Gout is a disease that involves the build-up of uric acid in the body. About 95 percent of gout patients are men. Most men are over 50 when gout first appears. Women generally don’t develop gout until after menopause. But some people develop gout at a young age.
痛風(fēng)患者的身體里有過(guò)多的尿酸。大約95%的痛風(fēng)患者是男性。大多數(shù)男性第一次痛風(fēng)發(fā)作時(shí)已經(jīng)五十歲以上。女性一般在停經(jīng)之前不會(huì)發(fā)作痛風(fēng)。但是也有一些病人年輕的時(shí)候就患有痛風(fēng)。
This guide will help you understand
這個(gè)指南會(huì)幫助你理解
· how gout develops
· which parts of the body are affected by gout
· what can be done for the condition
· 痛風(fēng)是如何發(fā)生的？
· 身體的哪些部分會(huì)受痛風(fēng)的影響？
· 對(duì)于這個(gè)病癥可以做些什么？
What is gout?
什么是痛風(fēng)？
Gout was the first disease in which researchers recognized that crystals in the synovial fluid could be the cause of joint pain. Synovial fluid is the fluid that the body produces to lubricate the joints. In gout, excess uric acid causes needle-shaped crystals to form in the synovial fluid. Uric acid is a normal chemical in the blood that comes from the breakdown of other chemicals in the body tissues.
在滑膜液里形成的結(jié)晶可以導(dǎo)致關(guān)節(jié)疼痛，研究者們發(fā)現(xiàn)的第一種這樣的疾病就是痛風(fēng)。滑膜液是身體制造的液體，用來(lái)潤(rùn)滑關(guān)節(jié)。痛風(fēng)患者過(guò)多的尿酸會(huì)在滑膜液里形成針狀結(jié)晶。尿酸是血液中的一種正常化學(xué)物質(zhì)，由其他化學(xué)物質(zhì)在身體組織里分解而來(lái)。
Everyone has some uric acid in his blood. As your immune system tries to get rid of the crystals, inflammation develops. For the person with too much uric acid, this inflammation can cause painful arthritis.
所有人的血液里都有尿酸。當(dāng)你的免疫系統(tǒng)試圖清除結(jié)晶的時(shí)候，就會(huì)發(fā)生炎癥。如果一個(gè)人有過(guò)多的尿酸，這種炎癥就會(huì)導(dǎo)致疼痛性關(guān)節(jié)炎。
痛風(fēng)的第一次發(fā)作通常只在一個(gè)關(guān)節(jié)發(fā)生。一般的情況下，痛風(fēng)影響到的是跖趾關(guān)節(jié)。這是大腳趾根部的關(guān)節(jié)。事實(shí)上，90%的痛風(fēng)病人會(huì)產(chǎn)生跖趾關(guān)節(jié)的疼痛。其他常見(jiàn)的發(fā)病關(guān)節(jié)部位包括中足部、踝關(guān)節(jié)、足跟部和膝關(guān)節(jié)。痛風(fēng)影響到手指、腕關(guān)節(jié)和肘關(guān)節(jié)的情況較少。
Over time, patients with gout can develop tophi, or lumps that grow around crystal deposits in joints or near pressure points. Tophi most often occur in the fingers, wrists, ears, knees, elbows, forearms, and heels. Tophi can also grow in the kidneys, heart, and eyes.
隨著時(shí)間的推移，痛風(fēng)患者會(huì)長(zhǎng)出痛風(fēng)石，就是在關(guān)節(jié)或受壓部位附近尿酸結(jié)晶沉積處周圍長(zhǎng)出腫塊。痛風(fēng)石常常發(fā)生在手指、腕關(guān)節(jié)、耳朵、膝關(guān)節(jié)、肘關(guān)節(jié)、前臂和足跟部。痛風(fēng)石也可以在腎臟，心臟和眼睛里生長(zhǎng)。
Why does gout develop?
為什么會(huì)發(fā)生痛風(fēng)？
The underlying condition that causes gout is called hyperuricemia. It means that you have high levels of uric acid in your blood. This can happen for two reasons: (1) your body creates too much uric acid, or (2) your kidneys don’t excrete the uric acid effectively. Whether or not you will develop gout is related to how bad your hyperuricemia is over time.
