痛风患者高尿酸血症之治疗Therapyforhyperuricemiaingoutppt课件.ppt

痛風患者高尿酸血症之治療 Therapyforhyperuricemiaingout 主題選取的考量 常見的疾病 高盛行率醫療花費增加臨床治療標準不一國際已有治療指引 主題選取的考量常見的疾病 高盛行率 資料來源 PubMedKeyword HyperuricemiainTaiwan16篇since1968to2004 主題選取的考量常見的疾病 高盛行率 ChangHY PanWH YehWT TsaiKS HyperuricemiaandgoutinTaiwan resultsfromtheNutritionalandHealthSurveyinTaiwan 1993 96 JRheumatol 2001Jul 28 7 1640 6 Population 2754malesand2953femalesaged4yearsandolderTheprevalenceofhyperuricemiainaboriginalmalesandfemales 50 主題選取的考量常見的疾病 高盛行率 LaiSW TanCK NgKC Epidemiologyofhyperuricemiaintheelderly YaleJBiolMed 2001May Jun 74 3 151 7 Time 1998MayPopulation 586 66 Men 34 Women meanagewas73 1 5 3yearsTheproportionsofhyperuricemia p 01 57 3 inmen40 9 inwomen 主題選取的考量常見的疾病 高盛行率 LiuCS LiTC LinCC TheepidemiologyofhyperuricemiainchildrenofTaiwanaborigines Rheumatol 2003Apr 30 4 841 5 Time fromMarchtoMay2001Place centralTaiwanPopulation theBununtribe Childrenaged4 13Atotalof414children meanage 8 9 2 1yrs wererecruited Hyperuricemiawasdefinedasuricacid 416 5micromol l 7mg dl inboysand 357micromol l 6mg dl ingirlsNinetyof224girls 40 2 and56of190boys 29 5 werehyperuricemic 主題選取的考量常見的疾病 高盛行率 CHOUChungtei周昌德HyperuricemiaandgoutamongTaiwanAboriginesandTaiwanese prevalenceandriskfactorsChinMedJ2003 116 7 965 967TheprevalenceofhyperuricemiaandgoutinAtayalAboriginestobe41 4 and11 7 respectively 27 to45 ofaboriginalboysand13 to41 ofaboriginalgirlshadhyperuricemia Kinmen theprevalenceofhyperuricemiainmenwas25 8 391 1515 throughmorethan6yearsoffollow upson223asymptomatichyperuricemicpatients the5 yearcumulativeincidenceofonsetofgoutwas18 8 42 223 Theincidenceincreasedwiththreedifferentbaselinelevelsofuricacid from10 8 7 0 uricacid 8 0 to27 7 8 0 uricacid 9 0 to61 6 uricacid 9 0 主題選取的考量國際已有治療指引 資料庫 PubMedKeyword Hyperuricemiaguideline8篇 since1996to20031 MeyersOL CassimB ModyGM Hyperuricaemiaandgout clinicalguideline2003 SAfrMedJ 2003Dec 93 12Pt2 961 71 2 NakajimaH MatsuzawaY Introductionofthenewguidelineforthemanagementofhyperuricemiaandgoutwithspecialreferencetoitspolicy NipponRinsho 2003Jan 61Suppl1 442 9 3 TatsunoI SaitoY Hyperuricemiaandatherosclerosis NipponRinsho 2003Jan 61Suppl1 259 65 Review 主題選取的考量國際已有治療指引 4 NakajimaH Definitionanddeterminationofserumuricacidlevel NipponRinsho 2003Jan 61Suppl1 154 7 5 NakajimaH Managementofhyperuricemiainoccupationalhealth withreferenceto guidelinesforthemanagementofhyperuricemiaandgout SangyoEiseigakuZasshi 2003Jan 45 1 12 9 Review Japanese 6 GorterKJ RomeijndersAC Thestandard hyperuricemia fromtheDutchFamilyPhysician reactionfromrheumatologyandgeneralmedicine NedTijdschrGeneeskd 2002May4 146 18 872 authorreply872 3 Dutch 7 ChalmersJ Roleofdiureticsinthetreatmentofhypertension fromlargecontrolledtrialstointernationalguidelines ArchMalCoeurVaiss 1996Sep 89SpecNo4 39 43 Review French 8 CumminsD SekarM HalilO BannerN Myelosuppressionassociatedwithazathioprine allopurinolinteractionafterheartandlungtransplantation Transplantation 1996Jun15 61 11 1661 2 目前製作guideline之目的 台灣地區高尿酸血症的盛行率驚人 尤其施行成人健康體檢後 門診診療中常遇到病人詢問高尿酸血症該如何處理 而目前因無統一的guideline可供依循 治療標準不一 常造成醫師及患者的困擾 期待檢視文獻後 能提供有用的資訊 建立使用降尿酸藥物之臨床底線 以為臨床診療之準則 臨床問題1 無症狀之高尿酸血症需不需要治療 資料來源 PubMedKeyword Asymtomatichyperuricemiaandtreatmentandreview23篇 since1977to2003 臨床問題1 無症狀之高尿酸血症需不需要治療 DincerHE DincerAP LevinsonDJ Asymptomatichyperuricemia totreatornottotreat CleveClinJMed 2002Aug 69 8 594 597 600 2passim PublicationTypes ReviewTreatmentofasymptomatichyperuricemiaisnotnecessaryinmostpatients unlessperhapstheyhaveveryhighlevelsofuricacidorareotherwiseatriskofcomplications suchasthosewithapersonalorstrongfamilyhistoryofgout urolithiasis oruricacidnephropathy 臨床問題1 無症狀之高尿酸血症需不需要治療 UhligT Goutandhyperuricaemia shouldbothbetreated TidsskrNorLaegeforen 2003Oct23 123 20 2878 80PublicationTypes