痛风治疗方法的药理学

R. Sahai, P. Sharma, A. Misra, S. Dutta
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引用次数: 3

摘要

痛风是一种以高尿酸血症为特征的代谢紊乱。无症状高尿酸血症不应治疗,直到关节炎;肾结石或肾结石变得明显。治疗急性发作的基础通常是非甾体抗炎药(NSAIDs),除非秋水仙碱和皮质类固醇在特定情况下发挥作用。通常非甾体抗炎药具有更强的抗炎作用,使用高剂量快速重复,反应较慢,与秋水仙碱相比,耐受性更好。秋水仙碱具有独特的机制作用。关节内皮质类固醇可缓解急性发作,并给予不能耐受非甾体抗炎药和秋水仙碱的患者。慢性痛风需要使用促进排泄的药物(例如,probenecid, lesinurad)或通过抑制酶黄嘌呤氧化酶(别嘌呤醇,非布司他等)来阻止其合成的药物治疗。Pegloticase和rasburicase是一种重组尿酸酶,可将尿酸氧化为高可溶性尿囊素,排泄于尿中。尽管有这些有效的治疗方法,但它们的安全性仍存在问题。新的治疗方案正在被广泛研究,特别是白细胞介素-1 (IL-1)抑制剂,但它们的批准仍在等待中。寻求一种具有理想疗效和可接受安全性的最佳设计药物的工作仍在继续。
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Pharmacology of the Therapeutic Approaches of Gout
Gout is a metabolic disorder characterized by hyperuricemia. Asymptomatic hyperuricemia ought not to be treated until arthritis; renal calculi or tophi become evident. The cornerstone of therapy of acute attack is often nonsteroidal anti-inflammatory drugs (NSAIDs), barring specific situations wherein colchicine and corticosteroids do have a role. Usually NSAIDs with stronger anti-inflammatory action are used in high and quickly repeated doses and have a slower response response as compared to colchicine, they are better tolerated. Colchicine has a unique mechanism action. Intra-articular corticosteroids provide relief in acute attack and are given in patients having inability to tolerate NSAIDs and colchicine. Chronic gout requires treatments with drugs that either promote excretion (e.g., probenecid, lesinurad) or prevent its synthesis through inhibition of enzyme xanthine oxidase (allopurinol, febuxostat, etc.). Pegloticase and rasburicase, being a recombinant uricase enzyme, oxidize uric acid to highly soluble allantoin excreted in urine. In spite of these effective treatment modali-ties, question arises on their safety profile. Newer treatment options are being extensively studied especially interleukin-1 (IL-1) inhibitors but their approval is still pending. The quest for an optimally designed drug with desirable efficacy and acceptable safety profile is still on.
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The Gout Introductory Chapter: Gout Pharmacology of the Therapeutic Approaches of Gout Personalized Medicine of Urate-Lowering Therapy for Gout Prophylaxis of Acute Arthritis at Initiation of Urate-Lowering Therapy in Gout Patients
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