導(dǎo)致痛風(fēng)發(fā)生的根本原因叫做高尿酸血癥。這意味著你的血液里尿酸含量過(guò)高。這有兩個(gè)原因。（1）你的身體產(chǎn)生了過(guò)多的尿酸；或者（2）你的身體不能有效地排出尿酸。你是否會(huì)發(fā)生痛風(fēng)與你逐漸形成的高尿酸血癥的嚴(yán)重程度有關(guān)。
For people who create too much uric acid, the cause is usually genetic. Some rare genetic and metabolic disorders can cause overproduction of uric acid, which can eventually lead to gout. The breakdown of purines in the body also releases uric acid. Purines are ingested through certain types of food such as sweetmeats (e.g., liver, kidney, brain) and seafood. The increased intake of fructose-sweetened soft drinks has also been linked with an increased risk of gout. Usually the excess uric acid is then passed out of the body through the urine.
產(chǎn)生過(guò)多尿酸的原因通常與基因有關(guān)。一些罕見(jiàn)的基因和代謝紊亂可以造成尿酸產(chǎn)生過(guò)多，最終可以導(dǎo)致痛風(fēng)的發(fā)生。身體內(nèi)嘌呤的分解也會(huì)釋放出尿酸。嘌呤是通過(guò)某些類型的食物例如動(dòng)物內(nèi)臟（例如肝、腎、腦）和海鮮等攝入的。過(guò)多飲用富含果糖的軟飲料也會(huì)增高痛風(fēng)的風(fēng)險(xiǎn)。通常身體通過(guò)尿液來(lái)排出多余的尿酸。
More than 90 percent of people with gout have kidneys that don’t effectively get rid of uric acid. Sometimes this is caused by certain kinds of drugs, such as diuretics, cyclosporine, and low-dose aspirin. Other medical conditions, such as obesity, hypertension, and diabetes, can also make some people more likely to develop gout.
超過(guò)90%的痛風(fēng)患者的腎臟不能有效地排出尿酸。有時(shí)候這是因?yàn)橐恍┧幬镌斐傻模热缋騽h(huán)孢素和小劑量的阿司匹林。其他情況，例如肥胖，高血壓和糖尿病，也可以導(dǎo)致一些患者更容易發(fā)生痛風(fēng)。
Many gout patients have a combination of overproduction and under-excretion of uric acid. Their bodies create too much uric acid and have problems getting rid of it. This combination of problems happens with drinking alcohol, especially beer. The more alcohol the patient drinks, the worse the problem is. Alcohol both raises uric acid levels in the body and impairs the kidneys’ ability to excrete the buildup.
很多痛風(fēng)患者既有尿酸的產(chǎn)生過(guò)多，也有排出障礙。他們的身體制造了過(guò)多的尿酸，但是在排出方面有困難。這些問(wèn)題發(fā)生于飲酒（特別是啤酒）的時(shí)候。患者攝取的酒精越多，問(wèn)題就越嚴(yán)重。酒精不但增高了體內(nèi)尿酸的水平，也損害了腎臟排除蓄積物的能力。
Attacks of gouty arthritis seem to be caused by sudden increases in the amount of urate (a solid form of uric acid) in your synovial fluid. This rapid change can be caused by injury to the joint, alcohol use, or use of certain drugs.
痛風(fēng)性關(guān)節(jié)炎的發(fā)作是由于滑膜液里的尿酸鹽（尿酸的固體形態(tài)）突然增加引起的。這種突然的變化可以因?yàn)殛P(guān)節(jié)的創(chuàng)傷、酒精攝入或者特定藥物的使用而導(dǎo)致。
An injury that can trigger gout can be very slight. Even gentle exercise can cause inflammation in the joint, although you may not notice it. Once the joint is at rest, the body absorbs some of the water in the synovial fluid. This leaves the synovial fluid more concentrated with urate, which may allow crystals to grow.
誘發(fā)痛風(fēng)的創(chuàng)傷可以非常輕微。即使是輕柔的鍛煉也能引起關(guān)節(jié)內(nèi)的炎癥，盡管你可能沒(méi)有注意到。當(dāng)關(guān)節(jié)休息時(shí)，身體會(huì)吸收滑膜液里的一些水分。這會(huì)讓滑膜液里的尿酸鹽濃度更高，從而可能發(fā)生結(jié)晶。
Heredity plays a role in gout. In some families, hyperuricemia tends to develop into gout, while in other families it doesn’t. But genes alone don’t account for gout. The rising number of people with gout since World War II suggests more than just a genetic or hereditary basis for this condition.
