Gout is caused by abnormal metabolism of purine. Its most common symptom attack of intense pain and swelling in the joints. Attacks of gout can according to the alteration if it is in acute interval periods. How can we get the optimal effect? The development of methodology has provided much convincing evidence for us to choose the most appropriate treatment.
目的:探讨不同治疗方法对急性痛风性膝关节炎的治疗效果。方法:自2006年9月～2008年3月共收治42例急性痛风性膝关节炎患者。对21例急性痛风性膝关节炎患者采取药物保守治疗,21例行关节镜手术配合药物治疗。两组治疗前后采用WOMAC评分对膝关节功能进行评定,用student-t检验进行统计学分析。结果:保守组:随访发现关节症状好转不明显,复发率19.05％;WOMAC评分治疗前49～72分,治疗后69～85分。关节镜手术配合药物组:随访发现关节症状均明显缓解,关节功能恢复良好,伤口甲级愈合,无术后并发症,6个月无复发病例;WOMAC评分治疗前49～71分,治疗后75～96分。两组治疗前后及之间有显著性差异,保守组(t=-9.864,Plt;0.001);关节镜手术配合药物组(t=-11.267,Plt;0.001);两组之间(t=-2.366,Plt;0.023)。结论:比较以上2种治疗方法,关节镜手术治疗急性痛风性膝关节炎具有创伤小、起效快、效果明显、关节功能恢复满意等特有优势,结合药物治疗,能取得良好的治疗效果。
ObjectiveTo evaluate the effectiveness of lesion clearance combined with Ilizarov technique for the treatment of tophi in first metatarsophalangeal (MTP) joint with bone defect.MethodsBetween July 2016 and June 2018, 14 cases of tophi in the first MTP joint with bone defect were treated by lesion clearance combined with Ilizarov technique. There were 12 males and 2 females. The average age was 39.3 years (range, 22-60 years). The disease duration ranged from 5 to 15 years, with an average of 11.2 years. The tophi volume ranged from 2.5 cm×2.7 cm×2.2 cm to 5.2 cm×2.9 cm×2.4 cm. The X-ray films showed that the length of the bone defect ranged from 2.0 to 4.6 cm, with an average of 3.4 cm. Preoperative visual analogue scale (VAS) score was 7.6±0.9; American Orthopaedic Foot and Ankle Society (AOFAS) score was 47.5±4.3; short-form 36 health survey scale (SF-36) score was 79.7±4.7.ResultsThe incision primarily healed in 13 patients after operation. The skin necrosis at the edge of the incision occurred in 1 patient and recovered after symptomatic treatment. All 14 patients were followed up 12-16 months, with an average of 13.6 months. X-ray films showed that the first metatarsal column defects were repaired. The time of bone extension ranged from 2 to 6 weeks, with an average of 3.6 weeks. The time of bone healing ranged from 9 to 16 weeks, with an average of 11.2 weeks. During follow-up, no complication such as nerve, blood vessel, or tendon injury, needle tract infection, or stress fracture occurred. At last follow-up, VAS score was 1.4±0.5, AOFAS score was 86.6±4.8, and SF-36 score was 89.1±3.3, all of which were superior to preoperative scores, with significant differences (t=22.532, P=0.000; t=22.702, P=0.000; t=6.124, P=0.000).ConclusionLesion clearance combined with Ilizarov technique is a safe and effective method for the treatment of tophi in the first MTP joint with bone defect.
摘要:目的: 系统评价非布索坦治疗痛风的疗效及安全性。 方法 :计算机检索PubMed、EMBASE、SCI、CBM、CNKI、VIP、万方数据库及Cochrane图书馆,手工补充检索;纳入非布索坦治疗痛风的随机对照试验(RCT);进行方法学质量评价和Meta分析。 结果 :共纳入3个RCT(受试者1985例),A级文献1篇,B级文献2篇。Meta分析结果显示:最后3月血清尿酸(SU)持续低于60 mg/dl患者数、随访结束时SU低于60 mg/dl患者数非布索坦组与对照组差异均有统计学意义;治疗相关不良事件发生数与安慰剂组差异无统计学意义,与别嘌呤组差异有统计学意义。 结论 :基于当前证据,非布索坦治疗痛风,能有效降低SU含量,减少治疗相关不良事件发生率。Abstract: Objective: Assessing the effectiveness and safety of febuxostat for the treatment of gout. Methods :Randomized controlled trails(RCT) of febuxostat for the treatment of gout were gathered from the Cochrane Library、PubMed、EMBASE、SCI、CBM、CNKI、VIP、Wangfang Database, other relative researches were handsearched, each RCT was methodological quality evaluated, then analyzed by software RevMan50 Results :A total of 3 RCTs were collected (involving 1985 subjects); 1 was graded A, 2 were B; according to the Metaanalysis: the differences of subjects with last 3 monthly serum urate(SU)＜60mg/dl and subjects with SU＜60mg/dl at final visits were significant; treatmentrelated adverse events between febuxostat and allopurinol was significant different, but not significant difference between febuxostat and placebo. Conclusion : According to the evidence currently, febuxostat could reduce SU and the episodes of treatmentrelated adverse events.
