2012年美国风湿学院（ACR）发布痛风管理指南（第一部分）

Gout is a disorder that manifests as a spectrum of clinical and pathologic features built on a foundation of an excess body burden of uric acid, manifested in part by hyperuricemia, which is variably defined as a serum urate level greater than either 6.8 or 7.0 mg/dl. Tissue deposition of monosodium urate monohydrate crystals in supersaturated extracellular fluids of the joint, and certain other sites, mediates most of the clinical and pathologic features of gout. Typically, the disease initially presents as acute episodic arthritis. Gout also can manifest as chronic arthritis of 1 or more joints. Tophi, mainly found in articular, periarticular, bursal, bone, auricular, and cutaneous tissues, are a pathognomonic feature of gout, and are detectable by physical examination and/or by imaging approaches and pathology examination. Renal manifestations of gout include urolithiasis, typically occurring with an acidic urine pH. Chronic interstitial nephropathy, mediated by monosodium urate monohydrate crystal deposition in the renal medulla, can occur in severe disease, but is currently considered to be an uncommon clinical manifestation of gout.

Gout is one of the most common rheumatic diseases of adulthood, with a self-reported prevalence in the US recently estimated at 3.9% of adults (8.3 million people). The prevalence of gout has risen in many countries (e.g., New Zealand) and especially in the US over the last few decades, mediated by factors such as an increased prevalence of comorbidities that promote hyperuricemia, including hypertension, obesity, metabolic syndrome, type 2 diabetes mellitus, and chronic kidney disease (CKD). Other factors in the rising prevalence of gout include certain dietary trends and widespread prescriptions of thiazide and loop diuretics for cardiovascular diseases. Many gout patients, including the growing subset of elderly patients affected with gout, have complex comorbidities and medication profiles that complicate overall management. Long-term morbidity and impairment of health-related quality of life are now better appreciated in many gout patients, particularly those with multiple comorbidities and/or chronic gouty arthritis. Despite advanced understanding of the molecular bases of hyperuricemia and gouty inflammation and the extensive practice experience of many providers, substantial quality of care gaps exist in gout management. Moreover, significant shortfalls in patient education and adherence have been identified in gout.