Axelrod D, Preston S
Department of Medicine, Mount Carmel Mercy Hospital, Detroit, MI 48235.
Arthritis Rheum. 1988 Jun;31(6):803-5. doi: 10.1002/art.1780310618.
One hundred male patients who presented with acute gouty arthritis were alternately assigned to 2 treatment groups. Seventy-six patients completed the study protocol, in which each gout attack during a 1-year period was treated. For each gout episode, 36 patients received a single intramuscular injection of 40 IU of adrenocorticotropic hormone (ACTH), and 40 patients received oral indomethacin, 50 mg 4 times daily with meals, until the pain abated. The time interval until the pain was relieved, as well as any untoward effects, were recorded for each gout attack treated. Both groups were of similar age, and had similar values for intercritical serum uric acid, 24-hour urinary uric acid, and creatinine clearance (1 month after entry into the study). The mean interval (+/- SD) to relief of pain was significantly shorter for the ACTH group (3 +/- 1 hours) than for the indomethacin group (24 +/- 10 hours). No side effects were noted in the ACTH group. However, of the 40 patients receiving indomethacin, 22 had abdominal discomfort of dyspepsia, 15 had headaches, and 12 had difficulty with mentation. Single-dose parenteral ACTH appeared to be effective more rapidly and was associated with fewer side effects than oral indomethacin in the treatment of acute gout.
100例急性痛风性关节炎男性患者被交替分配到2个治疗组。76例患者完成了研究方案，其中对1年期间的每次痛风发作都进行了治疗。对于每次痛风发作，36例患者接受单次肌内注射40 IU促肾上腺皮质激素（ACTH），40例患者接受口服吲哚美辛，50 mg，每日4次，与餐同服，直至疼痛缓解。记录每次接受治疗的痛风发作至疼痛缓解的时间间隔以及任何不良反应。两组年龄相似，在进入研究1个月时，临界期血清尿酸、24小时尿尿酸和肌酐清除率的值也相似。ACTH组疼痛缓解的平均间隔时间（±标准差）（3±1小时）明显短于吲哚美辛组（24±10小时）。ACTH组未观察到副作用。然而，在接受吲哚美辛治疗的40例患者中，22例有消化不良引起的腹部不适，15例有头痛，12例有精神障碍。在急性痛风的治疗中，单剂量肠外ACTH似乎起效更快，且副作用比口服吲哚美辛更少。
