- 由Grace Tom姊妹(已退休的註冊護士)撰寫  

 - Written by Grace Tom (Retired RN) 

 

 

 

 

文章使用中英對照  Article is in both Chinese & English

痛風症 – Gout

什麽是痛風症? 

痛風症是痛的風濕症。通常在大腳指，拇指，或在身體內其他細小的骨節，如手指或腳指內感覺到。

What is Gout?

Gout is a painful arthritis, commonly felt in a big toe, or thumb, or in any small joints in your body, like the fingers and toes.

 

起因

由於血內的尿酸積聚，稱為高尿酸血。當有痛風症發生時，通常尿酸型成水晶體聚在骨節內，使到它發炎，紅，腫及痛。當您的血內尿酸升高時，您的痛風症發生的機會或會提高。若痛風症不合時醫治，過後，這多次的突發症會更利害，更持久，會可更多次發生，會造成衰弱。有多數人認為痛風症時常有痛的打擊，但痛風症可以在隔有痛時可靜靜的進展，長期會損害骨節。

Causes

By a buildup of uric acid in the blood, known as hyperuricemia.  A gout attack happens when uric acid forms crystals in the joint, causing inflammation, swelling, and pain.  As your blood uric acid level rises, so does the chance for gout and gout attacks.  If gout is not treated, over time, these attacks, or flares, can become severe, last longer, happen more often and one will become more debilitated.

 

急性比慢性痛風症

急性痛風=有痛的痛風症

慢性痛風=慢性的長期發炎及有痛, 可影响多過一個關節。

Acute versus Chronic Gout

Acute Gout=painful gout attack

Chronic Gout=chronic inflammation and pain which can affect more than one joint.

 

誰會有高風險?

-在40-50歲的男仕，痛風症發生多過女人。有發炎的痛風症常發生在男人身上。

-女人通常在收經後，年長才有痛風症。

-很多人有很家族痛風症的歷史。

-有些人有很多種長期性疾病如高血壓，糖尿病，肥胖及腎病，也可能有痛風症。

Who is at risk for gout?

-Men, between 40-50 years old, are more likely to develop gout than women. Gout is the most common form of inflammatory arthritis in men.

-Women develop gout at an older age than men, typically after menopause.

-Many people have family history of gout.

-People with certain health conditions, including high blood pressure, diabetes, obesity, and/or kidney problems.

 

痛風症的症狀

-通常突然發生在晚上，有劇痛。

-受影响的骨節會感覺發熱，紅及腫，有時會輕摸也很痛。

-痛風常發生在大姆指，大腳指及其他關節。

-研究証實，痛風76%發生在大腳指，50%在腳踭及腳，32%在膝頭，

 25%在手指，11%在多過一個部位，及10%在手腕。

Gout- Signs and Symptoms

-Sudden attack of severe pain usually happens at night, without warning.

-Affected joint/joints become hot, red and swollen, at times tender to touch.

-It happens more often in the big toe or the thumb, or any other parts of the body.

-Researches showed that gout occurs 76% in big toe, 50% in ankle or foot, 32% in knees, 25% in fingers, 11% in more than one site and 10% in wrist.

 

痛風症怎樣進展?

第一次經驗有痛風症，常突然發生，沒有警訊，常在半夜有劇痛，維持一個或多過一星期。若血尿酸過高，在兩次痛風期間可損害關節。受害的關節及筋只能有限的活動。

How Gout progresses?

First experience of gout, it comes suddenly, without warning, severe pain in the middle of the night for a week or longer. One may have gout attacks for years, gout can become a chronic disease, which means it may get worse over time if not treated.  

Gout can progress silently, before the first painful attack. If blood uric level is high, joint damage may occur even between attacks.  Deposit of uric acid crystals-called Tophi – may form in the joints.  Long term consequences may include chronic pain that does not go away, damage to joints, and limited movement in the affected joints and tendons.

