類風濕性關節炎與痛風在流行病學及健康促進策略之差異

The Difference between Rheumatoid Arthritis and Gout in Epidemiology and Health Promotion Strategies

林逸君(Yi-Chun Lin) ； 林寬佳(Kuan-Chia Lin) ； 李信興(Shinn-Shing Lee) ； 林孝義(Hsiao-Yi Lin)

《內科學誌》 16卷2期 (2005/04) Pp. 71-78

https://doi.org/10.6314/JIMT.2005.16(2).02

摘要

類風濕性關節炎與痛風在流行病學的特徵上有許多差異。類風濕性關節炎好發於女性，長期以來，其發生率與盛行率一直具有特殊的變異性，整體來看，往往因出生世代、遺傳、種族、生活環境、年齡的不同而有所差異，因此，類風濕性關節炎的危險因子分佈，可循以「宿主—環境」之輪狀模式來加以解釋，其目的在於呈現類風濕性關節炎的發病，可能和個人的基因、體質與生活環境之間的交互作用有關。痛風則好發於男性，發病率有節節上升之趨勢，且發作年齡正逐漸下降中，其危險因子分佈主要以二階段致病模式來加以建構：第一，尿酸正常至無症狀高尿酸血症；第二，無症狀高尿酸血症演變為痛風。
根據類風濕性關節炎與痛風之各項流行病學差異，我們搭配健康促進的最新概念而提出一套涵蓋三層面之健康促進策略。第一層面—健康教育：在類風濕性關節炎方面，需著眼於病患自我信心的建立與加強對疾病的認知；在痛風方面，應增進民眾對於危險因子的認識。第二層面—健康保護：在類風濕性關節炎方面，強調早期診斷與早期治療的重要性；在痛風方面，教導患者避免誘發因子並控制症狀的復發。第三層面—健康預防：在類風濕性關節炎方面，強調團體治療的重要性以及疾病惡化的預防；在痛風方面則落實於合併症的控制與疾病惡化的預防。

關鍵字

類風濕性關節炎 ； 痛風 ； 流行病學 ； 健康促進

並列摘要

The epidemiology and health promotion strategies are different between rheumatoid arthritis (RA) and gout. RA occurs more in females. Recent studies demonstrate the secular trends in prevalence and incidence of RA are dynamic, not static. Reported factors include birth-cohort effect, genetic predisposition, racial difference, environmental factors and age effect. These findings lead further support to the hypothesis of a ”host-environment” interaction model in the pathogenesis of RA. In contrast to RA, gout occurs more frequently in hyperuricemic males. The prevalence and incidence have increased worldwide, and the age of onset was getting younger. In our previous studies, we have provided a model including two stages to present the risk factors of gout. Where phase 1 is from normal uric acid concentration to the development of asymptomatic hyperuricemia. Phase 2 is from asymptomatic hyperuricemia to the development of gout. Based on these epidemiologic differences, we will further provide two health promotion strategies of RA and gout. There are three major concepts of these new health promotion strategies. First concept is the health education program (emphasis on self-confidence and disease awareness in RA; recognizing the risk factors in gout). The second concept is the health protection effort (emphasis on early diagnosis and early treatment in RA; avoiding the promoters and controlling disease recurrence in gout). The third concept is the health prevention action (emphasis on teamwork and preventing complications in RA; prevention of complications and disease deterioration in gout).

並列關鍵字

Rheumatoid arthritis ； Gout ； Epidemiology ； Health promotion