So many gout patients, how many people fully understand this disease? Not much.
How should gout be treated? Can gout be cured? This is also a question that patients who come to Dr. Liu's gout department often ask. In the contact with gout patients, everyone has their own different understanding of this common crystallization, metabolism and rheumatic immune disease. Some people think that gout is an occasional attack, and it is good to diminish inflammation and relieve pain; Some people think that gout is a problem with renal function, so it is good to drink plenty of water to promote renal excretion; Some people think that gout can't be cured anyway, and it doesn't matter if it is released.
People have all kinds of misunderstandings about gout; But people often feel that their understanding is right. Even in the face of doctors, they may argue. I don't know if this is natural self-confidence or gout has a different definition and understanding. Today, Dr. Liu took stock of the top ten gout treatment misunderstandings for gout patients encountered in outpatient clinics.
What is the mechanism of acute gout attack? What makes gout painful is not the high blood uric acid, but the reaction that uric acid salt recognized by human immune cells is deposited in joints caused by high blood uric acid concentration.
When the blood uric acid value of gout patients exceeds 420μmol/L, the blood can't dissolve uric acid, so uric acid will precipitate to form crystal salt, which will flow to all parts of the body with the blood, especially in places with low body temperature and poor blood circulation. When urate crystals accumulate to a certain extent, macrophages and neutrophils in the blood will "attack" them and release a variety of inflammatory substances, thus causing inflammatory reactions.
Can antibiotics, especially cephalosporins, penicillin and streptomycin treat acute gout attack? Of course not. Because antibiotics are antibacterial drugs, as the name implies, they are only suitable for inflammation caused by bacteria. Antibiotics interfere with the biochemical metabolism process of pathogenic microorganisms or destroy their structural integrity by targeting various bacteria that cause inflammation, some inhibit the growth and reproduction of pathogenic bacteria, and some kill pathogenic bacteria, thus producing anti-inflammatory effects. However, other types of inflammation, such as blood stasis, redness, pain and diseases caused by allergic reactions, cannot be effectively treated.
Many people regard antibiotics as a panacea for colds, fever, joint pain and dizziness. In fact, antibiotics can't cure all diseases. Especially acute gouty arthritis, is not a disease caused by bacteria. At this time, the use of antibiotics excreted by the kidneys can not only treat gout, but also bring a burden to the kidneys.
But some patients said to me, "Dr. Liu, I have been infusion for a few days, and acute gout is fine." What's wrong? " My answer is: perhaps it is not the pain relief caused by infusion, but the gout relieves itself; Because acute gout attack is not prolonged, but has the function of "self-healing". Generally, even if you ignore it, the pain will disappear in 3~7 days.
In addition, many grass-roots doctors will add some commonly used glucocorticoids during infusion, but glucocorticoids can still quickly relieve pain and reduce joint congestion and edema, but they are not suitable for long-term use. Because glucocorticoids are easy to relapse after stopping taking drugs, they are only used in clinical diagnosis and treatment for patients with very serious symptoms and recurrent gout, generally not more than 65,438+00 days, and need to be used under the guidance of doctors.
Many gout patients actually know that when acute gouty arthritis occurs due to overeating, heavy drinking, trauma, hunger, fatigue, cold and other reasons, they should seek medical advice as soon as possible. When acute gouty arthritis attacks, it is often sudden; Especially in the case of redness, swelling, fever and pain for the first time, patients may feel helpless or panic. Generally, the first attack will occur in the first metatarsophalangeal joint (big toe) of the foot, and more than two affected areas will appear after entering the chronic stage.
What should I do when acute gouty arthritis attacks? Don't move, fix the affected area above the heart; If you have been lying on your back, you can put a pillow or quilt on the affected area. Then you can cover the affected area with cold compress to cool down, but it is not recommended to use ice packs or ice water to cool down.
Followed by anti-inflammatory and analgesic treatment. Generally speaking, non-steroidal anti-inflammatory drugs such as colchicine, indomethacin, naproxen, oxaprozin and pranoprofen are commonly used by rheumatologists to relieve acute gout. If used within 24 hours of pain onset, it can relieve pain in most cases; If the pain cannot be relieved, adrenocortical drugs, such as prednisolone, methylprednisolone, dexamethasone and betamethasone dipropionate, should be used. After the general severe pain disappears, the joint pain continues; Then you need to take the medicine normally 1~2 weeks, and you can stop taking the medicine after the inflammation is relieved.
After the pain disappeared, the real gout treatment actually began. Why do you say that? Because even if the pain disappears, uric acid will continue to deposit in the body:
If gout only relieves joint pain and usually does not reduce uric acid, then metabolic diseases such as hypertension, hyperlipidemia and hyperglycemia and other cardiovascular and cerebrovascular diseases such as atherosclerosis, coronary heart disease and stroke may also occur. Therefore, even if the joints are not painful, uric acid reduction treatment should be carried out.
Some patients think that gout attacks, especially joint redness and swelling, are caused by blocked blood vessels, so they soak their feet with hot towels or hot water to achieve the purpose of relieving pain.
In fact, the joint redness and swelling during gout attack is caused by the release of inflammatory substances and the expansion of capillaries. If hot compress is used, it will lead to hyperemia and edema in the lesion, more severe telangiectasia and accelerated deposition of urate crystals, which will lead to aggravation and escalation of pain.