 

痛風症的四個階段

第一階段----高血尿酸，但沒有症狀，及沒有痛風症。若有痛風症，通常有多過二十年高血尿酸。在第一次痛風突發時,很重要保持血尿酸低過6mg/dl。

應請問您的醫生做第一次血尿酸檢驗，知道您的初步報告。

The 4 stages of gout

Stage 1 – High blood uric acid levels – no symptoms. During the first stage, one may have high uric acid level, but have no symptoms, and don’t actually have gout. Those who have gout may have more than 20 years of high blood level of uric acid level before first gout attack.  It is very important to maintain your blood uric acid level below 6mg/dl.  Ask your doctor for a simple blood test of uric acid to know your baseline level.

 

第二階段----有痛的襲擊痛風症，腳腫及痛，有時不能穿鞋或走幾步路。有時就算很輕簿的床單接觸到痛的關節都感覺到極度痛楚。

State 2 – Gout attack. A gout attack is very painful.  One may not be able to put on shoes or even walk a few steps.  Sometimes even a light bed sheet touching the painful joint can be agonizing.

 

怎樣會觸發痛風的襲擊呢?

體內的尿酸積聚會引起痛風。但有時在沒有特別的原因或可發生。有時酒精，有些藥物，有另外的病或在生活中有特發事情令壓力增加都可觸發有痛風症。

其他觸發痛風的原因包括:-

  • 骨節受傷
  • 手術
  • 吃太多一些食物
  • 暴食
  • 感染                                      

What triggers a gout attack?

A buildup of uric acid in the body causes gout.  It sometimes occurs for no apparent reasons. Sometimes alcohol, certain medicines, another illness or stressful events may trigger gout attacks.

Other known gout triggers include:-

  • Joint Injury
  • Surgery
  • Eating too much certain foods
  • Crash diets
  • Infection

 

第三階段----當突發痛風經正當處理後應與醫生商談您如何可以日後减低痛風突發的風險。很不幸有很多人有突發痛風在一年內又會復發。

Stage 3 – Between Gout Attacks

Once the immediate gout attack is over after proper management, it is time to talk to your doctor about ways to reduce the risk of having attacks in the future.

Unfortunately many who have suffered an acute gout attack will suffer another one within a year.

 

第四階段----長期痛風症-------當血尿酸度數長期高過6mg/dl及重覆有多年痛風突發症，痛風便成長期性。

Stage 4 – Chronic Gout

When blood uric acid level maintain higher than 6mg/dl and repeated gout attacks over years, gout will become chronic.
 

短期及長期性有效治療目標應該注重:-

  • 減低痛風突發
  • 防止未來的痛風症            
  • 降低高血尿酸到健康度數
  • 改變生活習慣，如不飲酒，不吃有些食物及做定期運動。

Short and long term goals of effective gout treatment should aim at:-

  • Reduce the pain of gout attacks
  • Prevent painful future attacks
  • Lower high uric acid to a healthy level
  • Make diet or lifestyle changes, such as refrain from alcohol, avoiding certain food and getting regular exercise.

                                                      

降低血尿酸度數

目標------是保持低過6mg/dl。若您不知道自己的血尿酸度數，可問您的醫生。

高過6mg/dl的血尿酸=高風險未來有痛風。

低過6mg/dl的血尿酸=低風險未來有痛風。

Lowering Uric Acid Level

Goal – is to maintain less than 6mg/dl.  Ask your doctor for a blood test of uric acid if you don’t know your uric acid level. 

Higher than 6mg/dl uric acid level=Higher risk of future attacks. 

Lower than 6mg/dl uric acid level=lower risk of future attacks.

