Conservative treatment of gout 1
(1) Non-steroidal anti-inflammatory drugs: Non-steroidal anti-inflammatory drugs can effectively alleviate the symptoms of acute gout and are first-line drugs. Non-selective non-steroidal anti-inflammatory drugs such as indomethacin and other common adverse reactions are gastrointestinal symptoms. If necessary, gastric protective agent can be added, active peptic ulcer is prohibited, and patients with renal insufficiency should use it with caution. Selective cyclooxygenase -2 inhibitors, such as celecoxib, have less gastrointestinal reactions, but attention should be paid to the adverse reactions of cardiovascular system.
(2) Colchicine: It is a traditional medicine for treating acute attack. Generally, the first dose is 1 mg, 0.5mg after 1 hour and 0.5 mg after 1.2 hours, three times a day as needed. There are many adverse reactions of colchicine, mainly gastrointestinal reactions, which can also cause bone marrow suppression, liver injury, allergy and neurotoxicity. Adverse reactions are dose-related, and renal insufficiency should be reduced. Low dose (such as 0.5 mg, twice a day) is effective for some patients, and the adverse reactions are obviously alleviated, but the effect is slow, so NSAIDs can be used in combination 1 day after starting medication.
(3) Glucocorticoid: It has obvious curative effect on acute gout, and is usually used for those who cannot tolerate non-steroidal anti-inflammatory drugs and colchicine or those with renal insufficiency. For the acute attack of a single joint or a few joints, fluid can be extracted from the joint cavity and injected with long-acting glucocorticoid to reduce the systemic reaction of drugs, but infection should be ruled out. For multi-joint or severe acute attack, low-dose glucocorticoids, such as oral prednisone 20 ~ 30 mg/d, can be taken orally, intramuscularly or intravenously to avoid symptoms after drug withdrawal? Rebound? Small doses of colchicine or non-steroidal anti-inflammatory drugs can be added when stopping the drug.
Conservative treatment of gout II
(1) Uric acid inhibitor: xanthine oxidase inhibitor. It is widely used for primary and secondary hyperuricemia, especially for those who produce too much uric acid or are not suitable for using uric acid excretion drugs. At present, there is only one allopurinol in China. The initial dose is 100 mg/d, and then increase 100 mg every 2~4 weeks until it reaches 100~200 mg, three times a day (the daily dose is less than 300 mg, or/kloc-0 times a day). Serum uric acid and 24-hour uric acid levels were detected every 2 weeks. If it is still on the high side, the dosage can be increased, but the maximum dosage should not exceed 600 mg/d. The adverse reactions of this product include gastrointestinal symptoms, rash, drug fever, elevated liver enzymes, bone marrow suppression, etc., and should be monitored. About 5% of patients can't stand it. Occasionally, severe hypersensitivity syndrome occurs, showing high fever, eosinophilia, toxic epithelial necrosis and exfoliative dermatitis, progressive liver and kidney failure, and even death. Renal insufficiency will increase the risk of adverse reactions. The glomerular filtration rate should be reduced. Some patients develop drug resistance after long-term medication, which reduces the curative effect.
