Why do you pay attention to quitting gout and still have frequent attacks? How should I eat and how to move? How to choose an acid-lowering drug? In fact, in addition to the acid-lowering drugs and painkillers of Western medicine, Chinese medicine also has many suggestions to help you regulate and manage purines and uric acid in your daily life.
Recently, under the guidance of guangdong provincial bureau of traditional Chinese medicine, sponsored by Guangdong Provincial Association of Traditional Chinese Medicine and Guangzhou Daily Newspaper Group, co-organized by Guangdong Provincial Hospital of Traditional Chinese Medicine and Southern Life Broadcasting, and supported by Guangzhou Caizhilin Pharmaceutical, the latest issue of the "Lingnan Traditional Chinese Medicine Science Popularization Forum" was launched, and Professor He Yiting, secretary general of The Guangdong Provincial Association of Traditional Chinese Medicine and rheumatic immunology expert of Guangdong Provincial Hospital of Traditional Chinese Medicine, came to draw the focus for everyone.
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Xiaobian helped you to sort out the top ten "pain points" that patients had the most questions about, and come and take them away.
A question: Why can't you lower uric acid and gout still occurs frequently?
Professor He Yiting introduced that gout is essentially a disease of metabolic disorder, which is mainly directly related to hyperuricemia caused by disordered purine metabolism and reduced uric acid excretion in the body.
The uric acid in the human body has two kinds of endogenous and exogenous, of which 80% of the uric acid is endogenous, so if the metabolic problem is not solved, then the abstinence can not reduce endogenous uric acid. Secondly, uric acid is mainly excreted by the intestine and kidneys, the most important of which is to rely on the kidneys, so the core problem of high uric acid is that there are problems with metabolism and excretion. This is why many patients quit speaking, but gout still occurs frequently or uric acid remains high.
So should gout stop talking? "Most of the purines from food sources are used to produce uric acid and are rarely utilized by the body. The amount of purine ingested in food directly affects the level of uric acid in the blood and even induces an acute attack of gout. He Yiting said that for gout patients, it is necessary to quit speaking.
Second question: Why should uric acid be checked "repeatedly"?
Does uric acid need to be checked repeatedly? Many patients cannot understand this kind of "repeated examination".
He Yiting explained that uric acid indicators will affect the doctor's diagnosis, but uric acid is a particularly "sensitive" indicator to various influencing factors, and the uric acid in the blood will fluctuate due to various factors, and will change due to different changes such as physical condition on the day of the examination, diet the day before, amount of exercise, and drugs used.
Therefore, the diagnostic criteria propose "not the same day twice", which means that on different days, in the same time period, the average is measured 2 or more times, so that the results obtained are more reliable.
He Yiting also reminded that in order to detect the value of uric acid level as accurately as possible, so as not to affect the diagnosis, everyone should pay attention to several details before drawing blood to check uric acid:
Normal Purine Diet: It is recommended to eat a light diet 3 days before checking uric acid, and eat less high-purine foods.
Avoid strenuous exercise: After strenuous exercise, muscles break down adenine nucleoside triphosphate (ATP), which indirectly promotes the production of uric acid, and some people also induce attacks of gout.
Testing uric acid on an empty stomach: Eating a meal can cause changes in uric acid levels, affecting the accuracy of the test. Fast after 22:00 the night before and go for an early morning check-up on an empty stomach.
Adjusting drugs that affect blood uric acid: Uric acid levels are also affected by drugs, such as hydrochlorothiazide, metoprolol, low-dose aspirin, pyrazinamide and other drugs, which can increase blood uric acid after long-term use. It should be reminded that many drugs that affect uric acid are used to control blood pressure and lipids, if the doctor requires the measurement of blood uric acid, everyone should tell the doctor that their medication is adjusted by the doctor's guidance, do not stop the drug at will.
Three questions: When gout is acute, should I apply hot or cold compresses?
In the case of a gout attack, in terms of non-drug treatment, the first step is to take the brakes to avoid movement of the affected limb. Bed rest may be given if necessary, and the affected limb may be elevated. Local cold compresses can be taken to reduce the local temperature and relieve local redness, swelling, heat and pain.
It should be noted that for acute gout attacks, heat compresses and massages must not be applied, which will lead to further aggravation of existing redness, swelling and heat pain.
Four questions: How to choose painkillers and different acid-lowering drugs?
