Medical Director of Health Services, Collegeville Family Practice, Ursinus College, Collegeville, PA 19426, USA.
Postgrad Med. 2012 Nov;124(6):98-109. doi: 10.3810/pgm.2012.11.2616.
Gout is a chronic, progressive condition for which hyperuricemia is the primary risk factor. The initial episodes of gout may be brief, only lasting for 3 to 5 days, and patients may experience pain-free intercritical periods that last from months to years. However, as the disease progresses, acute gout flares become more frequent and prolonged (typically lasting ≥ 5-10 days). Chronic gouty arthritis develops, with shorter pain-free intervals; tophi become visible and interarticular joint damage occurs. Patients with advanced gout experience chronic pain and a decreased quality of life. Gout prevalence has increased significantly over time. Despite the increase in the number of gout cases, the disease is often mismanaged, especially in primary care. Hyperuricemia is inadequately controlled as a result of suboptimal dosing with urate-lowering drugs, intolerance to therapy, or poor patient compliance. This review article provides a comprehensive discussion of gout pathophysiology, risk factors, and approaches to treatment that encourage the clinician to appreciate hyperuricemia as a multifaceted disorder and manage the condition optimally.
痛风是一种慢性、进行性疾病，高尿酸血症是其主要危险因素。痛风的初始发作可能是短暂的，仅持续 3 至 5 天，且患者可能会经历无痛的间歇期，持续数月至数年。然而，随着疾病的进展，急性痛风发作变得更加频繁和持久（通常持续≥5-10 天）。慢性痛风性关节炎发展，无痛间歇期缩短；可见痛风石，并发生关节内关节损伤。患有晚期痛风的患者会经历慢性疼痛和生活质量下降。痛风的患病率随着时间的推移显著增加。尽管痛风病例数有所增加，但该疾病的管理往往并不理想，尤其是在初级保健中。降尿酸药物的剂量不足、治疗不耐受或患者依从性差导致高尿酸血症控制不佳。这篇综述文章全面讨论了痛风的病理生理学、危险因素和治疗方法，鼓励临床医生将高尿酸血症视为一种多方面的疾病，并对其进行最佳管理。
