双跟腱痛风肉芽肿1例

患者男,18岁,发现双跟骨后上方软组织包块两年,以右侧为大,呈渐进性缓慢生长,伴疼痛、踝关节背伸困难.自诉无长期体力劳动及明显外伤史.查体:肿块质硬,边缘光滑,活动度差,压痛明显,局部皮肤发红,无溃烂,皮温未见增高.     

Effectiveness and safety of anakinra in gout patients with stage 4–5 chronic kidney disease or kidney transplantation: A multicentre,retrospective study

Objectives

Interleukin (IL)-1β blocking is effective for the treatment of gout flares and is recommended in patients with contraindications to the standard of care, such as stage 4–5 chronic kidney disease (CKD) patients. However, efficacy and safety data regarding these agents are lacking in this population. We aimed to investigate the efficacy and safety of anakinra for the treatment of gout flares in patients with stage 4–5 CKD or renal transplantation.

微信公众号联合电话随访在痛风出院患者健康教育中的应用研究

目的探讨微信公众号联合电话随访在痛风出院患者健康教育中的应用效果。方法收集我院2015年1月-2016年6月出院的痛风患者80例作为研究对象,随机分为观察组和对照组。对照组采用常规电话随访,观察组采用微信公众号联合电话随访。在出院时对所有患者进行治疗依从性评估及血尿酸水平测定,出院后1个月、3个月再次评估患者的依从性、监测血尿酸水平,以及痛风复发率。结果出院后1个月、3个月,观察组失访率均低于对照组(t=2.469,P=0.0135;t=2.590,P=0.010)、治疗依从性评分均高于对照组(t=2.668,P=0.010;t=2.320,P=0.025)、血尿酸水平均显著低于对照组(t=3.887,P0.001;t=5.122,P0.001)。痛风复发率出院1个月、3个月组间差异无统计学意义(P0.05)。结论微信公众号联合电话随访能显著降低痛风患者出院后的失访率、提高治疗依从性、降低血尿酸水平,值得在临床推广应用。     

广西壮族自治区农村地区痛风与代谢综合征的相关性研究

目的 探讨广西壮族自治区（广西）3个农村地区痛风患者发病与代谢综合征（MS）的相关性。方法 采用1∶1配对的病例对照研究设计方法,于2015年收集广西3个县379 例痛风病例,以同一区域的人群为对照,分析调查对象中MS的患病率以及痛风与MS各相关指标的相关关系。结果 痛风组MS患病率为33.25%、非痛风组MS患病率为11.87%,痛风组高于非痛风组（2=49.546,P0.01）。两组MS相关指标均值和阳性率差异有统计学意义。相关因素分层后,痛风组MS的患病风险明显高于非痛风人群。痛风组MS诊断标准中异常项检出率随着项目增多呈上升趋势。多因素logistic回归分析显示,超重和（或）肥胖、高舒张压和甘油三酯升高为痛风的独立危险因素。结论 痛风患者中MS的患病率增高,痛风与MS各相关指标密切相关,对 MS 及各相关指标的积极干预可减少痛风的发病。     

超声在鉴别类风湿性和痛风性跖趾关节炎骨质侵蚀中的应用

目的探讨超声在类风湿性关节炎与痛风性关节炎骨质侵蚀的诊断与鉴别诊断价值。方法回顾性分析本院43例类风湿性关节炎患者和52例痛风性关节炎患者的足部跖趾关节骨质侵蚀声像图特征,观察骨质侵蚀发生的部位、形态、边界、内部血流分布等直接征象及滑膜或关节腔积液内点状高回声、痛风石、双轨征等特异性间接征象。结果骨侵蚀在类风湿性关节炎中第五跖趾关节均受累(n=43例,100%),边界模糊(n=40例,93.0%),外形以圆形为主(n=39例,90.7%),滑膜增生(n=38例,88.4%);而在痛风性关节炎中第一跖趾关节均受累(n=52例,100%),边界清晰(n=39例,75%),外形呈椭圆形或圆形(61.5%vs 38.5%),滑膜增生(n=10例,19.2%),两组之间差异均有统计学意义(P0.001);且在痛风组中出现了特异性间接征象(P0.001),滑膜或关节腔积液内点状高回声(n=23例,44.2%),痛风石(n=33例,63.5%),双轨征(n=21例,40.4%),而在类风湿性关节炎中均无上述间接征象出现。结论超声可以依据骨侵蚀的特征鉴别类风湿性与痛风性跖趾关节炎。     

Investigational drugs for hyperuricemia,an update on recent developments

Introduction: The significant proportion of gout patients not reaching serum urate levels below 6.0 mg/dL and the debated pathogenicity of hyperuricemia (HU) itself motivate investigators to develop new drugs to decrease uricemia.

Areas covered: This review discusses the drugs considered to be in active development from pre-clinical to phase III studies. This review covers 11 drugs in development, including a xanthine oxidase inhibitor (topiroxostat), uricosurics (verinurad, arhalofenate, UR-1102, tranilast), dual inhibitors (RLBN1001, KUX-1151), a uricase (pergsiticase), an inhibitor of hypoxanthine production (ulodesine), and drugs with yet-to-explain mechanisms of action (levotofisopam, tuna extracts).

