High uric acidemia and gout, how to use drugs?

Hyperuric acidemia (HUA) is non-day 2 fasting blood uric acid more than 420 smol/L, can be divided into excretion of undesirable type, synthetic excessive type, mixed type and other typesGout is blood uric acid that exceeds its saturation inbloodor tissue fluid and locally forms and depositions sodium uric acid in the joint, induced local inflammatory reactions and tissue damageIncurable gout refers to acute gout arthritis after several years of recurrence, the emergence of chronic multiple, destructive arthritis, accompanied by gout stone formation and/or acidic kidney stones, conventional dose of uric acid drugs difficult to make blood uric acid standard gout, its treatment principle is mainly to reduce blood uric acid and improveclinicalsymptomsIncurable gout is at least 1 of the following 3 articles, namely, single or joint conventional uric acid-lowering drugs sufficient, foot course of treatment, but blood uric acid is still 360 ?mol/L; "China's hyperuric acidemia and goutdiagnosis and treatmentguidelines (2019)) also pointed out that: in recent years, a number of difficult goutclinicalstudies will be the baseline blood uric acid s 480 mol/L, and the existence of the following clinical characteristics of at least one defined as difficult to treat Sexual gout, i.emore than 3 gout attacks in the last 18 months; at least 1 gout stone; persistent joint pain or imaging shows gout-related joint damage;1The drug of hyperuric acidemia and goutthe treatment of high uric acidemia and gout mainly includes the suppression of uric acid production drugs, uretic excretion drugs, alkaline urine drugs, acute seizure treatment drugs, uric acid oxidase, leukocyte interleukin 1 (IL-1) antagonists, etc2High uric acidemia and gout drug selection(1) uric acid excretion of undesirable type optional benzene bromon, uric acid synthesis of excessive type optional with other than puritanol, non-bustam, mixed type can be on the drug single use or co-use(2) recommends bethanol, non-bustamol or phenyl bromonion as the first-line drug for the treatment of urea in gout, and bemotherol or phenyl brominated malone as a first-line medication for the treatment of hypouric acid in people with asymptomatic hyperuric acidemiaSingle-drug sufficient, foot treatment, blood uric acid is still not up to standard, may consider the use of 2 different mechanisms of urea-reducing acid drugs, not recommended uric acid oxidase and other uric acid-reducing drugs combined(3) Anti-inflammatory analgesia during the acute onset of gout: It is recommended to use small doses of autumn daffodilor or NSAIDs (sufficient, short course of treatment) as early as possible, and to those who are intolerant of the above-mentioned drugs, inpoor efficacy or contraindications, it is recommended that the whole body use glucocorticoidsPain Visual Simulation Scoring (VAS) score of 7 points, or 2 large joints are affected, or more arthritis, or a drug efficacy is poor, recommended 2 anti-inflammatory analgesic drugs combined with, such as small doses of taffy daffodil saline combined with NSAIDs or systemic glucocorticoidsSevere acute gout attacks (pain VAS.7), polyarthritis or tired of 2 large joints, or a drug efficacy is poor, recommended to use 2 kinds of analgesic drugs, such as small doses of autumn daffodils and NSAIDs, autumn daffodils and systemic glucocorticoids and other forms of combination, do not recommend oral NSAID and whole body glutacoid combination(4) Gouter hypothermia treatment earlypreventiongout attack: gout patients began to reduce uric acid drug treatment, due to fluctuations in blood uric acid level, can cause gout or uric acid crystal slutypes inside and outside the joint dissolved, causing gout arthritis recurrenceGouters in the initial stage of uric acid treatment, recommended a small dose (0.5-1mg/d) autumn daffodilpreventgout attacks, maintain at least 3-6 months, renal insufficiency, recommended according to eGFR dose, eGFR 10.min-1( 1.73 m2) -1 when disabledFor those with intolerant teraphaine, a small dose of NSAIDs (no more than 50% of the regular dose) is recommended for second-line drugs to prevent gout attacks, maintained for at least 3-6 monthsAutumn daffodils and NSAIDs intolerance or contraindications, such as chronic renal insufficiency, recommended small doses of glucocorticoids (pernison s 10 mg/d) for the prevention of gout attacks medication, maintained for at least 3-6 months It is also recommended that small doses of the initial uric acid reduction drug, slowly increased to avoid or reduce gout attacks (5) have the risk of digestive bleeding or need to use small doses of aspirin for a long time, it is recommended to give priority to the use of COX-2 inhibitors, COX-2 inhibitors may cause cardiac the risk of vascular events increase, combined myocardial infarction , heart insufficiency to avoid use (6) recurrent pain, difficult gout beyond the control of conventional drugs, may consider using IL-1 antagonists 3 The drug of hyperuric acid and gout combined hyperuric acidemia and gout often combined hypertension , diabetes , lipid metabolism disorders, etc., of which 47.2-77.7 percent were combined hypertension , 12.2-26.9% combined with diabetes , 67% combined with fat metabolism disorders Treatment is both uric acid reduction, to avoid acid-boosting drugs by Gao Lili Source: