痛風患者高尿酸血症之治療（Therapy for hyperuricemia in gout）,主題選取的考量,常見的疾病高盛行率 醫療花費增加 臨床治療標準不一 國際已有治療指引,主題選取的考量常見的疾病高盛行率,資料來源：PubMed Keyword: Hyperuricemia in Taiwan 16篇 since 1968 to 2004,主題選取的考量常見的疾病高盛行率,Chang HY, Pan WH, Yeh WT, Tsai KS. Hyperuricemia and gout in Taiwan: results from the Nutritional and Health Survey in Taiwan (1993-96). J Rheumatol. 2001 Jul;28(7):1640-6. Population: 2754 males and 2953 females aged 4 years and older The prevalence of hyperuricemia in aboriginal males and females：50,主題選取的考量常見的疾病高盛行率,Lai SW, Tan CK, Ng KC. Epidemiology of hyperuricemia in the elderly. Yale J Biol Med. 2001 May-Jun;74(3):151-7. Time： 1998 May Population：586 (66% Men 30(4):841-5. Time： from March to May 2001 Place：central Taiwan Population：the Bunun tribe ，Children aged 4-13 A total of 414 children (mean age, 8.9 +/- 2.1 yrs) were recruited. Hyperuricemia was defined as uric acid 416.5 micromol/l (7 mg/dl) in boys and 357 micromol/l (6 mg/dl) in girls Ninety of 224 girls (40.2%) and 56 of 190 boys (29.5%) were hyperuricemic.,主題選取的考量常見的疾病高盛行率,CHOU Chungtei 周昌德 Hyperuricemia and gout among Taiwan Aborigines and Taiwanese-prevalence and risk factors Chin Med J 2003;116(7):965-967 The prevalence of hyperuricemia and gout in Atayal Aborigines to be 41.4% and 11.7%, respectively. 27% to 45% of aboriginal boys and 13% to 41% of aboriginal girls had hyperuricemia. Kinmen：the prevalence of hyperuricemia in men was 25.8% (391/1515) through more than 6 years of follow-ups on 223 asymptomatic hyperuricemic patients, the 5-year cumulative incidence of onset of gout was 18.8% (42/223). The incidence increased with three different baseline levels of uric acid, from 10.8% (7.0 uric acid8.0), to 27.7% (8.0uric acid 9.0), to 61.6% (uric acid9.0).,主題選取的考量國際已有治療指引,資料庫：PubMed Keyword: Hyperuricemia guideline 8篇，since 1996 to 2003 1: Meyers OL, Cassim B, Mody GM. Hyperuricaemia and gout: clinical guideline 2003. S Afr Med J. 2003 Dec;93(12 Pt 2):961-71. 2: Nakajima H, Matsuzawa Y. Introduction of the new guideline for the management of hyperuricemia and gout with special reference to its policy Nippon Rinsho. 2003 Jan;61 Suppl 1:442-9. 3: Tatsuno I, Saito Y. Hyperuricemia and atherosclerosis Nippon Rinsho. 2003 Jan;61 Suppl 1:259-65. Review.,主題選取的考量國際已有治療指引,4: Nakajima H. Definition and determination of serum uric acid level Nippon Rinsho. 2003 Jan;61 Suppl 1:154-7. 5: Nakajima H. Management of hyperuricemia in occupational health: with reference to guidelines for the management of hyperuricemia and gout Sangyo Eiseigaku Zasshi. 2003 Jan;45(1):12-9. Review. Japanese. 6: Gorter KJ, Romeijnders AC. The standard hyperuricemia from the Dutch Family Physician; reaction from rheumatology and general medicine Ned Tijdschr Geneeskd. 2002 May 4;146(18):872; author reply 872-3. Dutch. 7: Chalmers J. Role of diuretics in the treatment of hypertension: from large controlled trials to international guidelines Arch Mal Coeur Vaiss. 1996 Sep;89 Spec No 4:39-43. Review. French. 8: Cummins D, Sekar M, Halil O, Banner N. Myelosuppression associated with azathioprine-allopurinol interaction after heart and lung transplantation. Transplantation. 1996 Jun 15;61(11):1661-2.,目前製作guideline之目的,台灣地區高尿酸血症的盛行率驚人，尤其施行成人健康體檢後，門診診療中常遇到病人詢問高尿酸血症該如何處理。而目前因無統一的guideline可供依循，治療標準不一，常造成醫師及患者的困擾。期待檢視文獻後，能提供有用的資訊，建立使用降尿酸藥物之臨床底線，以為臨床診療之準則。,臨床問題1：無症狀之高尿酸血症需不需要治療？,資料來源：PubMed Keyword: Asymtomatic hyperuricemia and treatment and review 23篇，since 1977 to 2003,臨床問題1：無症狀之高尿酸血症需不需要治療？,Dincer HE, Dincer AP, Levinson DJ. Asymptomatic hyperuricemia: to treat or not to treat. Cleve Clin J Med. 2002 Aug;69(8):594, 597, 600-2 passim. Publication Types: Review Treatment of asymptomatic hyperuricemia is not necessary in most patients, unless perhaps they have very high levels of uric acid or are otherwise at risk of complications, such as those with a personal or strong family history of gout, urolithiasis, or uric acid nephropathy.,臨床問題1：無症狀之高尿酸血症需不需要治療？,Uhlig T. Gout and hyperuricaemia-should both be treated? Tidsskr Nor Laegeforen. 2003 Oct 23;123(20):2878-80 Publication Types: Review Patients with increased levels of uric acid will usually be treated with drugs if symptoms of acute arthritis or kidney stones occur. There is still no consensus on the treatment of individuals with asymptomatic hyperuricaemia.,臨床問題1：無症狀之高尿酸血症需不需要治療？,Harris MD, Siegel LB, Alloway JA. Gout and hyperuricemia. Am Fam Physician. 1999 Feb 15;59(4):925-34. Publication Types: Review Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle.,臨床問題1：無症狀之高尿酸血症需不需要治療？,Pollmann G, Kullich W, Klein G. Therapy of hyperuricemia and gout Wien Med Wochenschr. 1997;147(16):382-7 Publication Types: Review Dietary regimen are in the forefront in treatment of asymptomatic hyperuricemia. Uric acid lowering drugs can only be supported in repeated serum-measures from 9 mg/dl up.,臨床問題2：痛風患者高尿酸血症之治療,Keyword: Hype