 

治療

-藥物可治療痛風----藥物可在您的身體降低及排出積聚過多的尿酸，幫助减低痛風突發的風險。您需要長期保持正常的度數。

-高嘌呤的食物的作用----您的血尿酸是從您的身體排出。嘌呤是一種物質在您的身體內，也可以在很多食物內。三份二的尿酸是從您的身體內自然排出，而三份一是從飲食內攝取。高嘌呤的食物可觸發痛風突發，但不是痛風的起因。

-飲大量沒有酒精的飲料如清水會有幫助。

-健康生活的改變------保持健康體重、定期做運動、若您知道進食有些食

 物或飲料使到您有痛風突發，便不要選擇那種食物及飲料。

有些人仕就算跟進最嚴格低嘌呤的飲食, 通常都不能降低他們的尿酸度數多過1mg/dl.

Treatment

1.  Medication for the treatment of gout.  

Medication helps to reduce the production of excess uric acid in your body. To reduce your risk of gout flares, you need to keep your blood uric acid level down and keep it below 6mg/dl at all times.

2.  The role of high purine foods

The uric acid in your blood comes from purines, substances that are produced by your body and also found in many food. Most of your uric acid (2/3) is produced naturally by your body, while the rest (1/3) comes from your diet. High purine diet can trigger a gout attack but it is not the cause.

3.  Drinking plenty of non-alcoholic beverages especially water will help.

4.  Healthy life style changes.

     -Maintain a healthy weight

     -Getting regular exercises

     -If you notice after eating certain food and drinking certain beverages you have a gout flare, avoid those choices.

   -Even some people follow the strictest low-purine diet, generally don’t reduce their uric acid levels by not much   more than 1mg/dl.

 

健康的建議

-飲多量的流質, 如清水,可幫助排出體內的尿酸。

-加低脂奶類食物在您飲食內。吃多些低脂奶類食物與可降低痛風症的風險有關。

-若您已有高血尿酸, 避免及減少進食高嘌呤食物, 可降低引發有突發痛風的風險。

Healthy tips

a) Drink plenty of liquids, like water.  Fluids like water help to remove uric acid from your body.

b) Add low-fat dairy products to your diet.  Eating more of the low-fat dairy product is associated with a lower risk of gout.

c) Avoiding or limiting high purine food may help to reduce the risk to trigger a gout attack if you already have a high uric acid level.

 

高嘌呤食物

-肉類 - 如豬, 牛, 羊肉及內 臟 (肺, 肝, 腸, 腎及腦), 及肉汁。

-海鮮如鳳尾魚, 沙丁魚, 鯡魚，魚子, 青口貝, 鱈魚, 扇貝(帶子), 鱒魚, 及黑線鱈魚。

     -飲品-啤酒。

     -疏菜-菠菜, 蘆筍, 椰菜花, 及菌類。

    -其他-燕麥片, 豌豆, 干豆, 及扁豆。

High purine food

-Meat like beef, pork, lamb, organ meat (liver, kidney and brain ) and meat base gravies.

-Seafood like anchovies, sardines, herring, roe( fish eggs ), mussels, codfish, 

  scallops, trout and haddock.

-Beverages – beer.

-Vegetables-spinach, asparagus, cauliflower and mushrooms.

-Others-Oatmeal, peas, dried beans and lentils.

 

 低嘌呤食物

   -飲品-有氣的碳酸飲品, 咖啡, 奶, 及奶類飲品。

   -蔬菜-蕃茄, 及一些綠葉菜。

Low purine diet

   -Beverages-carbonated drinks, coffee, milk and milk products.

   -Vegetables-tomatoes and some green vegetables.

 

結論

記著與您的醫生溝通有關完整的治療計劃,來講及健康生活的改變, 包括進食及運動, 有痛風突發的治痛處理, 及長期的治療高尿酸所引致痛風症。時常跟進醫生的建議。 您會如任何人一樣健康。

Conclusion

Remember to keep communicating with your doctor about a comprehensive treatment plan that addresses healthy life style changes, including diet and exercise, pain management for gout attacks, and long term treatment of high uric acid level that causes gout.  Follow doctor’s advices at all times. You can be just as healthy as anyone.

 

 

預防勝於治療  wink

Prevention is better than cure  wink