Objective To investigate the method and the effectiveness of a combination of the arthroscopic debridement and joint irrigation postoperatively for treating gouty arthritis of the knee. Methods Between August 2000 and November 2009, 41 patients with gouty arthritis of the knee were treated by arthroscopic debridement. All patients were males with an average age of 42 years (range, 21-71 years), including 8 incipient cases and 33 relapsed cases. The unilaterial knees wereinvolved in 36 cases, including 22 left knees and 14 right knees, and both in 5 cases. The disease duration ranged from 2 months to 20 years (median, 6 years and 2 months). The extention, flexion, and range of motion (ROM) of the knee joint were (4.88 ± 6.22), (93.95 ± 35.33), and (87.79 ± 35.19)°, respectively, and Lysholm score was 63.2 ± 11.7 preoperatively. The serum uric acid levels were higher than normal value in 32 cases. Twenty-seven cases were definitely diagnosed as gouty arthritis before operation. Arthroscopic debridement was performed in 11 cases, and the arthroscopic debridement with joint irrigation postoperatively in 30 cases. After operation, the anti-gout agents and diet control were given. Results Arthroscope and pathologic examinations confirmed diagnosis of gouty arthritis in 41 patients. Intra-articular hemorrhage occurred in 1 case and was cured after arthroscopic evacuation of hematoma. The other patients achieved heal ing of incision by first intention. All 41 patients were followed up 15-126 months (mean, 50 months) postoperatively. The Lysholm score was 96.8 ± 5.8 at 15 months after operation, showing significant difference when compared with the preoperative value (t= — 13.844, P=0.000). The postoperative extention (1.16 ± 3.91)°, flexion (125.93 ± 18.65)°, and ROM (126.86 ± 16.33)° of the knee joint were significantly improved when compared with the preoperative ones (P lt; 0.05). Thirteen cases (14 knees) recurred postoperatively; but occurrence frequency and the duration were decreased and the symptoms of joint swell ing and pain were improved. Conclusion The arthroscopicdebridement is effective in cleaning up uric acid crystals thoroughly, reducing wounds, and speeding up recovery. If antigout agents and diet control can be used postoperatively, the recurrence of gouty arthritis can be prevented effectively, and the progression can be delayed.
Objective To compare the efficacy and safety of benzbromarone vs. allopurinol for primary gout. Methods Searching PubMed, Cochrane Library, EMbase, CNKI, VIP and CBM, randomized controlled trials were collected and the quality of RCTs was evaluated using Cochrane systematic review. Meta-analysis was performed. Results 6 RCTs were included in this study,with a total of 350 patients. Meta-analysis showed that there was no statistical significance in total effective rate between two groups (Pgt;0.05). 4 RCTs were enrolled in comparison of ADR. There was statistical significance between two groups (Plt;0.05). Conclusion There is no significant difference in the efficacy between benzbromarone and allopurinol for the primary gout.But benzbromarone is safe than allopurinol for primary gout .
Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) on urate-lowering therapy (ULT) for chronic gout. Methods PubMed, EMbase, The Cochrane Library, Epistemonikos, CBM, WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating urate-lowering drugs in chronic gout from inception to April 8th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs using the AMSTAR tool, and assessed the quality of the body of evidence for each outcome using the GRADE approach. Results A total of 11 relevant SRs/Mets were included, containing 3 main outcome measures. All these SRs contained allopurinol. Ten SRs contained febuxostat, 3 SRs contained benzbromarone and 1 SR contained probenecid. Ten SRs assessed the risk of bias of included original studies. Eight SRs used the" assessing risk of bias”tool recommended by Cochrane Collaboration for this assessment while 2 used other tools. The assessment results of AMSTAR tool showed: the scores of 4 SRs were ≥9, and the others were ≤8. GRADE results showed: the quality of the evidence of 20 outcomes was low or very low, 10 outcomes was moderate and two outcomes was high. Conclusions Moderate quality evidence shows that febuxostat is beneficial in achieving target serum uric acid levels when comparing to allopurinol, and high quality evidence shows the incidence of gout flares is not significantly different between the two groups. High quality evidence also shows that the safety of febuxostat is better than allopurinol. Evidence of SRs is still insufficient to support the effectiveness and safety of other urate-lowering drugs. It is expected that more scientific and rigorous researches will be performed in the future, for which more high quality evidence will be produced to fill relevant gaps.
