Charles Darwin Horace Walpole Alfred Tennyson Charles Scudmore

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著名的痛風罹患者 (無特定排序!) • • • Charles Darwin • Horace Walpole • Alfred Tennyson •

著名的痛風罹患者 (無特定排序!) • • • Charles Darwin • Horace Walpole • Alfred Tennyson • Charles Scudmore David Garrick • Queen Anne • W. S. Gilbert • Caleb Parry • William Harvey • John Hunter • Samuel Johnson • Lord Palmerston • Edward Gibbon Alexander Pope Neville Chamberlain • William Congreve Thomas Graz Lord Chesterfield W. H. Woollaston Agrippa George IV Louis XIV Benjamin Franklin James I

著名的痛風罹患者 (無特定排序!) • • • Horatio Nelson • The Medici Brothers Sir John Falstaff

著名的痛風罹患者 (無特定排序!) • • • Horatio Nelson • The Medici Brothers Sir John Falstaff • Casanova Harold the Saxon • Martin Luther Oliver Cromwell • John Calvin John Wesley • Lord Burghley Cardinal Wolsey • Thomas Sydenham Robert Boyle • Francis Bacon Christopher Columbus • Isaac Newton William Pitt • John Milton Henry Fielding • Admiral Lord Howe

人類尿酸生成過程中的重要酵素 • 5 - 磷酸核糖 1 -焦磷酸合成� (5 -phosphoribosyl- pyrophosphate , PRPP synthetase) •

人類尿酸生成過程中的重要酵素 • 5 - 磷酸核糖 1 -焦磷酸合成� (5 -phosphoribosyl- pyrophosphate , PRPP synthetase) • 次黃嘌呤─鳥糞嘌呤磷酸核糖轉化� (hypoxanthine- guanine phosphoribosyl transferase, HGPRT) • 磷酸核糖焦磷酸銑胺轉化�(amidophosphoribosyl transferase) • 黃嘌呤氧化�(xanthine oxidase) 等。

造成高尿酸血症的酵素異常 • PRPP excess Ribose-5 -Phosphate+ATP PRPP + glutamine 尿酸前身形成過多   excess formation of uric

造成高尿酸血症的酵素異常 • PRPP excess Ribose-5 -Phosphate+ATP PRPP + glutamine 尿酸前身形成過多   excess formation of uric acid precursors Inosinic acid Uric acid PRPP synthetase

造成高尿酸血症的酵素異常 • HGPRT deficiency Guanylic acid Inosinic acid HGPRT Guanine Hypoxanthine 補救途徑受阻 salvage pathways

造成高尿酸血症的酵素異常 • HGPRT deficiency Guanylic acid Inosinic acid HGPRT Guanine Hypoxanthine 補救途徑受阻 salvage pathways blocked Uric acid

造成高尿酸血症的酵素異常 • APRT deficiency Inosinic acid Inosine Hypoxanthine 補救途徑受阻 salvage pathways blocked Adenylic acid

造成高尿酸血症的酵素異常 • APRT deficiency Inosinic acid Inosine Hypoxanthine 補救途徑受阻 salvage pathways blocked Adenylic acid Adenosine Adenine APRT

藥物與血清尿酸 (一)造成高尿酸血症之藥物: 增進嘌呤生物合成或尿酸鹽製造之藥物 乙醇 (Ethanol) Pancreatic extract Fructose Nicotinic acid Ethylamino-1, 3, 4 -thiadiazole

藥物與血清尿酸 (一)造成高尿酸血症之藥物: 增進嘌呤生物合成或尿酸鹽製造之藥物 乙醇 (Ethanol) Pancreatic extract Fructose Nicotinic acid Ethylamino-1, 3, 4 -thiadiazole 4 -Amino-5 -imidazole carboxamide riboside Vitamin B 12 (惡性貧血病患) Cytotoxic drugs Warfarin

減少腎臟廓清尿酸鹽之藥物 乙醇 (Ethanol) 利尿劑 低劑量之 salicylates Ethambutol Pyrazinamide 輕瀉劑 (Laxative) 濫用 (鹼血症 [alkalosis]) Levodopa

減少腎臟廓清尿酸鹽之藥物 乙醇 (Ethanol) 利尿劑 低劑量之 salicylates Ethambutol Pyrazinamide 輕瀉劑 (Laxative) 濫用 (鹼血症 [alkalosis]) Levodopa Methoxyflurane Cyclosporine

減少腎臟廓清尿酸鹽之藥物 CAN’T LEAP • • Cyclosporine Alcohol Nicotinic acid Thiazides • Lasix (furosemide) levodopa

減少腎臟廓清尿酸鹽之藥物 CAN’T LEAP • • Cyclosporine Alcohol Nicotinic acid Thiazides • Lasix (furosemide) levodopa • Ethambutol • Aspirin (low dose) • Pyrazinamide

具促尿酸排泄活性(uricosuric activity) 之藥物 • Acetohexamide • Glyceryl guaiacolate • Adrenocorticotropic • Glycopyrrolate hormone (ACTH)

