통풍의 치료
Recent Progress in the Management of Gouty Arthritis and Hyperuricemia
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초록
새로 개발되는 좋은 약제도 환자의 협조 없이는 효과를 볼 수 없다. 지속적인 환자의 평생치료에 대한 의욕고취가 중요하다. 급성 통풍관절염의 급성 염증이 조절되고 나면 대개의 경우에 환자는 치료가 종결되었다고 생각한다. 통증이 사라지면 치료의 의욕도 줄어든다. 그러므로 치료자는 교육을 통하여 환자에게 통풍에 대한 이해를 잘 시켜야 한다. 통풍은 일단 치료를 시작하면 평생을 통한 꾸준한 요산의 조절이 병행되어야 한다는 사실을 각인시켜야 한다. 물론 생활 습관변화와 식사요법도 병행하여 요산의 증가와 급성관절염의 발작과 만성 합병증의 예방에도 힘써야 한다, 위에서 언급 하였듯 최근에 통풍교육을 위한 웹사이트도 있어 환자나 의료인들에게 권하면 도움이 될 것이다(http://www.goutin.kr/).
Abstract
There is an increasing incidence of gout and hyperuricemia worldwide. It is because the population is getting older, their life style is sedentary, and they take protein-enriched food. Gout is one of the most common but best controllable chronic diseases of adult. There have been recent advances in the understanding of underlying mechanisms and treatment of gout and hyperuricemia. This article is aimed to provide the practical review of the currently recommended practice of care and also to introduce some recently approved drugs. The management concept of hyperuricemia is changing because not only the gout but also the hyperuricemia appear to be independent risk factors for hypertension, renal disease and cardiovascular disease. Gout causes a significant individual and social burden and loss of working force. Still hyperuricemia in the gout patient is often under-treated by the patients themselves and by the physicians also. Once the acute gout attack is controlled, patients should be followed with goal-oriented treatment of hyperuricemia and other risk factors. Allopurinol has remained as a first-line treatment for chronic hyperuricemia, but uricosuric agents may also be considered in some patients. These drugs have provided good control of the disease in most gout patients until now but the elderly patients with gout often carry co-medications, contra-indication to these drugs, and risk of adverse drug reaction. Febuxostat is a nonpurine xanthine-oxidase inhibitor. It is a new agent approved by the US FDA and Korean FDA for the treatment of hyperuricemia in patients with gout which may be used when allopurinol is not tolerated or contraindicated. Pegloticase is the PEGylated urate oxidase which is very potent and so recently approved by the US FDA for the gout refractory to conventional treatment. (Korean J Med 2011;80:260-268)
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