Three highs? Out! It’s necessary to understand this “fourth high” →

Popular Science Times reporter Shi Qi Recently, a 16-year-old middle school student in Inner Mongolia was diagnosed with hyperuricemia at a blood uric acid level of 800 micromoles/liter, far exceeding the normal maximum of 420 micromoles/liter. Doctors said that more and more teenagers are suffering from hyperuricemia.

Hyperuricemia has become the "fourth highest"

Hyperuricemia is a typical metabolic disease. Many studies have shown that hyperuricemia is the "fourth highest" after diabetes, hypertension, and hyperlipidemia, and its prevalence is comparable to that of diabetes. According to the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China" issued by the Endocrinology Branch of the Chinese Medical Association in 2019, the overall prevalence of hyperuricemia in China is 13.3%, which means that about 177 million people are suffering from the disease, and the prevalence of men aged 18-29 is as high as 32.3%. Hyperuricemia is also the direct cause of gouty arthritis.

How is uric acid produced? Ma Yahui, deputy chief physician of the Endocrinology Department of Xuanwu Hospital of Capital Medical University, told the Science Times reporter that purine in the human body is metabolized by the liver to produce uric acid, which is excreted through the kidneys and intestines. Excessive production or reduced excretion of uric acid will lead to high uric acid. 20% of uric acid is produced by dietary intake, and 80% is produced by endogenous decomposition, including genetics, obesity, renal insufficiency, diabetes, hypertension and other factors.

Ma Yahui suggested that, first, people with high uric acid levels should reduce the intake of high-purine foods, such as animal offal, seafood, broth, etc., and eat more vegetables; secondly, fructose directly increases uric acid levels, and alcohol promotes uric acid production and hinders uric acid excretion, so the intake of fructose beverages and alcohol should be controlled, and eating a lot of fruit in a short period of time should be avoided; 2/3 of uric acid is excreted through urine, and drinking more water can reduce the retention of uric acid in the body; in addition, avoiding staying up late for a long time, quitting smoking and limiting alcohol, and losing weight can also help control blood uric acid levels.

High uric acid does not mean gout

So, will high uric acid levels definitely cause gout? Ma Yahui's answer is not necessarily. "But when the uric acid level in the blood is too high for a long time, if it is not treated in time, the high uric acid will easily exceed its solubility in the blood, forming urate crystals and depositing in the joints, kidneys and other parts, leading to gout and gouty nephropathy and other diseases."

Ma Yahui said that hyperuricemia is the pathological basis of gout. The course of hyperuricemia and gout is divided into the following stages: asymptomatic hyperuricemia stage, acute attack of gouty arthritis stage, interval between attacks of gouty arthritis, and chronic gouty arthritis stage.

At the same time, Ma Yahui reminded that currently about 80% of patients with hyperuricemia have no clinical symptoms. Therefore, it is particularly important to correctly grasp the timing of treatment for asymptomatic hyperuricemia. At this stage, it is believed that if the patient has comorbidities (such as hypertension, dyslipidemia, diabetes, obesity, stroke, heart failure, uric acid kidney stones, etc.) and the blood uric acid level is ≥480 mmol/L, or there are no comorbidities and the blood uric acid level is ≥540 mmol/L, uric acid-lowering drugs need to be added. Asymptomatic hyperuricemia patients with mild uric acid elevation do not need to use drugs, and can lower uric acid levels by adjusting their lifestyle. "Patients should be treated under the guidance of a doctor and take medication as prescribed by the doctor. They should not blindly take medication on their own to avoid damage to the body." Ma Yahui said.