Gout is a global metabolic disease, and the prevalence of hyperuricemia and gout in mainland China is also trending in a straight line. In recent years, statistics have shown that the prevalence of gout in all ages is about 0.84%, which is actually a very high proportion, of course, the proportion of the elderly will be higher.
First, gout endured and passed?
When gout forms tophi, gout arthritis is acute and recurrent (about 60% of acute gout-onset authors re-attack within 12 months), and in severe cases joint disability can occur. On the other hand, it can cause urinary tract stones (3 times more likely to occur than those with normal blood uric acid) and uric acid nephropathy, with urinary tract obstruction or renal insufficiency. In addition, hyperuricemia is an independent risk factor for cardiovascular and cerebrovascular diseases including hypertension and atherosclerosis. Therefore, uric acid-lowering therapy is very necessary.
Second, the goal of uric acid lowering therapy
When the concentration of uric acid in the body fluid is higher than (404umol/L), it is saturated, the uric acid crystals begin to precipitate, and the blood uric acid is lower than 404umol/L, no deposition occurs, so the goal of uric acid reduction is to reduce the blood uric acid below 360umol/L, but for patients who have a large number of tophi, in order to accelerate the dissolution of tophi, the target control value should be reduced to less than 297.5umol/L.
Third, the treatment of drugs preferred
1. Drugs that inhibit uric acid production: suitable for patients with primary and secondary gout who produce too much uric acid, are allergic or ineffective to urinating acid drugs, and should not use uric acid drugs (if there is renal insufficiency).
(1) Allopurinol: compared with other drugs, it is necessary to repeat the high dose of drug to maintain a high level of drug, and its excretion is reduced when the renal function is insufficiency, which will lead to drug accumulation, resulting in drug toxicity, so the elderly and people with impaired liver and kidney function should be cautious.
(2) Febutsotan (febutstat): Compared with allopurinol, febutsotan is not only highly selective but also has stronger activity, and its effect is 10 times stronger than allopurinol. It is mainly metabolized by the liver, its effect on the kidneys is much lower than that of similar uric acid-lowering drugs, mild to moderate hepatic and renal insufficiency without dose adjustment, priority by kidney disease is nonbuterita, adverse reactions are abnormal liver function, headache, dizziness, nausea, vomiting and abdominal pain. It can be used for the long-term control of hyperuricemia in patients with gout, but is not recommended for the treatment of asymptomatic hyperuricemia at a recommended dose of 40 or 80 mg once a day.
2. Drugs to promote uric acid excretion: Since most patients with gout belong to the type of uric acid excretion reduction, therefore, the drugs to promote uric acid excretion are suitable for patients with normal or mild abnormalities in kidney function, no urinary tract stones and urate nephropathy, when using uric acid drugs, it should not be used with salicylic acid, thiazide diuretics and other drugs that inhibit uric acid excretion.
(1) Probenecid: now it is relatively rare to use, no anti-inflammatory, analgesic effect, renal insufficiency is disabled
(2) Benzulazolone: the role of uric acid is stronger than that of probenecid, and patients with renal insufficiency should be used with caution.
(3) Benzbromomarone: at present, it is commonly used to promote uric acid excretion drugs, and it is banned in patients with moderate and severe renal function impairment and patients with kidney stones.
3. Uric acid-stimulating drugs: such drugs have labuli enzyme and Krystexxa, which make uric acid excreted after oxidation of allantoin by uric acid oxidase, which can be used to treat and prevent acute hyperuricemia in patients with hematologic malignancies with high-risk tumor lysis syndrome, especially for patients with hyperuricemia caused by chemotherapy.
4. In recent years, it has also been found that fenofibrate, atorvastatin, losartan, amlodipine also have a certain uric acid-lowering effect. May be preferred when there is hypertension and hyperlipidemia combined with hyperglypoic uricemia.
5. Traditional Chinese medicine treatment. Gout belongs to the "paralysis" of Traditional Chinese medicine, the causes are wind, phlegm, dampness, heat, stasis, early pathogenesis is mostly true, and the evil remains for a long time to damage the internal organs, and there is evidence of a mixture of false and real. For example, SiMiaosan is composed of yellow cedar, Cang shu, Yi Qiao Ren and Huai Niu Knee, which has the effect of clearing heat and dampness, relieving muscles and relieving pain. There are also flavored Simiao soups with white peony, burning licorice, lily, angelica, psyllium, etc., which play a role in reducing uric acid production and promoting uric acid excretion.