Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital.
Harvard Medical School.
Curr Opin Rheumatol. 2021 Mar 1;33(2):145-154. doi: 10.1097/BOR.0000000000000784.
To review recent literature with relevance to the management of multimorbid patients with gout, i.e., gout medication repurposed for comorbidities and vice versa.
Adding to the previous success of interleukin-1 inhibition, two trials on low-dose colchicine's role in cardiovascular disease (CVD) demonstrated potential benefits in patients with or without gout. In Colchicine Cardiovascular Outcomes Trial, a composite CVD endpoint was reduced by 23% among patients who had experienced a recent myocardial infarction. In Low-Dose Colchicine 2, the composite CVD endpoint was reduced 31% among those with stable coronary artery disease. Use of urate-lowering therapy (ULT) for renal protection in patients without gout produced null results. Allopurinol did not benefit the glomerular filtration rate in two trials (Controlled trial of slowing of Kidney Disease progression From the Inhibition of Xanthine oxidase and Preventing Early Renal Function Loss) among patients with chronic kidney disease (with or without hyperuricemia, but not gout). SGLT-2 inhibitors, a medication recommended for patients with diabetes and CVD, diabetic kidney disease, or heart failure, demonstrated a protective effect against gout flares in a secondary trial analysis and a large observational study.
The role of colchicine may expand beyond gout flare prevention to patients with existing CVD. The renal benefit of ULT among patients with gout remains unclear. SGLT-2 inhibitors may benefit diabetic patients who have gout as a comorbidity.
综述与多合并症痛风患者管理相关的最新文献，即痛风药物用于治疗合并症和反之亦然。
在白介素-1 抑制取得先前成功的基础上，两项关于小剂量秋水仙碱在心血管疾病（CVD）中作用的试验显示出对有或无痛风患者的潜在益处。在秋水仙碱心血管结局试验中，近期心肌梗死后的患者复合 CVD 终点降低了 23%。在低剂量秋水仙碱 2 试验中，稳定型冠状动脉疾病患者的复合 CVD 终点降低了 31%。在没有痛风的患者中，使用尿酸降低疗法（ULT）进行肾脏保护未产生结果。在两项试验（抑制黄嘌呤氧化酶减缓肾脏病进展和预防早期肾功能丧失的对照试验）中，别嘌醇对肾小球滤过率没有益处，这些试验的患者患有慢性肾脏病（无论是否存在高尿酸血症，但没有痛风）。钠-葡萄糖协同转运蛋白 2（SGLT-2）抑制剂是一种推荐用于患有糖尿病和 CVD、糖尿病肾病或心力衰竭的患者的药物，在一项二次试验分析和一项大型观察性研究中显示出对痛风发作的保护作用。
秋水仙碱的作用可能从预防痛风发作扩展到有现有 CVD 的患者。痛风患者 ULT 的肾脏益处仍不清楚。SGLT-2 抑制剂可能有益于患有痛风合并症的糖尿病患者。
