住院病患痛風復發之探討病例對照研究

Recurrent attack of gouty arthritis in patients hospitalized due to non-gout diseases: case-control study

背景與目的：住院病患痛風發作是風濕科照會最多的疾病。本研究旨在瞭解痛風發作的原因及特性。方法：藉由病例對照研究，收集216位有痛風病史病人，分成病例組（72人）及對照組（144人）加以分析。病例組為住院中有痛風發作而對照組為住院中無痛風發作。結果：病例組平均年齡59.1±14.7歲，男女比6.2：1。住院中痛風發作的原因以未服用抗痛風藥最重要（adjusted OR=4.6, 95% CI 2.34-9.06），另外消化道出血也是另一因素。有69.4%發作以單關節炎為主，48.5%發作時有高尿血症，32.3%有發燒。足踝和膝為較好發關節。結論：從此回溯研究發現未服用痛風藥為最重要之復發原因。應教育病患及醫師持續用藥之重要性。

Objective. Recurrent attacks of gouty arthritis at Chang Gung Memorial Hospital (CGMH), Kaohsiung, was the most common reason for consultation by a rheumatologist. The purpose of this study was to survey the clinical manifestations and predisposing factors of acute flares for gouty patients hospitalized due to non-gout diseases. Methods. This study reviewed the clinical features and predisposing factors of 216 hospitalized patients (186 males and 30 females) with known previous diagnoses of gout who were admitted to CGMH, Kaohsiung, during a 15-month period between Jan 2003 and Mar 2004. All subjects were categorized into two groups. Group I comprised patients who developed a recunent attack of gouty arthritis during hospitalization. Group 2 (control) consisted of subjects with a gout history and without a flare-up during admission. Each group 1 patient was age- (±5 years) and sex-matched with 2 control subjects. Results. Patient mean age was 59.1 ±14.7 years and the male-to-female ratio was 6.2: 1 in group I. The leading cause of recunent attack in group 1 compared with group 2 was lack of antigout medication (adjusted odds ratio 4.6, 95% confidence intervals 2.34-9.06). During recurrent attacks 69.4% of patients developed monoarthritis, 48.5% bad hyperuricemia, and 32.3% developed fever. Ankles were the joints affected most during recurrent attacks. Conclusion. Lack of antigout medication was a significant factor in the development of acute attacks of gouty arthritis in hospitalized patients admitted due to non-gout diseases. Education of patients and physicians to continue antigout therapy is strongly recommended to prevent recurrent attacks of gouty arthritis in hospitalized patients.