痛风

痛风是一种嘌呤代谢紊乱所致的疾病。由于蛋白质中的嘌呤代谢失调,使血液中尿酸含量增高,尿酸盐逐渐沉积于关节、软组织、软骨、肾脏等组织内,从而出现高尿酸血症、急性关节炎反复发作、痛风石沉积、慢性关节炎、关节畸形以及肾实质病变和尿酸结石等病变。本病的发生与饮食、遗传、环境、外伤等因素有关,多发于中老年男性。     

痛风性关节炎并急性肾功能衰竭的护理

痛风是嘌呤代谢失调所致疾病,基本病理改变是肾脏排泄尿酸功能减弱,血尿酸含量增加。慢性痛风患者尿酸盐广泛地沉积于关节软骨,软骨下骨质、软组织及肾等处,当尿酸盐沉积过多时,可在滑膜,腱鞘或耳廓软骨形成痛风石,引起胃关节组     

痛风病的前因后果

痛风是体内嘌呤代谢紊乱导致的免疫性疾病,验血可发现患者血尿酸升高。在正常生理条件下尿酸盐的溶解度为6.4毫克/分升,如果血尿酸超过这个数值,在某些诱因如损伤、全身疲劳和酗酒等促使下,尿酸盐结晶析出,可引起急性痛风发作。急性痛风反复发作,尿酸盐在关节内沉积增多,可使关节发生僵硬畸形,活动受限,影响关节功能,从而形成慢性关节炎。尿酸盐形成的细小针状结晶称痛风石,常发生于关节软骨、滑囊、耳轮、腱鞘、关节周围组织、皮下组织和肾脏间质等处,引起痛风的各种症状。 尿酸增高的原因无外乎是产生过多或排     

痛风的药物治疗

痛风是机体代谢性疾病之一,患者体内尿酸升高,尿酸盐沉积在关节、肌腱、滑囊及其附近,激活免疫系统,诱发急性和慢性的炎症反应。尿酸盐沉积的根本原因是高尿酸血症,所以,痛风的有效治疗有赖于有效的降尿酸治疗,充分纠正高尿酸血症。痛风治疗的重点是预防痛风发作,除此以外,痛风对代谢、心血管和肾脏都有不良影响。合理的药物治疗可以消除或降低这些不良影响。     

饮用小分子团水理疗高尿酸血症(痛风)

痛风是一种嘌呤代谢障碍、血尿酸增高所致的疾病,主要是由于患者体内缺少一种酶(与遗传相关),导致尿酸不能正常代谢,尿酸盐在组织中溶解度低,常沉积于关节、滑囊、软骨、肾脏及皮下组织、结缔组织等处,导致该处发生病理性变化而发病。     

什么是痛风暨如何治疗

<正>痛风(Gout)是一种常见且复杂的关节炎,各个年龄段均可能罹患本病,男性发病率高于女性。痛风患者经常会在夜晚出现突然性的关节疼,发病急,关节部位出现疼痛、水肿、红肿和炎症。其发病机制为嘌呤代谢紊乱、酶缺陷,尿酸产生量增加或排出减少,导致机体出现高尿酸血症。随着病情的持续发展,尿酸盐结石、尿酸盐结晶沉淀在无血供的组织,比如滑膜、韧带、肌腱。还可能沉积在耳朵、远端关节等低温器官组织。     

痛风的家庭调养

痛风是一种嘌呤代谢障碍性疾病,由于嘌呤生物合成代谢增加、尿酸产生过多或因尿酸排泄不良而致血中尿酸升高,尿酸盐结晶沉积在关节滑膜、滑囊、软骨及其他组织中,从而引起急慢性痛风性关节炎反复发作、关节畸形、痛风石沉积、肾结石及慢性间质性肾炎。     