In terms of drug treatment, Professor He Yiting reminded that taking medicine according to the doctor's instructions can minimize side effects and achieve therapeutic effects. For example, colchicine, which patients are most familiar with, some people are afraid of diarrhea after taking it, and they will feel that they should try not to use it until they can't stand it. However, according to the guidelines, it is recommended to start taking low doses of colchicine within 12 hours of the acute onset of gout, and the efficacy is significantly reduced after more than 36 hours.
The timing, time limit and contraindications, and applicability of nonsteroidal anti-inflammatory drugs, glucocorticoids and other painkillers are also very popular, and it is recommended to follow the guidance of doctors so as not to achieve the therapeutic effect and backfire.
In addition, for the application of uric acid-lowering drugs, many patients can also say casually, drugs that inhibit uric acid production are allopurinol, nonbutex; drugs that promote uric acid excretion are benzbromomarone... But how to use these drugs individually? How to evaluate the choice of allopurinol on the damage of liver and kidney function, the effect of febus on cardiovascular disease? How to follow up and monitor during medication? These are all things that need to be considered comprehensively, and patients should not be too "conceited", or should be handed over to professionals.
Compared with the obvious side effects of chemical drugs, TCM treatment of gout is actually its advantage, from the overall treatment to traditional therapies such as Chinese medicine prescription and acupuncture external application, there are many means that have been affirmed by patients. However, pay attention to asking Chinese medicine practitioners to treat them dialectically, and do not "copy the homework" by yourself.
Five questions: When gout is not painful, don't worry about it?
No pain doesn't mean "no disease" – gout is more than just joint pain. Even if there is no acute attack, as long as uric acid is still high, urist acid is deposited in the body for a long time, resulting in a variety of complications. Therefore, even if it is not painful, it is necessary to carry out uric acid reduction treatment under the guidance of a doctor, regularly monitor the level of blood uric acid, monitor kidney function, and adjust the treatment plan at any time.
Under the guidance of a doctor, long-term low-dose medication is an ideal indicator of maintaining uric acid, coupled with reasonable and healthy daily habits, in order to prevent the onset of the disease.
Six questions: Eating uric acid-lowering drugs is more painful, is it better to stop the drug?
He Yiting reminded, "The treatment of uric acid reduction in gout patients is a long-term process of reaching the standard, and the drug cannot be stopped after the blood uric acid drops to normal." Eating uric acid-lowering drugs, the cause of pain may be that in the process of taking drugs to lower uric acid, blood uric acid may appear to decline more rapidly, at this time the urate crystals dissolve rapidly, producing some "microcrystals", which has the risk of inducing gout.
The consequences of discontinuation of the drug, on the one hand, may lead to the rebound of the decreased uric acid back to its original state; on the other hand, the violent fluctuations of uric acid are more likely to cause the precipitation and deposition of uric acid. "The general principle of uric acid reduction treatment is to maintain the minimum dose of drugs to maintain blood uric acid levels to continue to meet the standard." He Yiting stressed.
Seven questions: Is joint redness, swelling, heat and pain necessarily gout?
Clinical doctors can clearly diagnose gout by scoring patients according to various indicators, but not all joints are red, swollen, hot and painful, and even sometimes there are symptoms such as mild elevation of uric acid, which are real gout.
"In addition to real gout, there is also a 'pseudo-gout.'" Professor He Yiting pointed out that this kind of "pseudo-gout" will have the above-mentioned "gout-like" symptoms, but its mechanism is arthritis caused by calcium pyrophosphate crystals, which is caused by the calcification of joint cartilage, which is more common in the elderly, the most common is the knee joint. At this time, if the joint bursa examination is performed, calcium pyrophosphate or apatite is shown, and cartilage calcification may be shown under x-rays. Depending on the diagnosis, there will be different treatment directions. Therefore, patients do not draw their own conclusions, and take their own medication according to "common sense".
Eight questions: How do gout patients undergo dietary conditioning?
The prevention and treatment of gout first starts with diet, especially pay attention to the content of purines in the general diet. Ultra-high purine foods are foods that patients with gout and high uric acid should avoid completely; it is recommended to eat medium and high purine foods in limited quantities, do not eat during the acute onset of gout; low and medium purine foods, pay a little attention when eating; and low purine foods, almost without regard for their purine content.
Alcohol consumption is one of the important reasons for the increase in serum uric acid value. Because on the one hand, the lactic acid produced by ethanol metabolism can inhibit the excretion of uric acid by the kidneys; on the other hand, alcoholic beverages contain purines, which are metabolized in the body to produce uric acid.
