Wilson Liza, Saseen Joseph J
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.
Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado.
Pharmacotherapy. 2016 Aug;36(8):906-22. doi: 10.1002/phar.1788. Epub 2016 Jul 22.
Gouty arthritis is one of the most common rheumatic diseases. The clinical burden of gouty arthritis has historically been well recognized; however, gout is often misdiagnosed and mismanaged. The prevalence of gout is rising and is likely attributed to several factors including increased incidence of comorbidities, lifestyle factors, and increased use of causative medications. With the increasing prevalence, there have been several innovations and evidence-based updates related to the diagnosis and management of gout. Acute gouty arthritis should be treated with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids, or a combination of two agents. Xanthine oxidase inhibitor therapy remains the consensus first-line treatment option for the prevention of recurrent gout. Add-on therapies that reduce serum urate concentration include traditional uricosuric agents and a novel uric acid reabsorption inhibitor. Prophylaxis of acute gout with NSAIDs, colchicine, or corticosteroids is universally recommended when initiating any urate-lowering therapy in order to prevent acute gouty arthritis for a period of at least 6 months. In this review, we discuss the epidemiology and risk factors for gouty arthritis and evaluate diagnostic strategies and therapeutic regimens for the management of gout, including a new drug approval.
痛风性关节炎是最常见的风湿性疾病之一。痛风性关节炎的临床负担在历史上已得到充分认识；然而，痛风常常被误诊和管理不当。痛风的患病率正在上升，这可能归因于几个因素，包括合并症发病率增加、生活方式因素以及致病药物使用增加。随着患病率的上升，在痛风的诊断和管理方面出现了一些创新和基于证据的更新。急性痛风性关节炎应使用非甾体抗炎药（NSAIDs）、秋水仙碱或皮质类固醇，或两种药物联合治疗。黄嘌呤氧化酶抑制剂疗法仍然是预防复发性痛风的共识一线治疗选择。降低血清尿酸浓度的附加疗法包括传统的促尿酸排泄剂和一种新型尿酸重吸收抑制剂。在开始任何降尿酸治疗时，普遍建议使用NSAIDs、秋水仙碱或皮质类固醇预防急性痛风，以预防急性痛风性关节炎至少6个月。在本综述中，我们讨论痛风性关节炎的流行病学和危险因素，并评估痛风管理的诊断策略和治疗方案，包括一种新药的批准。