夜间脚趾痛 警惕痛风

痛风主要是由于患者体内缺少一种酶（与遗传相关），无法分解食物中一种叫嘌呤的物质，影响尿酸的正常代谢，大量的尿酸无法排泄，致使血尿酸增高所致。尿酸盐最易沉积于关节（尤其是指趾小关节）、肾脏等处，引起关节疼痛（痛风性关节炎）和肾脏的结石（痛风性肾结石）。由于白天活动量较大，血液循环较快，喝水多，排尿也多，促使尿酸排出，疼痛就有所缓解，夜间血液循环减缓，排尿减少，尿酸盐沉积增加，加重关节局部组织的刺激而疼痛明显，因而痛风最典型的症状就是夜间趾（指）小关节的疼痛。如果脚趾（或手指）小关节疼痛，夜间明显，并伴有局部发红、发热、肿胀等不适，就应高度警惕痛风，尤其是肥胖者、有痛风家族史者更应注意。检查血尿酸可帮助确诊（正常为2～4mg％，超过6mg％应考虑痛风）。     

痛风危险因素的临床浅析

痛风是嘌呤代谢障碍而导致血尿酸水平增高或因尿酸排出减少而导致尿酸盐在组织中沉积的一组疾病。包括高尿酸血症及尿酸盐结晶沉积所致的急、慢性痛风性关节炎、痛风石、间质性肾炎及尿酸性尿路结石等,严重者可致关节畸形及功能障碍。近年来,痛风患者逐年增加,且因其常伴有高血     

痛风的微创手术治疗

痛风是一种嘌呤代谢异常引起的代谢性疾病,通常会表现为高尿酸血症以及尿酸盐结晶的沉积。特指急性特征性关节炎和慢性痛风石疾病,主要包括急性发作性关节炎、痛风石形成、痛风石性慢性关节炎、尿酸盐肾病和尿酸性尿路结石,重者可出现关节残疾和肾功能不全。     

急性痛风性膝关节炎关节镜手术治疗及术中配合

目的 探讨关节镜手术对治疗痛风性膝关节炎的疗效及手术配合.方法 对16例急性痛风性膝关节炎患者行关节镜下常规滑膜清理、结晶石清除手术治疗.结果 术后16例患者症状明显缓解,随访平均12个月,均取得了满意疗效.结论 关节镜手术对具有组织创伤小、恢复快、方法简单等优点,可作为治疗急性痛风性膝关节炎的首选手术方法.     

Crystal deposition in the knee and great toe joints of asymptomatic gout patients

Crystal deposition in asymptomatic knee and first metatarsophalangeal (MTP) joints has been studied in 31 patients with previously proven gout. All had had clinical gout in their MTP joints but their knee joints had never been the site of acute gout. Knee arthroscopy was performed permitting synovial membrane inspection, photography and biopsy. Crystalline material was seen in 9 knees (28%) and confirmed histologically as monosodium urate (MSU) in 4 (12.5%). Synovial fluid analysis on 26 samples using a polarizing light microscope demonstrated MSU crystals in 4 (12.5%) and calcium pyrophosphate dihydrate (CPPD) in 2 (6%). Fluid aspirated from 27 of the metatarsophalangeal joints revealed MSU crystals in 14 (52%) and no CPPD crystals.     

Neuropathic arthropathy of the shoulder

Neuropathic arthropathies is a destructive and deforming joint process related to a disruption of propioceptive and nocioceptive innervation. Growth factors, neurological and vascular factors might be involved. Diabetes, alcoholic neuropathy or syringomyelia appear as the most common causes. We report the case of a 61-year-old woman affected by syringomyelia, with a neuropathic arthropathy of the shoulder. Differential diagnosis includes neurological diseases, septic arthritis, tumours and other destructive arthropathies such as aseptic nechrosis, chronic osteomyelitis, synovial chondromatosis, metabolic diseases (gout, chondrocalcinosis) or repetitive haemarthrosis in haemophilia.     

Gout and coronary heart disease: the Framingham Study

The relationship between gout, not associated with the use of diuretics, and the development of coronary heart disease was examined in 5209 subjects originally enrolled in the Framingham Study. Based on 32 years of follow-up, the two year incidence of gout was six times greater in men (3.2/1000) as compared to women (0.5/1000). For both sexes, the incidence of gout showed no clear relationship with age. Among men who never received diuretics, those afflicted by gout, as compared to those without gout, experienced a 60% excess of coronary heart disease (95% confidence limits, 1.1-2.2), primarily attributed to a two fold excess of angina pectoris (95% confidence limits, 1.2-3.1). Although gout was usually associated with other atherogenic risk factors, control of systolic blood pressure, total cholesterol, alcohol intake, body mass index, and diabetes failed to alter the effect of gout on the preceding coronary events in men. For women, there were no significant associations between gout and coronary heart disease. We conclude that gout, unrelated to the intake of diuretics, imparts an additional risk of coronary heart disease in men, unexplained by clinically measured risk factors.     

