Mr. Mou, a 26-year-old young man, usually pays great attention to health care. "Keeping good health" does not mean growing flowers and grass, practicing Tai Chi, or buying health care products. Mr. Mou, a young man, does not drink alcohol and eats very little meat and fish. But even so, he still suffers from gout, which we often call the "disease of wealth". What is going on?
In my clinic, Mr. Mou told me: "Dr. Liu, look, the fingers of my left hand are bent and cannot be straightened." He raised his hands and placed them on my table.
I saw something strange on his other finger, so I asked: "What about the fingers on his left hand? How did it become like this?"
Mr. Mou told me embarrassedly : "The index finger of my right hand was picked with an embroidery needle. I didn't pick the white ones like these."
Mr. Mou didn't know what the "white bumps" on his fingers were, so I told him : "You have tophi! How can you pick it out on your own? You see, your fingers are already broken, and the white chalk-gray things in the broken areas are urate crystals."
The main component of tophi is urate crystals. When gout ruptures, these urate crystals will flow out from the broken skin opening. The urate crystals are milky white and semi-solid. After being left for a long time, they turn into lime. Powdered solid.
Mr. Mou said: "I don't know. I thought I just had a bump. How could I know that it would look like this after picking it up?"
I asked He said: "There are dense needle holes on your fingers. How many times have you picked them?"
Mr. Mou recalled it himself, rubbed his fingers and said, "You have picked them a dozen times, right?" ”
The Mr. Mou in front of me is only 26 years old and comes from Zigong, Sichuan. Zigong produces well salt, and Zigong cuisine is also called Yanbang cuisine. From the name, you can tell that the cooking method is "heavy-flavored," with heavy salt and spicy emphasis. Although Mr. Mou is young, he has had gout for five years.
Mr. Mou told me: “In the past two years, many bean-sized tophi have grown on my limbs. I don’t know what these are, so I use a needle to pick them out at home, usually with my fingers and Heel."
I asked him: "Doesn't it hurt when you pick it with a needle?"
Mr. Mou said: "It hurts, but it hurts even more when it hurts. When there is an acute attack, pick it up and squeeze it out, just like squeezing out toothpaste." I was a little curious about this: "Will it be disinfected when picking it up? Alcohol or something?"
Mr. Mou said: "I don't use alcohol. I watch TV and use fire to disinfect it. I burn it on the fire myself and then start picking."
p>To be honest, Lao Liu has actually seen many patients like Mr. Mou who pick out tophi themselves in clinical practice. In fact, we do not advocate this approach in medicine, because it is easy to get infected and the patients themselves cannot be strict. disinfect. Ulcerated tophi is not easy to heal on its own. The main reasons include:
The structure and nutritional status of the skin at tophi are different from those of normal skin. The local blood circulation is poor and the cell regeneration ability is low. Once it is broken, It is difficult to repair and heal on its own after ulceration; the urate crystals in tophi continue to flow out from the ulceration opening, irritating the local window and hindering the healing of the wound; the local skin and soft tissue after ulceration are prone to bacterial infection. Once infection forms, local It often becomes a chronic suppurative lesion, causing local ulceration that does not heal for a long time.
When talking about the scattered tophi on the body, Mr. Mou became a little troubled: “I got this disease when I was 21 years old, and my friends around me couldn’t figure it out. How could such a disease appear in such a thin person? "In the eyes of many people, gout is a disease of wealth, and it should be easy for people who are overweight or obese to suffer from it.
Mr. Peng, who accompanied Mr. Mou to see the doctor, said to me: "Severe gout like his only occurs when he is very intemperate in his diet. But for As for my brother, I understand him well. His diet is regular, he doesn’t drink, he doesn’t smoke, and he doesn’t like anything, but he still suffers from it because of drinking.”
In everyone’s mind, overeating such as “beer with seafood”, “beer with hot pot”, “old fire soup”, etc. can easily lead to “gout knocking on the door”, but Mr. Mou has always The diet structure is relatively simple: "I don't like seafood, I don't eat lobsters or crabs, and I don't drink wine. I don't even know why I suffer from gout?"
Mr. Mou recalled that since he suffered from gouty arthritis, he has paid more attention to his diet. However, since the past year, the condition has not improved, but has become more serious: "Dr. Liu, the tophi you mentioned is just this one." It took two years to develop very quickly. It has been painful for five years, and it only hurt occasionally, but it didn’t grow out. Didn’t others grow out after ten years of pain? ”
Age Why can a young man suffer from gout even if he eats a "light diet"? Why do tophi grow so much in such a short period of time after suffering from gout? Today Lao Liu will talk to you.
Many people think that tophi is caused by gout for a long time, but in fact, tophi is caused by persistently high uric acid concentration. For example, in some patients with gouty arthritis, uric acid is above 600 μmol/L and the body cannot excrete it in time, so it will be deposited in cartilage, synovial membrane and soft tissue, forming an accumulation of urate crystals; and if uric acid remains high, it will The more it accumulates, the easier it is to form tophi.
The formation of tophi and chronic gouty arthritis are both chronic processes. Urate crystals will not only accumulate in joints to form tophi, but excessive accumulation will also affect blood vessels and kidneys, and even cause severe renal failure. Exacerbation of kidney disease will further affect uric acid excretion, forming a vicious cycle, leading to tophi in the body. Deposition in the body further increases.
For Mr. Mou’s tophi, we used acupuncture to remove the tophi. Generally speaking, when the following situations occur, early surgical intervention should be sought: ① The tophi ruptures and discharges chylous material to prevent secondary infection; ② The tophi does not disappear after conservative medical treatment, affecting joint function; ③ There are tophi in the tendon, and there is obvious pain and dysfunction; ④ There is nerve compression, and the symptoms are obvious; ⑤ The tophi lesions destroy the bone and cause local fractures.
Since long-term hyperuricemia is the "primary culprit" of tophi formation, Mr. Mou is wondering again, why does he still become a hyperuricemic person if he eats so restrainedly? In fact, Lao Liu often tells gout patients not to think that a low-purine diet is suitable for gout patients. When you have severe nutritional imbalances, immune problems, and metabolic dysfunction, your body cannot metabolize in a timely manner, which will lead to an increase in uric acid concentration. high.
Dr. Liu would like to emphasize that: for patients with gouty arthritis, dietary treatment and lifestyle adjustments can lower uric acid and regulate metabolism to a certain extent; however, standard treatment, continuous use of uric acid-lowering drugs, and Controlling the disease through immunoadsorption therapy, acupotomy therapy, meridian knife therapy and other treatment methods is the key.
Especially for patients like Mr. Mou, although surgical removal of tophi can partially remove gout crystals and reduce the total amount of uric acid in the body, it cannot cure gout and cannot reduce the recurrence rate of tophi; In the end, it is still necessary to standardize uric acid-lowering treatment to maintain the uric acid value below the standard value of 300 μmol/L.