Dalbeth Nicola, Merriman Tony R, Stamp Lisa K
Department of Medicine, University of Auckland, Auckland, New Zealand.
Department of Biochemistry, University of Otago, Dunedin, New Zealand.
Lancet. 2016 Oct 22;388(10055):2039-2052. doi: 10.1016/S0140-6736(16)00346-9. Epub 2016 Apr 21.
Gout is a chronic disease of deposition of monosodium urate crystals, which form in the presence of increased urate concentrations. Although environmental factors contribute to hyperuricaemia, renal and gut excretion of urate is central to regulation of serum urate, and genetic factors are important. Activation of the NLRP3 inflammasome and release of interleukin 1β have key roles in initiation of acute gout flares. A "treat to target serum urate" approach is essential for effective gout management; long-term lowering of serum urate to less than 360 μmol/L leads to crystal dissolution and ultimately to suppression of flares. An allopurinol dose-escalation strategy is frequently effective for achieving treatment targets, and several new urate-lowering drugs are also available. Worldwide, rates of initiation and continuation of urate-lowering therapy are very low, and, consequently, achievement of serum urate targets is infrequent. Strategies to improve quality of gout care are needed.
痛风是一种尿酸钠晶体沉积的慢性疾病，尿酸盐浓度升高时会形成这些晶体。尽管环境因素会导致高尿酸血症，但尿酸的肾脏和肠道排泄是血清尿酸调节的核心，遗传因素也很重要。NLRP3炎性小体的激活和白细胞介素1β的释放 在急性痛风发作的起始中起关键作用。 “将血清尿酸治疗至目标值”方法对于有效的痛风管理至关重要；将血清尿酸长期降至低于360 μmol/L会导致晶体溶解并最终抑制发作。别嘌醇剂量递增策略通常对实现治疗目标有效，并且也有几种新的降尿酸药物可用。在全球范围内，降尿酸治疗的起始率和持续率非常低，因此，很少能达到血清尿酸目标。需要改善痛风护理质量的策略。
