Uric acid is a byproduct of the body's metabolism of purines, which are found in all cells. High uric acid usually occurs when this substance is excreted too much or insufficiently.
It is difficult to pinpoint the specific cause of excessive or insufficient secretion because doctors do not yet understand the metabolic mechanism. The relationship between gout and specific risk factors is often understood as the cause of high uric acid.
Criteria for hyperuricemia
Under normal purine diet, the level of fasting blood uric acid twice on the same day was 416.5 μmol/L for men > or 357 μmol/L for women >. When the absolute value of blood uric acid > 540 μmol/L, drug therapy should be given under the premise of lifestyle intervention.
Typing-based diagnosis helps to identify the cause of hyperuricemia and give targeted treatment. Patients with hyperuricemia are kept for 24 hours to measure uric acid levels after 5 days of low-purine diet.
(1) Poor uric acid excretion
Uric acid excretion is less than 2.86 μmol/(kg·h), and uric acid clearance is less than 6.2ml/min.
(2) Excessive uric acid production
The excretion of uric acid is greater than 3 μmol/(kg·h), and the uric acid clearance is greater than or equal to 6.2 ml/min.
(3) Hybrid type
Uric acid excretion exceeds 3 μmol/(kg·kh), and the uric acid clearance is less than 6.2ml/min.
Considering the effect of renal function on uric acid excretion, the classification of hyperuricemia according to the ratio of uric acid clearance / creatinine clearance is as follows: >10% is the type of excessive uric acid production; <5% are poor uric acid excretion; 5%~10% is a hybrid type.
What are the dangers of high uric acid?
Hazard 1: Leads to tissue fibrosis and even necrosis of the joint. Patients with more severe uric acid levels will basically have decreased joint mobility, varying degrees of fibrosis of bones, and also have the phenomenon of easy fractures.
Hazard 2: Leads to the appearance of gout. Patients develop numbness of the joints, to severe pain, swelling, skin warmth, dark redness and other obvious indications.
Hazard three: The most serious harm of high uric acid is that there is a great damage to the patient's kidney function, and the kidney function of patients who have been in a state of high blood uric acid for a long time will slowly decline until necrosis. Early manifestations are the appearance of chronic nephritis.
Hazard four: Hyperlipidemia and hyperglycemia and uric acid metabolism exist simultaneously, and these two diseases are also very important influencing factors. Arteriosclerosis is a serious manifestation of uric acid, and basically all arteriosclerosis is accompanied by a high uric acid reaction.
The "purine household" was discovered, and the doctor appealed: stop eating 8 kinds of meat, don't wait to get sick before hurrying
[1] Mussels 414mg/100g
Mussels are one of the meats with the highest purine content, and after cooking, they are processed into a dry product, mussels, which is a food that people with high uric acid and gout should not eat. Long-term, large intake of mussels will cause the purine components in it to be converted into uric acid in the body, causing the level of uric acid in the body to rise, and will also lead to purine metabolism disorders in the body, so healthy people should try to avoid eating.
[2] Foie gras 377mg/100g
Foie gras is actually a fatty liver cultivated in live goose, the fat content is extremely high, eating it will increase the cholesterol content, so patients with hyperlipidemia, obesity, coronary heart disease, fatty liver, try to eat less foie gras. Per 100 grams of foie gras, there are about 377 mg of purine, which belongs to high-purine food, purine will be converted into uric acid in the body after entering the human body, so for people with high uric acid, it is not recommended to eat foie gras.
[3] Duck intestine 346mg/100g
Duck intestines are high-purine foods, excessive consumption can cause elevated blood uric acid and induce the risk of gout, therefore, patients with gout and hyperuricemia should avoid eating duck intestines. Duck intestine contains protein, B vitamins, vitamin C, vitamin A and calcium, iron and other trace elements, has the effect of strengthening the spleen, stomach, brain and purpose, moderate consumption is beneficial to the nervous, cardiovascular, digestive system, etc.
【4】Shrimp 345mg/100g
Shrimp is a high-protein nutritious food, can strengthen bones, enhance physique, promote metabolism, but for gout patients and allergy patients, is not to eat the best, gout patients after eating will make the body uric acid rise rapidly, resulting in hyperuricemia, joint red, swollen, hot, painful gout symptoms. The purine of shrimp is about 345mg/100g, and gout patients should be avoided.
