{"id":3920,"count":8,"description":"Gout is caused by deposition of monosodium urate crystals in joints (most often the first metatarsophalangeal joint \u2014 \"podagra\") and soft tissues, secondary to chronic hyperuricaemia. Modern management has two parallel goals: (1) abort the acute flare with anti-inflammatory treatment, and (2) reduce serum uric acid to below 360 \u00b5mol\/L (300 \u00b5mol\/L in tophaceous gout) with long-term urate-lowering therapy. The MedsBase Gout Treatment catalogue carries both arms, supplied by <strong>WHO-GMP certifikovan\u00fdch v\u00fdrobc\u016f<\/strong>.\n\n<strong>Akutn\u00ed z\u00e1chvat \u2013 protiz\u00e1n\u011btliv\u00e1 l\u00e9\u010dba.<\/strong> T\u0159i mo\u017enosti funguj\u00ed, v\u00fdb\u011br z\u00e1vis\u00ed na kontraindikac\u00edch. NSAIDs (vysok\u00e9 d\u00e1vky po dobu 5\u20137 dn\u016f) jsou prvn\u00ed volbou u pacient\u016f bez ren\u00e1ln\u00edho po\u0161kozen\u00ed, peptick\u00e9ho v\u0159edu, srde\u010dn\u00edho selh\u00e1n\u00ed nebo antikoagula\u010dn\u00ed l\u00e9\u010dby. Naproxen 500 mg dvakr\u00e1t denn\u011b, indomethacin 50 mg t\u0159ikr\u00e1t denn\u011b (historick\u00fd \"zlat\u00fd standard\" pro akutn\u00ed dnu) a ibuprofen 800 mg t\u0159ikr\u00e1t denn\u011b jsou b\u011b\u017en\u00e9 volby. M\u00e1me skladem <a href=\"https:\/\/medsbase.com\/cs\/brufen\/\">Brufen<\/a> (ibuprofen), <a href=\"https:\/\/medsbase.com\/cs\/inmecin-r\/\">Inmecin-R<\/a> (indometacin SR), <a href=\"https:\/\/medsbase.com\/cs\/indicid-75-sr\/\">Indicid-75 SR<\/a>, a <a href=\"https:\/\/medsbase.com\/cs\/indoga\/\">Indoga<\/a> (indometacin). Kolchicin 1,2 mg peror\u00e1ln\u011b n\u00e1sledovan\u00fd 0,6 mg po jedn\u00e9 hodin\u011b (pot\u00e9 0,6 mg 2\u00d7 denn\u011b po dobu 2\u20133 dn\u016f) je alternativou \u2013 zvl\u00e1\u0161t\u011b u\u017eite\u010dnou, kdy\u017e jsou NSAID kontraindikov\u00e1na. Skladem jako <a href=\"https:\/\/medsbase.com\/cs\/goutnil\/\">Goutnil<\/a> (kolchicin 0,5 mg). Sledujte pr\u016fjem (z\u00e1visl\u00fd na d\u00e1vce) a vyhn\u011bte se pod\u00e1v\u00e1n\u00ed p\u0159i v\u00fdznamn\u00e9m ren\u00e1ln\u00edm nebo jatern\u00edm posti\u017een\u00ed. Peror\u00e1ln\u00ed kortikosteroidy (prednisolon 30\u201340 mg denn\u011b po dobu 5 dn\u016f) jsou t\u0159et\u00ed mo\u017enost\u00ed, kdy\u017e jsou jak NSAID, tak kolchicin kontraindikov\u00e1ny \u2014 viz kategorie L\u00e9ky na bolest.\n\n<strong>Terapie sni\u017euj\u00edc\u00ed hladinu ur\u00e1t\u016f \u2014 pro chronickou l\u00e9\u010dbu.<\/strong> Indikace: \u2265 2 ataky ro\u010dn\u011b, tof\u00f3zn\u00ed dna, ur\u00e1tov\u00e1 nefroliti\u00e1za nebo chronick\u00e9 onemocn\u011bn\u00ed ledvin stadia \u2265 3 s hyperurik\u00e9mi\u00ed. Allopurinol (inhibitor xanthinoxid\u00e1zy) je l\u00e9kem prvn\u00ed volby \u2014 za\u010dn\u011bte s 100 mg denn\u011b (50 mg p\u0159i CKD), zvy\u0161ujte o 100 mg ka\u017ed\u00e9 2\u20134 t\u00fddny s c\u00edlem s\u00e9rov\u00e9ho ur\u00e1tu &lt; 360 \u00b5mol\/l. V\u011bt\u0161ina pacient\u016f pot\u0159ebuje 300\u2013600 mg denn\u011b. Skladem jako <a href=\"https:\/\/medsbase.com\/cs\/zyrik\/\">Zyrik<\/a> (allopurinol). P\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby se u populace Han \u010c\u00ed\u0148an\u016f, Korejc\u016f a Thajc\u016f doporu\u010duje testov\u00e1n\u00ed HLA-B*5801 (riziko z\u00e1va\u017en\u00fdch ko\u017en\u00edch ne\u017e\u00e1douc\u00edch reakc\u00ed). Febuxostat (alternativn\u00ed inhibitor xanthinoxid\u00e1zy \u2014 vhodn\u00fd p\u0159i intoleranci nebo nedostate\u010dn\u00e9 \u00fa\u010dinnosti allopurinolu) je skladem jako <a href=\"https:\/\/medsbase.com\/cs\/hyloric\/\">Hyloric<\/a>. Studie CARES upozornila na sign\u00e1l kardiovaskul\u00e1rn\u00ed mortality \u2014 p\u0159ed p\u0159echodem z allopurinolu zhodno\u0165te kardiovaskul\u00e1rn\u00ed riziko. Probenecid (urikosurikum \u2014 zvy\u0161uje ren\u00e1ln\u00ed exkreci ur\u00e1t\u016f) jako <a href=\"https:\/\/medsbase.com\/cs\/bencid\/\">Bencid<\/a>. U\u017eite\u010dn\u00fd u pacient\u016f s nedostate\u010dnou exkrec\u00ed a eGFR &gt; 50; kontraindikov\u00e1n p\u0159i anamn\u00e9ze uroliti\u00e1zy.