病風患者之降尿酸治療藥是不是一定要吃一輩子？

2016有新的gout guidelines出來，和大家分享。

是不是一旦開始了痛風患者的降尿酸藥物治療後(例如：allopurinol/febuxostat），就一定要吃一輩子？如果這患者這一輩子只發作那一次，也要吃藥一輩子嗎？或是一輩子痛風發作沒幾次？這就讓我想起以前在神經內科學習時，老師問的：dilantin是不是在有seizure發作過的患者，一定要吃一輩子的藥？

根據這2016新的準則，反對在只單一次發作或是不常發作的痛風患者，給予長期的降尿酸治療。也不再建議一定要把患者的尿酸值降至目標 6 mg/dl以下。

New ACP Gout Guidelines Exclude Treat-to-Target Recommendation
http://annals.org/aim/article/2578528/management-acute-recurrent-gout-clinical-practice-guideline-from-american-college

CLINICAL GUIDELINES |1 NOVEMBER 2016

Recommendation 1:

ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence)

Recommendation 2:

ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence)

Recommendation 3:

ACP recommends against initiating long-term urate–lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence)

Recommendation 4:

ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate–lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence)

New gout guidelines from the American College of Physicians notably don't include a recommendation to lower serum uric acid levels below 357 µmol/L (6 mg/dL), in contrast with the American College of Rheumatology's 2012 guidelines.