痛风的药物治疗进展

目的:系统性回顾分析并总结治疗痛风的新的药物进展。方法:对近年国内外文献进行系统性回顾,归纳总结了痛风不同阶段的新的药物的进展。结果:痛风急性发作期,非甾体消炎药、秋水仙碱、激素为一线用药,白介素-1受体拮抗剂对传统药物有禁忌的患者疗效好。间歇期和慢性期治疗中,非布司他疗效和耐受性好,尿酸酶可有效降低血尿酸水平。结论:痛风的药物治疗不同时期均有新的药物,如白介素-1受体拮抗剂、非布司他、尿激酶等均有良好疗效,为临床医生治疗痛风时提供了更多的选择。     

关节镜下清理术联合内科药物治疗急性痛风性膝关节炎1例报告

痛风是嘌呤代谢紊乱和（或）血尿酸升高引起的一组综合征,临床表现为关节的急慢性炎症、痛风石、泌尿系结石以及痛风性肾病。反复发作的急性痛风性关节炎为大多数痛风患者的临床表现。痛风的治疗方法是综合性的,保守治疗适用于大部分患者,对于急性痛风性关节炎患者,内科治疗效果不佳。关节镜下关节腔清理术联合内科降尿酸治疗急性痛风性关节炎效果明显。     

36例痛风患者营养治疗的临床观察

目的：教育广大痛风患者如何通过正确的平衡营养来预防和治疗痛风病。方法：对本科2006年1月～2010年7月收治的36例急性痛风性关节炎患者,进行药物治疗配合合理的营养治疗,观察治疗效果。结果：按急性痛风的饮食要求严格控制饮食,经1周治疗后,大部分患者关节红、肿、热、痛症状减轻,继续治疗1～2周,上述症状消失,化验尿酸均有不同程度下降。结论：痛风与饮食有着密不可分的关系,通过合理的营养治疗,控制嘌呤、蛋白质、脂肪等的摄入量,可使血尿酸下降,痛风症状改善,达到良好的治疗效果。     

使用苯溴马隆有哪些注意事项?

1出现持续性腹泻应停药。2不能在痛风急性发作期服用,因为开始治疗阶段,随着组织中尿酸溶出,有可能加重病症。3为了避免治疗初期痛风急性发作,建议在给药初期合用秋水仙碱或抗炎药。4治疗期间需大量饮水以增加尿量(治疗初期饮水量不得少于1.5~2L),以免在排泄的尿中由于尿酸过多导致尿酸结晶。定期测量尿液的酸     

痛风定片联合塞来昔布治疗急性痛风40例

［摘要］目的观察痛风定片联合塞来昔布治疗急性痛风的临床疗效。方法急性痛风患者80例,随机分为治疗组和对照组各40例。治疗组给予痛风定片1.6 g,tid,塞来昔布200 mg,bid,均po。对照组给予秋水仙碱口服,初始剂量为1 mg,以后每2 h服1 mg直至关节疼痛缓解或出现恶心、呕吐及腹泻等不良反应或每日总量达到6 mg为止,关节症状缓解以后改为每次0.5～1.0 mg,每天1或2次服用。观察两组患者治疗后疼痛缓解程度、血沉、血尿酸水平变化及不良反应。结果两组急性痛风的临床症状均改善;治疗组和对照组总有效率分别为92.5%,75.0%（P＜0.05）;治疗组血沉、血尿酸水平明显降低,而且不良反应较小。结论痛风定片联合塞来昔布治疗急性痛风具有明显优势,值得临床推广应用。     

痛风三个阶段的治疗

目的痛风是由于人体内嘌呤类物质代谢障碍而导致的一种急性或是慢性关节炎,即体内血尿酸浓度过高导致尿酸以钠盐的形式沉积在关节、软骨、肾脏而引起的组织异物炎性反应。研究痛风患者在治疗中何时开始降尿酸,降至多少为宜,观察治疗结果。方法将我院1995年1月至2012年1月的痛风患者60例,均分为安痛风三阶段指导用药的观察组,及不安阶段治疗的对照组。结果在观察组与对照组的总有效率方面,观察组患者分别为96.00%、92.00%,均远远高于对照组患者的78.57%、77.27%,二者差异显著,具有统计学意义(P<0.05);指导用药组的总有效率,观察组的96.00%明显高于对照组的76.00%,差异具有统计学意义(P<0.05)。结论痛风的三个阶段合理用药更有效,值得临床推广使用。     

