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欧洲抗风湿病联盟（EULAR）在2006年发布了第一版的《痛风及高尿酸血症的诊断和治疗建议》，这是全世界最权威的痛风防治指导性文档，可以说全世界的痛风防治都会以此文档作为参照。
这个文档每5年更新一次，2011年更新了一版，参见老杨之前的两篇文章：《EULAR的16条痛风治疗建议》和《EULAR的10条痛风诊断建议》。
前段时间，EULAR再次更新了这个文档，给出了痛风治疗的3个总原则和11条防治建议。为了避免翻译错误，老杨把英文原文也放在这儿，英文好的建议还是看英文。
因为都是大白话，就不解释了。
A： Every person with gout should be fully informed about the pathophysiology of the disease, the existence of effective treatments, associated comorbidities and the principles of managing acute attacks and eliminating urate crystals through lifelong lowering of SUA level below a target level.
痛风病人应该知道痛风的病理机制、 治疗方法、可能引发的并发症、急性发作时如何处理，以及： 痛风必须通过将血尿酸浓度维持在某个水平之下才能消除尿酸结晶。
Every person with gout should receive advice regarding lifestyle: weight loss if appropriate and avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks, heavy meals and excessive intake of meat and seafood. Low-fat dairy products should be encouraged. Regular exercise should be advised.
痛风病人要保持健康的生活方式：适当减肥，不喝酒 （尤其是啤酒和烈酒） 和含糖饮料、重口味食品和过多的肉和海鲜。应鼓励低脂肪奶制品（参见《食品嘌呤表》），建议定期锻炼（参见《痛风患者该怎么运动？》）。
Every person with gout should be systematically screened for associated comorbidities and cardiovascular risk factors, including renal impairment, coronary heart disease, heart failure, stroke, peripheral arterial disease, obesity, hyperlipidaemia, hypertension, diabetes and smoking, which should be addressed as an integral part of the management of gout.
痛风患者要知道痛风会引发并发症，了解对心血管不利的因素，包括肾功能不全、 冠心病、 心衰、 中风、 外周动脉疾病、 肥胖、 高脂血症、 高血压、 糖尿病和吸烟。
这11条的内容中特别专业、不需要病人们深入了解的，老杨就不翻译了，用省略号表示。
在老杨看来，对大部分痛风朋友来讲，这11条主要是三句话：急性发作时吃药消炎，平时降酸治疗，降酸目标是360mmol/L。
1：Acute flares of gout should be treated as early as possible. Fully informed patients should be educated to self-medicate at the first warning symptoms. The choice of drug (s) should be based on the presence of contraindications, the patient’s previous experience with treatments, time of initiation after flare onset and the number and type of joint(s) involved.
痛风急性发作应该尽快尽早治疗。病人应该能够出现症状后，自己选择合适的药物。 病人应该基于自己的身体过敏等禁忌症状、以往的治疗经验、发作时间、发作的关节和数量来选择该吃哪些药。
2：Recommended first-line options for acute flares are colchicine (within 12 hours of flare onset) at a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1 and/or an NSAID (plus proton pump inhibitors if appropriate), oral corticosteroid (30–35 mg/day of equivalent prednisolone for 3–5 days) or articular aspiration and injection of corticosteroids. Colchicine and NSAIDs should be avoided in patients with severe renal impairment. Colchicine should not be given to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors such as cyclosporin or clarithromycin.
痛风急性治疗药物包括： 老杨提醒：国内也有同样的做法，但会注明第1天总剂量不能超过6mg。建议大家以安全第一为准则，听从医生建议。
对于肾功能重度损害的患者，应避免服用秋水仙碱和非甾体抗炎药。...
3：In patients with frequent flares and contraindications to colchicine, NSAIDs and corticosteroid (oral and injectable), IL-1 blockers should be considered for treating flares. Current infection is a contraindication to the use of IL-1 blockers. ULT should be adjusted to achieve the uricaemia target following an IL-1 blocker treatment for flare.
痛风经常发作，且对秋水仙碱、 非甾体类抗炎药和皮质类固醇激素过敏的患者 ，可以考虑采用IL-1 blockers （白细胞介素-1受体阻滞剂）。...
4：Prophylaxis against flares should be fully explained and discussed with the patient. Prophylaxis is recommended during the first 6 months of ULT. Recommended prophylactic treatment is colchicine, 0.5–1 mg/day, a dose that should be reduced in patients with renal impairment. In cases of renal impairment or statin treatment, patients and physicians should be aware of potential neurotoxicity and/or muscular toxicity with prophylactic colchicine. Co-prescription of colchicine with strong P-glycoprotein and/or CYP3A4 inhibitors should be avoided. If colchicine is not tolerated or is contraindicated, prophylaxis with NSAIDs at low dosage, if not contraindicated, should be considered.