The acute attack of gout is not only hot, but also cold. If the temperature is too low, especially if ice water or ice packs are directly applied to the painful joints, it will stimulate local blood vessels to contract and reduce blood flow, which is not conducive to the absorption and dissipation of inflammation; In addition, it may also cause frostbite to the originally red skin. So pay attention to the temperature when cold compress. It is generally recommended to apply hot compress or cold compress at the same temperature as the body temperature. Even if the pain can be temporarily relieved, the inflammation will not be absorbed and dissipated, and then anti-inflammatory and analgesic treatment is needed.
There are also gout patients who, like other rheumatism, apply dampness-removing and pain-relieving ointment, tiger bone ointment or wind oil essence, bone-setting water and medicinal liquor. In fact, Dr. Liu does not recommend this, because these plasters, drugs and medicated wine have a certain stimulating effect on the skin, and failure to relieve pain will aggravate local congestion.
There are also patients who believe too much in Chinese medicine treatment. When acute gout attacks, they go to street massage shops for physical therapy, massage or acupuncture. In the acute attack of gouty arthritis, the local swelling is obvious and the inflammation is serious, which is not suitable for these irritating treatments. In particular, improper physical therapy may increase local blood flow and temperature and aggravate congestion.
Of course, if you enter the intermission, you can carry out physical therapy, acupuncture and physical therapy under the guidance of a Chinese medicine therapist or a Chinese medicine doctor. Proper Chinese medicine treatment is helpful to improve and restore the joint function of gout patients.
Febusotan, a commonly used drug in endocrinology and rheumatology, has also recently entered the medical insurance catalogue. In the knowledge of some gout patients, only febuxostat is a drug to reduce uric acid.
Is that really the case? In fact, patients do not fully understand the treatment of gout and the reduction of uric acid. The uric acid reduction treatment of gout is not only to reduce or avoid the recurrence of acute gout, but also to avoid joint deformity and gouty nephropathy. In addition to febuxostat, allopurinol and benzbromarone are also used to reduce uric acid. Each drug can reduce uric acid, but it depends on which one is suitable for gout patients.
In short, different drugs for reducing uric acid have indications and contraindications, as well as related precautions; Sometimes it is necessary to use uric acid lowering drugs in combination according to the situation. Not all uric acid lowering drugs are suitable for every gout patient. Improper medication can not only cure gout, but may make uric acid out of control and cause other diseases.
How did uric acid come from? 20% of food purine and 80% of human metabolic purine are metabolized by the liver; How to get uric acid? 80% is excreted through the kidney; 20% is excreted by the intestine and sweat.
Uric acid is excreted through the kidneys. If hyperuricemia occurs, excessive uric acid in the body is easy to form crystal salts and deposit in the kidney, while renal interstitial and renal tubules are interfered by chronic inflammation, which will affect renal function for a long time, and the ability to excrete uric acid will also decrease, and blood uric acid will further increase, thus continuing to damage renal function again and forming a vicious circle.
In other words, persistent high uric acid is easy to cause kidney damage. The treatment of gout is mainly to reduce uric acid. Some patients will be very entangled, and drugs that reduce uric acid will also damage the kidneys. Should I answer it or not? Can I change to Chinese medicine? As a western doctor, I will first tell you how the commonly used uric acid lowering drugs allopurinol, febuxostat and benbromarone are used for "kidney weight".
Generally speaking, for gout patients, it is necessary to check the liver and kidney function, carry out blood routine, renal B-ultrasound or other related examinations before taking the medicine to understand the renal function and other related conditions, so as to avoid further damage during the treatment of uric acid reduction and use the medicine rationally. In fact, normal uric acid is not controlled, which may lead to more serious kidney damage.
Can traditional Chinese medicine reduce uric acid? Of course. Traditional Chinese medicine divides gout into damp-heat syndrome, cold-dampness syndrome, heat toxin with dampness syndrome, phlegm and blood stasis syndrome, spleen deficiency with dampness syndrome, liver and kidney deficiency syndrome, qi and blood deficiency syndrome, spleen and kidney yang deficiency syndrome, dampness accumulation syndrome, bladder damp-heat syndrome, qi and yin deficiency syndrome, etc. The treatment of gout follows the changes of its etiology, pathogenesis and pathological changes. Acute symptoms are treated, while slow symptoms are cured, and there are different stages. Because my major is western medicine, I won't teach fish to swim here.
But gout patients sometimes believe in "kidney-protecting" drugs under the banner of "natural, green and no side effects". In fact, some drugs, such as Aristolochia and Aristolochia manshuriensis, have obvious toxic and side effects on the kidney, and long-term use will cause acute renal damage or chronic renal damage. Moreover, some health care products also say that they can "cure" gout without hurting the kidneys, but in fact, hormone drugs are added.
No matter western medicine or Chinese medicine, it is one person to treat gout and reduce uric acid, not a thousand people. Dr. Liu's advice is not to use Chinese medicine indiscriminately, which may cause damage to the kidneys; Don't blindly believe in health care products under the banner of "protecting kidney". Even if you use Chinese medicine, please use it under the guidance of a reliable Chinese medicine doctor.
# Health Guardian # # My 2020#