Siegel L B, Alloway J A, Nashel D J
N. Chicago VAMC, Medical Service, IL 60064.
J Rheumatol. 1994 Jul;21(7):1325-7.
To determine the best alternative therapy for acute gouty arthritis when nonsteroidal antiinflammatory drugs or colchicine are contraindicated.
Thirty-one patients with crystal proven gout presenting with an acute attack of < 5 days' duration were treated prospectively with either a single intramuscular injection of adrenocorticotropic hormone (ACTH) 40 IU or triamcinolone acetonide 60 mg. The patients were followed for 30 days.
Resolution of all symptoms occurred at an average of 8 days for both groups. No adverse reactions were noted in either group; however, there were 11 reinjections in the ACTH group and 5 reinjections in the triamcinolone acetonide group. Two patients from the ACTH arm were transferred to the triamcinolone acetonide arm because of rebound arthritis.
Although recent studies of ACTH and triamcinolone acetonide have demonstrated efficacy and safety comparable to indomethacin, in a direct comparison of the 2 at the doses used, triamcinolone acetonide resulted in fewer rebound attacks and treatment failures than ACTH and required fewer reinjections.
确定在非甾体抗炎药或秋水仙碱禁忌时急性痛风性关节炎的最佳替代疗法。
31例经晶体证实为痛风且急性发作持续时间<5天的患者，前瞻性地接受单次肌内注射40 IU促肾上腺皮质激素（ACTH）或60 mg曲安奈德治疗。对患者进行30天的随访。
两组所有症状平均在8天内缓解。两组均未观察到不良反应；然而，ACTH组有11例再次注射，曲安奈德组有5例再次注射。ACTH组有2例患者因反弹性关节炎转至曲安奈德组。
尽管最近对ACTH和曲安奈德的研究已证明其疗效和安全性与吲哚美辛相当，但在所用剂量下对两者进行直接比较时，曲安奈德导致的反弹性发作和治疗失败比ACTH少，且再次注射次数更少。