痛风的药物治疗进展

痛风属于代谢性风湿病范畴,严重者致关节畸形、尿酸盐肾病、尿酸性尿路结石、肾功能不全。痛风的药物治疗应按临床期分进行,遵循个体化原则。本文对痛风药物治疗进展情况进行综述,促进临床正确合理用药。1急性发作期的药物治疗进展痛风急性发作时不一定血尿酸升高,为避免血尿酸水平波动过大,正使用降尿酸药物者不要停用,未使用降尿酸药物     

痛风间歇期，不能放松警惕

正古往今来,帝王将相、科学界精英等,不乏受过痛风折磨的,如亚历山大、忽必烈、牛顿等。因此,痛风又称"帝王病""富贵病""酒肉病"。如今,随着生活水平的提高,饮食结构的改变,痛风的发生率大大增加,尤其是40岁以上的男性和绝经期后的女性,发病更为多见。痛风按病程分为无症状高尿酸血症期、急性发作期、发作间歇期和慢性痛风石病变期。其中,痛风间歇期是指两次急性痛风性关节炎发作之间的阶段,这个时期虽然症状明显缓解,但是患者体内的高尿酸环境仍然存在,如果控制不佳仍会再次出现痛风急性发作。     

痛风的药物治疗进展

目的了解目前治疗痛风的药物进展情况,促进临床正确合理的应用。方法对近几年国内外的相关文献进行了检索、分析、分类和整理。结果目前．对于痛风的常规治疗仍以西药为主,通常选用秋水仙碱、非甾体抗炎药、苯溴马隆、别嘌吟醇等。这些药物以不同的作用机制达到缓解或治疗痛风的目的。但越来越多的临床观察发现它们都具有一定的毒副作用。中药的治疗效果尚待进一步的临床验证。结论虽然临床已有一些防治痛风的药物,防治痛风取得了一定的进步,但更多的临床资料表明,由于药物治疗不及时或不合理．现有药物的适应证限制及不良反应以及该病治疗药物品种很少,导致药物选择受限．使痛风没有得到很好的预防和治疗．导致急性痛风的慢性化和并发症产生。随着痛风分子发病机制的揭示,人们发现了治疗痛风的新靶点．将会出现一些新型药物。     

高血压合并痛风的用药指导：附典型病例

本文通过药师参与1例高血压合并痛风典型病例的用药指导,对各类抗高血压药和抗痛风药进行比较,提出合理选择药物的建议。该病例为中年男性,缺乏运动,有高血压病史,出现痛风急性发作。选用3种不同作用机制的降压药物硝苯地平控释片、琥珀酸美托洛尔缓释片和具有降尿酸作用的氯沙坦钾片治疗后获得满意的降压效果。抗痛风治疗采用指南推荐的新方法,用小剂量秋水仙碱联合双氯芬酸钠治疗,临床疗效显著,且不良反应小。     

Management of acute and chronic gouty arthritis: present state-of-the-art

There are three stages in the management of gout: (i) treating the acute attack; (ii) lowering excess stores of uric acid to prevent flares of gouty arthritis and to prevent tissue deposition of urate; and (iii) providing prophylaxis to prevent acute flares. It is important to distinguish between therapy to reduce acute inflammation in acute gout and therapy to manage hyperuricaemia in patients with chronic gouty arthritis.During the acute gouty attack nonpharmacological treatments such as topical ice and rest of the inflamed joint are useful. NSAIDs are the preferred treatment in acute gout. The most important determinant of therapeutic success is not which NSAID is chosen, but rather how soon NSAID therapy is initiated. Other treatments include oral and intravenous colchicine, intra-articular and systemic corticosteroids, and intramuscular corticotropin.Optimal treatment of chronic gout requires long-standing reduction in serum uric acid. The urate-lowering drugs used to treat chronic gout are the uricosuric drugs, the uricostatic drugs, which are xanthine oxidase inhibitors, and the uricolytic drugs. Xanthine oxidase inhibitors such as allopurinol, oxipurinol and febuxastat should be used as first-line treatment in patients with renal calculi, renal insufficiency, concomitant diuretic therapy and ciclosporin (cyclosporine) therapy, and urate overproduction. Uricosuric drugs include probenecid, benzbromarone, micronised fenofibrate and losartan. They are the urate-lowering drugs of choice in allopurinol-allergic patients and underexcretors with normal renal function and no history of urolithiasis. The use of recombinant urate oxidase in patients with chronic gout is limited by the need for parenteral administration, the potential antigenicity and production of anti-urate oxidase antibodies, and declining efficacy.The effectiveness of colchicine prophylaxis as an isolated therapy is still to be confirmed by placebo-controlled trials. Another issue is prophylaxis with NSAIDs. There are no comparative studies with colchicine.     

