Out of the clinic last week, a middle-aged and elderly man asked me for help. When he showed his fingers, I was surprised to see that the middle finger, the index finger, and other joint deformities were thick, which is a gout stone that is hard to see now. Since the clinic of hyperuricemia and gout has been opened in the clinical nutrition department, there are many typical cases caused by the metabolic disorder of uric acid such as this. According to the patient’s self-report, gout has a history of more than 30 years. It has a feeling of pain at the beginning of the illness and can be controlled by medicine. However, in the past 10 years, because there were no symptoms of pain, nothing was taken seriously, neither medical treatment nor medicine was taken. As a result, the disease developed further. Spread from the hands and feet to the knee, ankle, and gout stone more and more, leading to walking, movement restrictions, seriously affected normal life.
Uric acid is the final product of purine metabolism in human body. Normal adults produce 700mg or so uric acid every day, including about 500mg of uric acid excreted through kidney and 200mg of uric acid excreted through intestinal tract, maintaining the balance of uric acid in vivo. Too much uric acid or poor uric acid excretion can lead to an increase in uric acid in the blood. In general, when the concentration of uric acid is higher than 416umol/L, hyperuricemia can be diagnosed clinically, but most patients do not have obvious symptoms, and because of this, many people also find that hyperuricemia is not available for medical treatment, which often delays the disease.
In patients with hyperuricemia, uric acid crystals are deposited in the synovium, skid sac, cartilage and other tissues, causing recurrent inflammatory diseases called gout. The symptoms were gouty acute arthritis, chronic arthritis, gout stone and joint deformity, gouty nephropathy and so on. The higher the level of uric acid, the greater the risk of gout in the next five years. Patients with high uric acid had different conditions: those with uric acid as high as 700umol/L were asymptomatic, and those with uric acid close to 400umol/L ‘s left and right toes were too painful to walk. And the disease does not distinguish between the North and the South, regardless of men and women, young and old, clinical can also see teenage patients.
There are two sources of uric acid in human body: endogenous nucleic acid is constantly renewed and decomposed by nucleic acid purine uric acid, about 80% of uric acid comes from the decomposition of nucleic acid in the body, and 20% comes from food rich in purine in the diet. But don’t underestimate this 20% of the purine from food, because patients with high uric acid, gout have a common feature, like to eat foods rich in purine, seafood, viscera, pig beef and mutton, chicken and duck fish, all kinds of broth, soy products.
People with a family history of gout, obesity, men, alcoholics, and eating a high-purine diet are susceptible to gout. Every attack in a person with gout has an incentive. For example, long-term eating fish stewed tofu, such as the annual crab market season, such as the National Day, Spring Festival holiday meal, drinking, overeating can lead to increased uric acid, induced gout attack.
What if uric acid is found to be too high? Pay attention to diet regulation. Because hyperuricemia is one of the “rich diseases” eaten out, diet treatment is the first choice to control hyperuricemia and gout. To see the patient, the nutritionist will calculate the individualized energy requirement according to the patient’s height, weight, activity and so on, and give the low purine diet according to different energy to guide the patient’s correct diet treatment.
Secondly, combined with drug therapy. During the acute attack of gout, in addition to the need for rest, raising the affected limbs, avoiding the weight of the affected joints, and so on, daily targeted use of sodium bicarbonate, diclofenac sodium and other non-steroidal anti-inflammatory drugs, colchicine and glucocorticoids, etc.Can effectively relieve symptoms. At the same time, the level of serum uric acid was checked regularly.
Need to stress is that some gout patients are often “good scars forget pain”, when symptoms can be shut down, with medication, when the symptoms as soon as relief, and began to eat and drink. A period of time ago a patient eats fish hot pot to cause gout (toe) arthritis acute attack, take painkiller relief, half a month later eat fish hot pot, cause gout (knee) arthritis acute attack again. In this solemnly remind patients, once the medical examination found hyperuricemia, will go to the hospital to see the doctor, must not wait until the serious condition before the doctor, only to reduce uric acid to the normal level and maintain in the normal range, in order to ensure your health.