诊断

帮助诊断痛风的检查包括:

  • 关节液检测。医生可能会用针从受累关节中抽取液体。在显微镜下检查液体时,尿酸盐晶体可见。
  • 血液检查。您的医生可能会建议通过进行血液检查来测量您血液中的尿酸和肌酐水平。但血液检查结果可能产生误导。有些人尿酸水平较高,但从未患过痛风。有些人有痛风的体征和症状,但尿酸水平并无异常。
  • X 线成像检查。关节 X 线检查有助于排除关节发炎的其他病因。
  • 超声波。肌肉骨骼超声波可以检测关节或痛风石中的尿酸盐晶体。这种技术在欧洲的应用比在美国广泛。
  • 双能 CT 扫描。即使不是急性关节炎,这类成像也可以检测关节中是否存在尿酸盐晶体。由于费用昂贵,该检查在临床实践中并不常用,也没有广泛应用。

治疗

治疗痛风通常需要用药。您和您的医生选择哪种用药将取决于您当前的健康状况以及您自己的偏好。

痛风用药可用于治疗急性发作并可预防将来发作。用药还可以减少痛风引起并发症的风险,例如从尿酸盐结晶沉积物中形成痛风石。

痛风发作治疗用药

用于治疗急性发作和预防未来发作的药物包括:

  • 非甾体抗炎药(NSAID)。NSAID 包括非处方药,例如布洛芬(Advil、Motrin IB 等)和萘普生钠(Aleve),以及更强效的处方类 NSAID,例如吲哚美辛(Indocin)或塞来昔布(Celebrex)。

    医生可能会开出较高剂量以阻止急性发作,然后降低每日剂量以防日后发作。

    NSAID 有引发胃疼、出血和溃疡的风险。

  • 秋水仙碱。医生可能会推荐秋水仙碱(Colcrys 和 Mitigare),这是一种能有效减轻痛风疼痛的止痛药。但是,这种药物的有效性可能会被恶心、呕吐和腹泻等副作用所抵消,尤其是大剂量服用时。

    在缓解急性痛风发作后,医生可能会开出低剂量的秋水仙碱,以防止日后发作。

  • 皮质类固醇。皮质类固醇药物(如泼尼松)可以控制痛风发炎和疼痛。皮质类固醇可以是药丸,也可以注射到您的关节中。

    通常只有无法服用 NSAID 或秋水仙碱的痛风患者才会使用皮质类固醇。皮质类固醇的副作用可能包括情绪变化、血糖水平升高和血压升高。

预防痛风并发症用药

如果您每年经历几次痛风发作,或者如果您的痛风发作频率不高但特别痛苦,那么医生可能会建议采用药物治疗以减少患痛风相关并发症的风险。如果关节 X 线检查表明痛风对您造成了损伤,或者您患有痛风石、慢性肾病或肾结石,则建议您用药降低体内尿酸水平。治疗选项包括:

  • 阻止尿酸生成用药。称为黄嘌呤氧化酶抑制剂(XOI)的药物会限制人体产生的尿酸量,这些药物包括别嘌醇(Aloprim、Lopurin 和 Zyloprim)和非布司他(Uloric)。这可以降低血液中的尿酸水平并降低痛风的风险。

    别嘌醇的副作用有皮疹和血球数低。非布索坦的副作用包括皮疹、恶心、肝功能下降以及与心脏相关的死亡风险增加。

  • 可以改善尿酸清除的药物。这些药物称为尿酸排泄药物,包括丙磺舒(Probalan)和莱辛纳德(Zurampic)。尿酸排泄药物可改善肾脏清除体内尿酸的能力。这可能会降低您的尿酸水平并降低痛风的风险,但是尿液中的尿酸水平会增加。副作用包括皮疹、胃疼和肾结石。莱辛纳德只能与 XOI 一起服用。

Medications to treat gout attacks

Drugs used to treat gout flares and prevent future attacks include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin, Tivorbex) or celecoxib (Celebrex). NSAIDs carry risks of stomach pain, bleeding and ulcers.
  • Colchicine. Your doctor may recommend colchicine (Colcrys, Gloperba, Mitigare), an anti-inflammatory drug that effectively reduces gout pain. The drug's effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea.
  • Corticosteroids. Corticosteroid medications, such as prednisone, may control gout inflammation and pain. Corticosteroids may be in pill form, or they can be injected into your joint. Side effects of corticosteroids may include mood changes, increased blood sugar levels and elevated blood pressure.

Medications to prevent gout complications

If you experience several gout attacks each year, or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications. If you already have evidence of damage from gout on joint X-rays, or you have tophi, chronic kidney disease or kidney stones, medications to lower your body's level of uric acid may be recommended.