Overview of the management of acute gout and the role of adrenocorticotropic hormone

It is important to distinguish between therapy used to reduce acute inflammation in gout and therapy used to manage hyperuricaemia in patients with chronic gouty arthritis. This article discusses treatments for acute gout, emphasizing the use of corticotrophin (adrenocorticotropic hormone; ACTH) and the evidence on which we base our treatment of acute gout. There are no formal guidelines for the treatment of acute gout and only a few randomized controlled trials have been conducted to evaluate the efficacy of the various treatments for acute gout. The options available for the treatment of acute attacks of gout are NSAIDs, colchicine, corticosteroids, corticotropin and intra-articular corticosteroids. Most rheumatologists practicing in the US use combination therapy to treat acute gout, a practice that merits study. In a patient without complications, NSAIDs are the preferred therapy. The most important determinant of therapeutic success is not which NSAID is chosen, but rather how soon NSAID therapy is initiated. Exciting new research shows that corticotropin acts peripherally by activation of the melanocortin type 3 receptor, and this could be responsible, at least in part, for its efficacy in acute gout. Hopefully, this will lead to renewed interest in corticotropin as a treatment for acute gout.     

Pathophysiology, clinical presentation and treatment of gout

Gout is a common form of inflammatory arthritis that has been managed primarily in general medical practices for centuries. It appears that there has been an increasing prevalence of gout over the past decades, implying a growing public health burden. Accurate diagnosis and recognition of the various stages and manifestations of gout enable realistic goal setting for management. Recent evidence suggests new risk factors and potentially refutes others. Management of gout requires characterising and modifying risk factors and associated disorders, and commonly initiating drug therapy. Pharmacotherapy of gout includes the management of acute flares with anti-inflammatory agents such as NSAIDs and glucocorticoids and long-term treatment with urate-lowering drugs. Although pharmacotherapy is generally safe and effective, there are caveats and limitations to all gout therapies. Patient non-adherence and errors with the use of drugs for gout treatment are important factors leading to medical failures. With early intervention, careful monitoring and patient education, gout is a condition that can be managed very effectively. The advent of new drugs (such as febuxostat and urate oxidase [uricase]) and enhanced understanding of the pathogenesis of gout continue to improve our therapeutic options, particularly in a subset of patients with refractory disease and those who are intolerant to currently available medications.     

急性痛风关节炎的治疗选择

痛风关节炎是男性最常见的炎性关节炎。急性发作时患者遭受剧烈关节疼痛,关节红、肿、热及活动受限。对急性痛风的治疗药物包括:非甾体消炎药(NSAIDs)、秋水仙碱、关节内皮质类固醇、全身性皮质类固醇及促皮质素。白细胞介素-1抑制药看来也是一有效治疗药物。     

New facets of androgen replacement therapy during childhood and adolescence

There has been an increase in the incidence and prevalence of gout in the past several decades. A distinction needs to be made between the treatment of gout as an acute inflammatory disease and the lowering of the serum urate (SU) levels into a normal range. Treating acute gout attacks alone is not sufficient to prevent the disease from progressing. When treating gout one needs to treat acute attacks, and lower excess stores of uric acid to achieve dissolution of monosodium urate crystals through a long-term reduction of SU concentrations far beyond the threshold for saturation of urate and provide prophylaxis to prevent acute flares. The options available for the treatment of acute gout are NSAIDs, colchicine, corticosteroids, adrenocorticotropic hormone (ACTH) and intra-articular corticosteroids. The most important determinant of therapeutic success is not which anti-inflammatory agent is chosen, but rather how soon therapy is initiated and that the dose be appropriate. Prophylaxis should be considered an adjunct, rather than an alternative, to long-term urate-lowering therapy. For purposes of maintaining patient adherence to urate-lowering therapy, there is interest in improving prophylaxis of such treatment-induced attacks. The optimal agent, dose and duration for gout prophylaxis are unknown and require further investigation. The importance of long-term management of gout is the reduction and maintenance of SU in a goal range, usually defined as less than 6.0 mg/dL. Allopurinol and benzbromarone remain the cornerstone drugs for reducing SU levels lower than the saturation threshold to dissolve urate deposits effectively. Febuxostat and pegloticase help to optimize control of SU levels, especially in those patients with the most severe gout. Other agents, such as fenofibrate and losartan may be helpful as adjuvant drugs. Treatment for gout has advanced little in the last 40 years, until recently. The recent development of new therapeutic options promises to provide much needed alternatives for the many patients with gout who are intolerant of or refractory to available therapies. It is important to note that inappropriate use of medications as opposed to an apparent refractoriness to available therapies is not uncommon.     

