The imperial disease is getting younger! To stay away from gout, control your weight first

Taiwan is nicknamed the "Kingdom of Gout" because the pain of gout is like the wind blowing through the gout area, and the pain is as fast as the wind. It is also called the "Emperor's Disease" because eating too much meat and fish every meal causes excessive uric acid crystals to accumulate in the joints, which leads to an immune inflammatory reaction.

Gout at a younger age is linked to obesity

In the past, gout was more common in middle-aged and elderly men, but a survey by the Ministry of Health and Welfare shows that gout patients are becoming younger. Recent outpatient clinics have also shown that the average age of gout onset has dropped to under 40 years old, and there are more and more young people suffering from gout. Why? Westernized diet and overnutrition have led to an increase in the obese population, and obesity is closely related to the problem of gout; it is worth noting that many young patients have a family history, so genetic factors cannot be ignored.

Is hyperuricemia the same as gout? Will gout heal once it's over?

Hyperuricemia is not the same as gout. About 1 in 10 patients with hyperuricemia (blood uric acid level > 7 mg/dl) will experience gout symptoms, which include sudden local redness, swelling and severe pain in the foot joints (mostly the big toe). The pain is so severe that the patient cannot walk or wear shoes, and feels that this is the greatest pain they have ever experienced in their life. Some people often mistakenly believe that the treatment of gout is only to relieve pain, and treatment will stop once the pain is gone. This is a big misconception.

In addition to the unbearable pain caused by repeated gout attacks, excessive urate crystals will cause tophi to accumulate in various parts of the body, and may also lead to complications such as kidney disease, heart disease, arteriosclerosis, hypertension, cerebral stroke and kidney stones. Therefore, the most important thing for gout is to treat hyperuricemia. Controlling the blood uric acid level below 6mg/dl can prevent gout attacks and its complications.

Clinical application of skeletal muscle ultrasound in gout

The detection of uric acid crystals in joint fluid is the main condition for diagnosing gout, but it has its clinical limitations. For example, it is difficult to extract joint fluid from small joints, and laboratory tests such as serum uric acid testing are non-specific. Although the early clinical manifestations of gout are atypical and non-specific, ultrasound and other imaging examinations can detect lesions and provide treatment in a timely manner.

Ultrasound has a much higher sensitivity than conventional radiography, but a lower specificity. Literature indicates that the application of ultrasound imaging technology can be used to diagnose early gout. The first metatarsophalangeal joint is the joint most commonly affected by gouty arthritis, so preliminary screening can be performed through ultrasound examination. If ultrasound finds uric acid deposits on the surface of cartilage, the white irregular high-echo lines formed by them and the white high-echo lines on the hard bone surface below the cartilage form the so-called double contour sign (Figure 1). Studies have shown that its specificity is as high as 97.3%, making it an important sign for diagnosing gouty arthritis.

Tophi are characteristic lesions of the chronic stage, which are formed by the aggregation of urate crystals, protein matrix and inflammatory cells. More than half of gout patients will develop tophi if they do not receive treatment. On ultrasound, tiny tophi appear as high-echoic dots, while larger tophi (Figure 2) may have a low-echoic to high-echoic pattern and may have an anechoic ring around it.

Can gout be cured?

There are currently three types of uric acid-lowering drugs in clinical practice; the first type is drugs that increase uric acid excretion: benzbromarone. The second category is drugs that inhibit uric acid synthesis: Allopurinol and Febuxostat. The third type of drug that breaks down uric acid: Pegloticase (not available in China). This drug is an enzyme that can break down uric acid and needs to be used by intravenous injection. According to the latest foreign journal research, it is suitable for patients with chronic gout stones.

In fact, gout is very easy to control but cannot be cured as long as you follow the doctor's advice and use uric acid-lowering drugs on time. In daily life, in addition to remembering to take medicine on time, you cannot suddenly reduce the dosage on your own initiative. You should have a full discussion with your doctor. In addition to abstaining from alcohol, try to reduce the intake of seafood, offal, sprouted and fermented foods; pay attention to weight control.