Prophylaxis for acute gout flares after initiation of urate-lowering therapy
Rheumatology, Volume 53, Issue 11, November 2014, Pages 1920–1926,
當開始降尿酸藥物治療之後, 如何預防痛風急性發作
有兩種第一線治療, 可以使用六個月
1. 低劑量秋水仙素 colchicine 0.5 mg qd or BID
2. 低劑量消炎止痛藥物 NSAID naproxen 250 mg bid.
如果因任何原因無法使用上述兩種藥物治療. 可考慮低劑量類固醇
prednisone 或 prednisolone.
近期還有其他研究, 在服用 allopurinol 期間, 使用介白素抑制劑 IL-1 inhibitor 輔助治療
canakinumab
rilonacept
Abstract
This review summarizes evidence relating to prophylaxis for gout flares after the initiation of urate-lowering therapy (ULT). We searched MEDLINE via PubMed for articles published in English from 1963 to 2013 using MEsH terms covering all aspects of prophylaxis for flares. Dispersion of monosodium urate crystals during the initial phase of deposit dissolution with ULT exposes the patient to an increased rate of acute flares that could contribute to poor treatment adherence. Slow titration of ULT might decrease the risk of flares. According to the most recent international recommendation, the two first-line options for prophylaxis are low-dose colchicine (0.5 mg once or twice a day) or low-dose NSAIDs such as naproxen 250 mg orally twice a day. They can be given for up to 6 months. If these drugs are contraindicated, not tolerated or ineffective, low-dose corticosteroids (prednisone or prednisolone) might be used. Recently, reports for four trials described the efficacy of canakinumab and rilonacept, two IL-1 inhibitors, for preventing flares during the initiation of allopurinol therapy. Prophylaxis for flares induced by ULT is an important consideration in gout management. Low-dose colchicine and low-dose NSAIDs are the recommended first-line therapies. Although no IL-1 blockers are approved as prophylactic treatment, this class of drug could become an interesting option for patients with gout with intolerance or contraindication to colchicine, NSAIDs or corticosteroids.
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