(2) Ururic acid excretion promoting drugs: mainly by inhibiting renal tubular reabsorption of uric acid, reducing blood uric acid. Mainly used for normal renal function and decreased uric acid excretion. 24-hour uric acid excretion >: 3.57mmol or patients with uric acid stones, chronic uric acid nephropathy and acute uric acid nephropathy should not be used. During medication, especially within a few weeks after starting medication, urine should be alkalized and urine volume should be maintained. ① Probenecid: the initial dose is 0.25 g, twice a day, and gradually increases to 0.5 g, three times a day, and the maximum dose is 2 g; (2) Sulfophenylpyrazolone: the initial dose is 50 mg, twice a day, and gradually increased to 100 mg, three times a day, and the maximum dose is 600 mg/d; (3) Benzbromarone: the initial dose is 25 mg/d, and it is gradually increased to 50~ 100 mg, once a day 1 time, and it is adjusted to the maintenance dose according to the uric acid level, and the drug is used for a long time. This product can be used for mild and moderate renal insufficiency, but serum creatinine
(3) New drugs for reducing uric acid: Some new drugs for reducing uric acid abroad have been used in clinic or are undergoing later clinical observation. 1) Oxypurine 0 1: This product is an active metabolite of allopurinol oxidation, and its drug action and curative effect are similar to allopurinol, but there are relatively few adverse reactions. It is suitable for some patients who are allergic to allopurinol, but there is still about 30% cross-allergic reaction between them. 2) febuxostat: a selective xanthine oxidase inhibitor, which is a drug for inhibiting uric acid production and has better curative effect than allopurinol. Suitable for people who are allergic to allopurinol. In addition, because this product is metabolized by the liver and cleared by the kidney at the same time, it is not completely dependent on renal excretion, so it can be used for patients with mild to moderate renal insufficiency. The main adverse reactions are abnormal liver function, others are diarrhea, headache and musculoskeletal symptoms, most of which are transient mild to moderate reactions. 3) Uricase: Human beings lack uricase, so it is impossible to further oxidize uric acid into more soluble allantoin and excrete it. Biosynthesis of urate oxidase mainly includes: ① recombinant Aspergillus flavus urate oxidase; ② PEG uricase. Both of them have the effect of rapidly and powerfully reducing blood uric acid, and are mainly used for patients with hyperuricemia and refractory gout, especially tumor lysis syndrome.
(4) Alkaline drugs: Uric acid in urine exists in two forms: free uric acid and urate. Uric acid, as a weak organic acid, can be converted into urate with higher solubility in alkaline environment, which is beneficial to renal excretion and reduces the damage of uric acid deposition to kidney. The urine pH value of gout patients is often lower than that of healthy people, so urine should be alkalized at the same time of uric acid reduction treatment, especially during the beginning of taking uric acid excretion drugs, and the urine pH value should be monitored regularly to keep it around 6.5. At the same time, maintaining urine volume is a necessary measure to prevent and treat gout-related kidney diseases. ① Sodium bicarbonate tablets: 0.5~2.0 g orally, three times a day. Because this product produces carbon dioxide in the stomach, it increases the intragastric pressure, and common adverse reactions such as belching and abdominal distension will also aggravate gastric ulcer. Long-term large-scale administration can cause alkalemia, electrolyte disorder, congestive heart failure and edema. Use with caution in patients with renal insufficiency. ② Potassium sodium citrate mixture: Shore solution (potassium citrate 140 g, sodium citrate 98 g, add distilled water to 1000 m 1), once 10~30 ml, three times a day. Blood potassium concentration should be monitored during use to avoid hyperkalemia. In addition, potassium sodium citrate granules and tablets can also be selected.
Gout prevention method
In addition to using appropriate drugs under the guidance of doctors, gout patients should also pay attention to the following points in their daily lives:
(1) Diet: ① Pig, cattle, mutton, ham, sausage, chicken, duck, goose, rabbit, viscera (liver, kidney, heart, brain), bone marrow, etc. Purine content is high and should be avoided as much as possible; Fish and shrimp, spinach, beans, mushrooms, peanuts, etc. There is also a certain amount of purine, so eat less; Most vegetables, all kinds of fruits, milk and dairy products, eggs, rice, sugar and so on can be eaten.
(2) Drink plenty of water and keep the urine volume above 2000ml every day. Because the occurrence of urinary calculi is related to the concentration of uric acid and the pH value of urine, alkaline drugs can be taken when necessary to prevent the occurrence of urinary calculi.
③ Avoid overeating or hunger.
(4) control alcohol and tobacco, especially alcohol.
⑤ Do not drink strong tea, coffee and other drinks.
(2) Properly handle the inducing factors, and prohibit or use less drugs that affect uric acid excretion, such as penicillin, tetracycline, high-dose thiazides, aminopterin and other diuretics and vitamin B? 1 and b? 2. Insulin and low-dose aspirin (less than 2g per day).
(3) Obese people should actively lose weight, which is very important to prevent gout.
(4) Pay attention to the combination of work and rest to avoid overwork, mental stress, infection and surgery. Generally speaking, it is not recommended for gout patients to participate in strong physical activities such as running, or to travel long distances on foot.
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