Mr. Sun is a regular outpatient, has a history of COPD and diabetes, every month to prescribe inhalants, sometimes will review the biochemistry, this biochemical examination showed that his uric acid is higher than before, has reached 500, liver and kidney function are normal. On this uric acid problem, he consulted some doctors online, some said that there was no gout attack, no need to take medicine, and some said that even if there was no gout, it should also lower uric acid.
If I am simply high in uric acid, have not had gout, and do not have any other symptoms, do I need treatment?
Hyperuricemia and hypertension, hyperglycemia, and hyperlipidemia are collectively referred to as the "four highs". Uric acid is too high, and gout may occur. But in fact, not high blood uric acid will necessarily appear gout, only about 10% of patients with hyperuricemia will have gout problems, most patients with hyperuricemia do not have gout attacks, which is called asymptomatic hyperuricemia.
Diagnostic criteria for hyperuricemia: Under the normal purine diet, the diagnosis of hyperuricemia can be diagnosed in men with > 420umol/l and female > 360umol/l in women without two fasting blood uric acid on the same day.
180 million people on the mainland suffer from hyperuricemia. But many people do not understand the dangers of hyperuricemia. In addition to causing gout, high uric acid may also cause vascular endothelial damage, increase the risk of chronic diseases such as diabetes, hypertension, coronary heart disease, stroke, etc., increase the incidence of kidney stones, chronic nephritis, and may even cause kidney failure.
The 2019 China Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout recommend:
In asymptomatic patients with hyperuricemia, joint ultrasound, bipotent CT, or x-rays are required, and subclinical gout is defined if sodium urate crystal deposits and/or gouty bone erosion are found. The first subclinical gout was treated with drug therapy when the blood uric acid level was ≥ 480 umol/L, with colchicine used continuously for 3 to 6 months, while alkalizing the urine for 3 to 6 months, controlling the blood uric acid level at a level of <360 umol/L.
In simple hyperuricemia without any chronic disease (comorbidities), when the blood uric acid level is ≥ 540 micromol/L, uric acid reduction therapy is recommended so that the blood uric acid is controlled at
For one of the comorbidities (eg, hypertension, abnormal lipid metabolism, diabetes mellitus, obesity, stroke, coronary heart disease, cardiac insufficiency, uric acid nephrolithiasis, renal impairment (≥ CKD2 stage)), blood uric acid level ≥ 480 μmol/L, which requires uric acid reduction therapy, it is recommended to control at
Uric acid-lowering drugs recommend allopurinol, febuxta, or benzbromomarone as first-line treatments for uric acid-lowering therapy. If there is renal impairment, febuxita is recommended; if hypertension is present, the antihypertensive drug is preferred losartan and/or calcium channel blocker, and thiazides and loop diuretics are not recommended for antihypertensive therapy alone.
As can be seen from the guidelines, even if there is no gout attack, the simple elevation of uric acid to a certain extent requires active uric acid lowering therapy. In addition, it is also necessary to 1. keep your mouth shut, do not drink alcohol, do not drink sugary drinks, and do not eat foods rich in purine substances; 2. Drink more water, the daily water intake should be more than 2000ml, and the urine output should be more than 1500ml. 3. Exercise more, control weight, and maintain regular work and rest.