Nine major causes of gout attacks, be sure to avoid them

Gout here refers to acute gouty arthritis, where uric acid crystals are deposited in the joints, causing aseptic inflammation of the joints. It is more common in young and middle-aged men. The typical course of its attack is: you are fine when you go to bed, but wake up in the middle of the night with foot pain, which becomes increasingly severe, with red, swollen, hot, and painful joints. The pain is severe and even unbearable. In severe cases, systemic symptoms such as headache, fever, and elevated white blood cells may also occur, which are sometimes mistaken for infection.

First metatarsophalangeal joint

Most gout occurs in the first metatarsophalangeal joint, which is the joint of the big toe. In severe cases, gout gradually spreads upwards and often occurs in the dorsum of the foot, heel, ankle, knee, wrist and elbow joints.

The root cause of gout is hyperuricemia. The higher the blood uric acid level, the more frequent gout attacks and the earlier the age of onset. Studies have confirmed that the incidence of gout is 30.5% when the blood uric acid level is ≥600μmol/L, and the incidence of gout is only 0.6% when the blood uric acid level is <420μmol/L; the average age of gout attacks is 55 years old when the blood uric acid level is <420μmol/L, and the average age of gout attacks is 39 years old when the blood uric acid level is ≥520μmol/L.

However, hyperuricemia does not necessarily lead to gout. Under certain conditions, such as alcoholism, joint injury, local temperature drop, local pH drop, fatigue, etc., uric acid forms uric acid crystals in the joints, thus inducing gout attacks.

Due to the poor blood supply to the feet, low skin temperature, low tissue fluid pH, and the high pressure on the toe joints, uric acid easily forms crystals in the foot joints, so gouty arthritis often occurs in the foot joints.

Rapid fluctuations in blood uric acid levels can easily trigger gout attacks. When blood uric acid levels suddenly rise, uric acid forms needle-shaped urate crystals in the synovial fluid of the joints; when blood uric acid levels suddenly drop, the surface of tophi in the joints dissolves, releasing the needle-shaped urate crystals.

Common triggers of gout attacks include:

1. Drinking

Ethanol causes a sudden increase in blood uric acid and triggers gout attacks, whether it is liquor, beer, rice wine or foreign wine. There are three main mechanisms:

1. Ethanol metabolism increases blood lactate concentration, and lactate inhibits the excretion of uric acid by the kidneys, leading to an increase in blood uric acid concentration;

2. Ethanol accelerates purine metabolism and rapidly increases blood uric acid concentration;

3. Alcohol can provide purine raw materials, and drinking alcohol also leads to the intake of a large amount of high-purine foods.

2. Overeating

Consuming a large amount of high-purine foods at one time, such as animal offal such as liver and kidney, seafood, beef, mutton and other meats, can cause blood uric acid to rise rapidly.

In addition, the way food is processed also affects the intake of purine. The purine content in broth is much greater than the purine content in the meat itself. Therefore, soups such as mutton offal soup and shabu-shabu soup are high-risk foods. Gout patients should try to eat less soup.

3. Catch a cold

When the joints get cold, such as not keeping warm in winter and using air conditioning in summer, the local temperature of the joints decreases, and the uric acid in the blood easily precipitates in the joints to form urate crystals and induce gout. Getting cold after being drunk is the most common cause of gout attacks.

4. Joint Injury

Vigorous exercise, excessive walking, etc. lead to chronic damage to the lower limb joints, an increase in white blood cells in the joint fluid, and uric acid stimulates white blood cells to produce inflammatory cytokines, leading to aseptic inflammation and inducing gout.

5. Drugs and Diseases

1. Some drugs interfere with the excretion of uric acid from the kidneys and cause a sudden increase in blood uric acid. These drugs include diuretics, low-dose aspirin, immunosuppressant cyclosporine, anti-tuberculosis drug pyrazinamide, most chemotherapy drugs, etc.

2. Some drugs cause massive destruction of tissue cells, resulting in the release of large amounts of purine, which leads to a sudden increase in endogenous blood uric acid and induces gout. These drugs include most chemotherapy drugs.

3. Any disease that causes massive destruction of human cells, such as leukemia, myeloma, polycythemia, myolysis, metabolic acidosis, tumor radiotherapy, etc., will cause a sudden increase in blood uric acid.

6. Uric acid lowering drugs

Uric acid-lowering drugs such as Febuxostat and benzbromarone can rapidly reduce blood uric acid concentration, dissolve the surface of tophi, and release needle-shaped urate crystals, which can also induce gout attacks.

When gout attacks, those who have been using uric acid-lowering drugs regularly should continue to use them; those who have not been using uric acid-lowering drugs regularly should wait until the gout attack disappears for more than a week before starting drug treatment to lower uric acid.

7. Infection

Severe infection leads to increased white blood cell count, massive destruction of tissue cells, metabolic acidosis, etc., which causes excessive uric acid production and uric acid excretion disorders, and a rapid increase in blood uric acid.

8. Fatigue and irregular work and rest schedule

Fatigue and irregular work and rest schedules lead to a large amount of energy consumption in the body and the accumulation of metabolic waste, which interferes with the excretion of uric acid and induces gout attacks.

