Hyperuricemia

Introduction Hyperuricemia, also known as gout, is a group of diseases caused by dysbial metabolic disorders. Its clinical features are hyperuricemia and the resulting recurrent attacks of gouty acute arthritis and tophi deposits. Chronic arthritis and joint deformity, often involving the kidney caused by chronic interstitial nephritis and uric acid kidney stones. It can be divided into two major categories: primary and secondary. The cause of primary disease is mostly unclear due to a small number of enzyme defects. It is often accompanied by hyperlipidemia, obesity, diabetes, hypertension, arteriosclerosis and coronary heart disease. Etc., is a hereditary disease. Secondary people can be caused by a variety of causes such as kidney disease, blood diseases and drugs.

Cause

Primary hyperuricemia

1. Molecular defects of unknown cause.

2. Congenital sputum metabolism disorder:

(1) The activity of 5-phosphate nucleotide-1-pyrophosphate synthase (PRPPS) is increased, causing excessive synthesis of 5-phosphate nucleotide-1-pyrophosphate synthase and excessive production of uric acid. The genetic characteristic is X-linked. .

(2) Partial deficiency of hypoxanthine-guanine phospho-transferase (HPRT), causing an increase in the concentration of 5-phosphate nucleotide-1-pyrophosphate synthase, excessive production of uric acid, and a genetic characteristic of X linkage.

(3) The hypoxanthine-guanine phospho-transferase is completely deficient, and the production of uric acid is excessive due to increased sputum synthesis. It is found in Lesch-Nyhan syndrome, and its genetic characteristic is X-linked.

(4) Glucose-6-phosphatase deficiency: excessive production of uric acid caused by increased sputum synthesis and reduction of renal uric acid reduction, found in glycogen accumulation disease type I, genetic characteristics of autosomal recessive inheritance.

Secondary hyperuricemia

Hyperuricemia caused by a variety of acute and chronic diseases such as blood diseases or malignant tumors, chronic poisoning, drugs or sorghum diet, increased blood uric acid production or uric acid excretion disorders.

an examination

Related inspection

Uric acid amniotic acid

1. General laboratory test

(1) Uric acid was used to detect elevated blood uric acid levels, of which men were higher than 416 mol/L and women were higher than 357 mol/L. Urinary uric acid level is affected by many factors, and its clinical significance is not significant, but it has certain significance in identifying excessive uric acid production or reducing excretion: lower than 600mg/24 hours after 5 days of low-grade diet or 1000mg/24 hours or less of normal diet is uric acid cut back. At the same time should pay attention to serum creatinine, blood lipids and blood sugar.

(2) Renal function test urine PH value.

2. Special inspection

(1) In the acute onset of synovial fluid, the synovial fluid was examined and the sodium acicular sodium urate crystals in the white blood cells were visualized under optical and polarized light microscopy. Neutrophil increased, usually (5 ~ 75) × 109 / L, and even as high as 1000 × 109 / L.

(2) Synovial biopsy confirmed the presence of urate crystals.

3. X-ray inspection

(1) Early soft tissue swelling can be seen. After repeated episodes, the edge of the articular cartilage can be gradually destroyed, the articular surface is irregular, the joint space is narrow, the tophi is deposited, and the bone is worn and cut like a worm.

(2) Abdominal plain film to detect the presence or absence of urinary calculi.

4. Double kidney B ultrasound

Showing kidney stones, the simple uric acid stone X-ray is not developed.

Differential diagnosis

Due to the diversity of the disease, sometimes the symptoms are not typical, the following differential diagnosis must be considered:

(a) rheumatoid arthritis

More common in young and middle-aged women, it occurs in the joints of the fingers and the joints of the wrist, knee, ankle, ankle and spine. It is characterized by migratory symmetry and polyarthritis, which can cause joint stiffness and deformity. On the basis of chronic diseases. Repeated acute attacks, easy to be confused with gout, but blood uric acid is not high, most of the rheumatoid factor is positive, X-ray shows that the articular surface is rough, joint space is narrow, and even articular surface fusion, and gouty bone defects are significantly different.

(two) septic arthritis and traumatic arthritis

Gout is often confused with septic arthritis or traumatic arthritis, but the latter two blood urate is not high, the sac fluid is not urate crystal, traumatic arthritis often has a history of heavier injury, suppurative Arthritis bursal fluid contains a large number of white blood cells, which can be used to identify pathogenic bacteria.

(3) Cellulitis

When the gout is acute, the soft tissue around the joint is often red and swollen. If the symptoms of the joint itself are neglected, it is easily misdiagnosed as cellulitis. The latter is not high in blood urate, and the systemic symptoms such as chills and fever and white blood cells are more prominent. Joint pain is often not obvious, and attention is not difficult to diagnose.

(four) pseudo gout

It is caused by calcification of articular cartilage. It is mostly seen in the elderly. It is most commonly involved in the knee joint. The symptoms are like gout in acute attacks, but the blood urate is not high. The joint bursal fluid contains calcium pyrophosphate crystal or phosphorish white, X-ray film. Show cartilage calcium.

(5) Psoriasis (psoriasis) arthritis

Often asymmetry involves the distal intercondylar joint, with joint damage and disability, joint space widening, toe (finger) end bone absorption, ankle joints are often involved, clinical manifestations resemble rheumatoid arthritis, accompanied by increased blood uric acid 20%, it is not easy to distinguish from gout.

(6) Other arthritis

The acute phase must be differentiated from lupus erythematosus, recurrent arthritis and Reiter syndrome. In the chronic phase, it must be differentiated from the sequelae of hypertrophic joint disease, traumatic and septic arthritis. Blood uric acid test can help diagnose.

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