Bailén Rebeca, González Senac Nicolás M, López Mónica M, Llena M Luisa, Migoya Marta, Rodríguez M Teresa, de Miguel Eugenio, Torres Rosa J, Puig Juan G
a Division of Internal Medicine, Metabolic-Vascular Unit , La Paz University Hospital , Madrid , Spain.
Nucleosides Nucleotides Nucleic Acids. 2014;33(4-6):174-80. doi: 10.1080/15257770.2013.853786.
Pharmacologic urate lowering therapy (ULT), at full maintenance doses, has been associated with acute gout arthritis (in up to 80% of patients). The American College of Rheumatology has recently advocated gradually titrating the maintenance dose upward to chosen serum urate target. Few studies have examined the efficacy and safety of a ULT in primary gout.
The ULT regimen examined included allopurinol (50 mg/day, with increases of 50 mg/month up to 300 mg/day) and colchicine, as prophylaxis to prevent acute gouty attacks. The efficacy and safety of this regimen was examined in 42 patients in whom allopurinol was withheld for ≥3 months and restarted after this assessment and followed up for 12 months. The efficacy and safety of the ULT regimen was related to the serum urate decrease and to the incidence of acute gout flares, respectively.
Fifty-nine patients (mean age 59 years, 56 men) with primary gout received the gradually titrated ULT regimen. Baseline serum urate was (mean±SD) 8.4±0.8 mg/dL. At 3, 6, 9, and 12 months serum urate fell by a mean of 1.8, 2.5, 2.7, and 2.5 mg/dL, respectively (p<0.001). A serum urate level<6.0 mg/dL was achieved by 38/59 (64%) patients. During the 12 months following the start of the ULT we documented 10 acute arthritis episodes (17% of patients).
A gradually titrated hypouricemic regimen for 6 months in patients with primary gout appears to be effective and safe.
在使用完全维持剂量时，药物降尿酸治疗（ULT）与急性痛风性关节炎相关（高达80%的患者）。美国风湿病学会最近主张将维持剂量逐步上调至选定的血清尿酸目标值。很少有研究探讨ULT在原发性痛风中的疗效和安全性。
所研究的ULT方案包括别嘌醇（50mg/天，每月增加50mg直至300mg/天）和秋水仙碱，作为预防急性痛风发作的药物。在42例停用别嘌醇≥3个月并在此次评估后重新开始用药且随访12个月的患者中，对该方案的疗效和安全性进行了研究。ULT方案的疗效和安全性分别与血清尿酸降低情况和急性痛风发作的发生率相关。
59例（平均年龄59岁，56例男性）原发性痛风患者接受了逐步滴定调整的ULT方案。基线血清尿酸为（均值±标准差）8.4±0.8mg/dL。在3、6、9和12个月时，血清尿酸分别平均下降1.8、2.5、2.7和2.5mg/dL（p<0.001）。38/59（64%）的患者血清尿酸水平降至<6.0mg/dL。在开始ULT治疗后的12个月内，我们记录到10次急性关节炎发作（占患者的17%）。
对于原发性痛风患者，采用逐步滴定调整的降尿酸方案治疗6个月似乎是有效且安全的。