The disutility of chronic gout

INTRODUCTION: Gout is a chronic painful inflammatory arthritis. Data regarding the impact of gout on health-related quality of life, however, are limited. METHODS: We interviewed patients with chronic stable gout. Health status was measured by using the Short Form 36 (SF-36) physical component summary (PCS) and physical component summary (MCS) and the Health Assessment Questionnaire-Disability Index (HAQ-DI). Direct preference-based measures included a health rating scale (RS), the time tradeoff (TTO), and standard gamble (SG) for one's current health state with gout and current health state without gout; indirect preference-based measures included the SF-6D and the EQ-5D. Disutilities for gout were assessed by subtracting preference scores for current health states with gout from those for current health without gout and were compared between patients ranking gout as their top health concern versus the rest of the patients. RESULTS: Of the 80 interviewees, 72 (90%) were male, 55 (69%) were Caucasian, and the mean (SD) age was 60 (11) years. The mean SF-36 PCS and MCS scores were 38.9 and 48.6, respectively. The mean (SD) SF-6D score was 0.68 (0.13) and the mean (SD) EQ-5D score was 0.73 (0.23). The mean (SD) RS disutility for gout was 0.05 (0.12), the mean TTO disutility was 0.03 (0.12), and the mean SG disutility was 0.02 (0.11). The RS disutilities of subject patients who ranked gout as their top concern (n = 17) trended towards being statistically significantly larger than those of the remaining patients, P = 0.06 but their TTO and SG disutilities were similar to those of the remaining patients. CONCLUSION: Although physical functioning of patients with gout is often compromised, patients with chronic stable gout do not assign a large disutility to gout per se. Still, patients who rank their gout as their top health concern tend to assign greater RS disutility to gout than do other patients.     

Diet and gout – what is the role of purines?

Anecdotally, consumption of ‘rich’ foods and drinks, such as cheese and port, has been associated with the development of gout, a painful condition linked to high serum uric acid which normally affects joints in the extremities, such as toes. Risk factors for gout include obesity, genetics and use of certain medications, and men appear to be more at risk. In addition, sufferers report that certain foods trigger gout flares, although there is a paucity of evidence from randomised controlled trials investigating the effect of specific foods on circulating uric acid. Observational studies have consistently identified a positive relationship between gout and some, but not all, foods higher in compounds known as purines, which have been demonstrated to increase serum uric acid in their purified form under controlled conditions. This evidence indicates that foods which should be avoided or consumed infrequently by gout sufferers are offal, seafood and alcohol, especially beer, whereas dairy foods seem to be protective. Current dietary guidelines for the prevention and management of gout share common features and largely reflect international healthy eating guidelines, but differences exist in terms of reference to particular foods or nutrients such as fructose, vitamin C and cherries. More randomised controlled trials are needed to fully ascertain the effects of dietary components on gout risk and to generate more consistent guidelines.     

金昌市职业人群痛风的影响因素分析

目的分析甘肃省金昌市职业人群痛风的影响因素,为在职业人群中采取干预措施和干预措施效果评价提供科学依据。方法以甘肃省金昌市2011年6月至2012年9月进入的职业人群为研究对象,采取面对面访谈的方法获取流行病学资料,采集血样检测生化指标,共收集样本35 099人。以样本人群中明确诊断为痛风者为病例组,选择没有患痛风者为对照组,分析金昌市职业人群痛风的影响因素。结果金昌市职业人群痛风总患病人数为175例,总患病率为4.99‰,男性总病率为6.89‰,女性患病率为2.04‰,男性患病率高于女性,差异有统计学意义（χ^2=39.65,P〈0.05）。多因素logistic回归分析结果显示,奶类（OR=0.38,95%CI：0.19-0.75）、豆类（OR=0.44,95%CI：0.25-0.80）、甘油三酯偏高（OR=1.91,95%CI：1.02-3.56）、尿酸偏高（OR=2.54,95%CI：1.64-3.93）、超重（OR=1.79,95%CI：1.56-2.05）、肥胖（OR=3.30,95%CI：2.74-3.96）是痛风的影响因素。结论奶类和豆类是痛风的保护性因素,甘油三酯偏高、尿酸偏高、超重和肥胖是痛风的危险性因素。应合理膳食,从饮食及生活习惯方面开展预防保健。     

Willingness to pay for a cure in patients with chronic gout.

