Therapie der Gicht und des akuten Gichtanfalls

ZUSAMMENFASSUNG

Für die bestmögliche Behandlung der Gicht ist eine umfangreiche Aufklärung des Patienten über die Erkrankung und Therapieoptionen sowie systematisches Screening auf Komorbiditäten und eine Lebensstilmodifikation elementar. Beim Management des akuten Gichtanfalls sollte möglichst frühzeitig mit der medikamentösen Therapie begonnen werden. Hier stehen Colchicin, nichtsteroidale Antirheumatika (NSAR) und Glukokortikoide oral oder intraartikulär oder eine Kombinationstherapie zur Verfügung. Canakinumab ist Mittel der Wahl bei unzureichendem Ansprechen auf die Behandlung. Für bis zu 6 Monate nach einem Anfall ist eine medikamentöse Prophylaxe indiziert. Die harnsäuresenkende Therapie (ULT) sollte zeitnah nach Indikationsstellung begonnen werden. Allopurinol ist Mittel der 1. Wahl. Liegen schwere Nierenfunktionseinschränkungen, Unverträglichkeit oder unzureichendes Therapieansprechen vor, kommen alternativ Urikosurika, Febuxostat oder die Kombination aus einem Urikosurikum mit Febuxostat in Frage. Bei unzureichendem Therapieansprechen ist auch die Kombination von Allopurinol und einem Urikosurikum möglich. Zuletzt kann auch Pegloticase off-label eingesetzt werden. Die Therapieadhärenz der ULT ist unzureichend.

ABSTRACT

Comprehensive education about the disease and therapeutic options as well as lifestyle modification and screening for comorbidities are essential to treating gout optimally. Early onset of therapy is important in managing acute gout flares. Colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids applied either orally or intraarticularly and combination therapy are regarded first choice in gout flare therapy. In case of insufficient treatment response, Canakinumab is indicated. Gout flare prophylaxis should be implemented for up to six months after the flare. Urate-lowering therapy is recommended to be commenced as early as possible. Whilst allopurinol is the substance of first choice, patients with severe renal impairment, allopurinol intolerance or an insufficient treatment response should be treated with febuxostat, a uricosuric or a combination of both. An additional option for patients responding inadequately to allopurinol is combining allopurinol with a uricosuric. In the last resort Pegloticase can be used off-label. Treatment adherence in ULT is poor.

Schlüsselwörter

Therapie - Anfallsprophylaxe - Adhärenz - Biologika - Harnsäuresenkung

Keywords

Therapy - flare prophylaxis - adherence - biologic therapy - urate-lowering therapy

Publication History

Article published online:
20 August 2020

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