Briefly talk about the impact of hyperuricemia.(Part. 2)😎😎😎

Hyperuricemia (Part. 2)✌

1. Life management of patients with hyperuricemia.

Health education:

Patients should avoid high-purine diets, and avoid inducements such as fatigue, cold, and stress. Patients should also regularly monitor blood pressure, blood sugar and other risk factors. At the same time, the blood uric acid level should be monitored regularly and checked regularly to improve the treatment effect.

Patients try to avoid using drugs that raise uric acid. Such as low-dose aspirin, immunosuppressive agents (cyclosporine), anti-tuberculosis drugs, most chemotherapy drugs, etc. Many people have to use anti-tuberculosis drugs, chemotherapy drugs and other treatments because of certain diseases such as tuberculosis and cancer. After weighing the pros and cons, it is generally believed that the harm of patients with hyperuricemia is not enough to make them give up those treatments.

Patients should quit smoking and carry out weight management. Target BMI <20 kg/m^2, male waist circumference <90 cm, female waist circumference <80 cm. The patient should have proper aerobic exercise.

Diet:

Patients should eat more fresh vegetables, a low-sugar and low-fat diet, and limit the intake of red meat, fish, and foods containing fructose and sucrose. Patients should also avoid the intake of animal offal, crustaceans, thick soups and broths. The daily purine content of the patient's diet is controlled below 200 mg.

The patient should consume 300 mL of skimmed or low-fat dairy products, 1 egg, and maintain a water intake of more than 2L per day. Patients can drink water, tea or unsweetened coffee.

Patients should strictly control drinking alcohol, especially beer and hard alcohol. The total amount of alcohol consumed daily should not exceed 28 grams for men (650 mL of beer, 280 mL of wine, or 50 mL of liquor), and 14 grams for women.

2. Drug treatment of hyperuricemia.

National guidelines have different recommendations on whether patients with asymptomatic hyperuricemia need medication.

Drugs that inhibit the synthesis of uric acid: 

They reduce the synthesis of uric acid by inhibiting the activity of xanthine oxidase.

1. Allopurinol: It is recommended that the initial dose of 50 mg for adults is 1-2 times a day, and thereafter it is increased by 50-100 mg each time. The general dose is 200-300 mg/d, divided into two to three doses. The maximum daily dose is 600 mg. Patients with renal insufficiency must reduce the dose. When eGFR is less than 10 mL/min or for dialysis patients, it is contraindicated. Use the lowest effective dose to maintain blood uric acid below the target level.
2. Febuxostat: The recommended initial dose is 20-40 mg, once a day, with an increase of 20 mg each time, and the maximum daily dose is generally 80 mg. After the blood uric acid level reaches the target, maintain the lowest effective dose. It should be noted that the FDA black box warns that febuxostat may increase the risk of cardiovascular death in patients. Febuxostat should be considered only when the patient does not respond to or cannot tolerate allopurinol treatment, and the specialist must fully assess the patient's condition and the risk of cardiovascular events before taking the drug.

Uric acid excretion drugs: 

They promote uric acid excretion by inhibiting renal tubular uric acid-anion transporter 1 (URAT1) and inhibiting renal tubular uric acid reabsorption.

1. Probenecid: Urinary stones and renal insufficiency are relatively contraindicated. For patients with renal insufficiency with eGFR> 30 mL/min, the recommended starting dose for adults is 25 mg/d, and the maximum dose is 75-100 mg/d. Drink more water during the administration to increase urine output.

Allopurinol, probenecid and febuxostat are all first-line drugs for lowering uric acid treatment. Patients with asymptomatic hyperuricemia can choose the first two categories, and patients with gout can choose the above. For patients with chronic kidney disease, the above all three types of drugs can be used, but febuxostat is the first choice when renal function is severely impaired.

Alkalized urine:

Urine pH <6 is an important factor in the formation of uric acid kidney stones. For patients with hyperuricemia and gout, the optimal morning urine pH is recommended to be 6.2 to 6.9. When the urine pH is <6, alkaline drugs, such as sodium bicarbonate, citric acid preparations, etc., can be used to alkalize urine according to the drug's indications, contraindications, and the individual characteristics of the patient.

Treatment of acute episodes:

When hyperuricemia develops into an acute attack of gout, it is recommended to use anti-inflammatory analgesia as soon as possible to improve the pain. Patients can use small doses of colchicine or adequate, short-term non-steroidal anti-inflammatory drugs, or systemic glucocorticoids. For patients with more serious conditions (such as acute gout involving multiple joints, large joints, or combined systemic symptoms), systemic glucocorticoid therapy is recommended. When the patient has severe pain, polyarthritis, or cumulative seizures of ≥ 2 large joints, a combination of two or more analgesic drugs can be used. During an acute attack, there is no need to adjust the dose of uric acid-lowering drugs that have been used.

Choice of drugs when there are comorbidities:

The principle of medication for each disease should be considered for comprehensive treatment. Try to choose drugs that lower uric acid and avoid drugs that raise uric acid.