Treatment of gout, high uric acid, these 3 Western medicines, 4 Chinese proprietary medicines, you must know:
1. Western medicine:
1. Allopurinol:
It belongs to the drug that inhibits uric acid synthesis - xanthine oxidase inhibitor, allopurinol and its metabolite oxypurinol by inhibiting the activity of xanthine oxidase (the latter can convert hypoxanthine to xanthine, and then convert xanthine into uric acid), reducing uric acid production. Suitable for the treatment of chronic primary or secondary gout, when controlling acute gout attacks, colchicine or other anti-inflammatory drugs must be used at the same time, especially within the first few months of treatment; uric acid nephropathy with or without symptoms of gout; Patients with recurrent uric acid stones; Prevention of intratissue urate deposition, kidney stones, etc. secondary to chemotherapy or radiotherapy in leukemia, lymphoma or other tumors.
Allopurinol adverse effects include gastrointestinal symptoms, rash, liver damage, and bone marrow suppression and should be monitored. About 5% of patients are intolerable. Occasionally, severe "allopurinol hypersensitivity syndrome" occurs. Hypersensitivity reactions to allopurinol occur mainly within a few months of initial use, most often with exfoliative dermatitis. Use of thiazide diuretics and renal insufficiency are risk factors for hypersensitivity reactions. More serious hypersensitivity reactions include Stevens-Johnson syndrome, toxic epidermal necrolysis, systemic diseases (eosinophilia, vasculitis, and diseases of major organs), and the mortality rate is reported to be 20%~25%.
Studies have proved that allopurinol-related severe hypersensitivity reactions are closely related to leukocyte antigen (HLA)-B*5801, and Asian people should undergo HLA-B*5801 rapid PCR test before using allopurinol, and it is forbidden to use it in patients with positive results, so it is recommended to perform genetic testing before taking drugs when possible.
2. Febuxostat:
In 2009, the US Food and Drug Administration (FDA) approved a gout drug for the treatment of hyperuricemia, namely febuxostat, and in 2013, China's State Food and Drug Administration (CFDA) approved febuxostat for marketing in China. This drug is a selective inhibitor of non-purine xanthine oxidase, which does not inhibit other enzymes involved in purine and pyrimidine synthesis and metabolism at conventional therapeutic concentrations, and reduces serum uric acid concentration by inhibiting uric acid synthesis. It is suitable for the long-term treatment of hyperuricemia in patients with gout, and is not recommended for hyperuricemia without clinical symptoms.
Common adverse drug reactions of febuxostat mainly include abnormal liver function, nausea, arthralgia, and rash. In the initial period of taking febuxostat, there is often an increase in the frequency of gout attacks. This is because the concentration of uric acid in the blood decreases, leading to the mobilization of urate deposited in the tissues. To prevent gout attacks in the early stages of treatment, it is recommended to take NSAIDs or colchicine at the same time. During febuxostat treatment, if gout attacks, there is no need to discontinue febuxostat treatment. Gout should be treated accordingly on a case-by-case basis.
3. Benzbromarone:
It is a drug that increases uric acid excretion, can inhibit the active reabsorption of urate in the renal tubules, increase the excretion of urate, thereby reducing the concentration of urate in the blood, can alleviate or prevent the formation of urate crystals, reduce joint damage, and can also promote the dissolution of urate crystals that have been formed. It is suitable for primary and secondary hyperuricemia, gouty arthritis intermittent period and gouty nodular swelling. Under normal circumstances, taking benzbromarone for 6~8 days blood uric acid decreased significantly, the intensity and compliance rate of blood lowering uric acid were stronger than allopurinol, and insistence on taking it could maintain the blood uric acid level in the body to reach the target value. Long-term treatment for more than 1 year (average 13.5 months) can effectively dissolve tophi.
Adverse reactions of benzbromarone may include gastrointestinal discomfort, diarrhea, rash, etc., but are rare. Rare impairment of liver function. During the treatment, it is necessary to drink a lot of water to increase urine output (the initial water intake should not be less than 1500~2000mL) to promote uric acid excretion and avoid excessive excretion of uric acid and the formation of stones in the urinary system. In the first 2 weeks of starting the drug, sodium bicarbonate or citrate mixture can be given as appropriate to control the pH of the patient's urine between 6.2~6.9. Regularly measure the pH of urine.
2. Proprietary Chinese Medicine:
1. Angelica pain pills:
The group is angelica, kudzu, codonopsis, cangshu (stir-fried), cohosh, bitter ginseng, ze lax, baiju (stir-fried), zhimu, windproof, qianghuo, skullcap, pork ling, fungus age, licorice, with the function of clearing heat and detoxification, promoting humidification and turbidity, for the treatment of acute gouty arthritis is moist heat taiyun evidence, symptoms see joint redness, swelling and heat pain, joint pain, frequent attacks of joint pain, fever, irritability, bitter mouth, bad breath, stool stickiness or odor, red tongue, moss yellow greasy or yellow thick, pulse string slippery or slippery number.
2. Blood stasis granules:
The formula is frankincense (made), myrrh (made), safflower, welling fairy, Sichuan ox knee, fragrant (made), turmeric, angelica, danshen, Chuanxiong, hot astragalus, with the function of dissolving phlegm and dispersing knots, activating blood circulation, used for the treatment of chronic gouty arthritis is sputum stasis obstruction, symptoms include joint swelling and pain, repeated attacks, local induration or dark red skin, joint tingling, joints
Poor flexion and extension, joint deformity, purple and dark tongue, white moss, and smooth veins or strings.
3. Mengxue Distinguishing Pills:
The formula is powder herb, calamus, licorice, black medicine, salt and zhiren, with the function of strengthening the spleen and benefiting the kidney, drying and humidifying turbidity, used for the treatment of gouty nephropathy and chronic gouty arthritis is a certificate of spleen and kidney deficiency, the symptoms are repeated joint pain, unfavorable joint flexion and extension, stiffness or deformity, fatigue, waist and knee soreness, heavy limbs, swelling around the body, pale tongue, slow or fine pulse.
4. Goutidine capsules:
The group is Qin Jiao, Huangbai, Yanhusuo, Red Peony, Sichuan Ox Knee, Ze Diarrhea, Psyllium, Soil Porridge, which has the function of clearing heat and dispelling dampness, activating blood circulation and fixing pain, and is used to treat paralysis caused by damp heat and stasis, the symptoms are redness, swelling, heat and pain in the joints, accompanied by fever, sweating, thirst and upset, yellow urine, red tongue and moss yellow greasy, and smooth pulse; Gout is seen in the above symptoms.
