ACTH revisited: effective treatment for acute crystal induced synovitis in patients with multiple medical problems.
ACTH revisited: effective treatment for acute crystal induced synovitis in patients with multiple medical problems.
复制标题
ACTH 重温：对患有多种医疗问题的患者的急性晶体诱发滑膜炎的有效治疗。
作者：
J. Ritter;Kerr Ld;J. Valeriano‐Marcet;H. Spiera
目的
确定促肾上腺皮质激素（ACTH）治疗急性痛风性关节炎和假性痛风患者的有效性。
方法
我们回顾性分析了38例患者使用静脉注射ACTH 40或80单位，静脉注射、肌肉注射或皮下注射，tid逐渐减量的治疗经验。33例患者记录了急性痛风，5例患者记录了急性假性痛风。共治疗了43例急性晶体诱导的滑膜炎。使用ACTH的适应症包括充血性心力衰竭、慢性肾功能不全、胃肠道出血或对NSAID无反应：
结果
所有假性痛风发作平均在4.2天内消退。在急性痛风发作中，97%在平均5.5天内消退。虽然出现轻度低钾血症、高血糖、液体潴留和反跳性关节炎等不良反应，但均不严重，且均易于控制。
结论
促肾上腺皮质激素是一种安全有效的治疗急性痛风和假性痛风，特别是在患者有多种医疗问题。
OBJECTIVE
To determine the effectiveness of adrenocorticotropic hormone (ACTH) for acute gouty arthritis and pseudogout in a population of patients with multiple coexisting medical problems.
METHODS
We retrospectively reviewed our experience with parenteral ACTH 40 or 80 units intravenous, intramuscular, or subcutaneous tid with tapering in the treatment of 38 patients. Thirty-three patients had documented acute gout and 5 patients had documented acute pseudogout. A total of 43 episodes of acute crystal induced synovitis were treated. The indications for using ACTH included congestive heart failure, chronic renal insufficiency, gastrointestinal bleeding, or no response to NSAID:
RESULTS
All episodes of pseudogout resolved in an average of 4.2 days. Of the episodes of acute gout, 97% resolved in an average of 5.5 days. Although mild hypokalemia, hyperglycemia, fluid retention and rebound arthritis occurred as adverse effects, none was severe and all were easily controlled.
CONCLUSION
ACTH is a safe and effective treatment for acute gout and pseudogout, especially in patients with multiple medical problems.