目的 探讨心理行为干预对痛风患者遵医行为的影响。 方法 2006年1月－2010年9月，选取痛风患者190例，随机分为干预组和对照组，两组均进行遵医行为评价和疾病相关检查；对干预组进行认知行为干预，分析患者存在的痛风饮食治疗的认知误区，有针对性地进行心理行为干预。 结果 干预后，干预组认知行为总分和各单项分均高于对照组（P＜0.05），胆固醇、甘油三酯和体质量指数均低于对照组（P＜0.05）；干预组19例（20.0%）复发，对照组36例（37.9%）复发，两组复发率比较，差异有统计学意义（χ2=7.390，P=0.007）。 结论 行为认知治疗可提高痛风患者的治疗依从性，从而有助于改善尿酸等相关指标。
ObjectiveTo observe the efficacy and safety of colchicine combined with etofenamate cream in the treatment of acute gouty arthritis. MethodsA total of 150 patients diagnosed with acute gouty arthritis from June 2013 to July 2014 were equally randomized to receive colchicine alone (group A), colchicine with etofenamate cream (group B) and colchicine with etoricoxib (group C). The assessment on joint pain, tenderness, health quality and clinical efficacy of patients in each group was carried out, and the results were compared before and 7 days after the treatment. ResultsBecause of adverse events, the number of patients who withdrew from group A, B and C was respectively 2, 3 and 7. So the actual number of patients completing the study was 48 for group A, 47 for group B and 43 for group C. The patients' and physicians' assessments of mean change in pain intensity from baseline over days 1-7 were comparable in each group, with no statistical significance between groups (P>0.05). The patients' assessment of response to treatment was the highest in the colchicine with etofenamate cream group, and the differences compared with other two groups were significant (P=0.012 and 0.025, respectively). The physicians' global assessment of response to treatment showed no statistical significance between groups (F=0.021, P=0.908). The joint tenderness was most improved in colchicine with etoricoxib group, and the differences compared with other two groups were significant (P=0.041 and 0.034, respectively). The assessments of health quality were similar between groups. The C-reactive protein and erythrocyte sedimentation rate were decreased at study-end in all groups, but statistically significant differences were only found between group A and C (P<0.05). The incidence rate of adverse events was the highest in colchicine with etoricoxib group and the difference from other two groups was significant (P<0.05). ConclusionColchicine with etofenamate cream is as effective as colchicine with etoricoxib for treating acute gout and may have a better safety and tolerability profile.
摘要:目的: 系统评价非布索坦治疗痛风的疗效及安全性。 方法 :计算机检索PubMed、EMBASE、SCI、CBM、CNKI、VIP、万方数据库及Cochrane图书馆,手工补充检索;纳入非布索坦治疗痛风的随机对照试验(RCT);进行方法学质量评价和Meta分析。 结果 :共纳入3个RCT(受试者1985例),A级文献1篇,B级文献2篇。Meta分析结果显示:最后3月血清尿酸(SU)持续低于60 mg/dl患者数、随访结束时SU低于60 mg/dl患者数非布索坦组与对照组差异均有统计学意义;治疗相关不良事件发生数与安慰剂组差异无统计学意义,与别嘌呤组差异有统计学意义。 结论 :基于当前证据,非布索坦治疗痛风,能有效降低SU含量,减少治疗相关不良事件发生率。Abstract: Objective: Assessing the effectiveness and safety of febuxostat for the treatment of gout. Methods :Randomized controlled trails(RCT) of febuxostat for the treatment of gout were gathered from the Cochrane Library、PubMed、EMBASE、SCI、CBM、CNKI、VIP、Wangfang Database, other relative researches were handsearched, each RCT was methodological quality evaluated, then analyzed by software RevMan50 Results :A total of 3 RCTs were collected (involving 1985 subjects); 1 was graded A, 2 were B; according to the Metaanalysis: the differences of subjects with last 3 monthly serum urate(SU)＜60mg/dl and subjects with SU＜60mg/dl at final visits were significant; treatmentrelated adverse events between febuxostat and allopurinol was significant different, but not significant difference between febuxostat and placebo. Conclusion : According to the evidence currently, febuxostat could reduce SU and the episodes of treatmentrelated adverse events.