INTRODUCTION: Gout is a chronic painful inflammatory arthritis. The authors interviewed patients with chronic stable gout to assess their hypothetical willingness to pay (WTP) to be cured of their gout. Patients and METHODS: Patients with gout were asked how much money they would be willing to pay every month out of pocket or as a co-pay to cure their gout. To assess determinants of WTP amounts, the authors performed stepwise multivariable linear regression analysis, controlling for demographics, health status, and relative concern about gout. RESULTS: Of the 78 patients, 70 (90%) were male, 54 (69%) were Caucasian, 21 (27%) were African American, and 32 (41%) had annual incomes < $25,000. The median WTP amount was $25 ($0, $75) per month, and the mean (s) was $52 ($74) per month (range, $0-$350); 23 (30%) patients were unwilling to pay any amount. Patients who rated their gout as their top health concern were willing to pay a median of $63 ($25, $100) per month. In multivariable analysis, gout as the top health concern, greater frequency of gouty attacks over the past 1 y, and younger age were significantly associated with WTP amounts (R(2) =0:19 ). CONCLUSION: Many patients with chronic gout would be willing to pay money every month in perpetuity to be cured of their gout. Younger patients, patients whose main health concern is gout, and patients with frequent attacks are willing to pay the most.     

对痛风患者行电话随访式健康教育的效果评价

目的对痛风患者行电话随访式健康教育,并对教育效果进行评价。方法将2011年1月—2012年6月在河北联合大学附属医院出院的血尿酸异常的痛风患者236人随机分为对照组和干预组,对照组给予常规治疗和出院健康教育。干预组在此基础上给予定期电话随访式健康教育。1年后评价两组患者对痛风相关知识的知晓率、血尿酸值正常率、痛风复发率、生活方式改变的情况。结果两组患者对痛风相关知识的知晓率、痛风复发率、血尿酸值正常情况、生活方式改变的差异比较,均有统计学意义（P〈0．05）。结论电话随访式健康教育可有效地提高痛风患者的自我保健知识和保健意识,降低血尿酸水平和痛风发病次数,改变痛风患者的生活方式,提高痛风患者生活质量。     

Arthroscopic lavage plus corticosteroids is more effective than joint aspiration plus corticosteroids in patients with arthritis of the knee

OBJECTIVE: To compare the efficacy of arthroscopic lavage plus corticosteroids (ALC), arthroscopic lavage plus placebo (ALP), and joint aspiration plus corticosteroids (JAC) in patients with arthritis of the knee, and to identify clinical or histological factors that predict outcome. DESIGN: Prospective, randomised. METHOD: Patients with arthritis of the knee (not due to gout, osteoarthritis or septic arthritis) were randomised to 1 of 3 treatment arms: ALC, ALP or JAC. The primary endpoint was time to recurrence; recurrence was defined as recurrent or persistent symptomatic knee swelling requiring local treatment, and/or non-improvement in knee joint score. Synovial tissue specimens were collected for histological analysis. RESULTS: Of the 78 patients enrolled, 3 did not receive the intended therapy and 3 were lost to follow-up. The median time to recurrence was 9.6 months in the ALC group, 3.0 months in the JAC group and 1.0 month in the ALP group. Compared with ALC, the relative risk of recurrence of arthritis (RR) was 2.2 for JAC (95% CI: 1.2-4.2; p = 0.02) and 4.7 for ALP (95% CI: 2.3-9.4; p < 0.0001). In the ALC group, extensive synovial fibrosis was associated with a higher risk of recurrence (RR 5-7; 95% CI: 1.6-20.5; p < 0.01). CONCLUSION: Arthroscopic lavage plus corticosteroids was more effective than arthroscopic lavage plus placebo or joint aspiration plus corticosteroids. The absence of synovial fibrosis predicted a beneficial response.