问题库/看病与吃药
痛风不疼了，降尿酸的药还要不要一直吃
要。长了痛风石、骨头被啃出缺损、或者一年发作两次以上的，得长期吃，把血尿酸压到 360 µmol/L 以下并维持住。由护士按化验帮着调量的人，两年后 95% 达标，照常看病的只有 30%。
这里不保证什么
发作少的人吃不吃，要和医生商量。头 3 到 6 个月降尿酸反而容易诱发发作，要同时吃预防药。忌口降得有限，替不了药。
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确诊痛风后长了痛风石、影像上看到骨头被啃出缺损或每年发作 2 次以上的，就长期吃降尿酸药，把血尿酸压到 360 µmol/L 以下并一直维持
长了痛风石、骨头被啃出缺损或每年发作 2 次以上的，要长期吃降尿酸药，把尿酸压到 360 µmol/L 以下。发作少的，吃不吃和医生商量。由护士按化验结果帮着调药量的病人，两年后 95% 达标，照常看病的只有 30%。达标之后也不能停药，靠忌口降得有限。
- 把过去一年的发作次数和日期记下来，复诊时给医生看
- 由医生定用不用药、用哪种，汉族人用别嘌醇前先问要不要查基因
- 头 3 到 6 个月同时吃预防发作的药，尿酸达标后也别自己停
坑刚开始降尿酸反而更容易诱发发作，所以头 3 到 6 个月要同时吃预防药；首选哪种药各国指南不一样，这条本身有分歧。
成本：别嘌醇每月几元到几十元。刚开始每几周查一次血尿酸来调药量，稳定之后每几个月查一次。头 3 到 6 个月还要同时吃一种预防发作的药。难在不疼的时候也得一直吃下去。第 16 节 · 得了慢性病之后怎么活
出处
Doherty M, Jenkins W, Richardson H, et al. (2018). Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet, 392(10156), 1403-1412. <https://doi.org/10.1016/S0140-6736(18)32158-5>；Abhishek A, Jenkins W, La-Crette J, Fernandes G, Doherty M (2020). Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. Rheumatology, 59(3), 575-579. <https://doi.org/10.1093/rheumatology/kez333>；FitzGerald JD, Dalbeth N, Mikuls T, et al. (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care & Research, 72(6), 744-760：「Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares」「For patients who have previously experienced >1 flare but have infrequent flares (<2/year), we conditionally recommend initiating ULT over no ULT」「For patients experiencing their first flare, we conditionally recommend against initiating ULT over no ULT」. <https://doi.org/10.1002/acr.24180>；White WB, Saag KG, Becker MA, et al.; CARES Investigators (2018). Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout. New England Journal of Medicine, 378(13), 1200-1210. <https://doi.org/10.1056/NEJMoa1710895>；Mackenzie IS, Ford I, Nuki G, et al.; FAST Study Group (2020). Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial. Lancet, 396(10264), 1745-1757. <https://doi.org/10.1016/S0140-6736(20)32234-0>；中华医学会内分泌学分会 (2020). 中国高尿酸血症与痛风诊疗指南(2019). 中华内分泌代谢杂志, 36(1), 1-13. <https://doi.org/10.3760/cma.j.issn.1000-6699.2020.01.001>
得过痛风的，吃烧烤、聚餐时别一顿吃下大量肉和海鲜，酒也要少喝
得过痛风的人，前两天吃进的嘌呤最多时，发作的可能是吃得最少时的近 5 倍，吃着降尿酸药也一样。前一天喝了两到四杯酒，发作的可能高约一半，啤酒、白酒、葡萄酒都算。
- 聚餐时先点菜再点串，肉和海鲜在一顿里只吃少量
- 酒少喝或不喝，啤酒、白酒、葡萄酒都算
- 当天多喝水，把发作次数和那两天吃了什么记给医生
坑研究看的是吃下去的肉、海鲜和酒的量，不分烤不烤；饮食只是诱因之一，体质占得更多，少吃也代替不了降尿酸药。
成本：不花钱。吃烧烤、聚餐时少点肉串和海鲜，少喝酒。难在饭桌上管住自己。第 16 节 · 得了慢性病之后怎么活
出处
Zhang Y, Chen C, Choi H, Chaisson C, Hunter D, Niu J, Neogi T (2012). Purine-rich foods intake and recurrent gout attacks. Annals of the Rheumatic Diseases, 71(9), 1448-1453. <https://doi.org/10.1136/annrheumdis-2011-201215>；Neogi T, Chen C, Niu J, Chaisson C, Hunter DJ, Zhang Y (2014). Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. The American Journal of Medicine, 127(4), 311-318. <https://doi.org/10.1016/j.amjmed.2013.12.019>；Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004). Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine, 350(11), 1093-1103. <https://doi.org/10.1056/NEJMoa035700>；Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004). Alcohol intake and risk of incident gout in men: a prospective study. Lancet, 363(9417), 1277-1281. <https://doi.org/10.1016/S0140-6736(04)16000-5>；Major TJ, Topless RK, Dalbeth N, Merriman TR (2018). Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts. BMJ, 363, k3951. <https://doi.org/10.1136/bmj.k3951>
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