SUNY Stony Brook, NY, USA.
Phys Sportsmed. 2011 Nov;39(4):98-123. doi: 10.3810/psm.2011.11.1946.
Gout is a major health problem in the United States; it affects 8.3 million people, which is approximately 4% of the adult population. Gout is most often diagnosed and managed in primary care practices; thus, primary care physicians have a significant opportunity to improve patient outcomes. Following publication of the 2006 European League Against Rheumatism (EULAR) gout guidelines, significant new evidence has accumulated, and new treatments for patients with gout have become available. It is the objective of these 2011 recommendations to update the 2006 EULAR guidelines, paying special attention to the needs of primary care physicians. The revised 2011 recommendations are based on the Grading of Recommendations Assessment, Development, and Evaluation approach as an evidence-based strategy for rating quality of evidence and grading the strength of recommendation formulated for use in clinical practice. A total of 26 key recommendations, 10 for diagnosis and 16 for management, of patients with gout were evaluated, resulting in important updates for patient care. The presence of monosodium urate crystals and/or tophus and response to colchicine have the highest clinical diagnostic value. The key aspect of effective management of an acute gout attack is initiation of treatment within hours of symptom onset. Low-dose colchicine is better tolerated and is as effective as a high dose. When urate-lowering therapy (ULT) is indicated, the xanthine oxidase inhibitors allopurinol and febuxostat are the options of choice. Febuxostat can be prescribed at unchanged doses for patients with mild-to-moderate renal or hepatic impairment. The target of ULT should be a serum uric acid level that is ≤ 6 mg/dL. For patients with refractory and tophaceous gout, intravenous pegloticase is a new treatment option. This article is a summary of the 2011 clinical guidelines published in Postgraduate Medicine. This article provides a streamlined, accessible overview intended for quick review by primary care physicians, with the full guidelines being a resource for those seeking additional background information and expanded discussion.
痛风是美国的一个主要健康问题；它影响了 830 万人，约占成年人口的 4%。痛风通常在初级保健实践中诊断和管理；因此，初级保健医生有很大的机会改善患者的预后。2006 年欧洲抗风湿病联盟（EULAR）痛风指南发布后，积累了大量新的证据，并且为痛风患者提供了新的治疗方法。这些 2011 年建议的目的是更新 2006 年 EULAR 指南，特别关注初级保健医生的需求。经过修订的 2011 年建议是基于推荐评估、制定和评估方法的分级，这是一种基于证据的策略，用于对证据质量进行评级，并对为临床实践制定的推荐强度进行分级。共评估了 26 项关键建议，其中 10 项用于诊断，16 项用于管理痛风患者，从而为患者护理提供了重要更新。单钠尿酸盐晶体和/或痛风石的存在以及秋水仙碱的反应具有最高的临床诊断价值。有效管理急性痛风发作的关键方面是在症状出现后数小时内开始治疗。小剂量秋水仙碱的耐受性更好，与高剂量一样有效。当需要降低尿酸治疗（ULT）时，黄嘌呤氧化酶抑制剂别嘌醇和非布司他是首选。对于轻度至中度肾功能或肝功能不全的患者，非布司他可以维持不变的剂量处方。ULT 的目标应是血清尿酸水平≤6mg/dL。对于难治性和痛风石性痛风患者，静脉注射培戈洛酶是一种新的治疗选择。本文是在《进修医学杂志》上发表的 2011 年临床指南的摘要。本文提供了一个简化、易于访问的概述，旨在供初级保健医生快速审查，完整的指南是那些寻求额外背景信息和扩展讨论的人的资源。
