Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout
Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout
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DOI：
10.1002/art.10511
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发表时间：
2002-08-15
期刊：
影响因子：
--
通讯作者：
Ruibal, A
中科院分区：
文献类型：
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作者：
Perez-Ruiz, F;Calabozo, M;Ruibal, A
目标。消除慢性痛风患者尿酸钠组织沉积所需的最佳血清尿酸水平是有争议的。这项观察性的前瞻性研究评估了慢性痛风患者治疗期间血清尿酸水平与痛风石减少速度之间的关系。63例晶体证实的痛风患者接受别嘌呤醇、苯溴马隆或联合治疗，使血清尿酸水平低于组织尿酸盐饱和阈值。随访时评估的痛风石为体格检查时发现的直径最大的。单独服用别嘌呤醇或与别嘌呤醇联合治疗的患者，其痛风的还原速度比单独服用别嘌呤醇的患者更快。在治疗期间，痛风石的还原速度与平均血清尿酸水平呈线性相关。血清尿酸水平越低，痛风石还原速度越快。血清尿酸水平应降低到足以促进痛风患者尿酸沉积的溶解。当治疗期间达到最佳血清尿酸水平时，别嘌呤醇和苯溴马龙同样有效。对于单药治疗血清尿酸水平降低不足的患者，联合治疗可能有用。
Objective. The optimal serum urate levels necessary for elimination of tissue deposits of monosodium urate in patients with chronic gout is controversial. This observational, prospective study evaluates the relationship between serum urate levels during therapy and the velocity of reduction of tophi in patients with chronic tophaceous gout.Method. Sixty-three patients with crystal-confirmed tophaceous gout were treated with allopurinol, benzbromarone, or combined therapy to achieve serum uric acid levels less than the threshold for saturation of urate in tissues. The tophi targeted for evaluation during followup were the largest in diameter found during physical examination.Results. Patients taking benzbromarone alone or combined allopurinol and benzbromarone therapy achieved faster velocity of reduction of tophi than patients taking allopurinol alone. The velocity of tophi reduction was linearly related to the mean serum urate level during therapy. The lower the serum urate levels, the faster the velocity of tophi reduction.Conclusion. Serum urate levels should be lowered enough to promote dissolution of urate deposits in patients with tophaceous gout. Allopurinol and benzbromarone are equally effective when optimal serum urate levels are achieved during therapy. Combined therapy may be useful in patients who do not show enough reduction in serum urate levels with single-drug therapy.