疾病与营养 | How to get out of Gout? 如何“养”好痛风?

 

Based on the messages received from some of the followers and also a promise to a friend. This article will introduce you to a common medical condition known as ‘Gout’.

Statistics show that a majority of gout patients have a low motivation to make healthier lifestyle choices, such as drinking less and maintaining a healthy fitness level. So try not to be one of those people and enjoy your life!

应一些读者请求以及一位好友的需要,特意准备了本篇关于“痛风管理”文章。有数据表明,痛风患者普遍拥有不良饮食和生活习惯,比如酗酒和没有健身习惯,并且普遍不够主动去做出相应的改变去改善。即使数据是如此,我们的目的是不做那样的人,才能好好享受我们应该有的生活喔!

Summary of Contents 内容大纲:

1. Definition of Gout 让我们来认识一下痛风

2. Patient Groups Vulnerable to Gout 容易患上痛风的人群

3. Common Symptoms of Gout 痛风的常见症状

4. Contributing Factors to Symptomatic Gout 痛风犯病的常见原因

5. Medical Management of Gout 痛风的西医管理

6. Nutritional Management of Gout 痛风的临床营养管理

7. References 参考文献

1. What is Gout? 痛风是什么?

The Rheumatology of Australia defined this condition as a painful condition where the formation of uric acid crystals is found in and around joints. The build-up of crystals results in inflammation, oedema and pain.

澳洲类风湿疾病学会把“痛风”定义为一种因在关节内以及周围的尿酸晶体形成所导致的极其疼痛的状况。这些所形成的晶体还会导致炎症、水肿和剧烈疼痛。

2. What is the demographics of Gout patients? 哪些人更容易得痛风呢?

a) Gender: Men

b) Age: 40-50 years old

c) Pharmaceutically: diuretics (elderly patients)

d) Hypertension

e) [Rare but possible] Pre-menopausal women

a) 性别:男性

b) 年龄:40-50岁

c) 药物性:利尿剂

d) 高血压

e) [罕见情况] 绝经前的女性

Women are generally safer because our oestrogen protects us by getting rid of uric acid faster.

How can diuretics cause gout? The mechanism is when the fluid removed by the diuretics, the remaining fluid in the body gets more concentrated. It increases the risks of developing uric acid crystals and thus gout. Some antihypertensive medications are diuretics, so discuss with your doctor if you have high blood pressure and gout. Your doctor would recommend the best pharmaceutical option for your conditions.

The listed are the conditions where people are more likely to get gout, however, an individual can still be at risk of developing Gout by practising poor dietary and lifestyle habits.

女性会比男性有较低的风险患痛风,因为雌激素有助尿酸更快地被排除。

利尿剂为什么会导致痛风风险变高呢?机理是由于利尿剂所排出的水分,会导致体内剩余的水分变少,血液变得浓稠,晶体更容易形成。比如针对高血压的一些药物就是模仿利尿剂的原理,因此如果你有痛风又有高血压,一定要和医生讨论商量最佳的药物决定。

以上列出的都是会增加痛风患病风险的因素,不良饮食和生活习惯也会增加患病风险。

3. How do we know if we have Gout attacks? 如何分辨痛风症状?

Gout always attacks overnight and happens quickly. Visually, joints turn red, swollen and excruciatingly painful. The big toes are often the victim, and also fingers, wrists, knees and ankles.

痛风通常在半夜会发作并且很急性的发作。你会发现发病的关节处会变得红肿以及剧烈的疼痛。最常见是在大脚趾上,此外还有手指、手腕、膝盖和脚踝。

Without appropriate management for Gout:

– The attacks could persist for one week, without immediate medical attention;

– Gout can progress into a chronic condition with regular flare-ups of gout attacks and inflammed joints, affecting daily living activities, some long-term consequences may include the formation and deposits of crystals in other organs.

如果对痛风不理不睬,不积极治疗预防的话:

– 每次发病可以持续一个礼拜左右;

– 还可以恶化成时常剧烈疼痛以及红肿关节的慢性症状,甚至影响日常生活;长期还会导致尿酸晶体在小关节以外的其他内脏形成,例如肾结石。

With appropriate management for Gout:

– Gout attacks may not happen for years;

– No undesirable complications to joints and influencing daily events, like cutting food, using cutleries, driving, etc.

如果积极管理和预防痛风:

– 痛风可能几年都不会复发;

– 没有任何痛风的症状(例如使用餐具、驾驶),享受正常人一般的生活。

4. Why are we getting Gout attacks? 痛风发病的导致原因。

a) Alcohol consumption

b) Dehydration

c) Low water intake

d) Excessive weight

e) Excessive food intake

f) ‘Crashing’ diet / fasting

g) Certain food items [e.g. meat, seafood and beer]

a) 酒精摄取

b) 人体脱水

c) 饮水过少

d) 超重

e) 食物摄入过量

f) 过度节食

g) 某些食物(例如 肉类、海鲜、啤酒)

5. How do doctors treat Gout? 西医医生如何治痛风呢?

Generally, gout comes as a co-morbidity with other serious conditions like hypertension, diabetes mellitus, ischaemic heart disease, kidney disease and obesity. These conditions should be screened and managed as a priority because the treatments (e.g. use of medications) for these conditions may interfere with the management of gout.

