통풍의 최신지견
An update on the management of hyperuricemia and gout
1
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Gout is a common chronic inflammatory arthritis that can lead to significant disability. Gout is one of the few rheumatologic diseases that can be diagnosed with certainty and can be cured with appropriate therapy. Alcohol and dietary consumption are related to hyperuricemia and gout attacks. A moderate intake of purine-rich vegetables or protein is not related to an increased risk of gout. A weight-reducing, calorie-restricted diet with moderate carbohydrate restriction was beneficial for gout patients and reduced the serum uric acid and frequency of gout attacks, although these findings need to be confirmed. Clinicians should consider therapeutic options that do not increase the serum uric acid when treating associated conditions in gout patients. The acute gout attack can be treated appropriately with non-steroidal anti-inflammatory drugs, colchicine, or glucocorticoids. Hypouricemic treatment reduces the uric acid concentration by inhibiting its production (allopurinol) or enhancing its excretion (benzbromarone). Allopurinol is the agent used most commonly, but the recommended dose often fails to control the serum uric acid. Benzbromarone effectively reduces the serum uric acid, but possible hepatotoxicity should be monitored. Febuxostat, a new xanthine oxidase inhibitor, was recently approved by the Federal Drug Administration (FDA). PEGylated uricase, a potent parenteral hypouricemic agent, is under investigation for the treatment of gout.
Abstract
Gout is a common chronic inflammatory arthritis that can lead to significant disability. Gout is one of the few rheumatologic diseases that can be diagnosed with certainty and can be cured with appropriate therapy. Alcohol and dietary consumption are related to hyperuricemia and gout attacks. A moderate intake of purine-rich vegetables or protein is not related to an increased risk of gout. A weight-reducing, calorie-restricted diet with moderate carbohydrate restriction was beneficial for gout patients and reduced the serum uric acid and frequency of gout attacks, although these findings need to be confirmed. Clinicians should consider therapeutic options that do not increase the serum uric acid when treating associated conditions in gout patients. The acute gout attack can be treated appropriately with non-steroidal anti-inflammatory drugs, colchicine, or glucocorticoids. Hypouricemic treatment reduces the uric acid concentration by inhibiting its production (allopurinol) or enhancing its excretion (benzbromarone). Allopurinol is the agent used most commonly, but the recommended dose often fails to control the serum uric acid. Benzbromarone effectively reduces the serum uric acid, but possible hepatotoxicity should be monitored. Febuxostat, a new xanthine oxidase inhibitor, was recently approved by the Federal Drug Administration (FDA). PEGylated uricase, a potent parenteral hypouricemic agent, is under investigation for the treatment of gout.
참고문헌 (39)
- Terkeltaub RA, "Clinical practice: gout", N Engl J Med, 349, pp.1647~1655 (2003)
- Arromdee E, "Epidemiology of gout: is the incidence rising?", J Rheumatol, 29, pp.2403~2406 (2002)
- Yoo B, "Serum uric acid levels in Korean adult population and their correlates", J Korean Rheum Assoc, 2, pp.60~68 (1995)
- Choi HK, "Purine-rich foods, dairy and protein intake, and the risk of gout in men", N Engl J Med, 350, pp.1093~1103 (2004)
- Fam AG, "Gout, diet, and the insulin resistance syndrome", J Rheumatol, 29, pp.1350~1355 (2002)
- Dessein PH, "Beneficial effects of weight loss associated with moderate calorie", carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study, 2000, pp.59, 539~543
- Vandenberg MK, "Gout attacks in chronic alcoholics occur at lower serum urate levels than in nonalcoholics", J Rheumatol, 21, pp.700~704 (1994)
- Choi HK, "Alcohol intake and risk of incident gout in men: a prospective study", Lancet, 363, pp.1277~1281 (2004)
- Huang HY, "The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial", Arthritis Rheum, 52, pp.1843~1847 (2005)
- Grundy SM, "Diagnosis and management of the metabolic syndrome: an American Heart Association", National Heart, Lung, and Blood Institute Scientific Statement, 2005, pp.112, 2735~2752
