Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France.
Service de rhumatologie, université de Lille, GH de l'institut catholique de Lille, Lille, France; EA4490, physiopathologie des maladies osseuses inflammatoires, université de Lille, Lille, France.
Joint Bone Spine. 2020 Oct;87(5):387-393. doi: 10.1016/j.jbspin.2020.05.001. Epub 2020 May 15.
To develop French Society of Rheumatology-endorsed recommendations for the management of gout flares.
These evidence-based recommendations were developed by 9 rheumatologists (academic or community-based), 3 general practitioners, 1 cardiologist, 1 nephrologist and 1 patient, using a systematic literature search, one physical meeting to draft recommendations and 2 Delphi rounds to finalize them.
A set of 4 overarching principles and 4 recommendations was elaborated. The overarching principles emphasize the importance of patient education, including the need to auto-medicate for gout flares as early as possible, if possible within the first 12h after the onset, according to a pre-defined treatment. Patients must know that gout is a chronic disease, often requiring urate-lowering therapy in addition to flare treatment. Comorbidities and the risk of drug interaction should be screened carefully in every patient as they may contraindicate some anti-inflammatory treatments. Colchicine must be early prescribed at the following dosage: 1mg then 0.5mg one hour later, followed by 0.5mg,2 to 3 times/day over the next days. In case of diarrhea, which is the first symptom of colchicine poisoning, dosage must be reduced. Colchicine dosage must also be reduced in patients with chronic kidney disease or taking drugs, which interfere with its metabolism. Other first-line treatment options are systemic/intra-articular corticosteroids, or non-steroidal anti-inflammatory agents (NSAIDs). IL-1 inhibitors can be considered as a second-line option in case of failure, intolerance or contraindication to colchicine, corticosteroids and NSAIDs. They are contraindicated in cases of infection and neutrophil blood count should be monitored.
These recommendations aim to provide strategies for the safe use of anti-inflammatory agents, in order to improve the management of gout flares.
制定法国风湿病学会认可的痛风发作管理推荐意见。
9 位风湿病学家（学术或社区医生）、3 位全科医生、1 位心脏病专家、1 位肾病学家和 1 位患者，使用系统文献检索、1 次现场会议起草推荐意见以及 2 次 Delphi 轮次，制定了这些基于证据的推荐意见。
制定了一套 4 项总体原则和 4 项推荐意见。这些总体原则强调了患者教育的重要性，包括尽早自我治疗痛风发作的必要性，最好在发作后 12 小时内，根据预先确定的治疗方案进行治疗。患者必须知道痛风是一种慢性病，除了痛风发作的治疗外，通常还需要降低尿酸治疗。应仔细筛查每位患者的合并症和药物相互作用的风险，因为这可能会使某些抗炎治疗方法产生禁忌。秋水仙碱必须按照以下剂量尽早开具：首剂 1mg，1 小时后 0.5mg，然后 0.5mg，每天 2 至 3 次，接下来几天。一旦出现秋水仙碱中毒的第一个症状——腹泻，就必须减少剂量。在慢性肾脏病或正在服用干扰其代谢的药物的患者中，也必须减少秋水仙碱的剂量。如果对秋水仙碱、皮质类固醇和 NSAIDs 不耐受或有禁忌，则其他一线治疗选择是全身/关节内皮质类固醇或非甾体抗炎药（NSAIDs）。如果对秋水仙碱、皮质类固醇和 NSAIDs 治疗无效、不耐受或有禁忌，IL-1 抑制剂可作为二线选择。在感染情况下，以及在监测中性粒细胞计数时，均应避免使用 IL-1 抑制剂。
这些推荐意见旨在提供安全使用抗炎药物的策略，以改善痛风发作的管理。
