ACR痛风管理指南.pptxVIP

2012版ACR痛风管理指南Gout has been called “king of diseases” 病中之王 “disease of kings” 王者之病Today, the term gout is used to represent a heterogeneous group of diseases found exclusively in humans that include the following characteristics:1.?? Elevated serum urate concentration (hyperuricemia)高尿酸血症Hyperuricemia is defined as a serum urate level greater than 6.8 mg/dL?2. Recurrent attacks of acute arthritis in which monosodium urate monohydrate crystals are demonstrable in synovial fluid leukocytes 急性痛风性关节炎反复发作3.? Aggregates of sodium urate monohydrate crystals (tophi) deposited chiefly in and around joints, which sometimes lead to deformity and crippling尿酸盐单水晶体在关节及其周围的聚集（痛风石）4.? Renal disease involving glomerular, tubular, and interstitial tissues and blood vessels 肾脏病变5. Uric acid nephrolithiasis 尿酸结石Clinical Featuresasymptomatic hyperuricemia无症状高尿酸血症acute gouty arthritis急性痛风性关节炎intercritical gout or interval gout 间歇期痛风chronic gouty arthritis慢性痛风性关节炎acute gouty arthritisA single joint is involved in about 85% to 90% of first attacks.The initial attack is polyarticular in 3% to 14% The first metatarsophalangeal joint being the most commonly affected site.Acute attacks rarely affect the shoulders, hips, spine, sacroiliac joints, sternoclavicular joints, acromioclavicular joints, or temporomandibular joints.Urate deposition and subsequent gout appear to have a predilection for previously damaged joints, such as in Heberdens nodes of older women.The course of untreated acute gout is highly variable. Mild attacks may subside in several hours or persist for only a day or two and never reach the intensity described for the classic attack. Severe attacks may last days to weeks.痛风管理的基础性建议痛风患者应该学习合理的饮食习惯和生活习惯需要避免引起继发性高尿酸血症的因素除非必须，否则避免使用引起尿酸增高的药物需要评估痛风的严重程度（是否有痛风石，痛风的发作次数等等）痛风的非药物治疗指南首先强调了患者宣教的重要性，单纯饮食及生活方式干预可在一定程度上起到降尿酸和（或）预防急性痛风关节炎发作的作用。饮食控制① 限制短时间内大量摄入富含嘌呤的食物，限制富含嘌呤的肉类、海鲜及果糖饮料的摄入，推荐低脂或脱脂乳制品和蔬菜；② 减少酒精摄入（特别是啤酒、白酒和烈酒），避免酗酒，疾病活动的患者须戒酒，尤其是药物无法有效控制病情进展及慢性痛风性关节炎患者。研究人员将食物建议分为三类：避免食用、限制食用和