The treatment principle and drug selection of primary gout

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Gout is a congenital genetic (physical) caused by common and acquired diet environment two factors of the disease, without the genetic const

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Gout is a congenital genetic (physical) caused by common and acquired diet environment two factors of the disease, without the genetic constitution of gout (not necessarily have a family history of gout), is not easy because of excessive diet caused by gout, but if there is excessive uric acid phenomenon, can be controlled through diet to reduce or prevent gout the onset of the disease, especially those with a family history of gout and hyperuricemia in high-risk population continued, more should start to develop good eating habits.

First, the principle of treatment: gout treatment according to the different stages of the disease to choose different treatment options.

1, no symptoms of hyperuricemia: This is the key period of the prevention and treatment of acute attack of gout, in addition to the control diet, urine alkalization, the uric acid level of > 535 mon/L patients need long-term use of drugs to lower uric acid, uric acid control in the normal range. Antihypertensive drugs should be avoided in patients with hypertension with recurrent agents containing diuretics.

2, the acute gouty arthritis: mainly to pain, can choose colchicine, non steroidal anti-inflammatory drugs or hormone therapy. In a 28 day period after the onset of gouty arthritis, the dose of the drug can not be switched on or changed, and the rapid fluctuations in uric acid (increase or decrease) during treatment can lead to increased arthritis. A sudden decline in uric acid can lead to dissolution of the stone surface of the crystallization of the crystallization of white blood cells, after the release of chemokines to attract more white blood cells to release lysosomal enzymes destroy joints.

3, gout episodes intermittent period: the purpose of this treatment is to maintain serum uric acid in the normal range, to prevent urate deposition in the tissue and protect renal function, and should avoid a variety of predisposing factors. In addition to strictly abide by the principles of dietary treatment, according to the renal excretion of uric acid, a reasonable choice of uric acid drugs. In order to prevent the rapid decline in serum uric acid induced acute arthritis, a variety of uric acid lowering drugs were started at a small dose, and gradually added to the effective amount of treatment, after the effective maintenance of long-term medication.

4, chronic gouty arthritis period: analgesia and uric acid at the same time, prevention and protection of damaged organ function. Surgical correction of deformed joints to improve their function.

Two, drug selection:

1, colchicine

1) mechanism:

To inhibit the chemotaxis, proliferation and phagocytosis of polymorphonuclear leukocytes, inhibit the release of lysosomes and lactic acid, increase the pH in the articular cavity, and reduce the crystallization of uric acid salts. But it could not reduce the blood uric acid, nor increase the excretion of uric acid.

2 indications: acute gouty arthritis pain and prevention.

3) preparation and usage:

Acute attack: oral colchicine first dose 1.0mg, 1 hours after the addition of 0.5mg, after 12 hours to 0.5mg, 2 to 3 times daily.

The prevention of acute gouty arthritis attacks: acute attack more than 3 times a year, suggests taking a small dose of colchicine in prevention of acute attack. Colchicine 0.5mg, two times a day. If the patient does not have a new onset of gouty arthritis in four months, reduce to one day. If no new gout attacks, immediately increased to two times a day, again and again.

4) side effects:

Gastrointestinal reactions such as abdominal pain, nausea, vomiting, and diarrhea often occur when symptoms are relieved. Serious person can produce hemorrhagic gastroenteritis. A small number of cases of drug use can cause white blood cell reduction, aplastic anemia, alopecia and myopathy. Diarrhea and other gastrointestinal symptoms appear to be close to the toxic dose, the drug should be discontinued. Long term medication must observe the hemogram, bone marrow function is low person jiyong. Consumption of liver and kidney disease needs to be properly reduced. The drug can cause birth defects, 3 months before pregnancy should be completely avoided. In addition it can enhance the sedative, hypnotic, analgesic and anesthetic effect can be enhanced; amphetamines, epinephrine and ephedrine tight; reduce anticoagulants and antihypertensive effect, so combined with when should pay attention to drug interactions, as appropriate, adjusting the dosage.

5) notes:

The drug in the acute attack of gout within 4 hours of taking the effect is better, more than 24-48 hours of attack, the effect decreased. Effective treatment dose and toxic dose close, should pay close attention to gastrointestinal symptoms, prevention and treatment of drug poisoning.

2, allopurinol

1) mechanism:

Inhibition of xanthine oxidase by competitive oxidation cannot make hypoxanthine xanthine, uric acid can not be converted into yellow. Human renal clearance of hypoxanthine and xanthine and hypoxanthine ratio of high uric acid, dissolved easily, so it does not cause damage to the kidney. Absorption after liver metabolism into xanthine are easily dissolved in water, the urine. The half-life of this drug is 1 to 3h. After taking 1 ~ 2D, serum uric acid began to decline, and reached the peak from 7 to 14d, usually from 3 to 6 months.

2) indications:

The low purine diet after treatment, 24h uric acid excretion is still greater than 600mg (3054mmol); the uric acid excretion is invalid, allergy or intolerance; the renal function significantly decreased and uric acid nephropathy or uric acid and urinary calculus; lymphocyte proliferative or granulocyte proliferative disease or chemotherapy before the start of radiotherapy; the serious sand gout accompanied by a lot of urate, hyperuricemia savings.

3) contraindications: there was a history of allopurinol allergy.

4) dosage and usage:

Start oral 50mg, 2 to 3 times a day, and then weekly or weekly increase of 100mg. The maximum dose of 1000mg/d. The serum uric acid was decreased from 178.4 to mol/L (~ 3 ~ 5mg/dl) in the range of from 300 to 600mg/d in China for about 1 to 3 weeks. Depending on the level of serum uric acid, usually 0.1 ~ 0.2g, daily from 2 to 3 times. Combined with uric acid drugs can enhance the efficacy, but generally do not need to use.

5) side effects:

The incidence of side effects was about 3% ~ 5%. Common side effects include: allergic rash, urticaria, drug fever, eosinophilia; bone marrow suppression, white blood cells hemolytic anemia; the toxic hepatitis or had elevated alanine aminotransferase; the vasculitis and ocular damage; the xanthine oxidase.

6) notes:

Must be used in the control of acute gout symptoms. For the first time, the patient should be treated with a small dose, and the patient should be informed of the presence of a rash and prompt treatment.

3, benzene bromine Malone

1) mechanism:

This product is a derivative of benzene and furan, for the promotion of uric acid excretion of drugs, the mechanism is mainly through the inhibition of renal tubular reabsorption of uric acid, thereby reducing the concentration of uric acid in the blood. The pharmacokinetics of oral health of adult 50mg, about 2~3 hours after the peak blood concentration of uric acid, 4~5 hours clearance rate reached the maximum value, the half-life of 12~13 hours, this product is mainly from urine and fecal excretion of drug prototype.

2) indications: simple primary hyperuricemia and gouty arthritis in non acute attack stage.

3) contraindications:

Patients with moderate or severe renal impairment; kidney stones; pregnant and lactating women.

4) usage and dosage:

Starting from a small dose, one day 25mg (half), no adverse reactions can be gradually increased to one day 100mg (2). After breakfast service, at the same time with sodium bicarbonate on the 1st 3G.

5) adverse reactions:

Gastrointestinal reactions: nausea and abdominal discomfort. Kidney stones and renal colic. Acute onset of arthritis. The rare fever, rash and liver or kidney function damage.

6) notes:

The process should take more water, alkaline urine. On the decline of renal function, serum creatinine greater than 130 mol/L is still valid, but must maintain a daily urine volume of 2000ml or more. The changes of renal function and blood uric acid were detected regularly. Must be able to use this product in the control of acute symptoms of gouty arthritis.

 

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