痛風(fēng)的藥物治療

Drug

Therapy

forHyperlipidemia1

Knowledge

objectivesTo

grasp

the

principles

for

treatment

of

gout

and

selection

of

drugs,

be

familiarwith

the

common

clinical

symptoms

of

gout,

understand

the

definition,etiology

and

pathogenesis

of

gout.2

Capability

objectivesTo

guide

the

rational

use

of

gout

drugsTo

instruct

patients

to

adopt

proper

diet

and

lifestyle.3

Literacy

objectivesTo

provide

care

for

patients

with

gout

and

improve

patient

compliance.Learning

objectivesOverview

of

goutClinical

featuresTreatment

principlesDrug

selection1

Overview

of

gout2.

Clinical

features3.

Treatment

principles4.

Drug

selectionOverview

of

goutWhere

do

purines

come

from?How

does

abnormal

uric

acid

occur?1

Overview

of

gout2.

Clinical

features3.

Treatment

principles4.

Drug

selection(1)

Definition

of

goutPurine

metabolism

disorderIncreased

uric

acidproductionDecreased

uric

acidexcretionUrate

crystal

precipitationTissue

and

organ

injury1

Overview

of

gout2.

Clinical

features3.

Treatment

principles4.

Drug

selectionDirection

is

more

important

than

hard

work(2)

Causes

of

increased

uric

acidDead

cellsGenerate

more

LiverdecompositionPurineHigh

uric

acid

contentEatPurineLess

excrement

Uric

acidHormone,

drug

HyperuricemiaGout1

Overview

of

gout2.

Clinical

features3.

Treatment

principles4.

Drug

selection(3)

Classification

of

goutPrimary

gout

90%Genetic

defectClassification

of

goutSecondary

gout

10%Enzyme

and

metabolic

defects

Kidney

disease

Blood

disease

DrugHigh

purine

foods1

Overview

of

gout3.

Treatment

principles4.

Drug

selection2.

ClinicalfeaturesClinical

featuresHow

severe

is

gout?1

Overview

of

gout3.

Treatment

principles4.

Drug

selection2.

ClinicalfeaturesJoint

lesionsGout

calculus

Kidneydamage1

Overview

of

gout3.

Treatment

principles4.

Drug

selection2.

Clinicalfeatures

(I)

Joint

lesions1.

Urgent,

often

starting

early

in

the

morning

and

starting

atthe

metatarsophalangeal

joint.2.

Often

attack

the

joints

of

lower

limbs,

particularly

distaljoints

of

limbs.3.

General

malaise,

increased

body

temperature.4.

Skin

presents

dark

red.5.

The

more

severe

the

disease,

the

longer

the

reliefduration.1

Overview

of

gout3.

Treatment

principles4.

Drug

selection2.

Clinicalfeatures(II)

Gout

calculusJoint

and

soft

tissue

calculuscalculus

on

body

surface1

Overview

of

gout3.

Treatment

principles4.

Drug

selection2.

Clinicalfeatures(III)

Kidney

damageUric

acid

urinary

calculusRenal

tubules

and

collecting

ductsFiltrationBloodGlomerulusFinalurine

Capillaries

around

renal

tubulesAcute

uric

acidnephropathyOriginalurineReabsorptionSecretionRenalcortexRenalpyramidCalycesrenalesminoresColumnaerenales

RenalpapillaeMajorrenalcalices

Pelvis

UreterUrate

nephropathy1

Overview

of

gout3.

Treatment

principles4.

Drug

selection2.

ClinicalfeaturesTreatment

principles1

Overview

of

gout4.

Drug

selection2.

Clinical

features3.

TreatmentprinciplesAnalgesic

Anti-acuteinflammation

Correction

ofhyperuricemiaPrevent

recurrenceProtect

joints

and

kidneysDrop4.

Drug

selection1

Overview

of

gout

2.

Clinical

features

3.

Treatment

principlesDrug

selection

4How

to

choose

drugs

in

different

stages

of

gout?Types

of

gout

medications4.

Drug

selection1

Overview

of

gout

2.

Clinical

features

3.

Treatment

principles

DrugselectionOne

analgesic

and

two

decreasing

effectsAspirin,Acetaminophen,Celecoxib,

Colchicine,

GlucocorticoidAnalgesic

and

anti-inflammatory(analgesic)(decreased)Promote

uric

acid

excretion(decreased)Inhibit

the

production

of

uric

acidBenzbromarone,

probenecidFebuxostat,Allopurinol4.

Drug

selection1

Overview

of

gout

2.

