最新GOUT Monosodium Urate Crystal Deposition Disease教学讲义ppt课件.ppt

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1、GOUTMonosodiumUrateCrystalDepositionDiseaseButitshouldbe!!!!!!!!Nameanotherdiseasethat-thecauseandpathophysiologyaresowellundeerstood-thediagnosiscanbemadewithsuchcertainty-availabletherapiescanbesoeffectiveObjectivesReviewtheclinicalfeaturesofgoutReviewtherationalef

2、ortherapiesofgoutyarthritisandtheunderlyinghyperuricemiaAnswerquestionsPrevalenceofHyperuricemiaAdultMalesU.S.France5%17%HospitalizedMalesLosAngelesVAMilwaukeeVA13%21%FactorsConsideredinTherapyofAsymptomaticHyperuricemiaRenalDiseaseFraminghamSMA-12AutoanalyzerAntihyp

3、eruricemicMedicationsIsHyperuricemiaariskfactorforcoronaryarterydisease?HyperuricemiaisacommonfeatureoftheMetabolicSyndromeEpidemiologicstudiesaremixedandconfusingRichardJohnson’sratmodelofhyperuricemiaManagementofAsymptomaticHyperuricemiaDeterminethecauseAddresscont

4、ributingfactorsHypertensionObesityAlcoholismHyperlipidemiaAtthistime,specificurate-loweringdrugsarenotindicatedStageIIAcuteGoutyArthritisIntercriticalGoutClinicalCourseofClassicGoutOverallGoutPrevalenceAmongAllEnrollees1990-1999JRheumatolAug2004AnnualGoutPrevalenceAm

5、ongAllEnrolleesbyAgeGroup1990-1999JRheumatolAug2004TherapyforAcuteGoutyArthritisColchicineOralIVNonsteroidalAnti-inflammatoryAgentsCorticosteroidsIntra-articularIM(ACTH)PODrugActionsInAcuteGoutColchicineinhibitsE-selectinmediatedPMNadhesionPMNL-selectinexpressionIl-1

6、expressionIl-8productionPMNmotilityChemotaxisDrugActionsInAcuteGoutNSAIDsInhibitsPGE2CorticosteroidsInhibitPGE2andLTB4StabilizelysosomalmembranesACTHAgonistoftheleukocytemelatoninreceptor-3Thesecretisnotwhatisused,buthowquicklytherapyisinitiatedaftertheattackbegins!S

7、tageIIIChronicGoutyArthritisTophionphysicalexamChronicdegenerativearthritisClinicalCourseofClassicGoutAntihyperuricemicTherapyTreatacuteattackuntilresolvedColchicineorNSAIDforprophylaxisXanthineoxidaseinhibitororuricosuricAddressotherproblemsHypertensionObesityAlcoho

8、lismGoalofAntihyperuricemicTherapySerumUrate5.0mg/dl!Loweringserumurateto>7.0mg/dldoesnotreversetheproblem.Itonlyslowstherateofpro