To cure gout clinically, uric acid must be lowered, but some gout patients, the re-examination of blood uric acid has dropped to more than 200 μmol / L, not only lower than the "high pressure line" of hyperuricemia 420 μmol / L, and even lower than the clinical cure standard of gout 300 μmol / L, but gout is still acute. There are two common reasons for this phenomenon, one is that the measurement of blood uric acid is not accurate, and the other is the melting pain in the process of lowering uric acid, and then we will explain in detail!
<h1 class="pgc-h-arrow-right" data-track="59" > (1) Is your blood uric acid measurement accurate? </h1>
Measuring blood uric acid concentration is an indispensable indicator for diagnosing gout and reviewing the effectiveness of gout treatment. In general, when the blood uric acid value reaches the standard of hyperuricemia (420 μmol/L), urate crystals are deposited in the joint and irritated the joint, which will cause an inflammatory response and lead to an acute attack of gout.
When blood uric acid levels are low but gout still occurs, the first step is to verify the authenticity of the test results.
When there is an error in the process of examination, such as sample confusion, it may lead to incorrect test results, which is rare but does not rule out the possibility. Moreover, because blood uric acid is affected by a variety of factors, the volatility is relatively large, and it also needs to be repeatedly measured to increase the accuracy of detection.
Blood uric acid is generally measured in the normal dietary state, and the fasting blood of the same day is collected twice, and the uridase method is measured.
Therefore, accidentally measure the low level of bleeding uric acid, first do not be complacent, review whether there has been a low purine diet or excessive uric acid-lowering drugs and other interventions recently, if not, the next day measurement is still low, it means that blood uric acid is really low.
<h1 class="pgc-h-arrow-right" data-track="65" > (2) If the blood uric acid concentration is low, there will be no gout! </h1>
Gout is divided into four periods: asymptomatic hyperuricemia, acute gout, intermittent, and chronic tophi arthritis. Looking at the entire process of joint lesions, high → uric acid crystal deposition in the blood uric acid→ acute gout attacks→ long-term high levels of blood uric acid → tophi, theoretically the more adequate the former condition, the more likely the latter result is to occur, but not absolutely.
Among the thousands of patients with gout and hyperuricemia who were treated, some patients had a perennial blood uric acid of more than 500 μmol/L, but did not gout, and some patients had blood uric acid of only 400 μmol/L, but gout. Blood uric acid concentration rises, urate crystal deposition, inflammatory response, each has its own independent influencing factors, the difference between individuals is also very large, can not be the blood uric acid concentration as the only measure of gout attack or not.
In patients with acute attacks of gout, the treatment goal is to reduce the blood uric acid concentration below 300 μmol/L and maintain it for a long time, dissolve and remove the urate crystals in the joint cavity, and achieve these two goals at the same time, in order to effectively prevent the acute attack of gout and avoid the occurrence of related complications.
Some patients through the treatment of uric acid, blood uric acid concentration seems to have dropped, but the urate crystals in the joint cavity will continue to dissolve, so that blood uric acid is in a low-high-low continuous fluctuation, which will also lead to acute attacks of gout, which is what we will talk about next.
<h1 class="pgc-h-arrow-right" data-track="70" > (3) What is the melting pain in the uric acid lowering process? </h1>
If gout patients do not know enough about the disease knowledge, the three words "melt crystal pain" are a little strange, but if you are in the process of lowering uric acid, obviously blood uric acid has dropped, but gout occurs more frequently, then you must be careful of melt crystal pain!
Melting pain, also called metastatic gout, is an acute attack of gout that occurs in the process of lowering uric acid. Why is this happening?
The deposition of urate crystals, in addition to the level of blood uric acid, is also related to local temperature of joints, PH value, trauma, hormone levels in the body and other factors, so hyperpurine diet, heavy alcohol consumption, joint cold, joint trauma, overexertion is a common cause of acute gout.
But most people don't know that a rapid decrease in blood uric acid levels can also lead to an acute attack of gout.
Some patients think that gout is not high in uric acid, so I will take more uric acid drugs, quickly lower the uric acid, it will not hurt. However, when the blood uric acid level is greatly reduced, it will promote the dissolution of the urate deposited in the joint, and a large number of urate crystals dissolved will be more likely to cause an inflammatory response, resulting in an acute attack or aggravation of gout.
This is the reason why melting crystal pain occurs, we do not know how long it took for the subject's blood uric acid to drop from more than 600 to more than 200, but there is no doubt that it is very likely to belong to melting crystal pain.
How to treat crystallization pain correctly?
It is estimated that many patients will think of stopping the drug. Is it not the crystal pain caused by uric acid dissolution, then I stopped the uric acid-lowering drug, the blood uric acid does not drop, the uric acid in the joint cavity does not dissolve, will not melt crystal pain! But if the drug is stopped, the uric acid in front of it has dropped? Suffered in vain in the front? What should I do if uric acid rises later?
It can be seen that stopping the drug is not a "good match", and the "great wisdom" of the patient's flash of inspiration does not mean that it is really smart!
There are three ways to prevent crystallization pain:
Uric acid-lowering drugs are used starting in small doses. Gout doctors generally use drugs in this way, starting in small doses, which can make the blood uric acid drop smoothly and avoid the occurrence of melting crystal pain. Patients should not feel that the effect is slow, and increase the dose on their own.
Do not use the wrong drug in the acute phase. Many patients with gout do not go to the rheumatology and immunology department for formal diagnosis and treatment, but use their own medication. In the acute attack period, I was eager to immediately lower uric acid, desperately eat uric acid drugs, and the joint redness, swelling, heat and pain were not only not relieved, but aggravated.
Prophylactic use of painkillers. In the early stages of uric acid-lowering drugs, small doses of colchicine or NSAIDs can be used prophylactically to help patients smoothly navigate the high incidence of thromina.
For patients who have lysolytic pain, do not blindly stop the drug, but follow up in time, first the doctor will give the patient a drug to relieve symptoms, and then consider whether to reduce the dose of uric acid-lowering drugs according to the specific situation.
To sum up, the concentration of blood uric acid dropped to normal levels, does not mean that gout will not occur, only by adhering to treatment, long-term maintenance of blood uric acid normal, dissolving and removing urate crystals in the joints, in order to effectively prevent acute attacks and complications of gout for a long time. In the process of lowering uric acid, it is necessary to use the drug correctly to prevent the occurrence of melting crystal pain, and do not blindly interrupt treatment after the occurrence of melting crystal pain.