In terms of carbohydrate, fat, and protein intake, increased fat intake will accelerate purine metabolism and lead to an increase in blood uric acid concentration, so it is necessary to control body weight and control fat intake. On the other hand, carbohydrates are the main source of heat energy for gout patients, and insufficient calories can lead to lipolysis mobilization, produce acid metabolites such as ketone bodies, inhibit uric acid excretion, and induce gout attacks. Therefore, people who rely on not eating staple foods and not ingesting carbohydrates to lose weight are best to pay attention to the level of uric acid in the body.
Protein intake, it is recommended to plant protein (legumes) mainly, with renal lesions should use a low-protein diet. Animal protein can be selected from milk without nuclear protein, cheese, skimmed milk powder, egg protein part, etc.
Vegetables and fruits are mostly alkaline foods, which can increase the alkali reserves in the body, prevent the formation of uric acid crystals and promote their dissolution, increase the amount of uric acid excreted, prevent the formation of stones and dissolve the stones that have been formed. Vegetables and fruits are rich in potassium, which can promote the excretion of uric acid and reduce urate deposition.
In general, the dietary control principle for gout patients is "three lows and one high": a low-purine or purine-free diet, a low-calorie intake, a low-salt diet, and a large amount of water. "The daily urine output should reach more than 2000ml, which is conducive to uric acid excretion and prevents uric acid from being deposited in the kidneys." From the perspective of traditional Chinese medicine health, it is to avoid overeating, put an end to fat, sweet and greasy or hot sea fishy hair, avoid gathering wet phlegm, phlegm damp and hot stasis to block the meridians, causing joint pain.
Nine questions: Gout joint pain, do not dare to exercise what to do? ，
"Patients with gout should have an appropriate amount of exercise to avoid the acute onset of gout arthritis." He Yiting pointed out that one of the pathogenesis of hyperuricemia and gout is insulin resistance, which is easily accompanied by hypertension, hyperlipidemia, hyperglycemia, coronary heart disease and cirrhosis of the liver. The appropriate amount of exercise can promote blood circulation throughout the body and improve cardiopulmonary function; enhance metabolism, consume fat, reduce blood sugar, blood lipids, and blood pressure; help reduce weight, which can indirectly reduce uric acid concentration; and also have a certain effect on the prevention of acute attacks of gout.
It is recommended that patients start with small exercise, such as brisk walking, jogging, swimming, etc., gradually increase the intensity and amount of exercise, and avoid excessive exercise and strenuous exercise.
From the perspective of traditional Chinese medicine health, controlling uric acid to prevent gout, but also conform to the four hours, appropriate exercise, combination of work and leisure, avoid staying up late, and comfortable feelings. For example, in the spring, pay attention to increasing or decreasing clothing to prevent wind and cold, avoid being in a hot and humid place for a long time in the summer, sleeping in the wind, soaking in rain and soaking water, greedily blowing cold air to eat cold drinks, caring for the yang in the body, and nourishing the lungs in autumn and fixing the kidneys in winter. These headwinds should also be avoided in various sports.
Ten questions: How do gout patients cook soup?
Guangdong people's daily life is inseparable from the soup, He Yiting suggested that patients with hyperuricemia drink less old fire soup, especially during the acute attack period, try not to drink. If you want to drink soup, it is best to blanch the meat of the soup and drink "boiling soup".
Here is a soup suitable for people with high uric acid:
Lily coix soup: lily nourishing yin, also contains colchicine, coix water to remove dampness, plus reed root heat and vitality diuretic, usually soup added to these three flavors of food herbs, soup taste sweet, more friendly to people with high uric acid.
Usually, you can also use soil porridge to boil porridge and corn into soup.
Recommended acid-lowering tea:
1. Corn whiskers: 60-120 grams of corn whiskers, fry 2 times, take a total of 400 ml, take 2 divided doses.
2. Psyllium lily drink: Psyllium can urinate uric acid, lily contains colchicine, and the combination of the two can prevent gout attacks. Take 30 grams of psyllium, 30 grams of lilies, fry the juice in water, take 2-3 times, 1 dose per day; psyllium can also be used in 30 grams of bags with 500 ml of water, soak for 30 minutes daily as a tea.
Text/Guangzhou Daily, New Flower City reporter Zhou Jieying Intern reporter Lin Xintong Correspondents Hu Jiahong and Song Liping
Photo @ Visual China
Guangzhou Daily New Flower City Editor: Wu Wanhong