【原】【晨读】痛风的最新指南（一）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Drug and Therapeutics Bulletin. Latest guidance on the management of gout. BMJ. 2018 Jul 18;362:k2893. 本次学习由阎芳副研究员主讲。

What you need to know

·  An acute attack of gout is likely to require treatment with a NSAID (with gastroprotection for those at high risk of gastrointestinal complications) or colchicine.

·  In general, urate lowering therapy (ULT) is targeted to patients with recurrent attacks, tophi, urate arthropathy, or renal damage and to symptomatic patients with very high serum uric acid levels. Allopurinal is the first line option.

·  Shared decision making about ULT should include consideration of harms, benefits, and limitations of ULT, along with patient preferences, comorbidities, and concomitant drug treatments.

·  All patients taking ULT require regular monitoring of renal function and serum uric acid level to ensure that the dose is appropriate. For many people, allopurinol 300 mg daily will be insufficient to achieve target serum uric acid reductions.

·  Despite limited evidence, patients should be encouraged to manage their weight, increase exercise, and reduce alcohol consumption.

你需要知道的

·痛风的急性发作可能需要使用非甾体抗炎药（对胃肠道并发症的高危人群进行胃保护）或秋水仙碱治疗。

·一般来说，降尿酸治疗（ULT）针对的是痛风反复发作、痛风石、尿酸性关节病或肾损害的患者以及血清尿酸水平非常高的有症状患者。别嘌呤醇是首选。

·在启动ULT时，需综合考虑到ULT的危害、益处和限制，以及患者偏好、合并症和同时服用的其它药物影响。

·所有进行ULT的患者都需要定期监测肾功能和血清尿酸水平，以确保剂量合适。对许多人来说，别嘌呤醇300毫克每天不足以达到血清尿酸减少的目标值。

·尽管证据有限，但应鼓励患者控制体重、增加运动量和减少饮酒。

Gout is the most common inflammatory arthritis and its incidence in the UK has steadily increased from 1.5% in 1997 to 2.5% in 2012.It is characterised by deposition of monosodium urate crystals in joints and tissues and usually presents with intermittent painful attacks followed by long periods of remission. Here, we review the latest guidance on the management of gout and consider the role of long term urate lowering therapy.

痛风是最常见的炎性关节炎，其发病率从1997年的1.5%稳步上升到2012年的2.5%。它的特点是尿酸单钠晶体沉积在关节和组织中，通常表现为间歇性疼痛发作，随后长期缓解。在这里，我们回顾了痛风治疗的最新指南，并探讨长期降尿酸治疗的作用。

What are the main risk factors for gout?

The single most important risk factor is sustained hyperuricaemia, which can be caused by overproduction or underexcretion of urate. Pathological hyperuricaemia has been defined as the serum uric acid concentration (408 μmol/L) above which monosodium urate crystals form in vitro at physiological pH and temperature. For most people with gout, underexcretion is the main cause of hyperuricaemia. Other factors associated with the development of gout include drugs (such as diuretics, ciclosporin, and low dose aspirin), renal impairment, excessive consumption of red meat or seafood, fructose-sweetened drinks, and alcohol (in particular, beer and spirits).

痛风的主要危险因素是什么？

一个最重要的危险因素是持续的高尿酸血症，这可能是由于尿酸盐生成过剩或排泄不足。病理性高尿酸血症被定义为血清尿酸浓度（408μmol/L）高于在体外生理pH和温度下尿酸单钠晶体形成的尿酸浓度。对于大多数痛风患者来说，排泄不足是高尿酸血症的主要原因。与痛风发生有关的其他因素包括药物（如利尿剂、环孢素和低剂量阿司匹林）、肾损害、过量食用红肉或海鲜、果糖饮料和酒精（尤其是啤酒和烈酒）。

How is it diagnosed?

Although the risk of developing gout increases with higher levels of serum uric acid, hyperuricaemia alone is not sufficient for diagnosis because most people with hyperuricaemia do not have gout.However, chronic hyperuricaemia is associated with recurrent flares and can lead to tophi, chronic gouty arthritis, and erosive arthritis.6 Although a definitive diagnosis of gout is made by the demonstration of monosodium urate crystals in synovial fluid, this is rarely undertaken in primary care.

如何诊断痛风？

尽管痛风的发病风险随着血尿酸水平的升高而增加，但高尿酸血症本身并不足以诊断痛风，因为大多数高尿酸血症患者没有痛风发作。不过，慢性高尿酸血症与痛风反复发作有关，并可导致痛风石，慢性痛风性关节炎，甚至侵蚀性关节炎。虽然痛风的确诊是应在滑液中发现尿酸单钠晶体，但这在基层医疗机构中很少付诸实践。