痛风管理-台湾教授概要1.pptx

林孝義醫師 台北榮民總醫院 過敏免疫風濕科 國立陽明大學醫學系內科;;高尿酸血症與痛風之治療台灣指引(2007年第一版);Education Prevention Initiative for Gout Management in Taiwan;Taiwan Guideline for the management of Gout and Hyperuricemia (2nd Edition);高尿酸血症與痛風之治療日本指引;章節目錄;Guideline/recommendation ;Guideline for the Management of Hyperuricemia and Gout 2nd edition ;References;1.One tablet of colchicine (0.5 mg) is used in the aura phase of gouty attack to stop further development of arthritis.. In case of frequent occurrence of gouty attack, daily medication with one tablet of colchicine, “colchicine cover,” is effective. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in the acute phase of gouty attack. NSAIDs are administered at a relatively high dose for a limited period to alleviate inflammation (NSAID pulse therapy). Thereby, the occurrence of adverse drug reactions should be noted. 3. Corticosteroids are orally administered when NSAIDs cannot be administered or their administration is ineffective or when polyarthritis occurs. ; 4. Since gouty attack is exacerbated when serum urate level is changed at the time of attack, in principle, medication with uric acid–lowering drugs should not be initiated. 5. Surgical resection is considered necessary in the treatment of some cases of gouty tophus, but drug therapy is also necessary in such cases. ;治療目標;Maintaining lower serum urate levels can lead to lower incidence of recurrent gouty attacks.;痛風有多痛？;急性痛風的治療;TW;痛風只是冰山的一角!;痛風很少是單一事件;Hjortnaes J, et al. J Rheumatol 34:1882-1887, 2007;尿酸與死亡率的關係: J型曲線;無症狀高尿酸血症的治療 (2007);尿酸結晶(MSU)是什麼？;台灣指引中高尿酸血症之治療方針;日本指引中高尿酸血症之治療方針;尿酸是引發痛風最顯著之危險因子;Subjects 6,356 Japanese men, aged 35-60 years with systolic blood pressure 140 mmHg and diastolic blood pressure 90 mmHg, normal glucose intolerance, and no history of hypertension or diabetes at baseline Methods Blood pressure was measured and Type 2 diabetes was defined. Results Serum uric acid level was associated with an increased risk for hypertension but not