Do I need to fast to test uric acid?

Uric acid is generally used to test kidney function. Uric acid testing usually requires fasting so that it can be clearly detected. Uric acid is mostly used for screening. If you unfortunately suffer from gout, you must pay attention to follow-up examinations, and it is best to eat less high-purine foods. Remember not to eat animal offal, and you also need to quit smoking and drinking, and eat more fresh vegetables and fruits. This is not only good for the condition, but also has a relieving effect on the treatment of the disease.

There are no precursors to acute gouty arthritis. Mild trauma, overeating of high-purine foods or excessive drinking, surgery, fatigue, emotional stress, and medical emergencies (such as infection, vascular obstruction) can all trigger acute gout attacks. Acute single or multiple joint pain, which often occurs at night, is usually the first symptom. The pain progressively worsens and is severe. The physical signs are similar to those of acute infection, with swelling, local fever, redness, and obvious tenderness. The local skin is tense, hot, and shiny, and appears dark red or purple. The metatarsophalangeal joint of the big toe is most commonly affected (foot gout). The arch of the foot, ankle, knee, wrist, and elbow are also common sites of disease. Systemic manifestations include fever, palpitations, chills, malaise, and leukocytosis.

The first few attacks usually affect only one joint and generally last only a few days, but later they may invade multiple joints simultaneously or successively. If untreated, they may last for several weeks. Finally, local symptoms and signs subside and joint function recovers. The length of the symptom-free interval varies greatly and becomes shorter as the disease progresses. If not prevented, attacks may occur several times a year, leading to chronic joint symptoms and permanent destructive joint deformities. The joints of the hands and feet are often restricted in movement. In a few cases, the joints of the sacroiliac, sternoclavicular or cervical spine may also be affected. Urate deposits are common in the bursal wall and tendon sheath. Enlarged tophi may appear in the hands and feet and chalky urate crystal fragments may be discharged. Gout caused by cyclosporine often occurs in large central joints, such as the hip and sacroiliac joints, and can also be seen in the hands, and even damage the renal tubules.

1. Asymptomatic period

Serum urate concentration increases with age and there are gender differences. This stage is mainly manifested by a continuous or fluctuating increase in blood uric acid. The time from the increase in blood uric acid to the onset of symptoms can be as long as several years to decades. Only when arthritis occurs is it called gout.

2. Acute arthritis attack

It is the most common onset symptom of primary gout, which is prone to occur in the joints of the lower limbs, especially the big toe and the first metatarsophalangeal joint. It is a single joint inflammation at the beginning, and repeated attacks will increase the number of affected joints. The onset of gout indicates that the blood uric acid concentration has been oversaturated for a long time, resulting in a large amount of urate deposition in the tissues.

3. Intermission

Gout attacks can last for several days to several weeks and then resolve naturally, leaving no sequelae and completely recovering. Then there is a symptom-free period, called the interval between acute attacks, after which gout may recur. About 60% of patients relapse within one year, and the interval can last for more than 10 years.

4. Gout stones

In patients with untreated or poorly treated chronic arthritis, urate crystals are deposited in cartilage, tendons, synovial fluid and soft tissues. Tophi are a common manifestation of this stage, often occurring in the helix, extensor side of the forearm, metatarsos, fingers, elbows, etc. Urate deposition in the joints increases, and repeated inflammation enters the chronic stage and cannot completely disappear, causing joint bone erosion and defects and surrounding tissue fibrosis, making the joints stiff and deformed, and limiting movement. With repeated attacks of inflammation, the lesions become more and more severe, seriously affecting joint function. Early prevention and treatment of hyperuricemia may prevent the patient from having symptoms of this stage.