Corrado A, D'Onofrio F, Santoro N, Melillo N, Cantatore F P
Unit of Rheumatology, University of Foggia, Hospital Colonello D'Avanzo, Foggia, Italy.
Minerva Med. 2006 Dec;97(6):495-509.
Gout is a chronic metabolic disease caused by a disorder of the purine metabolism leading to hyperuricaemia. It is determined by the deposition of monosodium urate crystals in joints and other tissues which causes an acute inflammatory response and can induce a permanent tissue damage which defines the urate chronic joint disease which is characterised by the appearance of ulceration of the joint cartilage, marginal osteophytosis, geodic and erosive lesions and chronic inflammation of synovial membrane. Gout and hyperuricaemia usually occur after the age of 30 years and more frequently in men. Hyperuricaemia is the result of an increased production of uric acid or its hypoexcretion by the kidneys, or both. In the pathogenesis of gout and hyperuricaemia are involved genetic and environmental factors; further, different pathologic condition such as glycogenosis, renal insufficiency, use of some drugs, are associated with gout. Treatment of acute gout includes colchicine, nonsteroidal anti-inflammatory drugs and glucocorticoids, whereas in the intercritical periods colchicine is effective for preventive purposes. Urate-lowering therapy with xanthine-oxidase inhibitors or uricosuric agents is indicate only in patients with more than two gout crisis per year, tophaceous deposits, uric acid nephrolithiasis, and interstitial renal disease, as asymptomatic hyperuricaemia does not requires any treatment but can be controlled with preventive dietetic measures and changes in lifestyle.
痛风是一种慢性代谢性疾病，由嘌呤代谢紊乱导致高尿酸血症引起。它取决于尿酸钠晶体在关节和其他组织中的沉积，这会引发急性炎症反应，并可导致永久性组织损伤，从而定义了尿酸盐慢性关节疾病，其特征为关节软骨溃疡、边缘骨赘形成、 geodes 样和侵蚀性病变以及滑膜慢性炎症。痛风和高尿酸血症通常在30岁以后出现，男性更为常见。高尿酸血症是尿酸生成增加或肾脏排泄减少，或两者兼有的结果。痛风和高尿酸血症的发病机制涉及遗传和环境因素；此外，不同的病理状况如糖原贮积症、肾功能不全、某些药物的使用，都与痛风有关。急性痛风的治疗包括秋水仙碱、非甾体抗炎药和糖皮质激素，而在发作间期，秋水仙碱用于预防有效。使用黄嘌呤氧化酶抑制剂或促尿酸排泄剂进行降尿酸治疗仅适用于每年发作超过两次痛风、有痛风石沉积、尿酸肾结石和间质性肾病的患者，因为无症状高尿酸血症无需任何治疗，但可通过预防性饮食措施和生活方式改变加以控制。
