Sloan R W
J Fam Pract. 1982 May;14(5):923-6, 930-1, 934.
Although chronic tophaceous gout has become increasingly uncommon, hyperuricemia and acute gout are still common clinical entities. Most patients with hyperuricemia are under-excreters, and many of these cases are drug induced. Since longstanding asymptomatic hyperuricemia does not appear to cause progressive renal insufficiency, and uric acid renal stones are uncommon in underexcreters, these patients generally require no treatment. The minority of patients who overproduce uric acid are at increased risk for urolithiasis, and therapy should be decided on an individual basis. Acute gout is best treated with colchicine or indomethacin. The newer non-steroidal anti-inflammatory drugs (ie, ibuprofen, sulindac) may prove to be equally effective and are associated with fewer gastrointestinal side effects. Prophylaxis should be undertaken in patients with recurrent gout or documented uric acid urolithiasis. Although uricosuric drugs appear to be less toxic than allopurinol, they should not be used in patients who overproduce uric acid or in patients who have a history of urolithiasis or renal insufficiency. The allopurinol hypersensitivity syndrome is being reported with increased frequency and may be fatal.
尽管慢性痛风石性痛风已越来越少见，但高尿酸血症和急性痛风仍是常见的临床病症。大多数高尿酸血症患者是尿酸排泄减少型，其中许多病例是药物所致。由于长期无症状的高尿酸血症似乎不会导致进行性肾功能不全，且尿酸肾结石在尿酸排泄减少型患者中并不常见，因此这些患者通常无需治疗。少数尿酸生成过多的患者患尿路结石的风险增加，治疗应个体化决定。急性痛风最好用秋水仙碱或吲哚美辛治疗。新型非甾体抗炎药（如布洛芬、舒林酸）可能同样有效，且胃肠道副作用较少。复发性痛风或有尿酸结石记录的患者应进行预防。尽管促尿酸排泄药似乎比别嘌醇毒性小，但不应在尿酸生成过多的患者或有尿路结石病史或肾功能不全的患者中使用。别嘌醇超敏综合征的报告频率越来越高，可能会致命。
