Gene testing sounds [Gao Da Shang], even doctors, many also can’t fully understand the doorway. In fact, the clinical application of gene testing is nothing more than diagnosis of diseases or guidance of treatment. For example, HLA-B27 gene, which is common in rheumatology, is significantly more likely to cause ankylosing spondylitis in people carrying this gene than in the general population.
So, is there a similar situation in the treatment of gout?
We often encounter patients in outpatient clinics who will ask: Doctor, I heard that there is a gene positive person who is prone to gout. Can you help me test it? Others say gout has a gene that is easy to measure. If it is measured, you will know whether it can be cured or not. Can you help me measure it?
So is this [gene] in the mouth of patients what? What role does it play in gout and its treatment?
This gene is HLA-B5801. Let’s take a look at it briefly.
HLA-B5801
Many people have heard that allopurinol, a commonly used uric acid lowering drug, may have serious side effects. Should it not be used? The answer is, of course, no. So how can we try our best to prevent such serious side effects?
One is to start with a small dose, the other is the main character of this article-HLA-B5801 gene.
1. Related to drug allergy
HLA-B5801 is a gene in the huge human genome. According to current research, it is highly related to serious skin adverse reactions caused by drug allergy, including allopurinol.
2. The positive rate of Chinese is high,
The positive rate of HLA-B5801 is relatively high among Asian people (including China), which has also become one of the important concerns for Asian people to take allopurinol.
3. Testing has not been widely carried out in the country.
As early as 2008, Taiwan’s local administrative department issued a directive that HLA-B5801 must be tested before taking allopurinol. The American Rheumatology Association also recommended Asian people to test HLA-B5801 gene before taking allopurinol in its 2012 guidelines for gout diagnosis and treatment.
However, in mainland China, relevant tests cannot be widely carried out, and there is currently no mandatory requirement for HLA-B5801 tests before allopurinol is used.
However, where HLA-B5801 detection can be carried out, it is recommended that patients should be tested for this gene before taking allopurinol to improve the safety of medication.
Allopurinol
Allopurinol, as the most widely used uric acid-lowering drug with the longest time on the market, the lowest price and the most widely used, can be said to have made great contributions in the war against gout. Until now, allopurinol has also been widely used in clinical practice. Although allopurinol has definite curative effect, it also has obvious shortcomings.
The biggest disadvantage of allopurinol lies in the possibility of hypersensitivity, which can lead to exfoliative dermatitis and even endanger life in severe cases.
This hypersensitivity reaction is related to the dose of allopurinol.
Therefore, when taking allopurinol, the dose should be started from a small dose (100 mg per day) and gradually increased until the blood uric acid reaches the standard (the initial dose should be smaller if patients with renal function problems have occurred).
However, even starting from a small dose, sometimes hypersensitivity, even exfoliative dermatitis, will occur (the mortality rate reaches 20%).
Therefore, doctors will still recommend HLA-B5801 testing for people with conditions. If the result is positive, doctors will try their best to avoid using allopurinol and adjust the medication according to the specific situation.
Prospect of Gene Detection
Researchers are working hard to develop a faster, more accurate and cheaper method for HLA-B5801 detection suitable for Chinese, and have made progress. I believe it will be applied in more places soon. The safety of allopurinol taken by gout patients can also be greatly improved.
However, it is still necessary to remind patients that gene testing is not once and for all, and cannot be achieved [100%] in medicine. Even after gene testing, medication needs to follow the doctor’s advice, pay attention to adverse reactions and follow up regularly.
Summary
1. Positive HLA-B5801 gene does not mean easy gout;
2. Whether HLA-B5801 gene is positive or not cannot explain whether gout can be cured.
3. Detection of HLA-B5801 gene can improve the drug safety of allopurinol.
Although gout cannot be cured according to the current medical level, as long as active and regular treatment is carried out, we are sure that the disease will be well controlled and gout [painless].
In addition, do not believe in the folk prescription of the Internet and take or stop taking drugs without authorization.