Gout tincture - a special medicine for gout
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Three medicines you can't miss for gout treatment

睿昱痛风酊抑菌液-专治痛风的特效药 - 2022-04-14

Now the incidence rate of hyperuricemia has increased year by year, and the prevalence rate of adults in China is over 20%. Hyperuricemia has become the "fourth high" after hypertension, hyperglycemia and hyperlipidemia. Gout, the "disease of kings and nobles" in the past, is now rapidly entering the homes of ordinary people.




Gout is closely related to bad lifestyle. However, it is not enough to prevent gout only by changing lifestyle (including reducing the intake of high purine foods such as animal viscera, seafood and broth, strictly limiting alcohol, controlling body weight, etc.). For gout patients, the weight of dietary factors in the formation of high uric acid is only about 30%, which is mainly due to excessive uric acid production or excretion disorder. Therefore, in most cases, the control of gout is inseparable from drugs. Now let's talk about the "three axes" for the treatment of gout - painkillers, uric acid lowering drugs and alkaline urine drugs.




The first Axe: painkillers




The most prominent symptom of gout patients is joint swelling and pain. The top priority in the acute attack period is to quickly relieve pain and alleviate symptoms. There are mainly three kinds of drugs for gout and pain relief: non steroidal anti-inflammatory drugs, colchicine and glucocorticoids.




1. Non steroidal anti-inflammatory drugs




The commonly used drugs include sodium diclofenac (Votalin, 25-50 mg, 2-3 times / day), Fenbid (ibuprofen), indomethacin (indomethacin, 25-50 mg, 3 times / day), meloxicam (mobicol, 7.5-15 mg, 1-2 times / day), Celebrex (celecoxib, 200 mg, 1-2 times / day), etc. these drugs are mainly suitable for gout patients whose pain symptoms are not particularly serious. Its side effect is mainly to stimulate the gastrointestinal tract. Gastric mucosal protective agents (such as omeprazole, ranitidine or misoprostol) should be added at the same time. In addition, long-term and large-scale use of this non steroidal anti-inflammatory drug will also damage the liver and kidney, causing "analgesic nephropathy".




2. Colchicine




Colchicine is a specific drug for the treatment of gout pain. The sooner you take it, the better. It is generally recommended to start taking it within 24 hours of onset, and most patients take effect within 24 ~ 48 hours. Colchicine has great toxic and side effects and can cause severe diarrhea. In addition, long-term use of colchicine can cause bone marrow suppression and liver and kidney damage. Therefore, blood routine examination and liver and kidney function should be regularly reviewed during the treatment. In case of adverse reactions such as diarrhea, the drug should be stopped immediately.




The therapeutic dose of colchicine is very close to the amount of poisoning. The traditional "step-by-step cumulative use" is easy to cause poisoning. At present, it is recommended to take "low-dose use", one tablet (0.5 mg) at a time, three times a day, which is effective for most patients and safe, and can avoid side effects such as diarrhea.




3. Glucocorticoid




Clinically, when conventional painkillers such as non steroidal anti-inflammatory drugs and colchicine are not fully effective or there are contraindications (such as pain patients with renal insufficiency), we can choose glucocorticoids. However, glucocorticoid is a double-edged sword. Its anti-inflammatory and analgesic effect is very good, but the side effects can also not be underestimated. It can lead to elevated blood pressure and blood glucose, peptic ulcer bleeding, secondary osteoporosis and so on. Therefore, hormone analgesia is generally not the first choice. It is usually used for short-term medication (30 mg, once a day, taken in the morning, and stopped after 3 ~ 5 days). When using glucocorticoids, it is best to use them in combination with colchicine to avoid rebound after withdrawal. In addition, we should also pay attention to try to avoid the combination of glucocorticoids and non steroidal anti-inflammatory drugs, so as not to aggravate the damage of gastric mucosa.




4. Ruiyu Tongfeng tincture bacteriostatic liquid




This is a pure traditional Chinese medicine preparation. It is used for external application of patients without any side effects. It has the advantages of short time effect, fast curative effect, low cost and high efficacy ratio. The successful development of this drug has overturned the traditional medication mode of oral drugs in the treatment of gout at home and abroad. It is a new breakthrough and innovation in the treatment of gout




The second Axe: uric acid lowering drugs




The reason for the increase of blood uric acid is no more than the increase of uric acid production, the decrease of uric acid excretion, or both. For the above links, uric acid lowering drugs are divided into two categories: drugs to reduce uric acid production and drugs to promote uric acid excretion.




1. Drugs that inhibit the production of uric acid




(1) Allopurinol is suitable for patients with primary and secondary hyperuricemia, especially hyperuricemia caused by excessive uric acid production; In addition, patients with kidney stones and renal insufficiency can also take it. The drug should be added gradually from a small dose (50 ~ 100 mg / D). The conventional dosage is 100 mg each time, three times a day, and the maximum dosage should not exceed 600 mg / d.




