April 20 is High Uric Acid Day. Choosing this 1 day to carry out relevant prevention publicity activities is an initiative in accordance with the diagnostic criteria for hyperuricemia, because 420 μmoL/L is the critical value to determine whether uric acid exceeds the healthy range, regardless of men and women, if the examination is carried out in different time periods, 2 consecutive times, fasting blood uric acid level exceeds 420 μmoL/L, can be diagnosed as hyperuricemia. Everyone knows that hyperuricemia can cause gout, and, in the impression of ordinary people, gout is a disease of wealth, and adults who eat meat and drink alcohol every day, especially men, will get gout. However, this has not been the case, with the incidence of hyperuricemia in people aged 12 to 17 years in some regions approaching 10 per cent. Or children, gout, hyperuricemia at a young age, what is the reason behind it? What special countermeasures are needed? Let's solve your doubts now.
Hyperuricemia was once considered a middle-aged and elderly disease, but in recent years, the aging trend of hyperuricemia and gout has become increasingly serious, and even primary gout patients who are only 10 years old have been found. Relevant research data show that the proportion of young gout patients has exceeded 54%. The detection rate of hyperuricemia in adolescents has reached about 10%, and the detection rate of adolescents is higher, and adolescent hyperuricemia is related to waist circumference, body mass index, blood pressure and other indicators, in addition, the uric acid level of young gout patients is often higher than that of middle-aged and elderly patients.
At present, our guidelines here, using the definition of hyperuricemia, is that in the normal purine diet, regardless of men and women, the blood uric acid level exceeds 420 μmoL/L twice a day. At the same time, for hyperuricemia of different ages, reference standards are also proposed. Infants aged 1 to 12 months are 500 μmoL/L, 300 μmoL/L for children aged 1 to 10 years, boys aged 11 to 15 years, the standard is 470 μmoL/L, and girls are 350 μmoL/L. Over 15 years of age, diagnosis is made by reference to adult standards.
At a young age, the uric acid level exceeds the standard, is it a genetic factor? From the conclusions of the epidemiological survey, gout does have a familial cluster, and the proportion of patients with gout with a family history is about 19%. Related studies have found that about 10% to 25% of the close family members of gout patients develop hyperuricemia. If 1 parent develops gout, the probability of developing gout in a child is 40% to 50%. If both parents have gout, the probability of the child falling ill is 75%. Therefore, if anyone in the family has had gout or has been diagnosed with hyperuricemia, a family check-up and related prevention should be performed as soon as possible.
In addition to the influence of genetic factors, living habits are also important factors leading to hyperuricemia, and there are four main factors in the life of hyperuricemia and gout at a young age. The first is the change in dietary structure, most families' meat intake is increasing, the production of exogenous purines is rising, and it exceeds physiological metabolism and excretion. Second, physical activity decreases. Third, overweight and obesity are not brought under control in time. Fourth, dietary intake increases dramatically, in which fructose, in the process of conversion into fat, produces a large amount of uric acid, and fructose affects the excretion of uric acid by the kidneys. Therefore, the prevention of hyperuricemia and gout by the whole family needs to start from changing the dietary structure, at the same time, active exercise is needed, weight control, in addition, the intake of sugary drinks and alcoholic beverages should be strictly restricted, and the intake of fruit juice should be reduced.
Hyperuricemia and gout are usually related to factors such as frequent social activities, greater work pressure, irregular work and rest, and irrational diet. In younger patients, multiple joints may be involved at the time of initial onset and are prone to tophi. In addition, the site of gout attack is atypical, unlike in middle-aged and elderly gout patients, which is mainly manifested by foot pain in the 1st metatarsophalangeal joint. Because young gout patients usually have a higher body mass index and waist circumference level, such patients, although the course of the disease is shorter, they will also be associated with dyslipidemia, which brings a higher risk of cardiovascular and cerebrovascular diseases and metabolic syndrome, and needs to strengthen the prevention of hypertension and diabetes, timely diagnosis and intervention.
In patients with young age hyperuricemia and gout, the treatment measures are mainly to control and maintain uric acid stability, and in the acute stage of gout attack, it is mainly to relieve pain quickly. The problem to be considered is that most uric acid-lowering drugs and anti-inflammatory analgesics can cause adverse reactions of different degrees, so during treatment, uric acid levels and liver and kidney function should be checked regularly. At the same time, genetic testing is required to identify specific conditions, such as renal cysts and diabetic syndrome RCAD, which may present with gout as the first symptom, or with type 2 diabetes mellitus without manifestations of metabolic syndrome, and drugs that promote uric acid excretion, such as benzbromarone or probenecid.
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