最新痛风治疗指南

欧洲抗风湿联盟（EULAR）对痛风治疗的12项建议 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, 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．痛风最佳治疗需药物和非药物治疗手段相联合，并根据以下情况调整：（1）特殊的危险因素（血尿酸水平，以前发作情况和放射线表现）；（2）临床阶段（急性/复发性痛风，发作间歇期痛风和慢性痛风石性痛风）；（3）一般危险因素（年龄、性别、肥胖、饮酒、增高尿酸药，药物相互作用和合并疾病）。推荐力度：96（95%的可信区间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[肥胖者控制体重、饮食控制及减少饮酒（尤其是啤酒）是治疗核心部分]。推荐力度：95（95%的可信区间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．应重视合并的疾病和发病相关的危险因素如高血脂、肥胖和吸烟，并作为痛风处理的重要部分。推荐力度：91（95%的可信区间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．急性痛风全身治疗的一线用药是口服秋水仙碱和/或非甾类抗炎药。如无禁忌，非甾类抗炎药是一种方便且易于接受的选择。推荐力度：94（95%的可信区间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．大剂量秋水仙碱会带来副作用，而低剂量秋水仙碱（如0.5mg,每日3次）足可控制某些急性痛风。推荐力度：83（95%的可信区间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．关节内穿刺和注射长效激素对治疗急性痛风有效和安全。推荐力度：80（95%的可信区间73-87） 7. Urate lowering therapy is indicated in patients with recurrent acute attacks, arthropathy, tophi, or radiographic changes of gout. Strength of recommendation: 97 (95% CI, 95 to 99) 7．急性痛风反复发作、关节病、痛风石或有放射线改变的痛风患者应行降尿酸治疗。推荐力度：97（95%的可信区间95-99） 8. The therapeutic goal of urate lowering therapy is to promote crystal dissolution and prevent crystal formation. This is achieved by maintaining the serum uric acid below the saturation point for monosodium urate ( 360 µmol/l or 6

mg/dl). Strength of recommendation: 91 (95% CI, 86 to 96) 8．降尿酸治疗的目标是促进晶体溶解和防止晶体形成，这就需要使血尿酸水平低于尿酸单钠的饱和点（360 µmol/l 或6 mg/dl). 推荐力度：91（95%的可信区间86-96） 9. Allopurinol is an appropriate 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 uricosuric agent, or allopurinol desensitisation (the latter only in cases of mild rash). Strength of recommendation: 91 (95% CI, 88 to 95) 9．别嘌呤醇是一种合适的长期降尿酸药物。应以低剂量开始（100mg/d），如有需要，则每2-4周逐步增加100mg。该剂量需根据患者的肾损害情况进行调节。如出现药物毒性，其他选择包括其他黄嘌呤氧化酶抑制剂、促进尿酸排泄药或脱敏疗法（后者仅适于轻度皮疹者）。推荐力度：91（95%的可信区间88-95） 10. Uricosuric agents 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 carries a small risk of hepatotoxicity. Strength of recommendation: 87 (95% CI, 81 to 92) 10．对于肾脏功能正常的患者可使用排尿酸药如丙磺舒和苯磺唑酮替代别嘌呤醇，但有尿路结石者为相对禁忌。苯溴马龙能用于轻中度肾功能不全的患者，但有引起肝毒性的轻度危险性。推荐力度：87（95%的可信区间81-92） 11. Prophylaxis against acute attacks during the first months of urate lowering therapy can be achieved by colchicine (0.5 to 1 mg daily) and/or an