[FETV=박제성 기자] Sudden torrential rains in summer continue to be hot and humid. In unpleasant weather like these days, cold beer and carbonated beverages come to mind, but you should be careful as you may be exposed to ‘gout’. Gout is so named because it is said to cause pain even when the wind brushes against it.
The number of domestic patients complaining of this is steadily increasing. According to the Health Insurance Review and Assessment Service, the number of gout patients increased by 24.6% in five years from 395,154 in 2017 to 492,373 in 2021. Gout is known to be a disease that occurs frequently in men after the age of 40, but in recent years, the incidence rate of the 2030 generation is rapidly increasing due to frequent drinking and westernized eating habits, so it is necessary to pay close attention regardless of age.
◆ The cause of gout is ‘hyperuricemia’… Alcohol and high-calorie food intake increase the level of uric acid in the blood = Gout is a disease in which excess uric acid that cannot be excreted accumulates in the blood to form urate crystals, which are deposited in tissues, causing pain. Uric acid refers to the product remaining after metabolizing a substance called purine contained in food.
It is usually excreted in urine or feces, but if it is not excreted, it accumulates in joint cartilage, tendons, kidneys, and blood vessels. This causes ‘hyperuricemia’, in which the level of uric acid in the blood becomes abnormally high, and pain appears in the process of attacking the body by mistaken it for a bacteria or virus.
There are various factors that interfere with uric acid excretion, such as kidney disease, taking aspirin, and diuretics. This is because alcohol or foods high in fat and protein contain a large amount of purines, high fat foods reduce uric acid excretion, and alcoholic beverages increase uric acid production and decrease excretion at the same time.
Beer contains the most purines among alcoholic beverages, so it is good to be careful about intake. In addition, consumption of carbonated drinks and fruit juices high in fructose, lack of exercise, and decreased kidney function due to excessive stress, underlying diseases, and genetic factors are also risk factors for gout.
The symptoms of gout are divided into 4 stages: asymptomatic hyperuricemia, acute gouty arthritis, intermittent gout, and chronic nodular gout. Asymptomatic hyperuricemia, an early symptom of gout, only increases uric acid levels and does not cause symptoms, so it may be difficult to recognize the early symptoms of gout. The main symptoms of gout are sudden inflammation, heat, swelling, and severe pain in the big toe, instep, ankle, and knee.
▲ If the joint, such as the big toe, is red or hot even though there is no injury ▲ If the joint is hard to bear pain or walking is difficult ▲ If there are nodules in the joints, ears, elbows, fingers, or tendons, early symptoms may be suspected have.
When gout symptoms appear, if left untreated without proper treatment, gout nodules can form around the joints. Continuous accumulation of gout nodules can cause chronic joint pain, damage and even deformation of joint tissues. As the number of times of pain increases with each passing year, it can cause chronic kidney disease such as joint damage and kidney stones.
Gout treatment is slightly different depending on the stage of the disease. In the acute period when joint pain is severe, drugs that reduce inflammation are used, and in the normal period when the joint pain is stable, a drug called ‘Allopurinol’ that helps control hyperuricemia and acute pain by suppressing uric acid levels is used to normalize blood uric acid concentration.
Allopurinol is recommended as the first-line treatment for gout, but in some patients, severe skin adverse reactions may occur after use. In general, adverse reactions to drugs are affected by genetic factors, and the occurrence of SCAR by allopurinol is known to be related to the HLA-B*5801 genotype. In particular, the proportion of HLA-B*5801 genotype in Koreans is about 12%, which is higher than that of Westerners (1-6%).
Therefore, ‘HLA-B*5801 genetic test’, which can determine the HLA-B*5801 genotype and predict the risk associated with allopurinol drugs, is recommended for gout patients who want to take allopurinol drugs. The HLA-B*5801 genetic test is performed by collecting a small amount of blood, and the results are usually available within 2 weeks.
There are two methods of testing: PCR (nucleic acid amplification) and sequencing. Among them, as of August 1, last year, for all patients who needed to administer the allopurinol drug, the benefit was recognized only once before the first administration, reducing the burden on patients.
Kim Soo-kyung, a specialist in diagnostic laboratory medicine at the GC Medical Foundation, said, “Since last year, the foundation has been providing the ‘HLA-B*5801 genetic test’ to medical institutions nationwide to find out in advance whether the HLA-B*5801 genotype and the risk of side effects in gout patients who require allopurinol prescription. “In the case of HLA-B*5801 positive patients, the risk of severe skin adverse reactions is expected to be higher than that of negative patients. said