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1、欧洲抗风湿联盟(EULAR)对痛风治疗的12项建议1.Optimaltreatmentofgoutrequiresbothnon-pharmacologicalandpharmacologicalmodalitiesandshouldbetailoredaccordingto:specificriskfactors(levelsofserumurate,previousattacks,radiographicsigns);clinicalphase(acute/recurrentgout,intercriticalgout,andch
2、ronictophaceousgout);generalriskfactors(age,sex,obesity,alcoholconsumption,urateelevatingdrugs,druginteractionsandcomorbidity).Strengthofrecommendation:96(95%CI,93to98)1.痛风最佳治疗需药物和非药物治疗手段相联合,并根据以下情况调整:(1)特殊的危险因素(血尿酸水平,以前发作情况和放射线表现);(2)临床阶段(急性/复发性痛风,发作间歇期痛风和慢性痛风石性痛风);(3)
3、一般危险因素(年龄、性别、肥胖、饮酒、增高尿酸药,药物相互作用和合并疾病)。推荐力度:96(95%的可信区间93-98)2.Patienteducationandappropriatelifestyle.adviceregardingweightlossifobese,diet,andreducedalcohol(especiallybeer)arecoreaspectsofmanagement.Strengthofrecommendation:95(95%CI,91to99)2.患者教育和良好生活方式[肥胖者控制体重、饮食控制及减少
4、饮酒(尤其是啤酒)是治疗核心部分]。推荐力度:95(95%的可信区间91-99)3.Associatedcomorbidityandriskfactorssuchashyperlipidaemia,hypertension,hyperglycaemia,obesityandsmokingshouldbeaddressedasanimportantpartofthemanagementofgout.Strengthofrecommendation:91(95%CI,86to97)3.应重视合并的疾病和发病相关的危险因素如高血脂、肥胖和吸
5、烟,并作为痛风处理的重要部分。推荐力度:91(95%的可信区间86-97)4.Oralcolchicineand/orNSAIDsarefirstlineagentsforsystemictreatmentofacutegout.IntheabsenceofcontraindicationsanNSAIDisaconvenientandwellacceptedoption.Strengthofrecommendation:94(95%CI,91to98)4.急性痛风全身治疗的一线用药是口服秋水仙碱和/或非甾类抗炎药。如无禁忌,非甾类抗
6、炎药是一种方便且易于接受的选择。推荐力度:94(95%的可信区间91-98)5.Highdosesofcolchicineleadtosideeffects,andlowdoses(forexample0.5mgthreetimesdaily)maybesufficientforsomepatientswithacutegout.Strengthofrecommendation:83(95%CI,74to92)5.大剂量秋水仙碱会带来副作用,而低剂量秋水仙碱(如0.5mg,每日3次)足可控制某些急性痛风。推荐力度:83(95%的可信区
7、间74-92)6.Intra-articularaspirationandinjectionofalongactingsteroidisaneffectiveandsafetreatmentforanacuteattack.Strengthofrecommendation:80(95%CI,73to87)6.关节内穿刺和注射长效激素对治疗急性痛风有效和安全。推荐力度:80(95%的可信区间73-87)7.Urateloweringtherapyisindicatedinpatientswithrecurrentacuteattacks
8、,arthropathy,tophi,orradiographicchangesofgout.Strengthofrecommendation:97(95%CI,95to99)7.急性痛风反复发作、关节病、痛风石或有放射