Why have gout patients doubled in recent decades? Advice: 4 kinds of food really should eat less

Ryoko (pseudonym) is 26 years old this year. In March, she accidentally fell and felt like her foot was twisted. I didn't care, but after two weeks, I felt weakness in my lower limbs, and I walked as if "floating" on the sea.

One day, Liang Zi had difficulty even getting up, so with the help of her family, she went to the hospital for examination, but unexpectedly found a full of "pebbles" in the thoracic spinal canal . The doctor told him that these "tophi stones" compress the spinal cord, making him unable to walk. If surgery is not performed in time, he may be paralyzed...

It turns out that Ryoko was born at the seaside, and she has been inseparable from seafood since she was a child. In fact, when he was 19 years old, he was found to have high uric acid . The doctor told him to pay attention to his diet, but he was young and didn't take it seriously, and he ate beer and seafood.

Last year, tophi the size of an egg grew on Liangzi's right foot, and there were similar lumps in the finger joints. I didn't expect that even the thoracic vertebrae had accumulated dense "tophi".

1. Why have gout patients doubled in recent decades?

Published in Arthritis & Rheumatology, scholars from Iran and Australia, Canada, and the United Kingdom used database resources to analyze the prevalence of gout from 1990 to 2017, and found that the global gout patients approximately doubled in 30 years.

According to relevant literature reports in 2016, the prevalence of gout in China is 1%-3%, and the burden of gout is at a moderate level in the world. The average age of patients is about 48 years old.

Thirty or forty years ago, there were not many gout patients in China. Why has the gout population developed so much in just a few decades?

Sustained elevation of serum uric acid level is a major risk factor for gout, and the progression of hyperuricemia to gout may be the main reason. But does high uric acid necessarily cause gout? Many gout patients will find that the blood uric acid value may be different each time they have gout. In most cases, it will be above 420 umol/L, but sometimes it is as high as 600 umol/L or more, and there is no gout .

So, while gout is associated with hyperuricemia, a gout attack is not caused by a specific level of uric acid, but by a sharp change in uric acid level.

In addition, about 10%-15% of patients with hyperuricemia progress to gout, but even in asymptomatic patients with hyperuricemia, urate deposition may be found through CT examination, and even bone lysis changes, with obvious joints Damaged, this is "subclinical gout". It is equivalent to a transitional stage. Do a good job of management and eliminate gout in the budding stage.

In addition, living habits are the main practical reasons, and hyperuricemia or gout caused by failure to keep one's mouth shut is not a minority.

2. These 4 kinds of food should really be eaten less

Gout not only needs to be controlled by drugs, but also the improvement of diet structure is also the key. ·

1. High purine foods

Long-term intake of high-purine foods means the increase of uric acid in the body, which leads to repeated symptoms and aggravation of the disease.

According to the dietary purine content, animal internal organs have the highest purine content , and gout patients should strictly control their intake, followed by most animal foods, including red meat, seafood, etc., should not be eaten too much.

Generally speaking, the dietary intake of purine for ordinary people is 600-1000mg per day; in the acute stage of gout, it is controlled at 100-150mg per day; in the stable stage of gout, it is controlled at about 300mg per day.

2, wine

Alcohol metabolism will also increase the concentration of lactic acid in the blood, resulting in the inhibition of renal tubular secretion, which is not conducive to the excretion of uric acid ; and alcohol itself contains purines, which will also increase the concentration of uric acid.

3. Fructose drink

As research into the gout diet progressed, it was found that sugar- sweetened beverages and fruit juices had a comparable risk of gout as beer . Fructose in sugar-sweetened beverages can be metabolized in the body to promote uric acid synthesis, but also increase insulin resistance and hinder uric acid excretion.

4. Coffee and strong tea

Strong tea and coffee themselves do not contain high purines, but they can cause autonomic excitation and may induce acute gout attacks. It is recommended that gout patients should reduce the intake of such drinks.

In addition, prevent strenuous exercise or sudden cold, increase the intake of fresh vegetables; drink plenty of water (above 2000ml per day); control body weight, exercise regularly; regular diet and rest are all habits that gout patients should abide by.

3. Gout is not controlled, beware of your kidney problems

Kidney damage is the second most common comorbidity of hyperuricemia and gout, why is gout and kidney damage related?

Published in BMJ OPEN, a new study from the University of Limerick in Ireland found that elevated uric acid levels can lead to glomerular hypertension and tubulointerstitial fibrosis, which can lead to kidney damage.

Repeated attacks of gout may cause chronic urate nephropathy, acute uric acid nephropathy, uric acid urolithiasis and other kidney diseases.

Therefore, it is very important to treat gout in a timely manner. According to the 2019 "Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout in China", gout patients are divided into three categories, and they are administered according to different categories.

Asymptomatic hyperuricemia patients : start uric acid-lowering drug therapy when blood uric acid ≥ 540 μmol/L; blood uric acid ≥ 480 μmol/L combined with any of the following complications: hypertension, diabetes, abnormal blood lipid metabolism, obesity, coronary heart disease , stroke, renal impairment, uric acid nephrolithiasis, etc.;

Non-acute gout patients: start uric acid-lowering drug therapy when blood uric acid ≥ 480 μmol/L; serum uric acid ≥ 420 μmol/L combined with any of the following conditions.

Aged less than 40 years old; the number of gout attacks is more than or equal to 2 times a year; suffering from tophi, kidney stones, chronic gouty arthritis, chronic kidney disease, hypertension, diabetes, dyslipidemia, stroke, ischemic heart disease, a disease such as heart failure;

· Patients with acute gout attack: start uric acid-lowering drug therapy 2 to 4 weeks after the attack is completely relieved. Discontinuation of the medication is not recommended for patients with acute gout attacks who are taking medication.

The harm of gout is not only as simple as joint pain, it can also harm other organs of our body. Therefore, all patients with hyperuricemia or gout, please pay attention, keep your mouth shut, and prevent attacks.

References:

[1] James Sl A D A K. Global， regional， and national incidence， prevalence， and years lived with disability for 354 diseases and injuries for 195 countries and territories， 1990-2017： a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet，2018，392(10159)：1789-1858.

[2] Rheumatology Branch of Chinese Medical Association. 2016 Guidelines for Diagnosis and Treatment of Gout in China [J]. Zhejiang Science, 2017, 39(21): 1823-1832. DOI: 10.3760/cma.j.issn.0578-1426.2016.11.019.

[3] Endocrinology Branch of Chinese Medical Association. Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019) [J]. 2020, 36 (1)

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