进行降酸的前6个月可能会痛风急性，这很正常，可以每天服用0.5-1 毫克的秋水仙碱预防，但是如果肾功能不正常，应减少剂量。 当病人的肾功能损害或他汀类药物治疗的情况下，患者和医生应该意识到，秋水仙碱可能的副作用。...
5：ULT should be considered and discussed with every patient with a definite diagnosis of gout from the first presentation. ULT is indicated in all patients with recurrent flares, tophi, urate arthropathy and/or renal stones. Initiation of ULT is recommended close to the time of first diagnosis in patients presenting at a young age (<40 years)="" or="" with="" a="" very="" high="" sua="" level="" (="">8.0 mg/dL; 480mmol/L) and/or comorbidities (renal impairment, hypertension, ischaemic heart disease, heart failure). Patients with gout should receive full information and be fully involved in decision-making concerning the use of ULT.
病人一旦痛风发作并确诊，就应该考虑是否有必要进行降酸治疗。 对于近期痛风急性发作过、痛风石或肾结石，都建议考虑降酸治疗。 第一次痛风发作低于40岁、尿酸水平较高 (> 8.0 mg/dL; 480mmol/L)、痛风并发症 （肾功能不全、 高血压、 缺血性心脏病、 心衰），都应该考虑降酸治疗。
6：For patients on ULT, SUA level should be monitored and maintained to <6 mg/dl="" (360mmol/l).="" a="" lower="" sua="" target=""><5 mg/dl;="" 300mmol/l)="" to="" facilitate="" faster="" dissolution="" of="" crystals="" is="" recommended="" for="" patients="" with="" severe="" gout="" (tophi,="" chronic="" arthropathy,="" frequent="" attacks)="" until="" total="" crystal="" dissolution="" and="" resolution="" of="" gout.="" sua="" level=""><3 mg/dl="" is="" not="" recommended="" in="" the="" long="">
降酸的目标应该是血尿酸水平低于 6 mg/dL (360mmol/L)（可参考《血尿酸浓度多少才算高？》）。 对于痛风石（可参考《痛风石，看这篇就够了。》）或者经常痛风发作的患者，降酸目标应该是低于5 mg/dL或 300mmol/L，这样能够促进晶体更快溶解。 注意，血尿酸水平不应该长期低于3mg/dL。
降酸治疗必须从低剂量开始，然后再逐渐增加剂量，降酸治疗的目标应该是终身血尿酸浓度维持在低于 6 mg/dL (360mmol/L)的水平。
8：In patients with normal kidney function, allopurinol is recommended for first-line ULT, starting at a low dose (100 mg/day) and increasing by 100 mg increments every 2–4 weeks if required, to reach the uricaemia target. If the SUA target cannot be reached by an appropriate dose of allopurinol, allopurinol should be switched to febuxostat or a uricosuric or combined with a uricosuric. Febuxostat or a uricosuric are also indicated if allopurinol cannot be tolerated.
肾功能正常的痛风病人，首选别嘌醇作为降酸药（可参考《降酸药及其副作用》）。最开始的剂量推荐100mg/天，之后如果为了达到血尿酸目标，可以每2-4周增加100mg/天。 如果服用别嘌醇不能达到降酸效果，可以考虑服用非布索坦或者其他能促进尿酸排泄的降酸药。 另外，如果服用别嘌醇过敏的，也应该考虑非布索坦或者其他降酸药。
9：In patients with renal impairment, the allopurinol maximum dosage should be adjusted to creatinine clearance. If the SUA target cannot be achieved at this dose, the patient should be switched to febuxostat or given benzbromarone with or without allopurinol, except in patients with estimated glomerular filtration rate <30>
对于肾功能受损的痛风患者，别嘌呤醇的最大剂量必须根据肌酐清除率进行调整。（有关肌酐基础知识，请看《痛风了，肌酐高是咋回事？》） 如果降酸目标无法实现，可以考虑换成非布索坦，如果病人的肾小球滤过率 < 30="">苯溴马隆（可以和别嘌醇合用）（可参考《别嘌呤醇和苯溴马隆能否一起吃?》）。
10：In patients with crystal-proven, severe debilitating chronic tophaceous gout and poor quality of life, in whom the SUA target cannot be reached with any other available drug at the maximal dosage (including combinations), pegloticase is indicated.
对于有严重痛风石病人或痛风严重影响生活质量的病人，如果其他药物不能达到降酸效果，可以考虑Krystexxa (pegloticase)。（参见《介绍一下普瑞凯希》）
11：When gout occurs in a patient receiving loop or thiazide diuretics, substitute the diuretic if possible; for hypertension consider losartan or calcium channel blockers; for hyperlipidaemia, consider a statin or fenofibrate.
痛风急性发作时，病人应该停服利尿剂，高血压应该考虑氯沙坦或钙离子拮抗剂类降压药，而高脂血症患者，应该考虑他汀类药物或非诺贝特。
好了，就翻译到这儿了。
如果觉得好就请您共享到朋友圈吧，赠人玫瑰，手留余香！
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