【5】Abalone 244mg/100g
Abalone is a common seafood in life, eating abalone in moderation is conducive to supplementing the vitamin E required by the human body, but the purine component of 100 grams of abalone is about 244 mg, which is a high-purine food. If abalone is consumed in large quantities, it will cause hyperuricemia to worsen, induce gout attacks, cause gouty arthritis, and even cause kidney damage, vascular lesions and fundus lesions.
【6】Sea bass 227mg/100g
There are two major types of sea bass and river bass, both rich in various nutrients, people with gout can eat a small amount of sea bass, can not eat sea bass. The purine content of sea bass is higher than that of river bass, resulting in elevated uric acid in the body, which is not only not conducive to the treatment of gout, but may also aggravate the symptoms of gout, causing patients to have symptoms of joint pain.
【7】Lamb 223mg/100g
Lamb refers to the meat obtained from sheep, is one of the most common meat products, but belongs to the purine content of higher food, excessive intake can lead to elevated blood uric acid, induce gout, especially lamb skewers purine content up to 233g/100g, lamb common practices such as stew, barbecue, etc., although delicious and refreshing, but will make purine rise, so try to eat less.
【8】Chicken breast 218mg/100g
Chicken breast is the two largest pieces of meat on chickens, with high protein content, and easy to be absorbed and utilized by the human body, suitable for eating during the fat loss period. However, there are about 218 mg of purine per 100 grams of chicken breast, which is a meat with high purine and will induce various symptoms of gout. If gout patients want to eat chicken breast, try not to exceed 50g each time, and control it within 3 times a month, cook meat with less oil and salt, and do not drink soup.
Knowledge expansion - the treatment of gout, it is recommended to know early!
One: diet and lifestyle
Each guide recommends lifestyle adjustments. In terms of diet, with the exception of the American College of Rheumatology guidelines, which state insufficient evidence for strict purine-restricted diets, all guidelines encourage a balanced diet low in fat, sugar, vegetables and fiber, avoid high-purine foods, and encourage diets that include skim and/or low-fat milk, soybeans, and vegetable sources of protein and cherries.
American rheumatology guidelines clearly state that diet has a limited effect on lowering uric acid, but improper diet can induce gout attacks, so dietary management is still recommended for patients with gout.
The American rheumatology guidelines clearly explain the problem of vitamin C supplementation, and vitamin C supplementation is conditionally not recommended for patients with gout, regardless of disease status.
British College of Rheumatology guidelines propose that vitamin C supplements (500~l 500 mg/d) also have a weaker uric acid excretion effect.
BSR, SIR and Chinese guidelines indicate that the starting time of gout ULT is after the acute inflammation disappears, preferably 2 weeks after the gout attack is relieved.
US rheumatology guidelines conditionally recommend that patients with gout with clear indications for ULT initiate ULT during an acute gout attack, rather than after the acute attack has resolved.
Three: Indications for ULT
The American Rheumatology Guidelines clearly state that: (1) 1 or more subcutaneous tophi, starting ULT is strongly recommended. (2) For any form of radiological injury caused by gout, starting ULT is strongly recommended. (3) Gout attacks are frequent (≥ 2 times/year), and the initiation of ULT is strongly recommended. However, recommendations for new-onset gout, asymptomatic hyperuricemia are inconsistent.
EULAR, BSR, SIR, SIR, and Chinese guidelines recommend ULT at first diagnosis in patients with gout who are young (< 40 years) or have uric acid levels >480 micromol/L, and/or who have other medical conditions (impaired renal function, hypertension, ischaemic heart disease, heart failure).
In patients with a first acute attack of gout, initiation of ULT is conditionally not recommended. However, ACR guidelines recommend initiation of ULT in patients with a first episode of chronic kidney disease (chronic kidney disease (CKD) > stage 3), blood uric acid > 9 mg/dl (535.5 micromol/L), or urolithiasis.
Foreign guidelines do not recommend asymptomatic hyperuricemia ULT. Mainland guidelines recommend that for asymptomatic hyperuricemia without comorbidities, blood uric acid level ≥ 540 μmol/L starting ULT;
Patients with hypertension, abnormal lipid metabolism, diabetes, obesity, stroke, coronary heart disease, cardiac insufficiency, uric acid nephrolithiasis, and renal impairment (CKD≥ stage 2), blood uric acid level ≥ 480 μmol/L is the starting ULT.