Clinical

features

3.

Treatment

principles

(I)

Treatment

in

the

acute

stage

(as

early

as

possible

and

adequately)Glucocorticoid

(30

mg/3-4d)Non-steroidal

anti-inflammatory

drugs

<within

24h>First-line

medication

for

acute

gout

is

sufficient

(1-2

g)Decrease

the

dosage

afterwards;

use

it

alone

for

5~7

days;prohibited

for

peptic

ulcer,

coagulopathy

and

severe

renalinsufficiency.Intra

articular

injection

or

oral

administration

Renal

insufficiency

or

intolerance,

non

-

steroidal

optional

Rest

in

bed

Colchicine

(<Within

48h>1.5-1.8

mg/d)Gastrointestinal

reactionsProhibited

for

peptic

ulcer,

liver,

kidneyand

heart

insufficiency,

diseases

ofblood

system

IcecompressionAntibiotics

are

not

effective

Elevate

theaffected

limb4.

Drug

selection1

Overview

of

gout

2.

Clinical

features

3.

Treatment

principles

(II)

Treatment

during

intermittent

and

chronic

stages

1.

Inhibition

of

uric

acid

productionFebuxostat,Allopurinol

2.Promote

uric

acid

excretionBenzbromarone,

probenecidtophusWithout

Without

tophus

Uric

acid:

<360

μmol/L(6mg/dl)

With

tophus

Uric

acid:

<4.0

mg/dl4.

Drug

selection1

Overview

of

gout

2.

Clinical

features

3.

Treatment

principles1.

Inhibition

of

uric

acid

production

Druginhibiting

uric

acid

production

Inhibition

of

uric

acid

productionAllopurinol

hypersensitivitysyndromeProhibited

for:Patients

with

severe

liver

injury,kidney

damage

and

allergies

Novel

xanthine

oxidase

non-purine,

specific

inhibitor

Occupy

the

channel

of

enzyme

active

site

Recommended

for

gout

patients

with

kidney

damageIt

is

safe

and

effective

for

patients

withdifferent

degrees

of

renal

insufficiency;

itis

forbidden

for

patients

with

severe

liverdamage,

coronary

heart

disease,

and

heartfailure.4.

Drug

selection

1

Overview

of

gout

2.

Clinical

features

3.

Treatment

principles2.Drugs

for

promoting

uric

acid

excretion

Drink

plenty

of

water

(>2

L)

Benzbromarone

Alkalized

urineProbenecid4.

Drug

selection1

Overview

of

gout

2.

Clinical

features

3.

Treatment

principles(III)

Treatment

of

kidney

diseases

Besides

controllingblood

uric

acidAcetazolamide

optionalSuch

as

hypotensivedrug,

optionalACEI,

ARB

Avoid

β

receptors

andcalcium

channel

blockersPolydipsia

and

polyuria2500

ml

of

waterAlkalized

urineAvoid

using

thiazide,furosemide

and

etanic

acid4.

Drug

selection1

Overview

of

gout

2.

Clinical

features

3.

Treatment

principles(IV)Asymptomatic

hyperuricemiaNo

need

to

take

medication

(but

it

is

necessary

to

control

diet

and

avoid

precipitating

factors)Blood

uric

acid

<9.0

mg/dl,

no

family

historyUric

acid

lowering

drugsBlood

uric

acid

≥9.0

mg/dl,

with

family

history,

combined

with

hypertension,

hyperglycemia

andhyperlipidemia,

cardiovascular

and

cerebrovascular

diseasesDiet

control

for

whole

life4.

Drug

selection

1

Overview

of

gout

2.

Clinical

features

3.

Treatment

principles2.

Nutritional

treatment

and

lifestyle

habitsControl

heatRestrict

fatRestrict

purineEat

more

fruits

andvegetablesAvoid

drinkingalcoholSummary

after

classDrinking

alcoholWhile

eating

foodscontaining

largeamounts

of

purine,take

drugs

thatinhibit

theexcretion

of

uricacid.Suffering

fromdiabetes

and

otherdiseases

that

notonly

increasepurines

but

alsoaffect

uric

acid

anduric

acid

excretionFactors

affecting

blood

uric

acid

level

Combined

type

factors

Human

cell

metabolism

accounts

for

about

80%

of

the

total

human

uric

acid.