  • Medications that block uric acid production. Drugs such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) help limit the amount of uric acid your body makes. Side effects of allopurinol include fever, rash, hepatitis and kidney problems. Febuxostat side effects include rash, nausea and reduced liver function. Febuxostat also may increase the risk of heart-related death.
  • Medications that improve uric acid removal. Drugs such as probenecid (Probalan) help improve your kidneys' ability to remove uric acid from your body. Side effects include a rash, stomach pain and kidney stones.

生活方式与家庭疗法

药物治疗通常是治疗急性痛风最有效的方法,并且可以预防痛风复发。然而,改变某些生活方式也很重要,例如:

  • 限制饮用酒精饮料和含果糖的饮料。替换为足量的非酒精饮料,尤其是水。
  • 限制摄入高嘌呤食物,如红肉、内脏和海鲜。
  • 经常锻炼和进行减重。保持健康的体重可以降低患痛风的风险。

准备您的预约

如果您有常见的痛风症状,请预约就诊。初次检查后,医生可能会将您转诊至关节炎和其他炎症性关节病的诊断和治疗专家(风湿科医生)。

以下信息可以帮助您做好就诊准备,并了解医生可能会做些什么。

您能做些什么

  • 写下您的症状,包括最开始出现的时间和频率。
  • 记录重要个人信息,比如您最近经历的任何生活变故或重大压力。
  • 列出主要医疗信息,包括正接受治疗的任何其他疾病以及正服用的任何药物、维生素或补充剂名称。您的医生还想知道您是否有痛风家族史。
  • 尽可能请家人或朋友陪同。有时,可能难以记住就诊期间提供给您的所有信息。陪同人可能记住您遗漏或忘记的信息。
  • 写下要问医生的问题。提前列出问题有助于充分利用就诊时间。

初次就诊时要问医生的问题包括:

  • 我出现症状或疾病的可能原因是什么?
  • 您建议做哪些检查?
  • 目前有没有任何对我的症状有帮助的治疗或生活方式改变?
  • 我是否应该看专科医生?

如果将您转诊至风湿科医生,要问的问题包括:

  • 您开的药可能有哪些副作用?
  • 开始治疗后多久我的症状应该会开始改善?
  • 我是否需要长期用药?
  • 我还有其他健康问题。我怎样才能同时管理好这些疾病?
  • 您是否建议我改变饮食?
  • 我喝酒是否安全?
  • 您有什么讲义或网站建议可以给我,让我进一步了解我的病情?

如果您在医疗就诊期间遇到其他问题,您可以随时提出来。

医生可能做些什么

医生会询问一些问题。准备好回答这些问题,以便为您希望深入讨论的问题预留时间。医生可能问:

  • 您有哪些症状?
  • 您是什么时候开始出现这些症状的?
  • 您的症状是否反复出现?频率如何?
  • 是否有什么特殊原因引发了您的症状,比如某些食物或身心压力?
  • 您是否正在接受其他疾病的治疗?
  • 您目前正在服用哪些药物,包括非处方药和处方药以及维生素和补充剂?
  • 您的一级亲属(如父母或兄弟姐妹)是否有痛风史?
  • 您平时吃些什么?
  • 您是否饮酒?如果喝酒,一次喝多少,多久喝一次?

What you can do

  • Write down your symptoms, including when they started and how often they occur.
  • Note important personal information, such as any recent changes or major stressors in your life.
  • Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking. Your doctor will also want to know if you have any family history of gout.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Questions to ask the doctor at the initial appointment include:

  • What are the possible causes of my symptoms or condition?
  • What tests do you recommend?
  • Are there any treatments or lifestyle changes that might help my symptoms now?
  • Should I see a specialist?

Questions to ask if you're referred to a rheumatologist include:

  • What are the possible side effects of the drugs you're prescribing?
  • How soon after beginning treatment should my symptoms start to improve?
  • Do I need to take medications long term?
  • I have these other health conditions. How can I best manage them together?
  • Do you recommend any changes to my diet?
  • Is it safe for me to drink alcohol?
  • Are there any handouts or websites that you'd recommend for me to learn more about my condition?

If any additional questions occur to you during your medical appointments, don't hesitate to ask.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

  • What are your symptoms?
  • When did you first experience these symptoms?
  • Do your symptoms come and go? How often?
  • Does anything in particular seem to trigger your symptoms, such as certain foods or physical or emotional stress?
  • Are you being treated for any other medical conditions?
  • What medications are you currently taking, including over-the-counter and prescription drugs as well as vitamins and supplements?
  • Do any of your first-degree relatives — such as a parent or sibling — have a history of gout?
  • What do you eat in a typical day?
  • Do you drink alcohol? If so, how much and how often?