9. Acute renal failure

Severe dehydration, massive blood loss, kidney-damaging drugs or drug allergies can lead to acute tubular necrosis and acute tubulointerstitial nephritis, which prevents uric acid from being excreted and causes elevated blood uric acid levels, thus inducing gout.

Drinking too much, overeating, irregular work and rest schedules, fatigue and injury, coupled with cold weather, are all factors that trigger gout, so you must pay attention.

Appendix: Purine content table of 205 foods

Category 1: Foods that can be eaten safely

Purine content in milk, eggs and seafood:

Milk powder (skim high calcium) 15.72 Egg white 3.73 Egg yolk 2.64 Duck egg white 3.45 Duck egg yolk 3.26

Purine content of grains, roots and stems:

White rice 18.42 Corn 9.43 Brown rice 22.44 Glutinous rice 17.75 Millet 7.36 Vermicelli 7.87

Vermicelli 19.88 Macaroni 16.59 Cereal 24.410 Flour 17.111

Rice flour 11.112 Oats 25.013 Wheat 12.114 Sorghum 9.715 Job’s tears 25.016 Sweet potato 2.617

Taro 10.118 Potato 3.619 Water chestnut 2.620 Cassava flour 6.021 Starch 14.8

Purine content in vegetables:

Chinese cabbage 12.62 Purple cabbage 9.73 Spinach 13.34 Lettuce 15.05 Amaranth 23.56

Cabbage 9.77 Celery 10.38 Chives 19.59 Chives 16.810 Chili 14.211

Green onion 13.012 Ginger 5.313 Shepherd’s purse 12.414 Coriander 20.215 Shallot 8.716 Bitter melon 11.317

Cucumber 3.318 Winter melon 2.819 Loofah 11.420 Cucumber 8.221 Eggplant 14.322 Carrot 8.923

White radish 7.524 Green pepper 8.7 Shepherd’s purse 18.526 Onion 3.527 Tomato 4.328 Dried radish 11.029

Bean sprouts without roots 14.6 Pickled vegetables 8.6 Snow mustard 24.432 Mustard tuber 10.233 Cauliflower 24.934

Zucchini 7.2 Fresh black fungus 8.8 Water spinach 17.5

Purine content of fruits:

Lemon 3.42 Peach 1.43 Watermelon 1.14 Cantaloupe 4.05 Orange 3.06 Tangerine 3.07

Lotus pod 1.58 Grape 0.99 Guava 4.810 Cherry tomato 7.611 Pineapple 0.912

Pear 1.113 Mango 2.014 Apple 0.915 Starfruit 1.416 Banana 1.217 Plum 4.218

Loquat 1.319 Papaya 1.620 Black date 8.321 Red date 6.0

Purine content of condiments:

Rice vinegar 1.52, aged vinegar 12.03, tomato sauce 3.04, jam 1.95, high-flavor MSG 12.36, cooking oil 0-25

Other purine content:

Honey 3.22 Melon seeds 24.23 Raisins 5.44 Dried longan 8.65 Winter melon candy 7.1

Category 2: Foods that can be eaten appropriately

Purine content of beans:

Mung bean 75.12 Red bean 53.23 Black bean 137.44 Red kidney bean 126.05 Peanut 79.06

Tofu 55.57 Dried tofu 66.58 Soy milk 27.8

Purine content in meat:

Chicken thigh 140.32 Chicken breast 137.43 Chicken heart 125.04 Chicken gizzard 138.45 Duck meat 138.46

Rabbit meat 107.6

Purine content in seafood:

Eel 92.82 Eel 113.13 Swordfish 109.84 Black eel 140.65 Grass carp 140.36

Crucian carp 137.17 Red carp 140.38 Knife fish 134.99 Fish balls 63.210 Shark skin 73.211

Abalone 112.412 Squid 87.913 Shrimp 137.714 Crab 138.415 Clam 132.416

Shark fin 110.617 Sea bass 70.0

Purine content in vegetables:

Rapeseed 30.22 Chrysanthemum chrysanthemum 33.43 Basil 33.94 Peas 75.75 Green beans 29.76

Oyster mushroom 35.07 Abalone mushroom 26.78 Kelp 96.69 Dried bamboo shoots 53.610 Enoki mushroom 60.711

Tremella 98.912 Hericium erinaceus 54.013 Cauliflower 81.0

Other purine content:

Cashew 80.52 Chestnut 34.63 Lotus seed 40.94 Almond 31.75 Wolfberry 31.76 Black sesame 57.07

White sesame 89.5

Category 3: Foods to eat less or avoid

Purine content of beans:

Malt 500.02 Soybean sprouts 500.03 Mung bean sprouts ≥ 150.04 Bean sprouts 500.05 Natto 172.06 Sprouted beans ≥ 150.0

Purine content in viscera:

Purine content in seafood:

White pomfret 238.12 Silver carp 202.43 Milkfish 180.04 Mullet 183.25 Four-finned fish 217.56

Dried scallops 390.017 Tuna 226.218 Clams 316.019 Oysters 239.0

Purine content in vegetables:

Asparagus 500.02 Seaweed 500.03 Mushrooms ≥ 150.0