通常痛风是伴随着其他严重的疾病,比如高血压、糖尿病、心脏疾病、肾病和肥胖。后者所列的疾病应当优先被筛查和管理,因为它们的疾病管理(例如所需的药物)有可能会影响痛风的治疗,所以必须同步管理。

Your doctor and pharmacist may prescribe you some medications to relieve the pain and inflammation, these may include:

1. Non-steroidal anti-inflammatory drugs (NSAIDs)

2. Colchicine

3. Corticosteroid injections or tablets

医生和药剂师会相对应开药来减轻疼痛和炎症,这些药属于:

1. 非甾体抗炎药(NSAIDs)

2. 秋水仙碱

3. 皮质类固醇

The NSAIDs and Colchicine are considered as the first line treatment for gout, as guided by the Royal Australian College of General Practitioners (RACGP). The Corticosteroid is only for those who cannot tolerate any of the first line treatment agents.

澳洲皇家医师协会(RACGP)建议非甾体抗炎药和秋水仙碱是针对痛风的第一线治疗方案。除非对非甾体抗炎药和秋水仙碱产生不适症,才会使用皮质类固醇。

You should take the prescribed medicines as indicated by your doctor no matter if you are experiencing an attack or not. Meanwhile, you should protect your affected joints. For instance, if your big toe is affected, walk less or create a bed cradle to keep the sheets off your feet while sleeping.

不论痛风是否发作,你都应该遵医嘱定时服药。同时要照顾好受伤的关节。比如说,如果大脚趾发病,那就尽量少走路;睡觉的时候,尽量把受伤的脚趾露在被子外面或者避免被有重量的物品压着。

The uric acid level should be checked 6-monthly and aim for a level close to or below 6 mg/dL.

每6个月都要复查一次尿酸值,尽量控制在6毫克/分升。

6. How do dietitians manage Gout? 临床营养师如何辅助管理和预防痛风呢?

Purine is found in animal and some plant foods and these purine-containing foods can make our bodies produce more uric acid. If your body struggles to get rid of the uric acid, you should consume less purine-containing foods to help minimise the complications of gout and prevent flare-ups of gout symptoms.

嘌呤存在于动物以及某些植物性食物中,嘌呤会让我们的身体产生更多的尿酸。如果你的身体已经难以及时排出足够多的尿酸了,那就要减少嘌呤的摄取来减少发病的可能性。

The following recommendations apply to all healthy individuals who are keen to reduce the risk of getting gout or gout patients who want to prevent future gout attacks.

  • Achieve and maintain your weight within a healthy weight range;
  • Maintain your blood pressure within the healthy range;
  • Keep a good habit to maintain your hydration status on a daily basis, and try to consume mainly plain water;
  • Decrease and abstain from alcohol consumption;
  • Reduce your consumption of salt and salt-containing foods;
  • Limit your intake of high-sugar and high-calorie foods and drinks;
  • Limit your intake of high-purine foods.

以下建议不仅仅适用于想要预防痛风发作的痛风病人,同时也适用于想要降低患痛风的健康人群喔:

  • 达到并维持健康体重;
  • 维持一个正常的血压值;
  • 做到每天饮水充足,以白开水/矿泉水为主;
  • 减少或避免酒精摄取;
  • 减少食用盐和高盐食品;
  • 限制高糖高热量的食物和饮品;
  • 限制高嘌呤的食物。

In terms of food, you do not have to avoid anything completely with asymptomatic gout. What you need to do is to follow a healthy diet and limit your intake of certain high-purine foods only. These may include:

  • Anchovies
  • Sardines
  • Offal foods (e.g. liver, kidney)
  • Sweetbreads
  • Gravy
  • Stock cubes
  • Meat and yeast extracts (e.g. Vegemite)
  • Beer and other alcohol

如果你没有任何发病的症状,恭喜你病情控制的很好!这样的话,你没有这个必要,一定要在饮食中完全避免什么食物,保持“少吃”的原则,而不是“完全不吃”。只要你控制的好,你还是有机会去享受你喜欢的食物的。保持健康的饮食准则,注意一点“少吃”以下几样食物:

  • 小银鱼
  • 沙丁鱼
  • 动物内脏(例如肝脏、肾)
  • 小牛/小羔羊胰腺
  • 肉汁
  • 浓缩固体汤料
  • 肉膏/酵母膏
  • 啤酒以及其他酒精饮品

*Practical tip: when cooking meat, get rid of the foam on top of the broth; cook your vegetables before meat if using the same pot and not changing water to avoid getting vegetables to absorb purine-containing water content or get coated by the purine-containing foam from the meat.

*举个例子:烹煮肉类的时候,记得要去除肉/肉汤上的暗灰色泡沫;如果用同一锅的水(不换水)烹煮,比如火锅,先煮蔬菜再煮肉,可以避免肉里的嘌呤包裹着蔬菜或被蔬菜吸收而被食用。

If you are currently suffering from a gout attack, please do not hesitate to see your doctor for immediate medical attention to relieve the pain. Your diet is not the first-line treatment option in any gout attacks.

最重要的是,如果你现在正被痛风发病所困扰,请尽快就医或遵医嘱服药,以减少疼痛和炎症。记得,当痛风发病的时候,你的饮食永远都不是第一线治疗的方案选项。饮食只能对痛风起到预防和辅助管理的作用。

7. References 参考文献

1. ‘Arthritis Information Sheet – Gout’ available from:

http://rheumatology.org.au/downloads/Gout_000.pdf

2. ‘Medical Education – The management of gout’ available from: https://www.racgp.org.au/afp/2016/may/the-management-of-gout-much-has-changed/

3. ‘Gout & Uric Acid Education Society’ available from: http://gouteducation.org/about-us/press-room/press-materials/

Thanks to Pinterest and cited sites for the photographs.


Copyright reserved with proper citations of all work where appropriate.

保留所有版权, 任何内容的引用均受尊重和有效引用方式。

 


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