When it comes to drugs for gout, fat people are more familiar.

In order to treat my gout, I spent almost all of my spare time studying gout knowledge.

In the field they are familiar with, people are often more confident, and now Liang Fatzi's confidence is getting stronger and stronger, he is like a river, and the feeling of speaking on the stage is so cool that he can't stop it at all.

"The treatment of gout is divided into acute phase and remission phase, the so-called acute phase is when the pain attacks, the treatment goal at this time is analgesia and anti-inflammatory, analgesia is analgesic, anti-inflammatory is to eliminate inflammatory reaction, this inflammatory reaction is not purulent inflammation that people are accustomed to thinking, but aseptic inflammation, so there is no need for antibiotic intervention, don't think that anti-inflammatory is the use of antibiotics, completely different things."

The lecture in the fat man's head was originally intended for ordinary people, and he suddenly found that the audience was all studying medicine, and there was no need to explain the concept of anti-inflammatory at all.

"There is a drug that can be analgesic and anti-inflammatory, that is, non-steroidal anti-inflammatory drugs, which represent etoricoxib, celecoxib, diclofenac, ibuprofen, etc., among which etoricoxib is recommended by some guidelines. Remember that the acute attack is not to lower uric acid, but to relieve pain and anti-inflammatory, if the wrong uric acid lowering is carried out, it will aggravate the pain, the timing of uric acid lowering is two weeks after acute pain control, of course, if you are on uric acid-lowering therapy, you can continue to take uric acid-lowering drugs, no need to stop the drug. ”

"Another acute phase medication--- colchicine! This drug belongs to cellular mitoxin, toxicity, once the overdose lacks rescue measures, special attention must be paid to --- drug can not be overdosed, must use a low dose of usage: the first dose of 1mg, followed by 0.5mg times, 2 days, it is best to start the drug within 12 hours of an acute attack of gout, more than 36 hours The efficacy is significantly reduced, once the gout symptoms are controlled, stop the drug! ”

"Therefore, the first-line drugs in the acute phase are two --- non-steroidal anti-inflammatory drugs and colchicine, which can be used in patients with ineffective drugs or renal dysfunction, but try to avoid them."

Fat Man's knowledge is by no means a mouthful, but a comprehensive textbook, the latest guides, and recent relevant summaries of top international journals, each sentence of which has been carefully considered and repeatedly verified.

"During the remission period of gout, the goal of treatment is to lower uric acid! The well-known drugs are allopurinol, febuxostat, probenecid, benzbromarone, allopurinol and febuxostat are drugs that inhibit the synthesis of uric acid, while benzenecid and benzbromarone are drugs that promote uric acid excretion, and the links of action are different. First of all, it is explained that the current latest concept tends to use drugs that inhibit the synthesis of uric acid, that is, allopurinol and febuxostat. ”

"Allopurinol is inexpensive and the effect is very good, but we should pay attention to its hypersensitivity reaction, once the hypersensitivity reaction occurs, the lethality rate is 30%, and it has now been determined that the HLA-B*5801 gene positive is closely related to the occurrence of allopurinol's hypersensitivity reaction, the positive rate of HLA-B*5801 in the Asian population is higher, and the Han nationality reaches 10%-15%, so before using allopurinol, HLA-B*5801 gene testing must be carried out, if it is positive, resolutely do not use this drug; If it is negative, it can be used normally. ”

"Allopurinol-induced hypersensitivity reactions are dose-dependent, so start with a small dose, generally 50 mg a day, and increase to 200-300 mgd after 2-3 weeks, and the highest dose cannot exceed 600 mgd, taken in three divided doses; Rashes often appear before hypersensitivity reactions, so once a rash occurs after taking medicine, stop taking the medicine immediately and seek medical attention, there is no room for negotiation! ”

HLA-B*5801！ Remembering this gene, many young doctors have almost forgotten about the knowledge of internal medicine, and the lack of knowledge in this area is very dangerous for doctors to lack certain knowledge.

