Treatment of gout, 7 types of situation hasten to take medication, 3 types of food to eat less! Guide time.

Don't want to miss Jiemei's push? Poke the blue word "medical rheumatism and nephropathy channel" to pay attention to us, and click the "··" menu in the upper right corner, and select "set as star" 2020 ACR gout guide. What has been said? On May 11, the American Society of Rheumatology guidelines for gout management (2020 Edition) was published in Arthritis & rheumatology. What are the contents of 2020acr guidelines? The small edition will be sorted out from the following eight parts.01 indications for initiation of ult are strongly recommended for patients with gout with any of the following characteristics: 1) for patients with one or more subcutaneous gout stones.(evidence level: high) 2) for patients with any evidence of gout induced imaging damage.(evidence level: medium) 3) for patients with frequent gout attacks (> 2 times / year).(evidence level: high) for patients with previous acute gout attack more than once, but not frequently (< 2 times / year), it is suggested to start ult conditionally.(level of evidence: medium) for patients with acute gout for the first time, it is recommended not to start ult treatment.except for patients with moderate to severe chronic kidney disease (CKD & gt; 3), serum uric acid (Su) & gt; 9mg / dl (535.5umol / L) or urolithiasis.(level of evidence: medium) for patients with asymptomatic hyperuricemia (Su & gt; 6.8mg/dl, no gout attack or subcutaneous gout stone), it is suggested that ult (allopurinol, febuxostat, probenecid) should not be initiated.(level of evidence: high) 02 recommendations for initial ult in gout patients: allopurinol is recommended as the first-line drug of ult, including in patients with moderate and severe CKD (CKD & gt; 3).(level of evidence: medium) in patients with moderate and severe CKD (CKD > 3), allopurinol and febuxostat had higher priority than probenecid.(evidence level: medium) it is strongly recommended to start with a low dose and then titrate gradually: the initial dose of allopurinol is less than 100mg / D (for patients with CKD > 3, the dose should be lower); the initial dose of febuxostat is less than 40mg / D; conditionally, the starting dose of probenecid is 500mg, QD or bid (evidence level: medium). It is strongly recommended to reduce uric acid and carry out individual preventive treatment at the same time Drugs such as colchicine, NSAIDs, prednisone / prednisolone.(evidence level: medium) it is strongly recommended that anti-inflammatory prophylactic treatment should be continued for 3-6 months (no less than 3 months). If the patient continues to have gout attack, continuous assessment and preventive treatment are required.(evidence level: medium) when patients with acute gout attack and have the indication of ult, it is conditionally recommended to start the ult during the acute attack rather than after the end of the attack.it is strongly not recommended to use peglotase as a first-line option.(evidence level: medium) 03ult initiation time for patients receiving ult, it is strongly recommended that: 1) for all patients receiving ult treatment, it is strongly recommended to adopt the target treatment strategy, that is, titrating the dosage of ult based on the continuous measured Su level to achieve the Su target, rather than the ult strategy of fixed dose.(evidence level: medium) 2) for all patients receiving ult treatment, continuous treatment is strongly recommended, and the target of Su treatment is < 6mg / dl (360umol / L).(evidence level: high) 3) for all patients receiving ult treatment, it is conditional to recommend the enhanced scheme of ult dose management provided by non doctor providers to optimize the strategy, including patient education, shared decision-making and standard treatment plan.(level of evidence: medium) in addition, it is conditionally recommended to treat ult indefinitely.(evidence level: very low) 04ult specific drug use recommendations allopurinol: it is conditionally recommended that Southeast Asian (such as Chinese Han, Korean, Thai, etc.) populations and African American patients be tested for HLA-B * 5801 gene before starting allopurinol treatment.(evidence level: very low) it is suggested that patients of other races or nationalities should not be tested for HLA-B * 5801 gene before allopurinol treatment.(level of evidence: very low) it is strongly recommended that the starting dose of allopurinol < 100mg / D (should be lower in CKD patients) rather than high dose initiation.it is suggested that patients with allergic reaction to allopurinol but can not be treated with other oral liquid should be given allopurinol desensitization therapy.(level of evidence: very low) febuxostat: for patients with a history of CVD or new CVD events who are using febuxostat, it is conditionally recommended to switch to other ult drugs.(level of evidence: medium) uric acid excretors: for patients who are considering using or are using uric acid excretors, it is recommended not to carry out uric acid test conditionally.(level of evidence: very low) for patients receiving uric acid excretion therapy, it is conditionally recommended not to use alkalized urine therapy.(evidence level: very low) 05 when to consider changing the ult policy? For patients who have received xanthine oxidase inhibitor (xoi) alone at the maximum tolerated dose or FDA approved dose for the first time, but still fail to achieve the Su treatment target [> 6mg / dl (360umol / L)] and / or gout is still frequent (> 2 times / year) or subcutaneous gout stone is still not dissolved, it is recommended to replace xoi with another xoi instead of the combined uric acid excretion drug.