Wise C M, Agudelo C A
Division of Rheumatology, Allergy, and Immunology, Medical College of Virginia, Richmond 23298, USA.
Curr Opin Rheumatol. 1996 May;8(3):248-54. doi: 10.1097/00002281-199605000-00014.
Important observations have continued to expand our understanding of gout. The increased risk of gout in black Americans has been linked more closely with the development of hypertension, and an increasing prevalence in African blacks and in England may have a similar association, possibly through the use of diuretics. The association of gout and insulin resistance appears to be related to fat distribution, and the link with hyperlipidemia may be related to genetic factors. The relationship between gout and renal disease and the frequency of gout in patients with renal failure continue to be areas of controversy. The mechanism and a possible therapeutic approach to the hyperuricemia associated with cyclosporine therapy are better understood. The potential for antibodies against urate crystals to potentiate further crystallization may explain some of the uncertainties about gouty attacks. Unusual manifestations of gout, including more cases of spinal involvement, were reported. The role of formalin in dissolving urate crystals in pathologic specimens was further clarified, and the use of atomic force microscopy to detect crystals was reported. Corticosteroids are increasingly accepted in treating acute gout, and the role of colchicine in acute and intercritical gout has come under increasing scrutiny. Urate-lowering drugs appear to be cost effective in patients with more than one or two attacks per year.
重要的观察结果不断拓展我们对痛风的认识。美国黑人痛风风险增加与高血压的发展联系更为紧密，非洲黑人和英格兰痛风患病率上升可能也有类似关联，或许是通过使用利尿剂所致。痛风与胰岛素抵抗的关联似乎与脂肪分布有关，而与高脂血症的联系可能与遗传因素有关。痛风与肾脏疾病的关系以及肾衰竭患者中痛风的发生率仍是存在争议的领域。与环孢素治疗相关的高尿酸血症的机制及可能的治疗方法已得到更好的理解。抗尿酸盐晶体抗体促使进一步结晶的可能性或许可以解释痛风发作的一些不确定性。有报告称出现了痛风的不寻常表现，包括更多脊柱受累病例。福尔马林在病理标本中溶解尿酸盐晶体的作用得到进一步阐明，且有报告称使用原子力显微镜检测晶体。皮质类固醇在治疗急性痛风方面越来越被接受，而秋水仙碱在急性和发作间期痛风中的作用受到越来越多的审视。降尿酸药物对于每年发作不止一两次的患者似乎具有成本效益。