Doctors are always walking on thin ice, and only by constantly accumulating knowledge can they be able to navigate between risks.

"Febuxostat has a potential cardiovascular risk, that is, it increases the occurrence of myocardial infarction and stroke, and if people with cardiovascular diseases, such as hypertension, coronary heart disease, etc., febuxostat should be used with caution."

"Probenecid and benzbromarone are drugs that promote uric acid excretion, so if it is high uric acid of the excretion disorder type, they are selected only if the first two drugs are ineffective. These two drugs, if there are kidney stones, kidney dysfunction, do not use, the two drugs will affect the kidneys, probenecid has a greater effect on the kidneys than benzbromarone, and benzbromarone is the largest of the four drugs for liver damage, in 2003, benzbromarone was withdrawn from the European market due to liver damage, but in 2004 it was re-registered in some countries. ”

Any drug is a treatment with risks, drugs are a double-edged sword, you have to be able to use the advantages and avoid the risks. ”

"According to the principle of promoting strengths and avoiding weaknesses, the above four drugs, in fact, if HLA-B*5801 is negative, allopurinol is preferred; If HLA-B*5801 is positive and there is no cardiovascular disease, febuxostat is chosen; If HLA-B*5801 is positive, and there is cardiovascular disease, and there is no problem with kidney function, probenecid and benzbromarone can be selected, and liver function must be monitored when using benzbromarone. ”

The introduction of these four drugs, although the fat man said it simply, but concise, to be detailed, the instructions are densely packed with hundreds of words.

There were people in the audience who were afraid: "You said this, I sweat on my back, my dad has been taking allopurinol, and he has never tested positive for HLA-B*5801." ”

A graduate student is more familiar with benzbromarone: "benzbromarone liver injury is its hard injury, it is best to check liver function regularly when taking it, around 2003, there was a case of serious liver damage related to drugs reported in Europe, but that is benzbromarone in the European population under the condition of high drug dose 100mg-200mg, the statistical incidence is only 117000. At our current clinical prescription dose is 50mg, and very few patients can be prescribed up to 100mg, at this dose, there are very few cases of liver damage of benzbromarone, but in view of its antecedents, it is still cautious. ”

"Febuxostat is not available in Asians, and there is no data to suggest that cardiovascular events are higher, so the safety is good, but people with cardiovascular disease try not to use it." Another graduate supplement.

"Dr. Liang, listening to you say this, these fragments of knowledge have been connected in principle, and I now have a clear understanding in my mind, the next time I manage a patient, I will encounter a patient with gout, and the choice of medicine will be much easier." Someone sincerely appreciates the fat man.

It seems that the fat man has really put a lot of thought into these commonly used drugs for the treatment of gout, especially several drugs for lowering uric acid, where the advantages are, where the disadvantages are, where the risks are, and how to use them.

"Saying so much, the key is not to say, under what circumstances do you need to lower uric acid, and what level is it appropriate to reduce uric acid?" There was an intern who listened to it for so long and still hadn't figured it out.

The fat man thinks that everyone knows more about these basic knowledge: "These textbooks and guidelines are available, I just skipped it, you go through the latest treatment guidelines: if the patient has frequent attacks of tophi, chronic gouty arthritis or gouty arthritis, the goal of uric acid-lowering treatment is 300 μmolL of blood uric acid, until the tophi is completely dissolved and the symptoms of frequent arthritis attacks improve, the treatment target can be changed to 360 μmolL of blood uric acid, and long-term maintenance. ”

"The lower the blood uric acid, the better?" An intern dared to propose.

The fat man immediately criticized: "Which department is the intern?" I didn't have a good grasp of medical knowledge! Uric acid in the normal range of the human body has its important physiological functions, low blood uric acid may increase the risk of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease, so it is not as low as possible, and the blood uric acid is not less than 180 μmolL during uric acid-lowering therapy. ”

The intern immediately blushed, the textbook was not thoroughly understood, and he had to read it carefully when he went back.

