Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon City, Gyenggi-do, 14584, South Korea.
Adv Rheumatol. 2019 Jul 25;59(1):31. doi: 10.1186/s42358-019-0075-7.
To evaluate the clinical features and risk factors for gout flare during postsurgical period in patients who were previously diagnosed with gout.
Seventy patients who had histories of gout and had been consulted in the rheumatologic clinic before surgery under general anesthesia were included. Clinical characteristics of patients who developed a postsurgical gout flare were compared with those of patients who did not develop gout flare.
Among 70 patients, 31 (44.3%) developed gout flare during the postsurgical period. Mean intervals from surgery to gout flare was 3.7 days. Flares tended to involve monoarticular joints (61.3%) and affect lower extremity joints (83.9%). Knee joints (26%) and foot joints except the first metatarsophalangeal (MTP) joint (26%) were more frequently involved than the first MTP joint (13%). Presurgical uric acid level ≥ 9 mg/dL (OR 3.77, 95% CI 1.28-11.10, p = 0.016) and amount of uric acid changes between before and after surgery (OR 1.62, 95% CI 1.21-2.18, p = 0.001) were risk factors for postsurgical gout flare. Taking allopurinol reduced the risk of postsurgical gout flare (OR 0.15, 95% CI 0.05-0.45, p = 0.001). Operation time, amount of blood loss during surgery, and surgery site were not significantly associated with postsurgical gout flare.
Adequate uric acid control before surgery could prevent the postsurgical gout flare.
评估既往诊断为痛风患者术后痛风发作的临床特征和危险因素。
共纳入 70 例曾在全麻下接受外科手术并在风湿科门诊就诊的痛风患者。比较术后发生痛风发作患者与未发生痛风发作患者的临床特征。
70 例患者中，31 例（44.3%）在术后发生痛风发作。痛风发作与手术的平均间隔时间为 3.7 天。发作倾向于累及单关节（61.3%），且累及下肢关节（83.9%）。膝关节（26%）和足部除第一跖趾关节（MTP）外的关节（26%）比第一 MTP 关节（13%）更常受累。术前血尿酸水平≥9mg/dL（OR 3.77，95%CI 1.28-11.10，p=0.016）和手术前后血尿酸水平变化（OR 1.62，95%CI 1.21-2.18，p=0.001）是术后痛风发作的危险因素。服用别嘌醇可降低术后痛风发作的风险（OR 0.15，95%CI 0.05-0.45，p=0.001）。手术时间、术中出血量和手术部位与术后痛风发作无显著相关性。
术前充分控制血尿酸水平可预防术后痛风发作。
