mg/d. If colchicine is not tolerated or is contra-indicated, prophylaxis with NSAIDs at a low dosage——2016EULAR • NSAIDs, low-dose colchicine and low-dose glucocorticoid can all be used for prophylaxis, alone or in combination—— 2015澳洲 • use colchicine (0.6–1.5 mg daily) for the initial 3–6 months, no evidence on the use of NSAIDs or glucocorticoids as prophylaxis was retrieved ——2014多国
• recommends possible initiation of ULT close to the first gout attack resolution——2016EULAR
降尿酸治疗时预防复发的措施
• Colchicine 500 mgs bd or od continued for up to 6 months— —2017BSR
severe renal impairment; / receiving strong Pglycoprotein and/or CYP3A4 inhibitors(such ascyclosporin or clarithromycin )
2015澳洲
renal impairment,
gastrointestinal disease and diabetes慎用
GC的相关证据
控制痛风急性发作的药物剂量推荐
2017BSR
2016中国 2016ACP
NSAID maximum dose / /
2016EULAR /
2015澳洲 / 2014多国 /
colchicine
Corticosteroids
0.5 mg bd-qds /
1.5-1.8mg/d 30mg/d,3d
痛风急性发作后降尿酸治疗的时机
• Commencement of ULT is best delayed until inflammation has settled——2017BSR
• recommends against initiating long-term ULT in most patients after a first gout attack or in patients with infrequent attacks——2016ACP
欧洲 澳洲
14 countries
控制痛风急性发作的用药选择推荐
• NSAID and colchicine without contraindications—— 2017BSR
• 首选NSAIDs→NSAIDs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GC——2016中 国
• 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
• Corticosteroids should be considered as first-line therapy without contraindications ——2016ACP
• first-line options are colchicine and/or an NSAID, oral corticosteroid or articular aspiration and injection of corticosteroids——2016EULAR
• 总不良反应、胃肠道不良反应、头晕：依托考昔<双氯芬 酸、吲哚美辛
• 发酸生>吲心哚血美管辛风>布险洛：芬依>托萘考普昔生>依托度酸>罗非昔布>双氯芬 • 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
痛风管理的最新国内 外指南比较
指南名称
BSR指南：痛风管理 中国痛风诊疗指南
ACP临床实践指南：急性和复发 性痛风的管理
EULAR循证建议：痛风的管理
澳大利亚和新西兰痛风诊断和 管理建议
痛风诊断与管理的多国证据推 荐意见
制定时间 2017 2016 2016
2016 2015
2014
制定国家 英国 中国 美国
• Colchicine, NSAIDs and/or glucocorticoids depending on comorbidities and risk of adverse effects——2014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
1.2 mg followed 35 mg/d,5d
by 0.6 mg 1
hour later
a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1
30–35 mg/d, 3-5d
low-dose
low-dose
1.8 mg in 24 h /
• NSAIDs, colchicine and glucocorticoids are all effective in management of acute gout; comorbidities and concomitant medications influence choice ——2015澳洲
• Recommends considering combination therapy, such as colchicine and an NSAID or colchicine and corticosteroids for patients with particularly severe acute gout——2016EULAR
renal impairment and in
patients taking strong CYP3A4 inhibitors减量
renal impairment,
gastrointestinal disease and diabetes慎用
2014多国 Individual treatment decisions should be based on consideration of an individual’s
• The combination of allopurinol and benzbromarone allowed a reduction in SUA levels except in cases of severe renal dysfunction ——2014多国
控制痛风急性发作的用药禁忌
NSAID
colchicine
Corticosteroids
2017BSR
Choice of first line agent will depend on patient preference, renal function and comorbidities
2016中国 /
characteristics and each drug’s safety profile
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
/
/
2016ACP
renal disease, heart failure, renal or hepatic impairment /
or cirrhosis
with P450 3A4 inhibitors or
P-glycoprotein inhibitors
2016EULAR severe renal impairment
• 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 weeks——2016ACP • Recommended prophylactic treatment is colchicine, 0.5–1
• 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 agents——2015澳洲
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 w urate target with optimal doses of monotherapy——2017BSR