Gout: What you need to know

Article written by Doctor Tran Thi Tuyet Nhung - Department of General Internal Medicine - Vinmec Times City International Hospital

Along with other metabolic diseases such as diabetes, lipid metabolism disorders, obesity, gout is increasing in developed countries as well as in Vietnam. If we know how to apply a reasonable diet, adhere to a treatment regimen and closely monitor the disease, we can completely prevent and control the disease.

The mechanism of the disease is due to increased uric acid in the blood (> 420μmol/l for men and >360μmol/l for women, when increased it will be deposited in organs and organizations of the body in the form of urate crystals. (in the synovial membrane causing arthritis; in the kidney causing interstitial nephritis, urinary stones gradually leading to kidney failure; bone cartilage; articular cartilage, ear cartilage; in subcutaneous tissues: elbows, ankles, knees); vascular wall ...).
This increase can be due to primary or secondary in which the cause of the increase is associated with genetic and local factors, the synthesis of endogenous purine increases much causing increased uric acid plus The causes of eating a lot of foods containing a lot of purines (liver, intestines, beef, dogs, shrimps, crabs...), drinking a lot of alcohol is the main cause of gout.

+ Acute form: Sudden swelling, pain, heat, intense redness in the joint of the big toe or other joints (lesser) such as the knee, ankle, elbow, wrist, finger joints. The pain can be after a hearty meal, an injury or after surgery, infection, after taking drugs (aspirin, diuretics...) or after cancer treatment (chemotherapy, radiation). Pain persists for 5 to 7 days, which may resolve spontaneously or more rapidly with treatment with colchicine or other non-steroidal anti-inflammatory drugs.
Whole body has mild fever, fatigue. The test can show that the blood uric acid is elevated but there are also cases that do not increase, which makes it easy for many clinicians to ignore the disease.
+ Chronic form: Due to not being treated, the prolonged increase in uric acid causes deposition in organs and tissues causing lumps (tophi granules; chronic arthritis gradually causes joint deformities, urinary stones, etc.) interstitial nephritis, renal failure, hypertension; tendinitis, bursitis...). Blood uric acid test is always increased, there is bone and joint damage on X-ray image.

Treatment has two relatively important parts, which are:
+ Nutrition
Avoid foods high in purines: animal organs (heart, liver, oval); seafood (shrimp, crab, salmon, sardines); beans, asparagus, spinach; red meat (buffalo, cow, dog); sour foods (sour fruits, pickled foods)
Avoid drinking alcohol and beer. Avoid diuretics and corticosteroids. Should drink a lot of water: about 2 liters/day (alkaline mineral water) Should eat a lot of green vegetables, carrots, cabbage Can drink milk, eat eggs, eat white meat (poultry without skin) Do not wear shoes that are too tight

In general, an energy-restricted diet because gout is often associated with other metabolic disorders.
+ Medicines
Anti-inflammatory drugs to treat acute attacks and prevent acute attacks: Colchicine often has diarrhea; other non-steroidal anti-inflammatory drugs (Voltazen, Piroxicam, Meloxicam, Etoricoxib...) in the absence of gastric ulcer, duodenal ulcer and internal kidney in patients with cardiovascular disease; Use of systemic corticosteroids or injections at joints must be prescribed by a doctor.
Drugs that reduce uric acid include: drugs that reduce uric acid production (Allopurinol - Zyloric), drugs that cause allergies, Febuxostat less allergenic. Probenecid (Probenecid) increases the excretion of uric acid through the kidneys. These drugs are only used when the patient is free of acute arthritis, but if they are taking but have an acute attack, continue taking them.

Drugs that alkalinize blood and urine, increase uric acid excretion, such as sodium bicarbonate solution.
Target uric acid < 360μmol/l with Gout without Tophy granules and < 300μmol/l with Gout with Tophy granules.
Patients usually stop treatment when the acute attack is over, so the uric acid in the blood increases, the disease progresses to chronic, leaving serious complications in the joints, kidneys and other organs.
Therefore, in order to prevent and control the disease in the most effective way, the patient must adhere to a reasonable diet, have regular checkups, and adhere to a long-term treatment regimen.
General health check is an effective method to protect health. During the general examination, the patient's overall body index will be evaluated through tests, imaging techniques, functional exploration techniques, etc., thereby helping to screen and detect early illnesses.
A general physical examination can help detect gout early through a blood uric acid test. This is a routine test performed on most health check-up packages. Although not all people with high uric acid in the blood have gout, but if the uric acid level in the blood is high and prolonged, the risk of gout is very high. When the blood uric acid test result is high, the patient will be assigned to carry out further tests along with imaging methods such as joint X-ray, CT scan,... to make a definitive diagnosis. sick.