"Patients who have developed gout, that is, uric acid is higher than normal, urate-lowering therapy is recommended; If you do not have gout symptoms and have simple hyperuricemia, you can first try to change your lifestyle--- eat a balanced diet, exercise, quit drinking, drink more water, etc. Supplement the basis, there will be no brother who does not know the diagnostic criteria for hyperuricemia, right? Fasting serum uric acid levels --- higher than 420 micromolL in men and 360 μmolL in women. ”

"How's it going, do you still have any questions?" The fat man is cool enough, and he should also rest and rest.

The fat man finally understood why when he was studying for a master's degree and doctorate in the past, once the tutor was doing rounds, once he grasped a certain issue and started to lecture, he always forgot the time, and he was full of enthusiasm.

It turns out that the feeling of lecturing is so sour!

"Lecturer Liangda, if you change careers and go to a health care product company as a lecturer, with today's lecture level, it is not a problem to earn one million a year." Zhang Lin said seriously.

Liang Fatzi waved his hand: "Talking about serious things, within the framework of evidence-based medicine, I can still fight; Once I get out of this framework and rise to free play, I can't say a word. ”

"Do you still have questions? If you have any questions, just mention it, you must master this knowledge now, marry a wife in the future, your father-in-law will have a gout attack, and the pain will be solved within a few hours, and your father-in-law's favorability will be doubled! Zhang Lin shouted, ready to end the lecture.

"Dr. Yang! What is there to summarize? Zhang Lin turned to Yang Ping.

The fat man gave a lecture in simple terms, which was very exciting, Yang Ping felt that there was nothing to add, he stood up and reminded everyone: "When everyone popularizes this knowledge to relatives and friends, we must tell them that all medical science knowledge is for better seeing doctors, and cannot replace seeing doctors, because general non-medical professionals, lack of basic medical knowledge, if they make their own decisions, it is easy to make mistakes, and they must maintain awe of their unknown fields, especially when it comes to health!" ”

"That's right! Last but not least, see a doctor when you are sick! This knowledge is to help you make better decisions, not to replace your trip to the hospital! Liang Fatzi felt that Yang Ping was reasonable.

The fat man has seen this kind of relative, and after reading a few medical and health care books, he feels that he is better than a doctor.

The growth of a doctor is far from being as simple as a few books, five years of undergraduate, three years of master's degree, three or four years of doctorate, even if you have a bachelor's and master's degree and a doctorate, you have to study for eight years, and after graduation, you have to accumulate many years of clinical experience with senior doctors, three years of residency, five years of attending exam, if you go to the associate high school or above, it is basically more than ten years of work experience, and the monographs and papers read during the period are accumulated, and you need a special study room to decorate, so as to be qualified to treat people.

"There is no end to learning, we are facing human life and health, the more knowledge we have, the better, the deeper the better, the more the merrier! We must also have a sense of reverence for knowledge, and we must not be a little bit of water, but must understand it thoroughly, so that we can be calm and confident in the face of complex risks. Yang Ping encouraged everyone.

"It's okay, just dismiss the meeting, Dr. Liang, you are ready, I recommend you to the medical department to go to the health lecture hall of the hospital." Finally, Yang Ping said.

That's the lecture hall, and it's just an internal warm-up and an exercise in eloquence.

The meeting was adjourned, and everyone retreated one after another.

"There are a lot of old ladies in the health lecture hall of the hospital, don't you want to try your luck and see if you can find your future mother-in-law?" Zhang Lin thought for a moment.

The fat man disdained: "Dirty! With my current conditions, do you know how many head nurses want to introduce me to a girlfriend? ”

"No, no, no, let me think about it, but I heard that the mother of the flight attendant of China Southern Airlines, which department did you live in last time and let you take care of it? I heard that her mother is a big fan of our hospital health lecture? Zhang Lin touched his chin.

The fat man's face flushed, and he stammered so much that he couldn't speak.