Department of Medicine, University of Otago, Christchurch, P.O. Box 4345, Christchurch, 8140, New Zealand.
Curr Rheumatol Rep. 2012 Apr;14(2):165-72. doi: 10.1007/s11926-012-0235-9.
Acute and chronic gout are common complications following organ transplantation. Risk factors include those shared with the general population (eg, diuretic use) and transplant-specific risk factors (eg, cyclosporine). Clinical features of gout are similar to those seen in the general population, although tophi may be more common. A definitive diagnosis requires demonstration of monosodium urate crystals within synovial fluid or tophi. Treatment is often empiric, although a poor response should prompt joint aspiration to exclude septic arthritis. Corticosteroids are commonly used to treat acute gout due to the adverse profile and drug interactions with NSAIDs and colchicine. Sustained reduction of serum urate (≤6 mg/dL) is critical in long-term management. Allopurinol is the most commonly used agent, although vigilant monitoring is required if combined with azathioprine. Other options include febuxostat and benzbromarone. The role of newer agents such as interleukin-1 inhibitors and uricases remains to be determined. General measures should include minimizing diuretic use.
急性和慢性痛风是器官移植后的常见并发症。危险因素包括与普通人群共同的因素（如利尿剂的使用）和移植特有的因素（如环孢素）。痛风的临床特征与普通人群相似，尽管痛风石可能更为常见。明确的诊断需要在滑液或痛风石中显示单钠尿酸盐晶体。治疗通常是经验性的，尽管反应不佳应促使关节抽吸以排除化脓性关节炎。由于 NSAIDs 和秋水仙碱的不良反应谱和药物相互作用，皮质类固醇通常用于治疗急性痛风。长期管理中关键是持续降低血清尿酸（≤6mg/dL）。别嘌醇是最常用的药物，但如果与硫唑嘌呤合用，则需要密切监测。其他选择包括非布司他和苯溴马隆。白细胞介素-1 抑制剂和尿酸酶等新型药物的作用仍有待确定。一般措施应包括尽量减少利尿剂的使用。