(level of evidence: very low) for patients with frequent gout episodes (> 2 / year) or subcutaneous dissolution of gout (very low level of evidence) who are unable to achieve Su compliance with xoi, uric acid excretion drugs, and other interventions, it is strongly recommended to switch to peglotase instead of maintaining the current ult regimen.(level of evidence: medium) for those who can not achieve Su standard after xoi, uric acid excretion drugs and other interventions, but gout attacks are not frequent (< 2 times / year) and there is no subcutaneous gout stone, it is strongly recommended to continue the current ult treatment scheme instead of converting to peglotase treatment.(evidence level: medium) 06 colchicine, non steroidal anti-inflammatory drugs, or glucocorticoids (oral, intra-articular or intramuscular) are strongly recommended as the first choice of drugs for the management of acute gout attack, rather than IL-1 inhibitors and adrenocorticotropic hormone (ACTH).(level of evidence: high) when choosing colchicine, it is strongly recommended to choose low-dose colchicine instead of high-dose colchicine (because the efficacy of low-dose colchicine is similar to that of high-dose colchicine, and the risk of adverse reactions is low).(level of evidence: high) if the patient is unable to apply the above anti-inflammatory therapy due to intolerance or contraindications, it is conditional to recommend IL-1 inhibitors.(level of evidence: medium) glucocorticoids (intramuscular, intravenous or intra-articular) are strongly recommended for patients who cannot receive oral dosage forms, rather than IL-1 inhibitors or ACTH. During the acute attack of gout, local ice compress is recommended as an adjuvant therapy.(evidence level: low) 07 lifestyle management for gout patients, regardless of disease activity, conditionally suggests that alcohol intake should be limited. (evidence level: low) limit purine intake. (level of evidence: low) limit intake of high fructose corn syrup. (level of evidence: very low) weight loss is recommended for overweight / obese patients. (level of evidence: very low) vitamin C supplements are not recommended. (evidence level: low) 08 for gout patients, regardless of disease activity, it is suggested that hydrochlorothiazide should be replaced with other antihypertensive drugs if feasible. If (evidence level: very low), losartan is preferred as antihypertensive drug. (level of evidence: very low) for gout patients, regardless of disease activity, it is conditionally recommended that low-dose aspirin should not be stopped (if there is indication for aspirin). (level of evidence: very low) do not add or convert fenofibrate to other cholesterol lowering drugs (such as statins, cholic acid chelators, nicotinic acid drugs, etc.). (evidence level: very low) Professor Zhou Yaou released the latest ACR clinical practice guidelines for gout in 2020. In addition to strengthening many contents of the 2012 ACR gout guidelines, and according to the latest literature, the evaluation, formulation and evaluation (grade) method of recommended grading was adopted, and a total of 42 recommendations were approved, taking into account patient preferences and treatment costs. the treatment of lowering uric acid (ult) is the root of controlling gout. The guideline gives detailed suggestions on the indication of starting ult in patients with gout, the choice of ult drugs, the starting time of ult, the duration of ult, how to add the ult drugs, and when to consider changing the ult strategy. the literature published in 2015-2018 shows that although the use of uric acid lowering drugs can reduce the incidence of gout (1% vs 5%), considering the effect risk ratio, the 2020 version of ACR guidelines proposed that asymptomatic hyperuricemia should not be treated with hypouricemia, which is similar to that in the 2012 version of ACR guidelines, "due to the lack of prospective research and evidence-based medical evidence, the treatment of asymptomatic hyperuricemia is not published It is also different from the Chinese guideline for diagnosis and treatment of hyperuricemia and gout in 2019, which suggests that "patients with asymptomatic hyperuricemia should start to reduce uric acid when they have the following conditions: blood uric acid level ≥ 540 μ mol / L or blood uric acid level ≥ 480 μ mol / L and one of the following complications: hypertension, abnormal lipid metabolism, diabetes, obesity, stroke, coronary heart disease, cardiac insufficiency, and urine Acid nephrolithiasis and renal function damage are different. for lifestyle management and combined medication management, such as limiting alcohol intake, purine intake, weight loss in obese patients, conversion of hydrochlorothiazide antihypertensive drugs to another antihypertensive drug when feasible, and not stopping the use of aspirin. in conclusion, the guidelines for gout in 2020 provide detailed guidance on uric acid lowering treatment, medication in acute phase, lifestyle management and combined medication management for gout patients. however, in addition to expert opinions, the guidelines also refer to the preferences and treatment costs of patients in the United States. Therefore, allopurinol is the preferred uric acid lowering drug in the guideline. however, the incidence of allopurinol allergy and severe allergy in Chinese population is significantly higher than that in the United States, so it needs specific analysis and individualized medication in clinical application. Prof. Zhou Yaou, female, doctor, deputy chief physician of Xiangya Hospital. young member of Hunan Provincial Society of immunology, member of infectious science group of cross strait rheumatology and Immunology Professional Committee. long term