Management of gout in older adults: barriers to optimal control

Gout, a common inflammatory arthritis, can be diagnosed with absolute certainty. Gout results from the body's reaction to urate crystals deposited in tissues, and this pathophysiology is well understood. If used appropriately, available therapies can be entirely effective in not only treating the symptoms of gout, but also in eliminating the excess urate from the body, thereby eradicating the disease. Because of these facts, management of patients with gout should be successful. However, management of gout is particularly challenging in the elderly, even though the principles of management are the same for all age groups. The purpose of this article is to review these principles and discuss them as they pertain to the elderly. The classic gout attack is acute in onset, extremely painful and associated with marked swelling, warmth, erythema and tenderness of a single joint. However, the diagnosis of gout may be challenging in the elderly because atypical presentations are more common in this group. Treatment of acute gout involves the use of NSAIDs, colchicine, corticosteroids or corticotropin (adrenocorticotropic hormone). Unfortunately, co-morbid conditions such as chronic kidney disease, peptic ulcer disease and congestive heart failure may make the use of these agents dangerous or contraindicated. Thus, it is important to try to treat an acute flare of gout at the earliest sign, because the sooner treatment is initiated, the faster the inflammation will resolve. Urate-lowering agents include allopurinol and uricosuric agents. These also must be used judiciously in the elderly. However, if used at the lowest dose that maintains the serum urate level below 5.0-6.0 mg/dL, the excess urate in the body will be eliminated, acute flares will no longer occur and tophi will resolve. Gout is often seen in association with hypertension, excessive alcohol consumption, obesity and hypertriglyceridaemia. These conditions and the medications used to treat them may contribute to the hyperuricaemia. Treating these conditions and using medications that do not promote hyperuricaemia will aid in the management of gout. Despite the challenges that often complicate the management of gout in the elderly, an understanding of the pathophysiology of the disease and both the indications and limitations of the medications used should allow successful treatment.     

高尿酸血症患者急性痛风发作的相关因素分析

目的 探讨和分析高尿酸血症患者痛风发作的高危因素,以便及时采取相应对策,降低痛风发作的风险.方法 对1 847例高尿酸血症患者的健康体检资料进行回顾性调查及问卷调查,对痛风高危因素,如年龄、性别、病程、血糖、血脂、血尿酸以及合并症情况进行单因素分析和Logistic回归分析.结果 性别、阳性家族史、体重指数、暴饮暴食以及合并高血压、高脂血症对高尿酸血症患者痛风发作有显著影响(均P＜0.01).结论 医护人员应熟知急性痛风发作的高危因素及其诱发因素,加强对患者的健康教育,制定针对不同高危因素的措施,以减少高尿酸血症患者痛风发作的风险.     

治疗痛风药物研究进展

随着人们生活水平的提高, 痛风的发病率不断上升并出现低龄化, 寻找高效低毒的抗痛风药物成为当务之急。目前,对于痛风的常规治疗仍以西药为主,这些药物以不同的作用机制达到缓解或治疗痛风的目的,但临床发现它们都具有一定的毒副作用。近年来,越来越多的研究者着手于抗痛风天然药物的开发,其疗效与毒副作用尚待进一步的临床验证。本文对目前临床上常用的抗痛风药物及正在研发中的抗痛风药物进行了综述,总结痛风病不同分期的药物治疗特点,阐述各期药物治疗潜在危害和处理方法,归纳抗高尿酸血症或痛风的中药研究,为开发新型抗痛风药物提供有效途径,并对抗痛风新药的研发进行了展望。     

Effect of oxametacin on endogenous uric acid clearance rate in healthy volunteers

Oxametacin, a new non steroidal anti-inflammatory compound, with analgesic, antipyretic and anti-inflammatory properties comparable to those of indomethacin, has been claimed to be effective in treatment of acute attacks of gout. The present study comprises an investigation in 8 healthy volunteers of the effect on the endogenous uric acid clearance rate, of oxametacin administered alone or in combination with the conventional hypouricaemic agents benzbromarone or allopurinol. Whether given alone or in combination with these drugs, oxametacin failed to alter the clearance rate of endogenous uric acid. In view of its good tolerance and its possible efficacy in treatment of acute attacks of gout, the present data help to validate use of oxametacin in acute gout.