Gout patients often have such questions:
I have had gout for some years. When I don’t go to the hospital to see a doctor, I also came here to take painkillers myself. How can the doctor prescribe so many examinations for me as soon as I go to the hospital?
Today’s article is to solve everyone’s doubts and let patients know what tests doctors will do when evaluating gout.
1. Detection of serum uric acid
In previous articles, we mentioned many times that high uric acid is the basic condition for causing gout attacks, so the determination of blood uric acid is very important for the diagnosis and evaluation of gout and the evaluation of the therapeutic effect of lowering uric acid.
[Increased uric acid] is helpful for the diagnosis of gout, However, patients need to pay special attention to the fact that not all gout patients have abnormalities in uric acid determination. We often see that the patients’ blood uric acid is not high during acute gout attacks. In this case, doctors can also diagnose gout according to typical clinical manifestations and other examination results.
After uric acid reduction treatment, blood uric acid is generally determined every 3-5 weeks, and the dosage and types of uric acid reduction drugs are adjusted accordingly.
Our goal is to reduce blood uric acid to 360 mol/L (without tophus) or 300 mol/L (with tophus).
2. Determination of serum creatinine and urea nitrogen
Creatinine and urea nitrogen reflect the renal function of patients.
The detection of renal function is also helpful for the selection of uric acid lowering drugs. For patients with obvious renal function abnormalities, febustat is the first choice. If allopurinol is selected for treatment, the dose of allopurinol should be adjusted according to renal function.
3. Liver function test
Checking liver function is very important for drug selection. Fabustat and benzbromarone may cause serious liver damage, so liver function should be closely followed up during medication.
If liver function is abnormal, doctors will give corresponding liver protection treatment according to the specific conditions of patients, and stop, reduce or continue to use uric acid-lowering drugs at the same time.
4. Determination of Blood Glucose and Blood Lipid
Gout and hyperuricemia are metabolic-related diseases. Through the determination of blood sugar and blood lipid, the status of glucose and lipid metabolism in patients can be evaluated. For those with abnormal glucose and lipid metabolism, active hypoglycemic and lipid-lowering treatment is of great benefit to the control of gout and hyperuricemia.
All the above four tests require blood tests.
5. Renal B-ultrasound
Due to long-term hyperuricemia, urate deposition often exists in the kidneys of gout patients, which may be crystals of urate or even stones. Therefore, kidney B-ultrasound is necessary for every gout patient, which can not only understand the condition of kidney injury, but also help doctors to choose drugs to reduce uric acid.
6. Gene detection
Gene detection is the [safety guard] before allopurinol is used. It can screen out high-risk groups of adverse drug reactions before medication and avoid taking allopurinol, thus ensuring the safety of medication.
For more information on gene testing, you can directly click on the link on the right: HLA-B5801, the [safety guard] of allopurinol.
7. Dual-energy CT
The most effective method to diagnose gout is to determine whether there are [gout crystals] (monosodium urate crystals) in the joint site. Dual-energy CT can be used for rapid and non-invasive examination, and may exceed the gold standard for joint puncture sampling according to preliminary evaluation.
In the treatment process, dual-energy CT is also a good method to test the treatment effect. After a long period of treatment and reexamination of dual-energy CT, if the crystals of the original gout crystals shrink or disappear, it can intuitively show that uric acid reduction therapy is effective.
8. Articular ultrasound
Joint ultrasound has been widely used in rheumatology in recent years. If a typical [double track sign] is found in painful joints by ultrasound, it indicates gout. It provides another efficient and non-invasive method for the diagnosis of gout.
In addition, joint ultrasound can also help doctors identify an arthritis called pseudogout.
It is worth mentioning that the above-mentioned examination is a possible examination for doctors to diagnose and follow up gout patients, but it is limited to the hardware and technical conditions of the hospital, such as HLA-B5801, dual-energy CT and joint ultrasound. These examinations are not carried out in every hospital, nor are the above-mentioned examinations required for every visit. Doctors will make choices according to the individual conditions of patients.