Université Paris 7, UFR Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris, France. pascal.richette@lrb
Lancet. 2010 Jan 23;375(9711):318-28. doi: 10.1016/S0140-6736(09)60883-7. Epub 2009 Aug 17.
Gout is a common arthritis caused by deposition of monosodium urate crystals within joints after chronic hyperuricaemia. It affects 1-2% of adults in developed countries, where it is the most common inflammatory arthritis in men. Epidemiological data are consistent with a rise in prevalence of gout. Diet and genetic polymorphisms of renal transporters of urate seem to be the main causal factors of primary gout. Gout and hyperuricaemia are associated with hypertension, diabetes mellitus, metabolic syndrome, and renal and cardiovascular diseases. Non-steroidal anti-inflammatory drugs and colchicine remain the most widely recommended drugs to treat acute attacks. Oral corticosteroids could be an alternative to these drugs. Interleukin 1beta is a pivotal mediator of acute gout and could become a therapeutic target. When serum uric acid concentrations are lowered below monosodium urate saturation point, the crystals dissolve and gout can be cured. Patient education, appropriate lifestyle advice, and treatment of comorbidities are an important part of management of patients with gout.
痛风是一种常见的关节炎,由慢性高尿酸血症后单钠尿酸盐晶体在关节内沉积引起。它影响发达国家 1-2%的成年人,是男性中最常见的炎症性关节炎。流行病学数据表明,痛风的患病率呈上升趋势。饮食和尿酸肾脏转运体的遗传多态性似乎是原发性痛风的主要病因。痛风和高尿酸血症与高血压、糖尿病、代谢综合征以及肾脏和心血管疾病有关。非甾体抗炎药和秋水仙碱仍然是治疗急性发作最广泛推荐的药物。口服皮质类固醇可能是这些药物的替代药物。白细胞介素 1β是急性痛风的关键介质,可能成为治疗靶点。当血清尿酸浓度降低到低于单钠尿酸盐饱和度时,晶体溶解,痛风可以治愈。患者教育、适当的生活方式建议和合并症的治疗是痛风患者管理的重要组成部分。