Pallalardo A, Gancitano A
Minerva Med. 1978 Feb 4;69(6):389-402.
Rational therapy of gout must be correlated with the two basic aetiopathogenetic factors, i.e. metabolic error and the inflammatory dysreactive moment. Due to its different action mechanism, the former is responsible for the typing of adult primary hyperuricaemia: a) hyperincorporating and hyperescretory forms; b) normo-incorporating and relatively or absolutely hypoexcretory forms; c) hyperincorporating and hyposcretory forms. It would be a mistake to treat the condition chemically without knowing the physiopathology of the metabolic error. On the basis of a preliminary typing assessment, rational chemical correction of the metabolic error in gout cases can be achieved with drugs that block the enhanced endogenous synthesis of uric acid (allopurinol, etc.) or correct the metabolite renal excretion defect. Therapy of the dysreactive-inflammatory component should involve non-steroid anti-inflammatory drugs. The disadvantages of using cortisones in gout treatment are stressed.
痛风的合理治疗必须与两个基本的病因发病因素相关联，即代谢紊乱和炎症反应异常阶段。由于其作用机制不同，前者决定了成人原发性高尿酸血症的类型：a）高摄入和高排泄型；b）正常摄入和相对或绝对低排泄型；c）高摄入和低排泄型。在不了解代谢紊乱的生理病理学情况下进行化学治疗是错误的。在初步分型评估的基础上，对于痛风病例，可使用阻断内源性尿酸合成增加的药物（如别嘌醇等）或纠正代谢产物肾脏排泄缺陷的药物，来实现对代谢紊乱的合理化学纠正。对炎症反应异常成分的治疗应使用非甾体抗炎药。文中强调了在痛风治疗中使用皮质激素的弊端。
