An international panel of leading gout experts has published new recommendations advising that doctors use a treat-to-target approach for managinggout, a painful form of arthritis that affects more than 8 million adults in the United States. Central to the recommendations is using medication to reduce and keep blood uric acid levels below 6 milligrams per deciliter (mg/dL) – and even lower in people with severe gout. The recommendations were published online inAnnals of the Rheumatic Diseases9月。
针对目标的治疗——医生确定与疾病相关的特定目标，并调整药物直至达到目标的一种方法——已经被用于治疗某些慢性疾病，包括类风湿性关节炎、高血压和糖尿病。
How Gout Develops
Gout, the most commonly diagnosed inflammatory arthritis in the U.S., occurs when uric acid builds up in the blood (called hyperuricemia) and forms needle-like crystals that are deposited around the joints – often in the big toe, but also in the feet, ankles, knees, wrists and elbows – leading to acute attacks of intense pain, redness and swelling. An attack passes in about a week to 10 days, and is typically treated with medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and colchicine (Colcrys, Mitigare).
But after an attack subsides, the disease typically doesn’t go away. More than 80 percent of people who have an attack have another within three years, if uric acid levels remain high. The condition can progress, leading to chronic pain, more frequent but milder attacks, tophi (hard, uric acid deposits under the skin) and permanent joint damage. Gout and hyperuricemia are also associated with other health problems, such as high blood pressure, diabetes, metabolic syndrome, cardiovascular and kidney disease.
Evolving Gout Treatment Protocol
Currenttreatment of gout该建议的合著者、波士顿马萨诸塞大学纪念医学中心风湿病临床研究主任乔纳森·凯医学博士说，通常需要开别嘌呤醇，它可以降低尿酸水平，直到推荐的每日剂量，然后停在那里，不管结果如何。
“A doctor gives the medication and hopes that [the patient does] well,” Dr. Kay says. “But with gout, the clear target is uric acid. It has been shown that if you maintain levels below 6 mg/dl it controls gout better … so adopting the treat-to-target approach makes sense.”
The treat-to-target recommendations developed by the expert panel state that blood levels of uric acid should be measured regularly and medication adjusted until it reaches 6 mg/dl or lower. Once that level is attained, the patient should be monitored regularly to ensure the target level is maintained. Patients with severe gout should target a uric acid level of 5 mg/dl or lower.
Another recommendation is to provide ample education to patients regarding risk factors for future attacks and treatment. This is important because gout results from a combination of genetic and modifiable lifestyle factors [link to: http://www.arthritis.org/about-arthritis/types/gout/causes.php]. While people with a family history of gout are at higher risk for the disease, being overweight also increase risk of developing gout, and consuming sugary drinks or excessive amounts of alcohol and eating certain foods can increase the risk of an attack.
Enough Evidence?
In the report outlining the recommendations, the expert panel noted a weak spot: Because there are no studies comparing patients who were treated-to-target to those received “routine care,” the recommendations are based on expert opinion and consensus rather than scientific data.
然而，阿拉巴马大学伯明翰医学院的风湿病学家和教授Jasvinder Singh医学博士认为，有充分的证据表明，尿酸水平需要保持在较低水平以降低耀斑的风险，目标低于6毫克/分升是一个很好的阈值。
“我们总是想要更多的证据和更多的试验……但对我来说，有足够的证据来治疗目标，”辛格博士说，他没有参与这些建议。
This was the first major consensus paper related to treat to target for gout, and it’s important because gout is often managed by physicians who are not rheumatologists, says Dr. Singh. “This gives attention for treat-to-target to internists, podiatrists and cardiologists.”
But not everyone agrees with Dr. Singh or the expert panel that treat to target should be the standard treatment approach for gout. The American College of Physicians (a national organization of internal medicine physicians) published its own guidelines for gout treatment in November in theAnnals of Internal Medicine. In it, the group recommends against starting long-term use of medication to lower uric acid in patients with infrequent flares until more research is available.
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Author: Tammy Worth for the Arthritis Foundation
We can test our blood at home for sugar but not for Uric Acid?
Is there anything available to use to monitor the foods you eat to
看摄入是否会增加尿酸?
Thank you for a reply