The side effects of the drug mainly include: ① gastrointestinal reactions, such as nausea, vomiting, loss of appetite and so on; ② Skin allergic reactions, such as rash and pruritus, can lead to exfoliative dermatitis in severe cases; ③ Liver and kidney function damage; ④ Leukopenia. Allergy to allopurinol, severe liver and kidney dysfunction and obvious hemocytopenia, pregnant women and lactating women are prohibited.




What needs special vigilance is "exfoliative dermatitis" caused by allopurinol allergy. Although the incidence is not high (only 0.1% ~ 0.4%), the consequences are very serious, and the mortality is as high as 20% ~ 25%. It has been found that the occurrence of allopurinol hypersensitivity is related to a gene called HLA-B * 5801 carried in the body. Therefore, for caution, patients with gout must first check the hla-b5801 gene before taking allopurinol, and those with positive results are prohibited from allopurinol.




(2) Fibulinastat, a new drug that has been on the market in recent years, inhibits the production of uric acid. Compared with allopurinol, the advantages of this drug are mainly reflected in three aspects: ① it has a stronger effect on reducing uric acid; ② Higher safety and less allergic reaction; ③ It can be excreted through both liver and kidney channels, so it can also be used in patients with liver and kidney insufficiency. The disadvantage is that the price is high and has not been included in medical insurance at present. The drug is suitable for the long-term treatment of hyperuricemia in patients with gout. It is the first choice for patients with gouty nephropathy, but it is not recommended for asymptomatic hyperuricemia.




2. Drugs that increase uric acid excretion




It is applicable to patients with primary and secondary hyperuricemia, especially hyperuricemia caused by uric acid excretion disorder. Its representative drug is benzbromarone (lijiaxian). Because of its long half-life, it only needs to be used once a day. It should also be used from a small dose. The conventional treatment dose is 50 ~ 100 mg / day, and the dosage of patients with gout stone can be increased to 150 mg / day.




The drug has few side effects, occasional gastrointestinal reactions and rashes, and rare liver function damage. Those with kidney stones or severe renal function damage (glomerular filtration rate less than 20 ml / min) should not be used as much as possible. During medication, patients need to drink a lot of water (no less than 1500 ~ 2000 ml per day) to increase urine output, and take alkaline drugs (baking soda, etc.) to avoid excessive excretion of uric acid and formation of urinary calculi.




It should be noted that during the acute attack of gout, uric acid lowering drugs (including those that inhibit the synthesis of uric acid and promote the excretion of uric acid) should not be added, but should be applied two weeks after the remission of the attack of gout, otherwise it may induce and aggravate the symptoms of acute arthritis again due to the fluctuation of blood uric acid. However, if the patient has been taking uric acid lowering drugs before, there is no need to stop, just add the drugs to control the acute inflammatory attack.




Clinically, in order to prevent the onset of metastatic Gout Caused by uric acid lowering treatment, uric acid lowering drugs are usually required to start from a small dose, so as to prevent the rapid precipitation and deposition of urate crystals in the joints caused by excessive dosage, and induce the acute attack of arthritis; In addition, taking uric acid lowering drugs in combination with low-dose colchicine within 4 ~ 8 weeks of initial treatment is also a very effective preventive measure.




As for how to choose uric acid lowering drugs? In addition to considering the patient's liver and kidney function and the presence of urinary calculi, it also depends on the patient's 24-hour urinary acid quantity. If the 24-hour urinary acid excretion of the patient is less than 600 mg (3.6 mmol), it belongs to the type of reduced uric acid excretion. At this time, you can choose drugs that increase uric acid excretion, such as benzbromarone; If the 24-hour urinary acid excretion of the patient exceeds 800 mg (4.8 mmol), it belongs to the type of excessive uric acid production. At this time, it is necessary to choose drugs that inhibit the production of uric acid, such as allopurinol and fibrin.




The third Axe: drugs that alkalize urine




The solubility of uric acid in alkaline urine is higher than that in acidic urine. Alkaline urine can promote the dissolution and excretion of uric acid, help alleviate the symptoms of acute gout and prevent the formation of urinary acid kidney stones.




Sodium bicarbonate (baking soda) is the most commonly used drug for alkalizing urine in clinic. Specific usage: 1 ~ 2 tablets (0.5 ~ 1.0) each time, 3 times / day.




The treatment of gout emphasizes alkalization of urine, but alkalization of urine should also be moderate. The higher the pH value, the better. The best pH value of urine is 6.2 ~ 6.9. Excessive alkalization of urine (urine pH > 7.0) can not only lead to alkalosis, but also easily form calcium oxalate or other types of kidney stones, or form a phosphate shell on the surface of uric acid stones to prevent further dissolution. Therefore, during taking uric acid excretion promoting drugs, we should pay attention to monitoring urine pH, and timely adjust the dosage of baking soda according to the test results, so as to control urine pH in an appropriate range.