遺傳因素對(duì)痛風(fēng)具有一定的影響。在一些家庭中，高尿酸血癥傾向于發(fā)展成痛風(fēng)，而在其他家庭則不會(huì)。但基因不是痛風(fēng)唯一的原因。自二次世界大戰(zhàn)以來(lái)痛風(fēng)患者數(shù)目逐漸上升，表明了這種疾病的基礎(chǔ)不僅僅是基因或者遺傳。
Dietary changes may be the major difference over the last 60 years. Food scarcity during the 1940s was followed by an increased intake of carbohydrates and especially carbohydrates containing high-fructose corn syrup. The increase in obesity (another risk factor for gout) during the same time supports this idea.
在過(guò)去的60年里，飲食改變可能是主要的區(qū)別。在1940年代的糧食短缺之后出現(xiàn)了碳水化合物的攝入增加，特別是含有高果糖玉米糖漿的碳水化合物。在同一時(shí)期肥胖者（痛風(fēng)的另一個(gè)風(fēng)險(xiǎn)因素）的增多支持了這種說(shuō)法。
There are several other risk factors for gout. These conditions do not cause gout, but they are closely related to severe hyperuricemia. The risk factors include metabolic syndrome, kidney problems, high hemoglobin levels, high triglyceride levels, and hypertension (high blood pressure). About 14 percent of hypertension patients have gout. A combination of factors such as eating lots of organ meat, a sedentary lifestyle without exercise, and drinking lots of alcohol increases the risk for symptomatic gout.
痛風(fēng)還有一些其他的危險(xiǎn)因素。這些因素并不引起痛風(fēng)，但是他們與嚴(yán)重的高尿酸血癥密切相關(guān)。這些風(fēng)險(xiǎn)因素包括代謝綜合征、腎臟疾病、高血紅蛋白水平、高甘油三酯水平和高血壓。約有14%的高血壓患者合并有痛風(fēng)。吃很多內(nèi)臟的肉，久坐不動(dòng)缺乏鍛煉的生活方式和大量飲酒等因素組合起來(lái)會(huì)增加有癥狀痛風(fēng)的風(fēng)險(xiǎn)。
It is important to note that hyperuricemia alone doesn’t cause gout. Most people with high levels of uric acid in their blood never develop any symptoms of gout. At least five percent of Americans have at least one period of hyperuricemia as adults without showing any symptoms of gout. And most people can tolerate fairly high levels of uric acid in their bloodstream without damage to their kidneys.
要注意單純高尿酸血癥不會(huì)引起痛風(fēng)，這很重要。大多數(shù)血液中尿酸水平高的人從來(lái)不會(huì)出現(xiàn)任何痛風(fēng)癥狀。至少5%的美國(guó)人在成年后至少有一段時(shí)期會(huì)有高尿酸血癥，但沒(méi)有表現(xiàn)出任何的痛風(fēng)癥狀。大多數(shù)人能夠承受血液中較高水平的尿酸含量而腎臟不受損害。
What does gout feel like?
得了痛風(fēng)會(huì)有什么感覺(jué)？
Gout causes attacks of very painful joint inflammation. This pain is often described as burning pain. Early gout attacks usually affect only one joint. This joint is most commonly the MTP joint at the base of your big toe. The joint becomes swollen, warm, and red within eight to 12 hours. Most of the time the attacks happen at night. Patients say the pain is so bad the joint can’t even stand the slightest touch. Even the weight of a sheet causes excruciating pain. Walking and standing are almost impossible if the legs or feet are affected. Many patients have flu-like symptoms, including fever and chills. The pain may go away on its own in a few hours, or it may take a few weeks.
