▎ WuXi AppTec content team editor
Many people believe that gout is the "first pain in the world", which is enough to make people tear their hearts and lungs, and even doubt life.
Therefore, many patients will eat a long wisdom after the attack of gout, pay attention to controlling the intake of uric acid in the diet, reduce weight, drink more water and so on in daily life.
There may also be some people, although the uric acid is found to be elevated during the physical examination, but there are no symptoms of joint pain, and usually do not pay special attention to diet and living habits.
In fact, regardless of whether there is a gout attack, uric acid should be controlled in the ideal range. Moreover, in addition to preventing the occurrence and development of gout, it is also necessary to prevent the occurrence of related complications.
The importance of controlling uric acid
We know that hyperuricemia refers to a normal purine diet with a blood uric acid (SUA) level of > 420 μmol/L on two fastings on the same day. Most patients with hyperuricemia are asymptomatic.
The progression of hyperuricemia and gout has four pathophysiological stages:
Development of hyperuricemia: the level of blood uric acid is poorly controlled and is in a prolonged state of elevation.
Deposition of urate crystals: approximately 25% of patients with hyperuricemia have urate crystal depositions, which can be confirmed by imaging. The occurrence of urate crystal deposition is considered to be an important node in the development of gout.
Gout attacks: caused by acute inflammation of deposited crystals, mainly due to a high-uric acid diet (drinking beer, eating kebabs, eating a lot of animal offal, fish soup, broth, etc.), joint injury, local temperature reduction, local pH reduction, fatigue, etc.
The advanced stage of the disease characterized by tophi: gout recurs repeatedly, and severe joint deformities occur, which seriously affect daily life.
Studies have shown that 13.3% of people in China have hyperuricemia, but only 1.1% of people suffer from gout. Although hyperuricemia is the "only way" for the development of gout, a considerable number of patients with hyperuricemia do not develop gout.
Studies have shown that even in people with severe hyperuricemia (≥600 mol/L), less than half of them will develop gout in 15 years.
However, it should be noted that elevated serum uric acid is an important risk factor for the development of gout, and the higher the blood uric acid, the greater the probability of gout attacks.
Studies have confirmed that the incidence of gout at blood uric acid ≥ 600 μmol/L is 30.5%, blood uric acid
Therefore, in the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)", it is clearly pointed out that it is recommended that all patients with hyperuricemia and gout know and pay lifelong attention to the influencing factors of blood uric acid levels, and always control blood uric acid levels within the ideal range.
Guidelines indicate that controlling blood uric acid levels within 240 to 420 micromol/L significantly reduces the frequency of gout attacks, prevents tophi formation, prevents bone destruction, reduces the risk of death, and improves patient quality of life.
Another study, published in The Lancet Rheumatology, also re-emphasized the importance of controlling blood uric acid, regardless of symptoms. The results of the study showed that when serum uric acid concentrations persisted, they were averaged
In addition, the harm of gout is far more than the redness, swelling, heat and pain of local joints (such as joints such as feet, ankles and knees), hyperuricemia and gout are also independent risk factors for chronic kidney disease, hypertension, cardiovascular and cerebrovascular diseases and diabetes, and are also independent predictors of premature death.
▲Gout attack mainly affects the lower limb joints (Image source: 123RF)
The prevention of these complications is equally important
Gout is a complex metabolic, inflammatory disease. Much evidence suggests that hyperuricemia and gout are systemic disorders with multisystem involvement and are often closely associated with the development of multiple diseases.
In addition to joint symptoms, it is also a risk factor for the development of metabolic syndrome, type 2 diabetes, hypertension, cardiovascular disease, chronic kidney disease, kidney stones, osteoporosis, sleep disorders and other diseases. Next, we will briefly introduce 4 common complications.
01
kidney stone
Kidney stones are one of the most common complications of gout, affecting about one in five people with gout. This is because urate crystals may accumulate in the urethra of gout patients, thereby promoting the formation of kidney stones.
When kidney stones appear, people may have the following symptoms:
Severe pain in the sides and back below the ribs;
Relieve pain when urinating;
Appearance of pink, red, or brown urine;
The pain may radiate to the lower abdomen and groin.
02
Cardiovascular diseases
Gout can cause inflammation of the joints and other parts of the body, and inflammation is also one of the risk factors for cardiovascular disease, so gout and cardiovascular disease often occur at the same time.
Studies have found that people with gout have a 15% increased risk of dying from cardiovascular disease or stroke compared to patients who have never had gout but have cardiovascular disease; the risk of dying from heart failure in people with gout has increased by 2 times.
Moreover, in patients with obstructive coronary artery disease, a history of gout is often associated with a worse prognosis. Although cardiovascular disease drugs can be used to treat them, they also do not address the cardiovascular risks associated with gout.
Image credit: 123RF
03
diabetes
It has been noted that patients with gout have a higher risk of diabetes than non-gout patients, and that the results were not related to other known risk factors (hypertension, hyperlipidemia, etc.) such as the participants' weight, lifestyle (smoking and drinking, etc.).
The researchers believe that gout may be independently associated with an increased risk of diabetes, and that women are significantly more associated than men. This may be because people with gout have persistent low levels of inflammation in their bodies, which may promote the formation of diabetes.
04
fracture
Patients with gout are more likely to develop osteopenia and osteoporosis, which increases the risk of fractures, especially in women. Studies have found that the overall fracture rate of gout patients is close to 23%, which is much higher than that of people who do not have gout.
According to the analysis in the study, there may be three reasons related to gout and fractures:
First, gout itself increases the risk of lower extremity and spinal fractures.
Secondly, hyperuricemia may cause severe acute arthritis, and the production of inflammatory markers may be associated with changes in bone density and absorption.
Finally, uric acid itself also has an effect on oxidative stress, which may initiate osteoclast activation, which affects bone quality and increases the risk of fracture.
Researchers point out that the prevention and treatment of gout is of great significance for patients with osteoporosis.
In addition, gout can severely affect a patient's mental and social health. If a patient's blood uric acid levels are poorly controlled, gout attacks may occur repeatedly, and chronic pain may cause the patient to experience emotions such as stress, anxiety, and depression.
Moreover, gout attacks can cause severe pain, making it difficult for patients to move around, complete their daily tasks, and socialize, which can have a huge impact on the patient's daily life.