ObjectiveTo evaluate the effectiveness of lesion clearance combined with Ilizarov technique for the treatment of tophi in first metatarsophalangeal (MTP) joint with bone defect.MethodsBetween July 2016 and June 2018, 14 cases of tophi in the first MTP joint with bone defect were treated by lesion clearance combined with Ilizarov technique. There were 12 males and 2 females. The average age was 39.3 years (range, 22-60 years). The disease duration ranged from 5 to 15 years, with an average of 11.2 years. The tophi volume ranged from 2.5 cm×2.7 cm×2.2 cm to 5.2 cm×2.9 cm×2.4 cm. The X-ray films showed that the length of the bone defect ranged from 2.0 to 4.6 cm, with an average of 3.4 cm. Preoperative visual analogue scale (VAS) score was 7.6±0.9; American Orthopaedic Foot and Ankle Society (AOFAS) score was 47.5±4.3; short-form 36 health survey scale (SF-36) score was 79.7±4.7.ResultsThe incision primarily healed in 13 patients after operation. The skin necrosis at the edge of the incision occurred in 1 patient and recovered after symptomatic treatment. All 14 patients were followed up 12-16 months, with an average of 13.6 months. X-ray films showed that the first metatarsal column defects were repaired. The time of bone extension ranged from 2 to 6 weeks, with an average of 3.6 weeks. The time of bone healing ranged from 9 to 16 weeks, with an average of 11.2 weeks. During follow-up, no complication such as nerve, blood vessel, or tendon injury, needle tract infection, or stress fracture occurred. At last follow-up, VAS score was 1.4±0.5, AOFAS score was 86.6±4.8, and SF-36 score was 89.1±3.3, all of which were superior to preoperative scores, with significant differences (t=22.532, P=0.000; t=22.702, P=0.000; t=6.124, P=0.000).ConclusionLesion clearance combined with Ilizarov technique is a safe and effective method for the treatment of tophi in the first MTP joint with bone defect.
ObjectivesTo compare the efficacy and economy of febuxostat and allopurinol in the treatment of chronic gout, and to provide reference for clinical rational drug use.MethodsThe Markov model was established to conduct cost-effectiveness analysis for febuxostat and allopurinol serving as the front-line treated medicines. In view of the uncertainty of model parameters, single factor, probability sensitivity analysis and other methods were used to analyze the stability of the results.ResultsThe cost of the therapeutic schedule of allopurinol 300 mg was lower than febuxostat 40 mg, and it saved RMB 4 339.6 Yuan for each patients on average, while obtained 0.067 more QALY. Uncertainty analysis revealed that only those utility value which could not reach the standard influenced the final results in all included variable elements. When the aspiration payment value was zero, the percentage of therapeutic schedule for allopurinol 300 mg was 100. With the increase of aspiration payment value, the probability for febuxostat scheme becoming the superior one showed a very gradual growth. When the aspiration payment value reached 150 000, the probability still remained under 10%.ConclusionsAllopurinol is more economical than finasteride as the first choice in the treatment of chronic gout. Therefore, it is recommended that allopurinol should be used as the first-line drug for economical considerations.