Maekawa Michitaka, Tomida Hidetaka, Aoki Takafumi, Hishida Manabu, Morinaga Takatoshi, Tamai Hirofumi
Department of Nephrology, Anjo-Kosei Hospital, Japan.
Intern Med. 2014;53(6):609-12. doi: 10.2169/internalmedicine.53.0698.
Gouty arthritis is a metabolic disorder associated with hyperuricemia. Despite the development of novel pharmacotherapies, some hyperuricemia patients are drug refractory and develop gout. A 74-year-old man with frequent gouty attacks and chronic renal failure presented with asymmetrical polyarthritis affecting multiple joints. The diagnosis of gout was confirmed based on the presence of monosodium urate crystals in the patient's right wrist. The administration of systemic corticosteroids relieved the joint inflammation and pain; however, the urate level increased to 28 mg/dL and the gout attacks recurred. Combined allopurinol, febuxostat, and benzbromarone therapy reduced the urate level to <6 mg/dL, and the attacks gradually declined. This is the first report of two xanthine oxidase inhibitors being used to treat refractory gout.
痛风性关节炎是一种与高尿酸血症相关的代谢紊乱疾病。尽管有新型药物疗法的发展，但一些高尿酸血症患者对药物难治，会发展为痛风。一名74岁男性，频繁发作痛风且患有慢性肾衰竭，表现为影响多个关节的不对称性多关节炎。根据患者右腕中存在尿酸钠晶体确诊为痛风。全身使用糖皮质激素缓解了关节炎症和疼痛；然而，尿酸水平升至28mg/dL，痛风发作复发。联合使用别嘌醇、非布司他和苯溴马隆治疗使尿酸水平降至<6mg/dL，发作逐渐减少。这是首次报道使用两种黄嘌呤氧化酶抑制剂治疗难治性痛风。
