Some common misconceptions of gout that many people have.🙀🙀🙀

Some people eat too much meat, seafood or drink a lot of alcohol at a
dinner party, and their toes or joints will suddenly experience redness, swelling and pain. Most of this is a gout attack. Many people think that only the elderly develop gout. In fact, gout not only occurs in the elderly, but young people are also at risk of gout. Here are some common misconceptions about gout.

The difference between gout and hyperuricemia.

In fact, gout and hyperuricemia are two different concepts.

Hyperuricemia is defined as serum uric acid levels greater than 420 μmol/L measured twice on different days in men or women. Hyperuricemia can be divided into three types according to the patient's serum uric acid level and uric acid in urine: too much uric acid production, poor uric acid excretion, and mixed type. About 90% of patients with primary hyperuricemia are caused by poor uric acid excretion.

Gout is due to the deposition of urate crystals, which causes uric acid nephropathy, uric acid nephrolithiasis and gouty arthritis in patients with hyperuricemia. Gout is more commonly referred to as gouty arthritis. When a patient is diagnosed with hyperuricemia, he should be actively treated with medication or lifestyle intervention. This avoids developing gout.

Do only the elderly get gout?

With the improvement of living conditions in today's society, the incidence of hyperuricemia and gout is getting higher and higher, and the patients are also getting younger. Although the incidence of hyperuricemia and gout increases with age, younger people are also at risk. Males have a higher incidence than females.

Serum uric acid levels rise during a gout attack?

Serum uric acid is temporarily reduced because of acute gout attack caused by the deposition of serum uric acid in the joints. At the same time, the acute phase of gout will increase the excretion of uric acid through the kidneys. Therefore, serum uric acid levels do not necessarily increase during a gout attack. 

Does only gout require treatment and hyperuricemia does not require treatment?

In fact, chronically high levels of serum uric acid can cause or worsen damage to many organs. Hyperuricemia is also an independent risk factor for many diseases such as hypertension, diabetes and chronic kidney disease. Therefore, hyperuricemia also requires treatment. The basis for the treatment of hyperuricemia is lifestyle intervention. It is a recommended lifestyle intervention for 3 to 6 months, with the addition of medication if there is no improvement. Additionally, if the patient has a serum uric acid level >540 μmol/L or has risk factors for cardiovascular disease, drug therapy is recommended.

Can diet alone control serum uric acid?

In the human body, serum uric acid is converted from purines. In general, 80% of serum uric acid is converted from purines in the body, while only 20% is converted from purines in the diet. Therefore, even severely restricting purine intake from the diet can only reduce the conversion of purines to uric acid by about 20%. Serum uric acid is not well controlled by diet alone.

Diet control means not eating meat and eating more fruits and vegetables?

Dietary control includes a low-purine diet, drinking more water, and limiting alcohol.

• Low-purine diet: Patients should limit total daily calorie intake and eat a balanced diet. Limit consumption of high-purine foods such as seafood, meat, and organ meats. Eat more foods such as eggs, fresh vegetables, and low-fat or skim milk. Beans and soy products should be consumed in moderation. Some studies have pointed out that some high-purine vegetables such as spinach and mushrooms have no significant correlation with hyperuricemia and gout attacks. In addition, patients should maintain good eating habits and avoid overeating.
• Drinking more water: Drinking plenty of water can reduce the symptoms and duration of gout attacks. Patients with normal heart and kidney function are advised to drink plenty of water. Daily urine output should be maintained at 2000 to 3000ml. Avoid sugar-sweetened beverages or high-fructose fruit juices such as apple juice and orange juice. It is recommended to consume fresh fruits such as strawberries, peaches, and cherries that are low in fructose. In addition, proper alkalization of urine (pH of 6.2 to 6.9) can facilitate the dissolution and excretion of urate crystals.
• Limiting alcohol: It is recommended to drink ≤2 alcohol units/day for men and ≤1 alcohol unit/day for women. (1 alcohol unit is about 14g pure alcohol. It is equivalent to 145ml of red wine at 12°, 497ml of beer at 3.5°, and 43ml of distilled wine at 40°)

Is more exercise better?

Regular exercise can reduce gout attacks, but more often or harder is not necessarily better. In addition, activities should be reduced during acute gout attacks. It is recommended to do at least 150 minutes of moderate-intensity aerobic exercise per week (about 30 minutes per day, 5 days a week). Moderate-intensity means heart rate during exercise = (220 - age) × 50% to (220 - age) × 70%. Strenuous exercise may trigger acute gout attacks. Lifestyle interventions also include smoking cessation and weight control.

Are the treatments all the same? Can the medication be stopped once the pain is relieved?

Treatment regimens require individualized dose titration and long-term management.

Gout treatment is divided into two types: acute treatment and uric acid-lowering treatment. 

1. Colchicine, NSAIDs, and glucocorticoids are used in the acute phase. Continuous use of low-dose colchicine or NSAIDs for 6 months is effective in preventing acute gout attacks. If the patient is intolerant, has contraindications or has no effect, it can be switched to continuous use of low-dose glucocorticoids for 6 months.
2. Uric acid-lowering therapy is a long-term treatment process that gradually reduces serum uric acid to the target range. Allopurinol and febuxostat inhibit the production of uric acid. Probenecid and benzbromarone promote uric acid excretion. They are commonly used uric acid-lowering drugs. Uric acid-lowering drugs should be selected according to the type of hyperuricemia of the patient.

Is uric acid down to normal enough?

Serum uric acid should be reduced to <360 μmol/L in patients with hyperuricemia. For gout patients, it is recommended to reduce serum uric acid to <300 μmol/L. This prevents gout from recurring.

Patients with hyperuricemia and gout should maintain a healthy lifestyle and choose appropriate drug therapy. Regularly check uric acid and adjust the serum uric acid level to the target value as soon as possible.