not the role of antibiotics, in many cases, it is only that patients with gout who are not severe in the early stage are self-limited in the acute stage, so the joint swelling and pain can be relieved naturally.

People with gout who are given antibiotics tend to have recurrent episodes, getting worse each time. So how should the treatment of gout be standardized in the acute stage?

At present, gout guidelines at home and abroad recommend the use of non-steroidal anti-inflammatory analgesics, colchicine, and glucocorticoids for the treatment of acute attacks of gout, with the aim of anti-inflammatory (non-infectious inflammation of joints caused by uric acid crystals) and analgesia (relieving severe pain in patients).

Myth 6: Believe in surgery

Modern medicine considers gout to be an internal disease (rheumatism), and surgery is generally not preferred even for patients with tophi unless the tophi has caused organ damage and seriously affected the quality of life. Because surgical treatment cannot fundamentally solve the problem, if the blood uric acid level of gout patients cannot be maintained for a long time, tophi will continue to form, and the postoperative surgical incision is difficult to heal, which greatly affects the quality of life of patients.

For patients with tophi, it is recommended to reduce uric acid to less than 300umol/L, as tophi may slowly soften or even be absorbed gradually. Excessive belief in surgical treatment, and ignoring the standardized drug treatment of gout in internal medicine, tophi will only be cut and grown like a "weed", "one year old and one withered", and surgical treatment can only treat the symptoms but not the root cause.

Myth 7: You can't eat high-purine foods

In the process of daily diagnosis and treatment of gout patients, almost every patient is still most concerned about diet. "What can be eaten" and "what cannot be eaten" are questions that almost every gout patient asks.

Undoubtedly, a high-purine diet (e.g., organ meats, seafood, beer) is a common cause of gout, but disorders of endogenous purine metabolism are also important mechanisms for gout attacks.

The traditional belief is that the daily diet of gout patients should strictly limit the intake of purines, but in recent years, with the publication of research reports on the mechanism of gout and diet, some old gout dietary concepts have been gradually corrected, and some new concepts have been gradually put forward and taken seriously. For example, people with gout are not absolutely "out of the picture" with seafood.

Seafood has high nutritional value for people, and is better than meat, which is beneficial to human health. At the same time, seafood, especially oily fish, is rich in unsaturated fatty acids, which are the main source of unsaturated fatty acids in the human body, and may have a protective effect on the human cardiovascular system.

Gout patients are also a group with a high incidence of cardiovascular diseases, so gout patients do not mean that they can only be "monks" and eat vegetarians. There is no need for gout patients to eat a vegetarian diet for a long time, and a long-term vegetarian diet can easily lead to malnutrition. Patients with gout are advocating controlled purine intake.

Many studies have shown that if the blood uric acid of gout patients is maintained at the target level (below 300umol/L), then it is not alarmist to eat foods with high purine content such as beef, mutton, shrimp, and crab in moderation during remission.

Seafood with low purine content: herring, herring, salmon, anchovies, tuna, white fish, lobsters, crabs, oysters, etc.

Myth 8: The lower the blood uric acid, the better

Most patients with gout have kidney involvement, especially those with chronic gout, and in severe cases, joint destruction deformities, renal impairment and even kidney function can occururemiaGout patients are often accompanied by hyperlipidemia, hypertension, diabetes, arteriosclerosis and coronary heart disease, which seriously endangers the quality of life of patients.

Therefore, many gout patients will think that since high uric acid is so harmful to the body, then uric acid should be lowered as low as possible. But everything has two sides, yin and yang, contradictions are opposites and unity, and uric acid is not as low as possible.

Large-scale epidemiological studies around the world have found that uric acid is associated with degenerative changes in brain tissue. Lower than normal levels of uric acid can lead to diseases such as Alzheimer's disease and multiple sclerosis.

2. Prevention methods of gout

Drink plenty of water

In summer, the weather is hot and sweating increases, which can cause hemoconcentration, which increases blood uric acid and induces gout attacks. Therefore, it is necessary to pay attention to replenishing more water and drinking about 2000ml of water every day. Plain water, weak tea, sugar-free soda, etc. are all good choices.

Eat fruits and vegetables rich in vitamin C in moderation

Research on vitamin C and gout continues, and some studies say that it is beneficial to gout and has the effect of promoting uric acid excretion; Some studies say that it is not very useful. Regardless of the final conclusion, eating fruits and vegetables in moderation is always harmful, and it may also have the effect of reducing gout attacks. However, some fruits are rich in fructose, eating too much fructose at one time will increase blood uric acid and even induce gout, it is recommended that gout patients eat 200~400g of fruits every day. Common fruits and vegetables rich in vitamin C include broccoli, peppers, papaya, etc.

Milk and yogurt can be drunk in moderation

Drinking skim milk and low-fat yogurt can help lower blood uric acid and reduce the flare-up of gout. The orotate in dairy products promotes the excretion of uric acid through the kidneys, casein and lactalbumin also have the effect of uric acid excretion, while glycomacropeptide and G600 milk fat extract have anti-inflammatory effects and can reduce the inflammatory response during gout attacks.

Insist on taking medication to lower uric acid

Taking medicine is the last thing everyone wants, but insisting on lowering uric acid and keeping uric acid at a low level is the most important thing to reduce gout attacks. Studies have shown that the lower the blood uric acid, the lower the gout recurrence rate, and when the blood uric acid is 540 μmol/L, the gout recurrence rate is 80%, which is

Therefore, in addition to improving your lifestyle, you must cooperate with your doctor to take medication so that you can better avoid gout attacks.

3. Relief of gout attacks

I believe that everyone is very familiar with gout, gout seriously affects the work and life of patients, and gout in an acute attack, the patient's pain is more intense, the feet can not move, the slightest touch will make the patient unbearable, therefore, the attack of gout urgently needs to be solved quickly.

1. The swelling and pain at the site of the disease make it difficult for you to sleep and eat, so it is recommended that you apply ice packs to the skin to relieve the pain associated with gout.

2. If the ice does not achieve the effect of relieving the pain, at this time, you should take medication to relieve it. Patients often use non-steroidal analgesics, but remember not to choose hormones and salicylic acid for pain relief, otherwise it will not have the effect of relieving pain.

3. Pay attention to regular exercise so that the joints can get a full activity, move your fingers and toes, knees and elbows more if you have nothing to do, and do stretching exercises, which can decompose the deposits at the joints and also relieve pain.

4. Soak your feet in Epsom salt: Soak your feet in water with Epsom salt for 20 to 30 minutes before going to bed at night, which can reduce pain and help uric acid to be excreted from the body.

After the acute attack is resolved, the patient should be treated in time, and the treatment of gout mainly includes two aspects, one is treatment, and the other is that the diet should be controlled.