Excessive

fitness,

surgery,

chemotherapy,

inflammation

in

the

body,

infection,

etc.

will

speed

up

cell

metabolism.Producing

factorsHigh

purine

diet,alcohol,accounting

forabout

20%

of

thetotal

uric

acid

ofhuman

bodyKidneydysfunction

Some

chronic

diseases

such

as

endocrine

diseases

and

ketoacidosis

will

competitively

inhibit

the

secretion

of

uric

acid

in

the

kidneysDischarge

factorsSummary

after

classNutritional

plan

for

the

4

stages

of

gout

First

stage

Asymptomatic

stage

Find

the

reason

for

the

increased

uric

acid,

overcome

bad

habits,

andknow

which

foods

should

be

eaten

and

which

should

be

reduced.

Stage

3

Stage

of

chronic

arthritis

Find

the

cause

forhyperuricemia,

take

specific

measures

and

reduce

the

intake

of

purines.

Stage

4Transition

period

of

renal

calculus

and

kidney

diseasePay

attention

to

the

filtration

rate

of

the

glomerulus,

findthe

cause

for

kidney

damage,

and

pay

attention

to

the

treatment

of

comorbidities

and

complications.

Second

stage

Stage

of

acute

arthritisStrictly

quit

alcohol,

reduce

the

consumption

of

foods

high

in

purines,

and

take

drugs

for

gout

treatment.Summary

after

classNutrition

collocation

principle

for

gout

population

Drink

more

water

The

total

daily

intake

should

be

2500~3000ml.

Avoid

non-drinking

or

temporary

overthinking.Choose

boiled

water,

light

tea

water

and

mineral

water.

Alcohol

quitting

requiredAlcohol

is

the

main

cause

for

gout

Pay

attention

to

food

cooking

methodsAdjust

the

cooking

methodconsidering

the

factor

that

purine

is

soluble

in

water.For

example,

boil

the

meat

for

a

while

first,

pour

the

soup

and

then

continue

cooking.

Limit

total

energy

and

maintain

normal

weightLose

weight

step

by

step,

avoid

losing

too

fast

Balancing

Three

major

nutrition

Carbohydrate

accounting

for

40%~50%,

proteinaccounting

for

10%~20%,

and

the

rest

is

fat,accounting

for

30%~40%

Restricted

diet

Purine

intakeStrictly

control

the

intake

of

purinesbased

on

the

purine

content

in

foodSummary

after

classaround

750

grams.

It

is

encouraged

to

eat

more

foods

with"medium-low"

and

"low”

purine,

such

as

wax

gourds,

cucumbers,tomatoes,

lettuces.

You

can

take

small

amount

of

black

fungus

andshiitake

mushrooms.

Green

leafy

vegetables

can

be

cooked

andblanched.

Eat

less

legume

vegetables

such

as

lentils,

cowpeas,

peas,and

bean

sprouts.

Conventional

drugs

for

the

treatment

of

gout

can

alleviate

thesymptoms

of

gout

in

the

short

term.

However,

if

you

use

it

for

a

longtime,

you

should

pay

attention

to

the

adverse

effects

of

the

drug,

andyou

should

know

that

the

medication

is

a

temporary

cure

but

not

theroot

cause.

The

use

of

the

drug

will

give

the

patient

the

illusion

ofimprovement.

Only

when

patients

make

changes

in

their

lifestyles,

canthey

truly

reverse

the

condition

and

remove

the

root

cause

of

thedisease.

Many

people

think

that

they

can't

eat

meat

any

longer

due

to

gout.In

fact,

it

is

not

wise

to

do

so.

Patients

with

gout

should

learn

toseparate

protein

and

purines

in

their

diet.

First,

choose

the

right

meat:choose

meat

with

less

purines

and

stay

away

from

visceral

foods,

thickbroth,

meat

and

thick

meat

broth.

Secondly,

choose

the

right

cookingmethod:

don't

stew.

Instead,

boil

the

meat,

blanch

and

then

cook.

Limitmeat

intake

to

about

100

grams

of

lean

meat

per

day.

Many

people

believe

that

patients

with

hyperuricemia

shouldreduce

fat

intake.

In

fact,

this

is

a

misunderstanding.

Lipids

areessential

components

of

the

body,

which

can

promote

cell

metabolism,and

are

also

different

from

purines

excreted

from

the

kidneys.Therefore,

fat

intake

of

gout

patients

can

be

about

the

same

as

that

ofordinary

people,

about

30%

of

total

heat

per

day.

The

key

is

to

stayaway

from

trans-fat

foods

such

as

cakes,

refined

breads

and

biscuits.

Patients

with

gout

should

eat

more

vegetables,

but

they

shouldIt's

definitely

right

to

eat

notice

how

to

eat.

The