- Young Hee Rho, "The Prevalence of Metabolic Syndrome in Patients with Gout :A Multicenter Study", Journal of Korean Medical Science, 20(6), pp.1029~1033 (2005), 대한의학회
- Choi HK, "Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey", Arthritis Rheum, 57, pp.109~115 (2007)
- Choi HK, "Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study", Arch Intern Med, 165, pp.742~748 (2005)
- Burnier M, "Salt-dependent renal effects of an angiotensin II antagonist in healthy subjects", Hypertension, 22, pp.339~347 (1993)
- Sennesael JJ, "Divergent effects of calcium channel and angiotensin converting enzyme blockade on glomerulotubular function in cyclosporine-treated renal allograft recipients", Am J Kidney Dis, 27, pp.701~708 (1996)
- Milionis HJ, "Effects of statin treatment on uric acid homeostasis in patients with primary hyperlipidemia", Am Heart J, 148, pp.635~640 (2004)
- Feher MD, "Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout", Rheumatology, 42, pp.321~325 (2003)
- Sutaria S, "Effectiveness of interventions for the treatment of acute and prevention of recurrent gout: a systematic review", Rheumatology, 45, pp.1422~1431 (2006)
- Zhang W, "EULAR evidence based recommendations for gout: part II. management", Ann Rheum Dis, 65, pp.1312~1324 (2006)
- Rubin BR, "Efficacy and safety profile of treatment with etoricoxib 120 mg once daily compared with indomethacin 50 mg three times daily in acute gout:a randomized controlled trial", Arthritis Rheum, 50, pp.598~606 (2004)
- Wortmann RL, "Recent advances in the management of gout and hyperuricemia", Curr Opin Rheumatol, 17, pp.319~324 (2005)
- Wilbur K, "Colchicine myotoxicity: case reports and literature review", Pharmacotherapy, 24, pp.1784~1792 (2004)
- Pascual E, "Therapeutic advances in gout", Curr Opin Rheumatol, 19, pp.122~127 (2007)
- Ritter J, "ACTH revisited: effective treatment for acute crystal induced synovitis in patients with multiple medical problems", J Rheumatol, 21, pp.696~699 (1994)
- Tausche AK, "Severe gouty arthritis refractory to anti-inflammatory drugs: treatment with anti-tumour necrosis factor alpha as a new therapeutic option", Ann Rheum Dis, 63, pp.1351~1352 (2004)
- Perez-Ruiz F, "Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout", Arthritis Rheum, 47, pp.356~360 (2002)
- Choy G, "An update on the treatment options for gout and calcium pyrophosphate deposition", Expert Opin Pharmacother, 6, pp.2443~2453 (2005)
- Hande KR, "Severe allopurinol toxicity: description and guidelines for prevention in patients with renal insufficiency", Am J Med, 76, pp.47~56 (1984)
- Vazquez-Mellado J, "Relation between adverse events associated with allopurinol and renal function in patients with gout", Ann Rheum Dis, 60, pp.981~983 (2001)
- Hung SI, "HLA-B* 5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol", Proc Natl Acad Sci U S A, 102, pp.4134~4139 (2005)
- Zurcher RM, "Excellent uricosuric efficacy of benzbromarone in cyclosporin-A-treated renal transplant patients:a prospective study", Nephrol Dial Transplant, 9, pp.548~551 (1994)
- Masbernard A, "Ten years’ experience with benzbromarone in the management of gout and hyperuricaemia", S Afr Med J, 59, pp.701~706 (1981)
- Arai M, "Fulminant hepatic failure associated with benzbromarone treatment: a case report", J Gastroenterol Hepatol, 17, pp.625~626 (2002)
- Schumacher HR Jr, "Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial", Arthritis Rheum, 59, pp.1540~1548 (2008)
- Pui CH, "Recombinant urate oxidase for the prophylaxis or treatment of hyperuricemia in patients with leukemia or lymphoma", J Clin Oncol, 19, pp.697~704 (2001)
- Pui CH, "Urate oxidase in prevention and treatment of hyperuricemia associated with lymphoid malignancies", Leukemia, 11, pp.1813~1816 (1997)
- Bomalaski JS, "Uricase formulated with polyethylene glycol (uricase-PEG 20): biochemical rationale and preclinical studies", J Rheumatol, 29, pp.1942~1949 (2002)
- Sundy JS, "Pharmacokinetics and pharmacodynamics of intravenous PEGylated recombinant mammalian urate oxidase in patients with refractory gout", Arthritis Rheum, 56, pp.1021~1028 (2007)
- Sundy JS, "Reduction of plasma urate levels following treatment with multiple doses of pegloticase (polyethylene glycol-conjugated uricase) in patients with treatment-failure gout: results of a phase II randomized study", Arthritis Rheum, 58, pp.2882~2891 (2008)