통풍의 치료(연수강좌)

초록

Principles of gout management 1. Patient education Unhealthy lifestyle, obesity, hypertension, excessive alcohol consumption and hyperlipidemia. Dietary restriction of purines fall plasma urate concentration only 1.0mg/dl (0.06mmol/l). Dietary restriction rarely sustain for long. Alcohol restriction has greater effect on the plasma urate concentration, depending upon the amount. Maintaining a urine volume of at least 1400ml/day facilitates urate excretion, although this usually only has a small impact on plasma urate concentrations. 2. Management of acute attacks: similar whatever the underlying cause. Initially, therapy is to relieve symptoms(NSAID, colchicine) & do not modify plasma urate concentration. Both gouty arthritis and nephrolithiasis are excruciatingly painful. Once the symptoms are controlled, initiate antihyperuricemic therapy. 3. Prevention of further attacks and the complications of chronic gout: normalizing the serum urate, Colchicine prophylaxis for at least 9 months after normalization of urate concentration. The use of hypouricemic drugs depends on the number of previous attacks, the degree of hyperuricemia, the presence of reversible factors, and the resence of tophi. Urate-lowering drugs after the second or third attacks. Used for tophaceous gout. Life-long treatment. 4. Attention to concomitant or etiologically related conditions. Renal impairment, thiazide. 5. Distinguish therapy for inflammation and that for hyperuricemia. Inappropriate use of antihyperuricemic agents during acute gout can cause a severe exacerbation.