Sutaria S, Katbamna R, Underwood M
Barts and The London, Queen Mary, University of London, Institute of Health Sciences, London, UK.
Rheumatology (Oxford). 2006 Nov;45(11):1422-31. doi: 10.1093/rheumatology/kel071. Epub 2006 Apr 21.
To determine the evidence for the effectiveness of treatments for acute gout and the prevention of recurrent gout.
Seven electronic databases were searched for randomized controlled trials of treatments for gout from their inception to the end of 2004. No language restrictions were applied. All randomized controlled trials of treatments routinely available for the treatment of gout were included. Trials of the prevention of recurrence were included only if patients who had had gout and had at least 6 months of follow-up were studied.
We found 13 randomized controlled trials of treatment for acute gout, two of which were placebo controlled. Colchicine was found to be effective in one study; however, the entire colchicine group developed toxicity. The only robust conclusion from studies of non-steroidal anti-inflammatory drugs is that pain relief from indometacin and etoricoxib are equivalent. We found one randomized controlled trial, reported only as a conference abstract, of recurrent gout prevention.
The shortage of robust data to inform the management of a common problem such as gout is surprising. All of the drugs used to treat gout can have serious side effects. The incidence of gout is highest in the elderly population. It is in this group, who are at a high risk of serious adverse events, that we are using drugs of known toxicity. The balance of risks and benefits for the drug treatment of gout needs to be reassessed.
确定治疗急性痛风及预防痛风复发的疗法的有效性证据。
检索了七个电子数据库，以查找从建库至2004年底有关痛风治疗的随机对照试验。未设语言限制。纳入了所有常规用于治疗痛风的疗法的随机对照试验。仅当研究患有痛风且随访至少6个月的患者时，才纳入预防复发的试验。
我们找到了13项关于急性痛风治疗的随机对照试验，其中两项为安慰剂对照试验。在一项研究中发现秋水仙碱有效；然而，整个秋水仙碱组都出现了毒性反应。关于非甾体抗炎药的研究中唯一可靠的结论是，吲哚美辛和依托考昔的止痛效果相当。我们找到了一项关于预防痛风复发的随机对照试验，仅作为会议摘要报道。
对于痛风这样一个常见问题，缺乏有力数据来指导治疗令人惊讶。所有用于治疗痛风的药物都可能有严重的副作用。痛风发病率在老年人群中最高。正是在这个严重不良事件风险高的群体中，我们使用了已知有毒性的药物。痛风药物治疗的风险和益处平衡需要重新评估。
