Prevalence of Contraindications and Prescription of Pharmacologic Therapies for Gout
Prevalence of Contraindications and Prescription of Pharmacologic Therapies for Gout
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DOI：
10.1016/j.amjmed.2010.09.012
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发表时间：
2011-02-01
影响因子：
5.9
通讯作者：
Pillinger, Michael H.
中科院分区：
文献类型：
--
作者：
Keenan, Robert T.;O'Brien, William R.;Pillinger, Michael H.
背景：痛风患者有合并症，但这些合并症对治疗的影响还没有研究。方法：根据国际疾病分类第9版、单独临床修改编码(队列I)、美国放射学会标准(队列II)和晶体诊断(队列III)，共有575名痛风患者根据诊断确定性进行分层。根据《国际疾病分类》第9版，临床修订代码定义合并情况，并将其分层为中度或重度。根据食品和药物管理局的标准和疾病的严重程度，药物禁忌症被定义为中度或重度。结果：最常见的共病是高血压(患病率为0.89)。合并症的存在导致经批准的痛风药物禁忌症的出现频率很高。超过90%的患者至少有一个非类固醇抗炎药的禁忌症。许多患者对一种或多种痛风药物有多种禁忌症。通常，患者会被开出禁忌证的药物。尽管至少有一个强烈的禁忌症，但仍使用秋水仙碱的患者的患病率分别为30%(队列I)、37%(队列II)和39.6%(队列III)。结论：痛风患者通常合并多种并发症，导致许多可用于治疗痛风的药物的禁忌症。通常，尽管痛风治疗有禁忌症，但患者经常被开这些药物。(C)2011 Elsevier Inc.保留所有权利。。《美国医学杂志》(2011)124,155-163
BACKGROUND: Patients with gout have comorbidities, but the impact of these comorbidities on treatment has not been studied.METHODS: A total of 575 patients with gout were stratified according to certainty of diagnosis according to International Classification of Diseases, 9th Revision, Clinical Modification code alone (cohort I), American College of Radiology criteria (cohort II), and crystal diagnosis (cohort III). Comorbid conditions were defined according to International Classification of Diseases, 9th Revision, Clinical Modification codes, and stratified as either moderate or severe. Drug contraindications were defined as moderate or strong, based on Food and Drug Administration criteria and severity of disease.RESULTS: The most common comorbidity was hypertension (prevalence 0.89). The presence of comorbidities resulted in a high frequency of contraindications to approved gout medications. More than 90% of patients had at least 1 contraindication to nonsteroidal anti-inflammatory drugs. Many patients demonstrated multiple contraindications to 1 or more gout medications. Frequently, patients were prescribed medications to which they harbored contraindications. The prevalence of patients prescribed colchicine despite having at least 1 strong contraindication was 30% (cohort I), 37% (cohort II), and 39.6% (cohort III).CONCLUSION: Patients with gout typically harbor multiple comorbidities that result in contraindications to many of the medications available to treat gout. Frequently, despite contraindications to gout therapies, patients are frequently prescribed these medications. (C) 2011 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2011) 124, 155-163