痛风管理的国内外指南比较.ppt

痛风管理的最新国内外指南比较,控制痛风急性发作的用药选择推荐,NSAID and colchicine without contraindications2017BSR 首选NSAIDsNSAIDs禁忌建议单独使用低剂量秋水仙碱对NSAIDs及秋水仙碱均不耐受建议使用GC2016中国 Corticosteroids should be considered as rst-line therapy without contraindications 2016ACP first-line options are colchicine and/or an NSAID, oral corticosteroid or articular aspiration and injection of corticosteroids2016EULAR NSAIDs, colchicine and glucocorticoids are all effective in management of acute gout; comorbidities and concomitant medications inuence choice 2015澳洲 Colchicine, NSAIDs and/or glucocorticoids depending on comorbidities and risk of adverse effects2014多国,痛风急性发作的用药选择循证证据,疼痛缓解及控制痛风急性发作：依托考昔双氯芬酸、塞来昔布吲哚美辛 总不良反应、胃肠道不良反应、头晕：依托考昔依托度酸罗非昔布双氯芬酸吲哚美辛布洛芬萘普生 COX-2ibs可更有针对抑制COX-2，减少胃肠道损伤等副作用，可用于胃肠道高危因素患者。 胃肠道出血风险：GC NSAIDs，但无针对关节内注射的GC的相关证据,控制痛风急性发作的药物剂量推荐,控制痛风急性发作的用药禁忌,控制痛风急性发作的联合用药,In patients with acute gout where response to monotherapy is insufficient, combinations of treatment can be used 2017BSR Recommends considering combination therapy, such as colchicine and an NSAID or colchicine and corticosteroids for patients with particularly severe acute gout2016EULAR The use of combination therapy was felt to be appropriate in certain situations such as severe or refractory disease or when comorbidities limit the use of individual agents2015澳洲,痛风急性发作后降尿酸治疗的时机,Commencement of ULT is best delayed until inflammation has settled2017BSR recommends against initiating long-term ULT in most patients after a rst gout attack or in patients with infrequent attacks2016ACP recommends possible initiation of ULT close to the rst gout attack resolution2016EULAR,降尿酸治疗时预防复发的措施,Colchicine 500 mgs bd or od continued for up to 6 months2017BSR 预防性使用小剂量秋水仙碱3-6个月)2016中国 prophylactic therapy with low-dose colchicine or low-dose NSAIDs more than 8 weeks2016ACP Recommended prophylactic treatment is colchicine, 0.51 mg/d. If colchicine is not tolerated or is contra-indicated, prophylaxis with NSAIDs at a low dosage2016EULAR NSAIDs, low-dose colchicine and low-dose glucocorticoid can all be used for prophylaxis, alone or in combination2015澳洲 use colchicine (0.61.5 mg daily) for the initial 36 months, no evidence on the use of NSAIDs or glucocorticoids as prophylaxis was retrieved 2014多国,降尿酸药物的联合使用,A uricosuric agent can be used in combination with a xanthine oxidase inhibitor in patients who do not achieve a therapeutic serum urate target with opti-mal doses of monotherapy2017BSR 别嘌醇联合苯溴马隆对溶解痛风石比单用苯溴马隆效果更好2016中国 Uricosurics are recommended combination with allopurinol in patients without proper control with allopurinol alone(probenecid-allopurinol or benzbromarone-allopurinol) 2016EULAR The com