Mr. Liu, 56, lives in Nanjing, Jiangsu Province, and has had gout for more than 20 years.
Just as the so-called "long-term illness into a doctor", usually a little pain, he will be himself as a "doctor", according to the "routine" of groping out to take medicine.
1 month ago, Mr. Liu accidentally broke his calf, and the wound was not good. After seeing the doctor, I learned that this difficult wound was actually caused by taking medicine indiscriminately.
After Mr. Liu was diagnosed with hyperuricemia, once, the large thumb joint of his right foot was in excruciating pain, and he was diagnosed by the doctor as a gout attack. After 3 days of infusion treatment, the pain is relieved.
At that time, Mr. Liu, who was "smart and careful", noticed that the list that the doctor hung water for him had the words "dexamethasone" written on it.
Later, as long as there was a small illness and pain, he would run to the pharmacy to buy dexamethasone tablets to eat. Take three or four tablets when it hurts, and then stop the drug after getting better. In this way, he ate intermittently for 20 years.
But Mr. Liu found that his face slowly became rounded, his skin was often red, and he was prone to acne. The stomach gradually became larger, but the limbs were thinner.
After another 10 years or so, Mr. Liu was diagnosed with diabetes and usually took antidiabetic drugs irregularly.
Image source: Stand Cool Helo
He summed up three major problems for himself:
1. Purple spots often appear on the skin;
2. Frequent bloating, stomach discomfort, and weakness;
3. High blood sugar, diabetes.
As for why this happened, he didn't know it himself, and he didn't care too much.
Just 1 month ago, Mr. Liu's left calf broke the skin, and the wound has not healed, so he went to the Zhongda Hospital affiliated to Southeast University for treatment.
Yin Han, deputy chief physician of the Department of Endocrinology, judged that the problem of Mr. Liu's wound not healing was a typical manifestation of diabetic foot, and it was difficult for the skin to grow well quickly and the infection to be controlled.
The root of the problem is to take medicine indiscriminately.
There are more than thirty common gout treatment drugs, some of which can be used for a long time and some for short-term use.
Dexamethasone, which Mr. Liu often eats, belongs to the adrenocortical hormone class drugs, belongs to short-term drugs, long-term use will affect the hormone levels in the body, and sudden discontinuation of drugs will cause a series of problems, such as fever, decreased appetite, and severe cases will appear coma.
Long-term use of hormonal drugs can also lead to increased blood sugar, causing stomach ulcers, osteoporosis, etc. [1].
Glucocorticoids are one of the strongest glycemic hormones in the body. It raises blood sugar through two pathways: open source throttling.
The so-called "open source" is to promote the decomposition of hepatic glycogen in the liver, so that the sugar is released into the blood in large quantities.
The so-called "throttling" means that it will reduce the consumption of glucose by muscle and fat tissue and reduce insulin sensitivity.
What is more frightening is that it can also directly act on the β cells of the islets, damage the function of the islets, make the secretion of insulin insufficient, and then induce high blood sugar.
There is a type of steroid diabetes that is medically associated with glucose metabolism disorders caused by glucocorticoid abuse [2].
The problem was found, the doctor debridement, dressing change, negative pressure treatment of Mr. Liu's wound, and formulated a more scientific treatment plan, gradually reducing the amount of hormones, and adjusting the use of hypoglycemic drugs, thereby controlling blood sugar. At present, Mr. Liu has improved.
Back to Mr. Liu's original question - hyperuricemia and gout, how to treat it?
The first thing to know is that uric acid lowering therapy is a long-term process. Like Mr. Liu, if you are in pain, you will take medicine randomly, and if you don't have pain, you will stop the medicine, which is not OK!
Because, elevated blood uric acid can cause ongoing damage to other organs. Even after the blood uric acid drops to normal, the drug cannot be discontinued immediately and maintenance therapy is often required.
The general principle of uric acid-lowering therapy is to use the smallest dose of the drug to persist the blood uric acid level at a level below 360 micromoles / L, which is medically called the "standard level".
For people with tophi, chronic gout, and frequent attacks of gout, blood uric acid should be maintained at a level below 300 micromoles/L for a long time.
On the basis of medication, it is also necessary to gradually reduce uric acid-lowering drugs to the lowest dose in conjunction with lifestyle improvements, and ideally achieve gradual discontinuation [4-7].
But the premise of all this is - listen! medical! bear! target! speech!
That is to say, if symptoms such as high uric acid and gout appear, you must go to a regular hospital in time. Endocrinologists will perform uric acid control according to the specific situation and select appropriate drugs for symptomatic treatment. There are many kinds of drugs for the treatment of gout, do not choose your own, do not use the drug at will, but should follow the doctor's instructions for drug adjustment or discontinuation.
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Gout life tips
1. Reduce the intake of high-purine foods, such as animal offal, beer, seafood, etc.
2. Alcohol restriction
Long-term drinkers are more likely to develop gout, and various alcoholic beverages such as beer and liquor will be [8-9]!
3. Avoid sudden colds
In autumn and winter, thick socks and knee pads can be worn to protect the toes and knees.
4. Reduce fructose intake [11-12]
The main ones are: soda, jam, honey, bread, etc.
5. Weight control and exercise appropriately[13]
Keep the BMI as close as possible to the normal range (18.5 to 25).
BMI = square of body weight (kg) / height (m).
Usually appropriate exercise, you can choose jogging, dancing, swimming, cycling, tai chi, yoga and other sports. Exercise 3 to 5 times a week for about 30 minutes.
If you have relatives and friends who like to take medicine like Mr. Liu, remember to forward this article to him
Audit expert: Yin Han | Deputy Chief Physician of the Department of Endocrinology, CUHK Hospital, Southeast University
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[9] Choi HK, Atkinson K, Karlson EW, et al.[M]: a prospective study[J]. Lancet, 2004, 363(9417): 1277-1281.
[10]Compilation Group of Rheumatology Branch of Chinese Medical Association.2016 Chinese Gout Diagnosis and Treatment Guidelines[J].Zhejiang Medicine, 2017, 39(21): 7823-1832.
[11] Choi HK, Willett W, Curhan G.Fructose - rich beverages and risk of gout in women[J]. JAMA, 2010, 304(20): 2270-2278.
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