A few days ago, Dr. Clove asked Brother Floating to tell the bitter experience of [he had two surgeries in three months due to gout]. After reading the article, many patients shared their treatment experience.
After reading it, Dr. Liu Lei was also deeply touched and wrote this article.
Hello, everyone! I am Liu Lei, a rheumatologist at Fudan Huashan Hospital in Shanghai.
After reading the article of Brother Floating, I felt quite deeply. Because I have met many similar patients, my whole body is covered with tophus, my joints are seriously deformed, which affects my normal life, and some even have renal failure and need dialysis treatment.
Every time I meet this kind of patient, I feel particularly sad, thinking that if I could pay attention to it earlier and receive regular treatment, I would not suffer from this crime. Therefore, according to the experience of floating elder brother, I have summarized the following four matters needing attention, which are also problems that often perplex everyone.
I hope everyone can avoid misunderstanding and take fewer detours and suffer less. As long as the treatment is standardized, gout is really not terrible.
First, how to avoid eating?
[Brother Floating] mentioned in his experience that [because of work reasons, it is always inevitable to have big fish and big meat at regular intervals, and wine bureaus that drink big wine]. Coincidentally, this includes foods that gout needs to be cautious about: wine, meat and seafood.
In daily life, everyone pays special attention to the problem of diet. Although the network is very developed and it is very convenient to acquire gout diet knowledge, what everyone knows is often inaccurate.
At the same time, with the deepening of research, some foods originally listed as taboo have proved that gout can also be eaten, such as the most classic tofu.
Some of the patients I met are very life-oriented and are willing to take the time to carefully arrange their diet according to the purine content table. This is of course the best. You can refer to the purine content table of food for arrangement.
However, more patients may be [rough]. For these friends, I think the basic principle should be remembered: alcohol must be abstained; Eat less meat and seafood and do not drink broth or seafood soup. Drink more milk (low-fat and skim milk are recommended) and eat less sweets. Avoid greasy diet and eat more vegetables.
Second, when is it appropriate to start treatment in what?
Almost every gout patient will seek treatment when gout attacks, which may be colchicine, non-steroidal anti-inflammatory drugs or hormones and other [painkillers], but the more important [uric acid reduction therapy] is often neglected after pain relief. As mentioned in the article, [floating elder brother] only started uric acid reduction therapy seven or eight years after gout.
In the past, it was believed that patients with [attacks twice a year or accompanied by kidney stones or renal insufficiency] should start uric acid reduction treatment, while the latest guidelines further recommend that patients with [attacks more than twice a year, with tophus or kidney stones; Young patients (480mol/L, or with complications (renal insufficiency, hypertension, cardiac insufficiency, ischemic heart disease) should consider starting uric acid reduction therapy after the first gout attack. This means that uric acid reduction therapy should be more active.
Therefore, it is suggested that friends who have had gout attacks should go to the rheumatology department or endocrinology department to see a doctor to judge whether uric acid reduction treatment should be started.
Third, should tophus be operated on?
[floating elder brother] because tophus affected the movement of fingers and wrists, I went to the hospital to remove tophus. There are also many patients consulting, whether they should have surgery to remove tophus. For general tophus, we do not recommend surgery to remove, the reasons are as follows:
- When gout patients want to remove gout stones, the number of gout stones is often relatively large, and it is obviously impossible to remove them all. Secondly, if there is no regular and effective uric acid reduction treatment, even if the tophus is removed, it will recur soon. More importantly, insisting on uric acid reduction treatment can make most of the tophus gradually fade away. We can also see that [floating elder brother] after uric acid reduction treatment, some of the tophus without surgery did fade away.
However, if the existence of tophus really affects activities and daily life and work, it is also possible to operate on these tophus.
4. How long will it take to take the medicine to reduce uric acid?
[Brother Floating] After using benzbromarone, he once stopped the uric acid lowering drug for a few days. After testing, he found that uric acid had increased again, and then he began to use it regularly.
Many patients will ask [how side effects are this drug? How long will it take? ]
In fact, when considering the side effects of drugs, everyone should first understand, gout and long-term high uric acid will cause what kind of damage to the body. The harm of the disease itself is definitely far greater than the side effects of drugs, what’s more, under the protection of regular reexamination, the side effects of drugs can be minimized.
The latest gout diagnosis and treatment guidelines in 2016 set short-term and long-term goals for reducing uric acid:
The short-term goal is what we often mention [360mol/L without tophus, 300mol/L with tophus];
The long-term goal is that gout patients should control uric acid below 360mol/L for life, which requires the combined effect of drugs and lifestyle improvement.
Of course, we all hope to reach the standard of uric acid reduction through the minimum dose of drugs or even no drugs. Doctors really can’t answer the specific time to reach the sub-goal, but the medication time must be relatively long, at least several years.