Abstract：
Gout is inflammatory arthritis caused by monosodium urate crystal deposition in articular and non-articular structures. Acute gout flares are often monoarticular/polyarticular involving lower extremity joints characteristically involving 1st metatarsophalangeal joint. However, gout flares can also be polyarticular, involving upper extremity joints, especially in patients with multiple comorbidities and contraindications to urate-lowering therapies (ULT). Risk factors exacerbating gout flares include obesity, high alcohol and purine-rich food consumption, and the use of diuretics. Diagnosis requires synovial fluid analysis with direct visualization of monosodium urate crystals. Acute flares are managed with steroids, non-steroidal anti-inflammatory drugs, or colchicine. Long-term management includes lifestyle modifications including a heavy emphasis on weight loss, avoidance of alcohol, purine-rich foods, and diuretics. ULT is indicated in patients with 2 or more gout flares/year, tophi, or radiographic evidence of gouty arthropathy. Although allopurinol is the first-line ULT agent, it does carry a risk of inducing severe cutaneous adverse reactions, especially in patients with chronic kidney disease and patients harboring the HLA-B*5801 allele. Other ULT agents include febuxostat and probenecid. ULT is usually titrated to achieve goal serum uric acid (SUA) levels below 6 mg/dL. However, in patients with tophi, a lower SUA target of less than 5 mg/dL should be implemented for prompt urate crystal dissolution.
摘要：
痛风是由尿酸单钠晶体沉积在关节和非关节结构中引起的炎性关节炎。急性痛风发作通常是累及下肢关节的单关节/多关节，其特征是累及第一跖趾关节。然而,痛风耀斑也可以是多关节，涉及上肢关节,特别是在有多种合并症和尿酸降低治疗（ULT）禁忌症的患者中。加剧痛风发作的危险因素包括肥胖，高酒精和嘌呤丰富的食物消费，和利尿剂的使用。诊断需要滑液分析，并直接观察尿酸单钠晶体。急性耀斑用类固醇治疗，非甾体抗炎药，或者秋水仙碱.长期管理包括改变生活方式，包括高度重视减肥，避免饮酒,富含嘌呤的食物,和利尿剂。ULT适用于2次或2次以上痛风发作/年的患者，托皮,或者是痛风性关节病的影像学证据.别嘌呤醇虽然是一线ULT剂,它确实有诱发严重皮肤不良反应的风险，尤其是在慢性肾脏病患者和携带HLA-B*5801等位基因的患者中。其他ULT药剂包括非布索坦和丙磺舒。通常滴定ULT以实现目标血清尿酸(SUA)水平低于6mg/dL。然而,在患有Tophi的患者中，应实施低于5mg/dL的较低SUA目标以迅速溶解尿酸盐晶体。