痛風(fēng)會(huì)造成非常疼痛的關(guān)節(jié)炎癥發(fā)作。這種疼痛通常被描述為燒灼樣疼痛。早期痛風(fēng)發(fā)作通常只影響到一個(gè)關(guān)節(jié)。這個(gè)關(guān)節(jié)最常見(jiàn)的是你大腳趾根部的跖趾關(guān)節(jié)。關(guān)節(jié)會(huì)在8到12小時(shí)內(nèi)變得腫脹、發(fā)熱和發(fā)紅。大多數(shù)情況下是在夜間發(fā)作的。病人會(huì)說(shuō)關(guān)節(jié)疼痛嚴(yán)重到甚至不能承受一點(diǎn)點(diǎn)輕微的觸碰，甚至一張紙的重量也會(huì)造成極度的痛苦。如果腿腳發(fā)病了，走或者站幾乎是不可能的。很多患者有類似感冒的癥狀，包括發(fā)熱和寒戰(zhàn)。疼痛可能在幾個(gè)小時(shí)內(nèi)自動(dòng)消失，或者延續(xù)幾個(gè)星期。
Gouty arthritis attacks come and go. There may be months between attacks. Over time the attacks happen more often, last longer, and involve more joints. Eventually the pain doesn’t ever completely go away. The joints stay swollen and tender even between flare-ups, and the flare-ups start to happen every few weeks. Eventually, some patients develop tophi on joints or pressure points and kidney stones.
痛風(fēng)性關(guān)節(jié)炎發(fā)作來(lái)去無(wú)蹤。發(fā)作之間可能會(huì)相隔數(shù)月。隨著時(shí)間的推移發(fā)作更為頻繁，持續(xù)時(shí)間更長(zhǎng)，并涉及更多的關(guān)節(jié)。到最后疼痛就不會(huì)完全消失了，在發(fā)作間隔期里關(guān)節(jié)也保持著腫脹并有壓痛，而且每隔幾周都會(huì)發(fā)作癥狀。最終，部分患者會(huì)出現(xiàn)關(guān)節(jié)和壓力點(diǎn)處的痛風(fēng)石或腎結(jié)石。
How do doctors identify the condition?
醫(yī)生如何識(shí)別這種病癥？
Diagnosis is important because crystals within the joint can lead to joint damage. This can happen without you knowing it. Patients with arthritic episodes that come and go may not seek medical help. Some patients are medically evaluated but complete testing is not done. They are misdiagnosed with rheumatoid arthritis. Either of these situations will delay treatment and increase the risk of erosive damage to the joint.
診斷很重要，因?yàn)殛P(guān)節(jié)內(nèi)的結(jié)晶可以導(dǎo)致關(guān)節(jié)的破壞。這可以在你不知道的情況下就發(fā)生了。患者可能會(huì)因?yàn)殛P(guān)節(jié)癥狀會(huì)自行消失而不去看醫(yī)生。有些患者去就診了但沒(méi)有做全面的檢查。他們被誤診為類風(fēng)濕性關(guān)節(jié)炎。任何這些情況都會(huì)延誤治療，并且增加關(guān)節(jié)受侵蝕的風(fēng)險(xiǎn)。
The diagnosis begins with a history of your symptoms and a physical exam. Your doctor will need to look at synovial fluid from the affected joint to identify the needle-like crystals. This is the most important part of the diagnosis. To get a sample of the synovial fluid, the physician performs an arthrocentesis. A long, thin needle is inserted into the affected joint and a small amount of synovial fluid isaspirated or removed. The fluid is sent to a laboratory where it is viewed under a special polarized light microscope to determine if uric acid crystals are present.
診斷首先需要病史和查體。醫(yī)生需要檢查發(fā)病關(guān)節(jié)的滑膜液，來(lái)辨認(rèn)是否有針狀的結(jié)晶。這是診斷最重要的部分。為了取得滑膜液的樣本，醫(yī)生會(huì)施行關(guān)節(jié)穿刺術(shù)。用一枚長(zhǎng)而細(xì)的針頭，穿刺進(jìn)入發(fā)病的關(guān)節(jié)，抽吸出少量的滑膜液。液體被送到化驗(yàn)室，在特殊的偏振光顯微鏡下辨認(rèn)是否有尿酸結(jié)晶。
If there are uric acid crystals, then you have gout. But only 80 per cent of the tests are positive when the person really has gout, so this test is not completely accurate. In some cases (such as the midfoot), it isn’t easy to aspirate fluid. Without the use of fluoroscopy (a special X-ray imaging) or ultrasound to guide the needle, aspiration isn’t done. In these situations, the diagnosis is made without joint aspiration when the patient responds favorably to therapy.
