2012年acr痛风指南解读与安康信的应用.ppt

病例介绍 患者、男性、45岁。 高尿酸血症10年，痛风性关节炎5年，右踝关节再发一周。 体检：全身多处痛风石，包括右肘关节伸侧、右手第三MCP关节伸侧、右足第一跖趾关节处。右踝关节红肿明显，皮温升高。 辅助检查：UA 568mmol/L，Cr148umol/L。 治疗经过 非甾体类抗炎药：双氯芬酸50mg bid*3d，洛索洛芬钠60mg tid*3d。 强的松：30mg qd*2d 20mg qd*2d 10mg qd*2d 5mg qd*1d 降尿酸治疗：别嘌醇 0.1qd 停强的松一周后，右踝关节肿痛再次发作。 治疗经过 关节局部注射得宝松1支。 复查尿酸：482mmol/L，肌酐：130umol/L。 依托考昔120mg qd*10d 60mg qd。 别嘌醇0.1bid 0.1tid。 治疗经过 治疗经过 谢 谢！ Today I would like to talk about gout. Gout is a very common disease and one of the few curable diseases treated by rheumatologists. We have typically treated gout by lowering serum urate levels and using prophylactic medications or nonsteroidal anti-inflammatory drugs and perhaps corticosteroids, either orally or injected into the joint. We have treated gout on the basis of clinical experience and lessons passed down from generation to generation, but we have never had evidence-based guidelines to treat this very common and important condition. In October 2012, the American College of Rheumatology published guidelines for the management of gout and urate-lowering treatment in 2 parts in Arthritis Care and Research. [1,2] I would like to highlight some of the important features of these guidelines. The goal of the 2012 American College of Rheumatology (ACR) guidelines was to develop systematic nonpharmacologic and pharmacologic recommendations for effective treatments in gout with an acceptable risk/benefit ratio. Four specific areas of gout management covered by the guidelines were urate-lowering therapy (ULT), chronic gouty arthritis with tophaceous disease, analgesic and anti-inflammatory management of acute gouty arthritis, and pharmacologic anti-inflammatory prophylaxis of attacks of gouty arthritis. * Gout results from an excess body burden of uric acid, with hyperuricemia variably defined as a serum urate level exceeding either 6.8 or 7.0 mg/dL. Tissue deposition of monosodium urate monohydrate crystals in supersaturated extracellular fluids of the joints and in certain other