\n\n<strong>Profylaxe atak\u016f p\u0159i zah\u00e1jen\u00ed terapie sni\u017euj\u00edc\u00ed hladinu ur\u00e1t\u016f.<\/strong> Zah\u00e1jen\u00ed terapie sni\u017euj\u00edc\u00ed hladinu ur\u00e1t\u016f m\u016f\u017ee mobilizovat tofy a vyvolat ataky po dobu 6 m\u011bs\u00edc\u016f. Profylaktick\u00e9 pod\u00e1v\u00e1n\u00ed kolchicinu 0,5 mg jednou nebo dvakr\u00e1t denn\u011b po dobu prvn\u00edch 6 m\u011bs\u00edc\u016f (nebo profylaxe NSAID) sni\u017euje incidenci atak\u016f \u2014 ukon\u010dete, jakmile je hladina ur\u00e1tu na c\u00edlov\u00e9 hodnot\u011b a nedoch\u00e1z\u00ed k atak\u00e1m po dobu 3\u20136 m\u011bs\u00edc\u016f.\n\n<strong>Jak vybrat.<\/strong> Prvn\u00ed ataka bez rizikov\u00fdch faktor\u016f \u2192 NSAID 5\u20137 dn\u00ed, terapie sni\u017euj\u00edc\u00ed hladinu ur\u00e1t\u016f zat\u00edm ne. Opakovan\u00e9 ataky (\u2265 2\/rok) \u2192 za\u010dn\u011bte allopurinolem 100 mg denn\u011b s titrac\u00ed + profylaxe kolchicinem. Selh\u00e1n\u00ed nebo intolerance allopurinolu \u2192 febuxostat (zhodno\u0165te kardiovaskul\u00e1rn\u00ed riziko). Pacient s nedostate\u010dnou exkrec\u00ed (24hodinov\u00e1 mo\u010dov\u00e1 exkrece ur\u00e1t\u016f &lt; 600 mg) bez uroliti\u00e1zy \u2192 zva\u017ete probenecid jako alternativu nebo dopln\u011bk. Tof\u00f3zn\u00ed dna, refraktern\u00ed onemocn\u011bn\u00ed nebo indikace k peglotic\u00e1ze \u2192 doporu\u010den\u00ed k revmatologovi.\n\n<strong>D\u016fle\u017eit\u00e9.<\/strong> Zm\u011bna \u017eivotn\u00edho stylu je kl\u00ed\u010dov\u00e1: sni\u017ete p\u0159\u00edjem alkoholu (zejm\u00e9na piva), omezte n\u00e1poje slazen\u00e9 frukt\u00f3zou, redukujte hmotnost, zajist\u011bte dostate\u010dnou hydrataci, dodr\u017eujte dietu s n\u00edzk\u00fdm obsahem purin\u016f, u\u017e\u00edvejte 500 mg vitam\u00ednu C denn\u011b, konzumujte ml\u00e9\u010dn\u00e9 v\u00fdrobky. Pokra\u010dujte v terapii sni\u017euj\u00edc\u00ed hladinu kyseliny mo\u010dov\u00e9 i b\u011bhem akutn\u00edch vzplanut\u00ed \u2014 p\u0159eru\u0161en\u00ed l\u00e9\u010dby vyvol\u00e1v\u00e1 dal\u0161\u00ed ataky. Jestli\u017ee je to mo\u017en\u00e9, vyhn\u011bte se kli\u010dkov\u00fdm a thiazidov\u00fdm diuretik\u016fm (zvy\u0161uj\u00ed hladinu kyseliny mo\u010dov\u00e9). Aspirin v d\u00e1vce 75\u2013100 mg m\u00e1 jen mal\u00fd vliv; kardiovaskul\u00e1rn\u00ed indikace obvykle p\u0159eva\u017euje nad obavami z kyseliny mo\u010dov\u00e9. Akutn\u00ed monoartritida s hore\u010dkou vy\u017eaduje punkci kloubu k vylou\u010den\u00ed septick\u00e9 artritidy \u2014 dna ji m\u016f\u017ee napodobovat, ale nelze ji p\u0159edpokl\u00e1dat.\n\nV\u0161echny p\u0159\u00edpravky MedsBase pro l\u00e9\u010dbu dny jsou odes\u00edl\u00e1ny z <strong>WHO-GMP certifikovan\u00fdch v\u00fdrobc\u016f<\/strong> s diskr\u00e9tn\u00edm balen\u00edm a jsou kryty na\u0161\u00ed <a href=\"https:\/\/medsbase.com\/cs\/medsbase-re-shipment-assurance-policy\/\">Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/a>.","link":"https:\/\/medsbase.com\/cs\/gout-treatment\/","name":"L\u00e9\u010dba dny","slug":"gout-treatment","taxonomy":"product_cat","parent":3223,"meta":[],"menu_order":0,"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat\/3920","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat"}],"about":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/taxonomies\/product_cat"}],"up":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat\/3223"}],"wp:post_type":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product?product_cat=3920"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}