Expert opinion: Drugs well advanced in their development – particularly arhalofenate, verinurad and topiroxostat – open the prospect of patient-comorbidity-tailored HU management. Development of novel therapies provides new insight into our understanding of gout and HU, particularly potential pathogenicity. Apart from potency to decrease serum urate levels and good tolerance profiles, novel therapies will need to focus on administration modalities facilitating treatment adherence.     

Change gout: how to deal with this “silently-developing killer” in everyday clinical practice

Background: Despite being regarded as an easily-treatable disease, gout diagnosis and management can be challenging.

Review: This review discusses current issues in gout management and proposes some potential solutions. Gout diagnosis should be reached as early as possible and often requires specific tests, such as synovial fluid analysis or imaging techniques that are not available in most centers, leaving healthcare professionals to rely only on clinical presentations and their experience. In addition, gout management requires the evaluation of multiple aspects, such as monitoring of serum uric acid (sUA) level (which should be reduced to <6?mg/dL) to ensure adherence and efficacy of treatment, evaluation of patient’s risk profile and comorbidities, and continuous assessments to manage clinical manifestations. An important premise in gout management is non-pharmacological intervention; however, pharmacological urate-lowering therapy is crucial for an optimal control of the disease. Available options include xanthine-oxidase inhibitors (XOI), targeting uric acid overproduction, and uricosuric agents which target the predominant cause of hyperuricemia (under-excretion). Among these, lesinurad is the novel uricosuric agent to be used in combination with XOI in patients with gout not adequately controlled with XOI alone, which can further contribute to the control of hyperuricemia in gout.

Conclusions: Multidisciplinary management is crucial for the diagnosis and treatment of gout, in order to ensure treatment continuity and improve management. This review, therefore, advises that educational activities for General Practitioners and specialists should be implemented to help raise awareness on gout diagnosis, monitoring, and treatment.     

Management of gout in the real world: current practice versus guideline recommendations

Objectives: Gout is a chronic, extremely painful disease that is potentially curable when treated effectively. Unfortunately approximately one-half of patients with gout are inadequately controlled. Methods: We surveyed 315 primary care physicians in the United States and Europe to investigate current practice in the real world, as distinct from recommendations in guidelines. Results: Our survey on 1657 patients found that regular testing of serum uric acid, in conformity with the guidelines, was conducted by approximately 50% of physicians. Advice to patients on diet and lifestyle was less well implemented, and identification of overweight/obese patients was inconsistent. Conclusion: Improvements in practice by physicians would include comprehensive assessment of the patient, adoption of regular monitoring during treatment, and the provision of patient education on adherence and lifestyle.     

The methanol extract of Euonymus laxiflorus,Rubia lanceolata and Gardenia jasminoides inhibits xanthine oxidase and reduce serum uric acid level in rats

Chinese herbal medicinal plants, Euonymus laxiflorus (EL), Rubia lanceolata (RL) and Gardenia jasminoides (GJ), have been used wildly to treat arthritis and gout in Taiwan for decades. To understand the beneficial effects of these three plants, their xanthine oxidase (XO) inhibitory activity in vitro and hypouricaemic activity in vivo were investigated. Our results suggested that methanol extracts were better than water extracts for inhibition of XO activity and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity, except the water extract of GJ, which exhibited the strongest radical scavenging effect. In animal study, the serum urate level was significantly decreased after oral administration of higher dose (0.39 g/kg) methanol extract of the mixture of three plants (ERG). In addition, methanol extract of ERG reduced the pain reaction time in the second phase of formalin induced pain. The results provide useful information on the pharmacological activities of these plants for the potential in treating hyperuricemia.     

痛风遗传易感基因及相关危险因素的病例对照研究

目的了解痛风遗传易感基因及相关危险因素,为痛风预防控制措施的制定提供科学依据。方法采用1：l配对病例对照研究的方法,于2008年2—12月,在山东省随机选取5家医院内科门诊确诊的痛风患者作为病例,同时,选取年龄相近、同民族、同县（市）、同一时间在该医院内科门诊就诊的胃肠炎患者作为对照,共调查95对病例对照,进行问卷调查、生化指标测定和基因多态性检测,并进行多因素条件logistic回归分析。结果多因素条件logistic回归结果表明,直系亲属患高尿酸血症者（OR=44．142,95％CI：5．832～334．095）,喝啤酒量较大（OR=1．539,95％CI：1．017～2．732）,经常吃蛤蜊（OR=2．256,95％CI：1．206—4．220）,总胆固醇水平高（OR=I．793,95％CI：1．010—3．183）,ApoAI—CⅢ-AIV基因簇-75位点A等位基因（OR：1．937,95％CI：1．001～4．983）,ApoAI—CIn—AIV基因簇＋83位点T等位基因（OR=1．891,95％CI：1．011～3．537）,ApoAI—CⅢ-AIV基因簇XmnI位点突变型等位基因X2（OR=4．417,95％CI：2．211．8．822）的频率升高是痛风发生的危险因素。结论痛风的危险因素涉及饮食、血脂指标和遗传基因多态性多个方面,应制定综合防控措施,预防痛风的发生。