Kim Karissa Y, Ralph Schumacher H, Hunsche Elke, Wertheimer Albert I, Kong Sheldon X
Temple University, School of Pharmacy, Philadephia, USA.
Clin Ther. 2003 Jun;25(6):1593-617. doi: 10.1016/s0149-2918(03)80158-3.
Gout is the most common cause of inflammatory arthritis in men aged >40 years and is frequently encountered in clinical practice.
The goal of this article was to review the published literature on the epidemiology, treatment, and estimated burden of illness of acute gout.
Articles on gout published in English between 1980 and June 2002 were identified through a MEDLINE search. Relevant clinical studies and review articles were found using the text- and keyword-search term gout alone and in combination with epidemiology, prevalence, incidence, complications, outcome, quality of life, economics, cost, prevention or drug therapy. The reference lists of identified articles, especially review articles, were checked for any additional studies that might have been missed in the original MEDLINE search.
The epidemiology of gout in various geographic regions has been well documented. Data suggest that environmental, racial, and hereditary factors may influence the development of gout, and that the prevalence of gout appears to be on the rise worldwide. Evidence from well-designed clinical studies evaluating drug therapies for gout is limited. Therapies for acute gout include corticotropin, corticosteroids, colchicine or, more often, nonsteroidal anti-inflammatory drugs (NSAIDs), which have shown comparable efficacy. A recent study suggests that etoricoxib, a new cyclooxygenase-2-selective inhibitor, may be as effective as and better tolerated than traditional NSAIDs in the treatment of gout. Urate-lowering therapy, prophylactic colchicine, and low-dose NSAIDs are used for the long-term prophylaxis of gout. However, all acute and prophylactic therapies are associated with adverse events. Using an economic model for gout, the annual direct burden of illness for new cases of acute gout can be estimated at 27,378,494 US dollars in the United States.
Gout is an increasingly prevalent condition worldwide and creates a heavy economic burden. Available treatments are generally effective; however, they are not devoid of adverse events. Well-designed, long-term, controlled clinical trials evaluating the comparative efficacy and tolerability of treatments for gout are needed.
痛风是40岁以上男性炎症性关节炎最常见的病因，在临床实践中经常遇到。
本文的目的是综述已发表的关于急性痛风的流行病学、治疗及疾病负担估计的文献。
通过医学文献数据库（MEDLINE）检索1980年至2002年6月期间发表的英文痛风相关文章。使用单独的文本和关键词搜索词“痛风”，以及与流行病学、患病率、发病率、并发症、结局、生活质量、经济学、成本、预防或药物治疗相结合的搜索词，找到相关的临床研究和综述文章。检查已识别文章的参考文献列表，特别是综述文章，以查找在原始MEDLINE搜索中可能遗漏的任何其他研究。
不同地理区域痛风的流行病学已有充分记录。数据表明，环境、种族和遗传因素可能影响痛风的发生，且痛风的患病率在全球范围内似乎呈上升趋势。评估痛风药物治疗的精心设计的临床研究证据有限。急性痛风的治疗方法包括促肾上腺皮质激素、皮质类固醇、秋水仙碱，或更常用的非甾体抗炎药（NSAIDs），它们显示出相当的疗效。最近一项研究表明，新型环氧化酶-2选择性抑制剂依托考昔在治疗痛风方面可能与传统NSAIDs一样有效且耐受性更好。降尿酸治疗、预防性秋水仙碱和低剂量NSAIDs用于痛风的长期预防。然而，所有急性和预防性治疗都与不良事件相关。使用痛风的经济模型，美国急性痛风新病例的年度直接疾病负担估计为27378494美元。
痛风在全球范围内日益普遍，并造成沉重的经济负担。现有的治疗方法通常有效；然而，它们并非没有不良事件。需要精心设计的长期对照临床试验来评估痛风治疗的比较疗效和耐受性。
