1、精品文檔歐洲抗風(fēng)濕聯(lián)盟（EULAR）對(duì)痛風(fēng)治療的12項(xiàng)建議1. Optimal treatment of gout requires both non-pharmacological and pharmacological modalities and should be tailored according to:specific risk factors (levels of serum urate, previous attacks, radiographic signs); clinical phase (acute/recurrent gout, intercritical gout

2、, and chronic tophaceous gout); general risk factors (age, sex, obesity, alcohol consumption, urate elevating drugs, drug interactions and comorbidity). Strength of recommendation: 96 (95% CI, 93 to 98) 1痛風(fēng)最佳治療需藥物和非藥物治療手段相聯(lián)合，并根據(jù)以下情況調(diào)整：（1）特殊的危險(xiǎn)因素（血尿酸水平，以前發(fā)作情況和放射線表現(xiàn)）；（2）臨床階段（急性/復(fù)發(fā)性痛風(fēng)，發(fā)作間歇期痛風(fēng)和慢性痛風(fēng)石性痛風(fēng)）

3、；（3）一般危險(xiǎn)因素（年齡、性別、肥胖、飲酒、增高尿酸藥，藥物相互作用和合并疾?。?推薦力度：96（95%的可信區(qū)間93-98）2. Patient education and appropriate lifestyle. advice regarding weight loss if obese, diet, and reduced alcohol (especially beer) are core aspects of management. Strength of recommendation: 95 (95% CI, 91 to 99)2患者教育和良好生活方式肥胖者控制體重、飲食控

4、制及減少飲酒（尤其是啤酒）是治療核心部分。推薦力度：95（95%的可信區(qū)間91-99）3. Associated comorbidity and risk factors such as hyperlipidaemia, hypertension, hyperglycaemia, obesity and smoking should be addressed as an important part of the management of gout. Strength of recommendation: 91 (95% CI, 86 to 97)3應(yīng)重視合并的疾病和發(fā)病相關(guān)的危險(xiǎn)因素如高血

5、脂、肥胖和吸煙，并作為痛風(fēng)處理的重要部分。推薦力度：91（95%的可信區(qū)間86-97）4. Oral colchicine and/or NSAIDs are first line agents for systemic treatment of acute gout. In the absence of contraindications an NSAID is a convenient and well accepted option. Strength of recommendation: 94 (95% CI, 91 to 98)4急性痛風(fēng)全身治療的一線用藥是口服秋水仙堿和/或非甾類抗

6、炎藥。如無禁忌，非甾類抗炎藥是一種方便且易于接受的選擇。推薦力度：94（95%的可信區(qū)間91-98）5. High doses of colchicine lead to side effects, and low doses (for example 0.5 mg three times daily) may be sufficient for some patients with acute gout. Strength of recommendation: 83 (95% CI, 74 to 92)5大劑量秋水仙堿會(huì)帶來副作用，而低劑量秋水仙堿（如0.5mg,每日3次）足可控制某些急性痛

7、風(fēng)。推薦力度：83（95%的可信區(qū)間74-92）6. Intra-articular aspiration and injection of a long acting steroid is an effective and safe treatment for an acute attack. Strength of recommendation: 80 (95% CI, 73 to 87)6關(guān)節(jié)內(nèi)穿刺和注射長效激素對(duì)治療急性痛風(fēng)有效和安全。推薦力度：80（95%的可信區(qū)間73-87） 7. Urate lowering therapy is indicated in patients wi

8、th recurrent acute attacks, arthropathy, tophi, or radiographic changes of gout. Strength of recommendation: 97 (95% CI, 95 to 99) 7急性痛風(fēng)反復(fù)發(fā)作、關(guān)節(jié)病、痛風(fēng)石或有放射線改變的痛風(fēng)患者應(yīng)行降尿酸治療。推薦力度：97（95%的可信區(qū)間95-99）8. The therapeutic goal of urate lowering therapy is to promote crystal dissolution and prevent crystal format

9、ion. This is achieved by maintaining the serum uric acid below the saturation point for monosodium urate ( 360 mol/l or 6 mg/dl). Strength of recommendation: 91 (95% CI, 86 to 96)8降尿酸治療的目標(biāo)是促進(jìn)晶體溶解和防止晶體形成，這就需要使血尿酸水平低于尿酸單鈉的飽和點(diǎn)（ 360 mol/l 或 6 mg/dl). 推薦力度：91（95%的可信區(qū)間86-96）9. Allopurinol is an appropriat

10、e long term urate lowering therapy. It should be started at a low dose (100 mg daily) and increased by 100 mg every two to four weeks if required. The dose must be adjusted in patients with renal impairment. If allopurinol toxicity occurs, options include other xanthine oxidase inhibitors, a uricosu

11、ric agent, or allopurinol desensitisation (the latter only in cases of mild rash). Strength of recommendation: 91 (95% CI, 88 to 95)9別嘌呤醇是一種合適的長期降尿酸藥物。應(yīng)以低劑量開始（100mg/d），如有需要，則每2-4周逐步增加100mg。該劑量需根據(jù)患者的腎損害情況進(jìn)行調(diào)節(jié)。如出現(xiàn)藥物毒性，其他選擇包括其他黃嘌呤氧化酶抑制劑、促進(jìn)尿酸排泄藥或脫敏療法（后者僅適于輕度皮疹者）。推薦力度：91（95%的可信區(qū)間88-95）10. Uricosuric agen

12、ts such as probenecid and sulphinpyrazone can be used as an alternative to allopurinol in patients with normal renal function but are relatively contraindicated in patients with urolithiasis. Benzbromarone can be used in patients with mild to moderate renal insufficiency on a named patient basis but

13、 carries a small risk of hepatotoxicity. Strength of recommendation: 87 (95% CI, 81 to 92)10對(duì)于腎臟功能正常的患者可使用排尿酸藥如丙磺舒和苯磺唑酮替代別嘌呤醇，但有尿路結(jié)石者為相對(duì)禁忌。苯溴馬龍能用于輕中度腎功能不全的患者，但有引起肝毒性的輕度危險(xiǎn)性。推薦力度：87（95%的可信區(qū)間81-92）11. Prophylaxis against acute attacks during the first months of urate lowering therapy can be achieved by

14、 colchicine (0.5 to 1 mg daily) and/or an NSAID (with gastro-protection if indicated). Strength of recommendation: 90 (95% CI, 86 to 95)11在使用降尿酸治療的第一個(gè)月可用秋水仙堿(0.5 -1 mg/d)和/或非甾類抗炎藥來預(yù)防急性痛風(fēng)的發(fā)作。推薦力度：90（95%的可信區(qū)間86-95）12. When gout associates with diuretic therapy, stop the diuretic if possible. For hypertension and hyperlipidaemia consider the use of losarta