如果存在尿酸鹽結(jié)晶，那么你患了痛風(fēng)。但是在確實(shí)患有痛風(fēng)的病人當(dāng)中，只有80%的檢驗(yàn)是陽(yáng)性的，所以這個(gè)檢驗(yàn)不是完全準(zhǔn)確的。在一些病例（例如在中足部），抽取液體并不容易。如果沒(méi)有透視（一種特殊的X線成像）或者超聲來(lái)引導(dǎo)注射針頭，那么抽吸不能成功。在這種沒(méi)有關(guān)節(jié)穿刺的情況下，可以根據(jù)病人對(duì)治療的良好反應(yīng)來(lái)作出診斷。
Ultrasonography may be helpful in the diagnosis because the crystals form into the shape of rosary beads inside the hyaline cartilage and this can be seen in the ultrasound pictures. Hyaline cartilage coats the ends of the bones to protect them. Ultrasonography can also show the double contour sign. This sign looks like a top covering or extra coating of the joint surface when crystals are deposited in the hyaline cartilage. Ultrasound studies do not replace fluid removal and examination under a microscope because ultrasound does not confirm infection.
超聲成像可能對(duì)診斷有幫助，因?yàn)榻Y(jié)晶體會(huì)在透明軟骨內(nèi)形成念珠樣的結(jié)構(gòu)，可以在超聲圖像中看到。透明軟骨是覆蓋了骨骼末端保護(hù)骨骼的結(jié)構(gòu)。超聲成像還能顯示雙邊征。當(dāng)結(jié)晶體在透明軟骨內(nèi)沉積的時(shí)候，這種征象看起來(lái)就像關(guān)節(jié)面上方的一個(gè)覆蓋物或者多出來(lái)的一個(gè)涂層。超聲不能代替抽取液體并在顯微鏡下檢查，因?yàn)槌暡荒艽_認(rèn)感染。
The diagnosis must rule out the presence of infection, which can be a hidden problem. Your doctor may also get a blood test to look at the levels of uric acid. However, uric acid levels rise and fall depending on many complex factors in your body. It is possible to have a normal uric acid level while you are having severe gout pain.
診斷必須排除感染的存在，這可能會(huì)是一個(gè)隱藏著的問(wèn)題。醫(yī)生可能還要抽血檢驗(yàn)?zāi)蛩崴健Ｈ欢蛩崴降纳凳艿缴眢w內(nèi)很多復(fù)雜的因素影響。所以在你發(fā)生嚴(yán)重的痛風(fēng)時(shí)，也有可能尿酸指標(biāo)卻是正常的。
If you have tophi, your doctor may want to biopsy one of the lumps.
如果你有痛風(fēng)石，醫(yī)生可能會(huì)對(duì)其中一個(gè)腫塊做病理檢查。
Your doctor will need to rule out other forms of arthritis. Gout can occur with other forms of arthritis, such as septic arthritis and rheumatoid arthritis. There are also other diseases that cause different kinds of crystals to form in the synovial fluid.
醫(yī)生會(huì)需要排除其他形式的關(guān)節(jié)炎。痛風(fēng)可以和其他形式的關(guān)節(jié)炎一起發(fā)生，例如化膿性關(guān)節(jié)炎和類風(fēng)濕性關(guān)節(jié)炎。有些其他的疾病也可以在滑膜液里形成不同種類的結(jié)晶體。
X-rays don’t show doctors much in the early stages of gout. X-rays can help monitor your disease, and they may be needed to rule out other problems.
痛風(fēng)早期拍X光片并不能給醫(yī)生提供很多信息。但X光片可以幫助監(jiān)測(cè)你的病情進(jìn)展，而且可以排除其他問(wèn)題。
（張弛 譯）
張弛，主治醫(yī)師，本科畢業(yè)于溫州醫(yī)科大學(xué)。曾在上海長(zhǎng)征醫(yī)院和德國(guó)哈雷大學(xué)醫(yī)院進(jìn)修學(xué)習(xí)。
技術(shù)專長(zhǎng)：四肢與脊柱骨折創(chuàng)傷的微創(chuàng)治療，關(guān)節(jié)病變與運(yùn)動(dòng)損傷的診治。
門診時(shí)間：周三全天
門診地點(diǎn)：慈溪市中醫(yī)醫(yī)院門診骨傷科
