Colchicine in clinical medicine. A guide for internists

Colchicine (COL) has been used in medicine for a long time. It is well recognized as a valid therapy in acute flares of gouty arthritis, familial Mediterranean fever (FMF), Behçet's disease, and recurring pericarditis with effusion. It has also been used to treat many inflammatory disorders prone to fibrosis, mostly with disappointing therapeutic results.The pharmacotherapeutic mechanism of action of COL in diverse diseases is not fully understood, thought it is known that the drug accumulates preferentially in neutrophils, and this effect is useful in FMF.COL shows a large interindividual bioavailability. Furthermore, interactions with drugs interfering with CYP3A4 dependent enzymes and P-glycoprotein occur and are clinically important. The dosage of COL must be reduced in patients with relevant hepatic and/or renal dysfunction. However, when appropriately used and contraindications have been excluded, oral COL is a safe treatment.     

痛风性关节炎的X线诊断

目的分析痛风性关节炎的X线诊断。方法对我院被确诊为痛风性关节炎患者的X线片进行分析。结果痛风性关节炎的X线表现为手足小关节的骨质破坏缺损。结论痛风性关节炎的X线表现为手足小关节发病,但以第1跖趾关节常见。     

痛风颗粒抗炎降尿酸作用的实验研究

目的:通过痛风颗粒对大鼠痛风性关节炎及痛风性高尿酸血症防治作用的实验研究,初步探究其药效学作用。方法:采用微晶型尿酸钠(monosodium urate,MSU)致大鼠踝关节肿胀、足跖肿胀模型和尿酸(uric acid,UA)诱导大鼠高尿酸血症模型,测定大鼠足肿胀率、患肢压力及步态积分、血尿酸值、白细胞计数及肾脏重量系数。结果:痛风颗粒能有效抑制大鼠踝关节、足跖肿胀以及患肢压力和步态积分,并能显著改善高尿酸血症大鼠体内尿酸水平,高剂量痛风颗粒能明显抑制白细胞增生。结论:痛风颗粒具有抑制炎症及降低血清高尿酸的作用。     

针灸配合放血疗法治疗痛风性关节炎临床观察

目的观察针灸配合放血疗法治疗痛风性关节炎临床疗效.方法将60例患者随机分为2组,对照组20例以别嘌呤醇和痛舒胶囊口服治疗,治疗组40例,在此基础上予针灸加放血,取穴隐白、昆仑、太溪、阿是穴等,疗程均为2周.比较两组临床疗效、急性期患者主要关节症状疗效,血尿酸变化、不良反应和复发情况.结果治疗组临床治愈率明显高于对照组（P〈0.05）;在降低血尿酸、改善急性期患者主要关节疼痛、肿胀症状及疗效稳定性方面均优于对照组;不良反应少.结论针药配合放血疗法治疗痛风有良好的协同效应,并能提高临床疗效.     

Excellent response to the clinical treatment of tophaceous gout

Gout continues to be a health problem around the world, and the treatment may turn into a real challenge when the patient presents a certain degree of chronic renal failure (CRF). We discuss a case of tophaceous gout in a 68-year-old male patient without urolithiasis and with uric acid (UA) underexcretion and CRF (creatinine clearance of 42 ml/min). Uricosuric treatment with benzbromarone and urinary alkalinization was administered, and acute gouty attacks improved substantially. Subsequently, allopurinol was added to the treatment to accelerate tophi reduction in the hands, feet, elbows and knees. After 30 months of treatment, serum UA declined from 10 to 3.2 mg/dl. Urinary UA excretion of 0.44 g/24 h in the baseline rose to 0.85 g/24 h, returning to the baseline value after 30 months. UA clearance tripled, rising from 3.05 ml/min before treatment to 9.48 ml/min, and remained at this level. It is worth stressing that even in cases of severe tophaceous gout, the response to clinical treatment may be satisfactory with substantial reduction of tophi and full acute gouty attack remission even in patients presenting a certain degree of CRF.     

羟氯喹治疗老年原发性慢性痛风关节炎的疗效观察

目的探讨原发性痛风关节炎三种不同的治疗方法的疗效、安全性和复发的相关因素。方法将2007年5月～2008年5月无锡市河埒街道卫生服务中心的56例老年原发性慢性痛风关节炎患者随机分为2组,A组32例采用一般治疗基础上加小剂量羟氯喹,B组24例在一般治疗的基础上加用小剂量秋水仙碱维持治疗,观察期12个月。结果A、B2组病人治疗前后比较,痛风急性发作次数及血尿酸浓度明显下降（P〈O05）。急性痛风关节炎发作次数减少（P〈0.05）。因药物相关的不良事件而终止观察,2组分别为A组3例（94％）,B组11例（458％）,B组高于A组（P〈0.05）。结论一般治疗加用小剂量羟氯喹及秋水仙碱可减少老年慢性痛风关节炎的急性发作次数及降低血尿酸浓度;羟氯喹作为预防性治疗其耐受性和安全性比秋水仙碱更好。     

Novel HGPRT 293 A>G point mutation presenting as neonatal acute renal failure

We report on a rare case of hypoxanthine guanine phosphoribosyl transferase (HGPRT) deficiency that presented in the newborn period with acute renal failure (ARF). The clinical diagnosis was made on the basis of non-oliguric ARF and evidence of crystal nephropathy on renal biopsy. HGPRT deficiency was eventually confirmed by enzymatic and genetic testing, showing a novel point mutation, 293 A>G. Immediate treatment consisted of peritoneal dialysis with, initially, lactate- then bicarbonate-buffered 1.36% glucose solution together with oral administration of allopurinol. Follow-up after more than 4 years continued to show hyper-echogenic kidneys with almost normal renal glomerular function. There continues to be no neurobehavioural abnormalities.     

Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial

Purpose

The purpose of this study was to test a pharmacist-led intervention to improve gout treatment adherence and outcomes.

The association of vitamin C,alcohol, coffee,tea, milk and yogurt with uric acid and gout

About 2500 years ago, gout was observed by Hippocrates and many people suffered severe pain and deformity. Lifestyle and diet play a significant role in gout and serum uric acid levels. Epidemiological and research studies have supported this evidence. Many recommendations and guidelines from different parts of the world mention the impact of diet on gout. Recently, new research has shown associations between vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and the risk of gout. Our review summarizes recently published research regarding dietary impact on the risk of gout and serum uric acid levels.