With the development of social economy, people’s material living standards have been continuously improved, and their lifestyle and diet structure have also changed. In recent years, the prevalence of hyperuricemia in China has increased year by year, and it has become the second largest metabolic disease after diabetes. The prevalence rate of gout caused by hyperuricemia is also increasing obviously. According to epidemiological survey, the current prevalence rate of gout in China is about 1.1%, and the number of patients is about 16 million. Professor Zeng Xiaofeng, chairman of the Rheumatology Branch of the Chinese Medical Association and director of the Rheumatology Immunology Department of Peking Union Medical College Hospital, said that although the disease can not be cured at present, it can be controlled through drug treatment, diet and exercise management.
How is gout formed?
Gout is a chronic metabolic disease which is directly related to hyperuricemia. There is a substance called purine in the food ingested by the human body, and the waste after metabolism of this substance is uric acid, which is excreted from the kidney in the form of urate. If purine metabolism fails, uric acid will increase in the body, and these increased urate will form crystals and deposit in joints and other tissues, which will cause acute inflammation of cartilage and synovium, which is clinical gout. Gout mostly occurs in men over 40 years old, mainly manifested as recurrent severe joint pain. Patients are often accompanied by complications such as hypertension, chronic kidney disease and diabetes, which increases the risk of death.
Why is this disease called gout? As the name implies, it is so painful that even the wind blows through the body will feel pain, which can also show the degree of pain of the disease.
When gout first breaks out, it is mainly manifested as acute joint pain, and most patients suddenly have severe pain in the first metatarsophalangeal joint at night or in the early morning. Intermittent attacks will occur after the acute phase. If not treated in time, it will develop into chronic gouty arthritis and affect limb movements. Patients with advanced gout have an increased risk of hypertension, renal and cerebral arteriosclerosis and myocardial infarction, and a few patients may die of renal failure and cardiovascular accidents.
In view of gout’s preference for middle-aged "greasy uncle", relevant experts explained that gout has a great relationship with diet and life, and drinking, high-purity food and strenuous exercise are all inducing factors. Obese people, men over 40 who eat meat and drink heavily have become high-risk groups of gout due to the decline of metabolic function. In women, because estrogen in the body helps to excrete uric acid, the incidence rate will increase after menopause.
The compliance rate of gout treatment is less than 40%
The acute attack of gout brings great pain and inconvenience to patients, which seriously affects their work and life. Gout is a metabolic disease. Strengthening the long-term standardized management of life and controlling the blood uric acid level to reach the standard continuously are not only very important for the disease control of gout patients, but also medical challenges to be solved urgently.
According to the data of gout disease in China of National Rheumatology Data Center, the follow-up rate of gout patients after 4 weeks, 12 weeks and 24 weeks of treatment decreased in turn, which were 20.7%, 10.8% and 3.9% respectively, that is, less than 4% of gout patients could be followed up for half a year. At the same time, the compliance rate of uric acid reduction treatment for gout patients is only 38% after half a year of medication.
With the development of rheumatology immunology, the level of gout treatment in China has improved rapidly. Compared with the correct judgment rate of initial diagnosis of 85.7%, clinicians are faced with three major challenges in the long-term management of gout patients, namely, how to properly handle acute attack; How to improve the continuous compliance rate of serum uric acid in gout patients and how to improve the medication compliance of gout patients. The existence of these challenges, in addition to the reason that gout can not be cured by medicine at present, is also closely related to the large side effects, poor dosage and poor treatment effect of traditional anti-gout drugs. 20 mg and 40 mg febuxostat tablets, which were first marketed in China, provided doctors and gout patients with better initial dose selection and flexible dose adjustment ladder, which helped to gradually and steadily reduce the level of serum uric acid during treatment.
Experts remind that hyperuricemia is not equal to gout. In fact, only about 10% of hyperuricemia patients may be diagnosed as gout, while 90% of hyperuricemia patients are not gout. People with hyperuricemia may not be gout, but people diagnosed with gout must have hyperuricemia.
The key to gout treatment is to control blood uric acid.
Gout is directly related to hyperuricemia, and long-term hyperuricemia can also cause or aggravate other multiple organ injuries, complicated with renal diseases (acute urate nephropathy, chronic urate nephropathy, nephrolithiasis), hyperglycemia, dyslipidemia, hypertension, coronary heart disease, cardiac insufficiency and stroke. Therefore, it is the key to treat gout and control the level of serum uric acid. In the past, allopurinol was the main drug to treat gout, and 90% of allopurinol was metabolized by kidney, which would increase the burden of renal function of gout patients, so many patients with impaired renal function could not take allopurinol drugs for treatment.
At present, febuxostat, a brand-new anti-gout drug, is metabolized through the intestine and kidney, which reduces the burden of kidney metabolism. Therefore, patients with mild to moderate renal insufficiency do not need to adjust the dose when treated with febuxostat, and the curative effect is more stable. Compared with allopurinol, febuxostat has wider indications and more powerful and lasting effect of reducing uric acid, so it is called "gout medicine" by many patients at home and abroad.
interlinkage
Under what circumstances can gout patients stop taking medication?
Because of different symptoms, the control requirements of serum uric acid value are different, and the effect is more powerful and lasting. The long-term management of gout treatment is very important.
Many people use drugs to treat acute pain, and once the pain is relieved and enters the intermittent period, they stop taking drugs, which leads to repeated attacks of gout. This shows that patients’ understanding of gout is low and their compliance is poor.
It should be recognized that gout is a chronic disease, which requires persistent treatment and even lifelong medication. However, different clinical symptoms have different requirements for the control of serum uric acid value. Therefore, when to reduce the dosage and when to stop taking drugs, we must listen to the doctor’s diagnosis and not do it without authorization. (Reporter Yu Jingying)
People’s Daily Overseas Edition (09th Edition, June 29th, 2019)