ReviewPatientswithincreasedlevelsofuricacidwillusuallybetreatedwithdrugsifsymptomsofacutearthritisorkidneystonesoccur Thereisstillnoconsensusonthetreatmentofindividualswithasymptomatichyperuricaemia 臨床問題1 無症狀之高尿酸血症需不需要治療 HarrisMD SiegelLB AllowayJA Goutandhyperuricemia AmFamPhysician 1999Feb15 59 4 925 34 PublicationTypes ReviewPatientswithasymptomatichyperuricemiadonotrequiretreatment buteffortsshouldbemadetolowertheiruratelevelsbyencouragingthemtomakechangesindietorlifestyle 臨床問題1 無症狀之高尿酸血症需不需要治療 PollmannG KullichW KleinG Therapyofhyperuricemiaandgout WienMedWochenschr 1997 147 16 382 7PublicationTypes ReviewDietaryregimenareintheforefrontintreatmentofasymptomatichyperuricemia Uricacidloweringdrugscanonlybesupportedinrepeatedserum measuresfrom9mg dlup 臨床問題2 痛風患者高尿酸血症之治療 Keyword HyperuricemiaandGoutandtreatment資料來源 PubMedBandolierGoogle 臨床問題2 痛風患者高尿酸血症之治療 UhligT Goutandhyperuricaemia shouldbothbetreated TidsskrNorLaegeforen 2003Oct23 123 20 2878 80PublicationTypes ReviewDrugsforthetreatmentofacutearthritisattacksincludenon steroidalanti inflammatorydrugs NSAIDs glucocorticoidssystematicallyorinjectedintothejoint andcolchicine Asprophylacticlong termtreatmentofrecurringattacks allopurinol probenicideandcolchicinearetherapeuticalternatives 臨床問題2 痛風患者高尿酸血症之治療 PittmanJR etalDiagnosisandmanagementofgout AmFamPhysician1999Apr1 59 7 1799 806 1810Treatmentgoals ofgout includeterminationoftheacuteattack preventionofrecurrentattacksandpreventionofcomplicationsassociatedwiththedepositionofuratecrystalsintissues Pharmacologicmanagementremainsthemainstayoftreatment Acuteattacksmaybeterminatedwiththeuseofnonsteroidalanti inflammatoryagents colchicineorintra articularinjectionsofcorticosteroids Probenecid sulfinpyrazoneandallopurinolcanbeusedtopreventrecurrentattacks Obesity alcoholintakeandcertainfoodsandmedicationscancontributetohyperuricemia Thesepotentiallyexacerbatingfactorsshouldbeidentifiedandmodified 臨床問題2 痛風患者高尿酸血症之治療 PollmannG KullichW KleinG Therapyofhyperuricemiaandgout WienMedWochenschr 1997 147 16 382 7PublicationTypes ReviewThetherapyofanacuteattackofgoutprimarilyisdonewithnon steroidalantiinflammatorydrugs inrarecaseswithcolchicineorcorticoids Goutyarthritisinintermission independentoftheextentofhyperuricemia aswellaschronicgoutareindicationsforanuricacidloweringpharmacotherapy usuallyforlife 臨床問題2 痛風患者高尿酸血症之治療 RottKT AgudeloCA Gout JAMA 2003 289 21 2857 60 Ashort practical up to datereviewarticletargetedatthenon rheumatologistclinician AgudeloCA WiseCM Crystal associatedarthritisintheelderly RheumDisClinNorthAm 2000 26 3 527 46 Acomprehensivereviewbytwooftheleadingauthoritiesongoutandothercrystal inducedarthropathies EmmersonBT Themanagementofgout NEnglJMed 1996 334 7 445 51 Adatedbutinsightfulclassicreviewarticle PRODIGYGuidance Gout April2002 www prodigy nhs uk ApracticalUKguidelinethatmaybeparticularlyusefulforUSclinicians especiallyuntilastandardevidence basedUSclinicalguidelineisavailable 臨床問題2 痛風患者高尿酸血症之治療 Bandolier Allopurinol oxipurinol benzbromaroneandprobenecidforloweringuricacidHEPaulusetal Prophylacticcolchicinetherapyofintercriticalgout Aplacebo controlledstudyofprobenecid treatedpatients ArthritisandRheumatism197417 609 614 HRArntzetal Serumuricacidloweringeffectofallopurinolandbenzbromaroneinlowdosage FortschrMed197919 1 3 GWSchepersetal Benzbromaronetherapyinhyperuricaemia comparisonwithallopurinolandprobenecid JIntMedRes19819 511 515 PWBull JTScott Intermittentcontrolofhyperuricaemiainthetreatmentofgout JRheumatol198916 1246 1248 HBerg Effectivenessandtoleranceoflong termuricosurictreatment ZGestamteInnMed199045 719 20 IWalter Sacketal Uricacidloweringeffectsofoxipurinolsodiuminhyperuricaemicpatients therapeuticequivalencetoallopurinol JRheumatol199623 498 501 Table1 Allopurinol benzbromaroneandprobenecidingout Table1 Allopurinol benzbromaroneandprobenecidingout Table1 Allopurinol benz