痛风：在中低收入国家和资源有限的环境中诊断和管理的实用方法
Gout: a practical approach to diagnosis and management in low- and middle-income countries and resource-limited settings.
摘要(中文译文)
痛风患病率在全球范围内呈上升趋势，据报道低收入和中等收入国家（LMICs）增长迅速，尤其是在亚洲、拉丁美洲和非洲部分地区。多个国际组织已发布了痛风优化管理指南，其中大多数来自高收入环境的发达国家。因此，由于多种障碍，在LMICs和其他资源有限环境（RLS）中实施这些推荐意见往往较为困难。这些障碍包括风湿病学家和其他相关专科医生的短缺、人力资源限制、先进诊断手段（如补偿偏振光显微镜、超声和双能计算机断层扫描）的可及性有限、新型有效疗法的可获得性和可负担性受限，以及在高危人群启动别嘌醇治疗前进行HLA-B*58:01检测的可及性有限。因此，这些环境中的痛风诊疗可能欠佳。本综述总结了上述障碍，并提出切合实际的、适合具体情境的应对策略。文中强调有针对性的教育以及多学科痛风诊疗团队的建设，包括在LMICs/RLS中承担大多数痛风诊疗工作的初级保健医生、护士和药师。本文还概述了与上级医疗机构的结构化协作（如通过远程会诊和病例讨论会），以支持疑难病例并强化转诊路径。国家风湿病学会和卫生主管部门应使国际指南适应本地限制条件，并为未纳入基本药物目录的高成本降尿酸治疗建立报销或授权途径。此外，经过培训的社区卫生工作者可通过识别痛风患者、提供基本教育、促进定期随访、协助获得适当诊疗以及纠正对痛风的误解来支持痛风诊疗。要点 • LMIC/RLS的痛风诊疗受限于诊断能力和管理约束，尤其是人力资源短缺。 • 上级医疗机构、风湿病学会和卫生主管部门之间的协作是改善痛风管理的关键。 • 国际指南应适应LMICs/RLS的本地限制条件。
Abstract
The prevalence of gout is increasing worldwide, with rapid rises reported in low- and middle-income countries (LMICs), particularly in parts of Asia, Latin America, and Africa. Several international organizations have published guidelines for optimal gout management, most of which are from developed countries with high-income settings. Therefore, implementing these recommendations in LMICs and other resource-limited settings (RLS) is often difficult due to several barriers. These include a shortage of rheumatologists and other relevant specialists, workforce constraints, limited access to advanced diagnostic modalities (e.g., compensated polarized light microscopy, ultrasound, and dual-energy computed tomography), restricted availability and affordability of newer effective therapies, as well as limited access to HLA-B*58:01 testing before initiating allopurinol in at-risk populations. As a result, gout care in these settings may be suboptimal. This review summarizes these barriers and proposes pragmatic, context-appropriate strategies to address them. It emphasizes targeted education and the development of multidisciplinary gout care teams, including primary care physicians, nurses, and pharmacists, who deliver most gout care in LMICs/RLS. It also outlines structured collaboration with higher-level facilities (e.g., through teleconsultation and case conferences) to support difficult cases and strengthen referral pathways. National rheumatology societies and health authorities should adapt international guidelines to local constraints and establish reimbursement or authorization pathways for high-cost urate lowering therapy not included in essential drug lists. In addition, trained community health workers can support gout care by identifying people with gout, providing basic education, promoting regular follow-up, facilitating access to appropriate care, and correcting misconceptions about gout. Key Points • LMIC/RLS gout care is limited by diagnostic capacity and management constraints, especially workforce shortages. • Collaboration among higher-level facilities, rheumatology societies, and health authorities is key to improving gout management. • International guidelines should be adapted to local constraints in LMICs/RLS.
如何引用
AMA
Patapong Towiwat, Suppachai Lawanaskol, Worawit Louthrenoo. Gout: a practical approach to diagnosis and management in low- and middle-income countries and resource-limited settings.. Clinical rheumatology. 2026; doi:10.1007/s10067-026-08285-7.
APA
Patapong Towiwat, Suppachai Lawanaskol, Worawit Louthrenoo (2026). Gout: a practical approach to diagnosis and management in low- and middle-income countries and resource-limited settings.. Clinical rheumatology. https://doi.org/10.1007/s10067-026-08285-7
GB/T 7714
Patapong Towiwat, Suppachai Lawanaskol, Worawit Louthrenoo. Gout: a practical approach to diagnosis and management in low- and middle-income countries and resource-limited settings.[J]. Clinical rheumatology, 2026 doi:10.1007/s10067-026-08285-7.
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