目的 探讨心理行为干预对痛风患者遵医行为的影响。 方法 2006年1月－2010年9月，选取痛风患者190例，随机分为干预组和对照组，两组均进行遵医行为评价和疾病相关检查；对干预组进行认知行为干预，分析患者存在的痛风饮食治疗的认知误区，有针对性地进行心理行为干预。 结果 干预后，干预组认知行为总分和各单项分均高于对照组（P＜0.05），胆固醇、甘油三酯和体质量指数均低于对照组（P＜0.05）；干预组19例（20.0%）复发，对照组36例（37.9%）复发，两组复发率比较，差异有统计学意义（χ2=7.390，P=0.007）。 结论 行为认知治疗可提高痛风患者的治疗依从性，从而有助于改善尿酸等相关指标。
Gout is the most common inflammatory arthritis, which is characterized by elevated urate and monosodium urate (MSU) crystal deposition in tissues, leading to arthritis, soft-tissue masses (tophi), nephrolithiasis, and urate nephropathy. It has a major impact on health-related quality of life. The American College of Rheumatology (ACR) published ACR guidelines for the management of gout in June 2020, in which 42 recommendations (including 16 strong recommendations) were generated. The guideline described indications for urate-lowering therapy (ULT), approaches to initiating, ongoing management, gout flares, and lifestyle and other medication strategies in patients with gout and in individuals with asymptomatic hyperuricemia. This paper interprets it to provide references for clinical practice.
Objective To investigate the method and the effectiveness of a combination of the arthroscopic debridement and joint irrigation postoperatively for treating gouty arthritis of the knee. Methods Between August 2000 and November 2009, 41 patients with gouty arthritis of the knee were treated by arthroscopic debridement. All patients were males with an average age of 42 years (range, 21-71 years), including 8 incipient cases and 33 relapsed cases. The unilaterial knees wereinvolved in 36 cases, including 22 left knees and 14 right knees, and both in 5 cases. The disease duration ranged from 2 months to 20 years (median, 6 years and 2 months). The extention, flexion, and range of motion (ROM) of the knee joint were (4.88 ± 6.22), (93.95 ± 35.33), and (87.79 ± 35.19)°, respectively, and Lysholm score was 63.2 ± 11.7 preoperatively. The serum uric acid levels were higher than normal value in 32 cases. Twenty-seven cases were definitely diagnosed as gouty arthritis before operation. Arthroscopic debridement was performed in 11 cases, and the arthroscopic debridement with joint irrigation postoperatively in 30 cases. After operation, the anti-gout agents and diet control were given. Results Arthroscope and pathologic examinations confirmed diagnosis of gouty arthritis in 41 patients. Intra-articular hemorrhage occurred in 1 case and was cured after arthroscopic evacuation of hematoma. The other patients achieved heal ing of incision by first intention. All 41 patients were followed up 15-126 months (mean, 50 months) postoperatively. The Lysholm score was 96.8 ± 5.8 at 15 months after operation, showing significant difference when compared with the preoperative value (t= — 13.844, P=0.000). The postoperative extention (1.16 ± 3.91)°, flexion (125.93 ± 18.65)°, and ROM (126.86 ± 16.33)° of the knee joint were significantly improved when compared with the preoperative ones (P lt; 0.05). Thirteen cases (14 knees) recurred postoperatively; but occurrence frequency and the duration were decreased and the symptoms of joint swell ing and pain were improved. Conclusion The arthroscopicdebridement is effective in cleaning up uric acid crystals thoroughly, reducing wounds, and speeding up recovery. If antigout agents and diet control can be used postoperatively, the recurrence of gouty arthritis can be prevented effectively, and the progression can be delayed.