具促尿酸排泄活性(uricosuric activity) 之藥物 • Acetohexamide • Glyceryl guaiacolate • Adrenocorticotropic • Glycopyrrolate hormone (ACTH) and • Halofenate glucocorticoids • Meclofenamate • Allopurinol • Merbarone • Ascorbic acid • Phenylbutazone • Azauridine

具促尿酸排泄活性(uricosuric activity) 之藥物 • • • Benzbromarone • Phenolsulfonphathalein Calcitonin • Probenecid Chlorprothixene •

具促尿酸排泄活性(uricosuric activity) 之藥物 • • • Benzbromarone • Phenolsulfonphathalein Calcitonin • Probenecid Chlorprothixene • Salicylates Citrate • Sulfinpyrazone Dicumarol • Roentgenographic • Diflunisal contrast agents • Estrogen • Zoxazolamine

痛風的臨床期程 (自然病程) (一)無症狀高尿酸血症 (asymptomatic hyperuricemia) (二)急性痛風性關節炎 (acute gouty arthritis) (三)痛風未發作期 (間歇期) (intercritical or interval

痛風的臨床期程 (自然病程) (一)無症狀高尿酸血症 (asymptomatic hyperuricemia) (二)急性痛風性關節炎 (acute gouty arthritis) (三)痛風未發作期 (間歇期) (intercritical or interval gout) (四)慢性痛風石痛風 (chronic tophaceous gout)

Three Oft-quoted Aphorisms of Hippocrates • Eunuchs do not take the gout (No. 28)

Three Oft-quoted Aphorisms of Hippocrates • Eunuchs do not take the gout (No. 28) • A woman does not take gout unless her menses be stopped (No. 29) • A young man does not take the gout until he indulges in coitus (No. 30)

痛風石發展階段 A 無結晶之巨嗜細胞腺胞 (crystal-free macrophage acinus) B 腺胞之無晶形中心(amorphous center)助成尿酸鹽結晶的形成 C 於結晶團 (crystalline mass)擴張之 同時,環繞之巨嗜細胞冠(surrounding

痛風石發展階段 A 無結晶之巨嗜細胞腺胞 (crystal-free macrophage acinus) B 腺胞之無晶形中心(amorphous center)助成尿酸鹽結晶的形成 C 於結晶團 (crystalline mass)擴張之 同時,環繞之巨嗜細胞冠(surrounding corona)同時變肥厚 D 進一步之結晶化造成環冠變薄,至纖 維性中隔(fibrous septae)分隔個別 之結晶形成核(nidus of crystal formation)為止 E 完全成熟之痛風石 Edwards NL. Gout: Clinical and Laboratory Features. In: Klippel JH, editor. Primer on the Rheumatic Diseases. 12 th ed. Atlanta: Arthritis Foundation; 2001. p. 313 -9.

Allopurinol 給藥劑量表 肌胺酸酐廓清率 Allopurinol 劑量 (creatinine clearance) (ml/min) 0 10 20 40 60 80

Allopurinol 給藥劑量表 肌胺酸酐廓清率 Allopurinol 劑量 (creatinine clearance) (ml/min) 0 10 20 40 60 80 100 120 140 每 每 三日 100 mg 每 二日 100 mg 每 日 150 mg 每 日 200 mg 每 日 250 mg 日 300 mg 每 日 350 mg 每 日 400 mg

Allopurinol 之重要藥物交叉反應 • Allopurinol 延長 azathioprine 與 6 - mercaptopurine 之半衰期 (二者均經由 xanthine oxidase-dehydrogenase

Allopurinol 之重要藥物交叉反應 • Allopurinol 延長 azathioprine 與 6 - mercaptopurine 之半衰期 (二者均經由 xanthine oxidase-dehydrogenase 使非活化) 加重彼等之治療及毒性效應。 • Allopurinol 增加 cyclosporine 之毒性。 • Allopurinol 使 ampicillin 及其相關之 皮疹發生率增加三倍。 • Allopurinol 使 5 -fluorouracil 之毒性減少。

平均血清尿酸鹽濃度與痛風石 減小速率之關係 r = - 0. 62 r 2 = 0. 48 P <

平均血清尿酸鹽濃度與痛風石 減小速率之關係 r = - 0. 62 r 2 = 0. 48 P < 0. 05 Perez-Ruiz F, et al. Arthritis Rheum (Arthritis Care Res) 2002; 47: 356 -60.

低嘌呤飲食及Allopurinol對血 清尿酸鹽之影響 Emmerson BT. Aust Ann Med 1969; 16: 205 -14.

低嘌呤飲食及Allopurinol對血 清尿酸鹽之影響 Emmerson BT. Aust Ann Med 1969; 16: 205 -14.

Multivariate Relative Risk of a New Case of Gout According to Quintile of Intake

Multivariate Relative Risk of a New Case of Gout According to Quintile of Intake of Various Food Groups and Body-Mass Index (Panels A, B, and C) or Alcohol Use or Nonuse (Panels D, E, and F) Choi, H. K. et al. N Engl J Med 2004; 350: 1093 -1103