Die Gichtarthritis: Pathogenese, Diagnostik und Behandlung

Abstract

The initial presentation of gouty arthritis can be a dramatic event. Chronic gout may lead to the destruction of joints, invalidity and increased mortality. The incidence of this disorder is high, despite effective therapeutic measures. The treatment of refractory cases may be a challenge to the general practitioner and the specialist alike. The article presented here summarizes the current state of diagnostics and treatment of acute and chronic gout.

Die Gichtarthritis kann in ihrer Erstmanifestation dramatisch verlaufen und in ihrer chronischen Form zu Gelenkdestruktion, Invalidität und erhöhter Sterblichkeit führen. Die Inzidenz der Erkrankung ist trotz guter Therapiemöglichkeiten hoch. Die Behandlung refraktärer Fälle stellt im haus- und fachärztlichen Bereich auch heute noch eine Herausforderung dar. Der Artikel bietet einen aktuellen Überblick über Diagnostik und Therapie der akuten Gicht wie auch ihrer chronischen Form.

Schlüsselwörter

akuter Gichtanfall - Tophusgicht - Colchicin - harnsäuresenkende Therapie

Key words

acute gouty arthritis - tophaceous gout - colchicine - urate-lowering treatment

Publication History

Article published online:
15 July 2020

• Literatur

• 1 Zhang Y, Neogi T, Chen C. et al Low-dose aspirin use and recurrent gout attacks. Ann Rheum Dis 2014; 73: 385-390 . doi:10.1136/annrheumdis-2012-202589
• 2 Dalbeth N, Choi HK, Joosten LAB. et al Gout. Nature Rev Dis Primers 2019; 5: 69 . doi:10.1038/s41572-019-0115-y
• 3 Chen-Xu M, Yokose C, Rai SK. et al Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: The National Health and Nutrition Examination Survey, 2007–2016. Arthritis Rheumatol 2019; 71: 991-999 . doi:10.1002/art.40807
• 4 Dalbeth N, House ME, Aati O. et al Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis 2015; 74: 908-911 . doi:10.1136/annrheumdis-2014-206397
• 5 Merola JF, Wu S, Han J. et al Psoriasis, psoriatic arthritis and risk of gout in US men and women. Ann Rheum Dis 2015; 74: 1495-1500 . doi:10.1136/annrheumdis-2014-205212
• 6 Merdler-Rabinowicz R, Tiosano S, Comaneshter D. et al Comorbidity of gout and rheumatoid arthritis in a large population database. Clinical Rheumatol 2017; 36: 657-660 . doi:10.1007/s10067-016-3477-5
• 7 Ben Salem C, Slim R, Fathallah N. et al Drug-induced hyperuricaemia and gout. Rheumatology (Oxford) 2017; 56: 679-688 . doi:10.1093/rheumatology/kew293
• 8 Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthrit Rheuma 2004; 51: 321-325 . doi:10.1002/art.20405
• 9 Dirken-Heukensfeldt KJ, Teunissen TA, van de Lisdonk H. et al Clinical features of women with gout arthritis. A systematic review. Clin Rheumatol 2010; 29: 575-582 . doi:10.1007/s10067-009-1362-1
• 10 Wendling D, Prati C, Hoen B. et al When gout involves the spine: five patients including two inaugural cases. Joint Bone Spine 2013; 80: 656-659 . doi:10.1016/j.jbspin.2013.06.002
• 11 Guillen-Astete CA, Garcia-Garcia V, Vazquez-Diaz M. Procalcitonin serum level is a specific marker to distinguish septic arthritis of the knee in patients with a previous diagnosis of gout. J Clin Rheumatol 2019; [Epub ahead of print]
• 12 Logan JA, Morrison E, McGill PE. Serum uric acid in acute gout. Ann Rheum Dis 1997; 56: 696-697 . doi:10.1136/ard.56.11.696a
• 13 Towiwat P, Chhana A, Dalbeth N. The anatomical pathology of gout: a systematic literature review. BMC musculoskelet Disord 2019; 20: 140 . doi:10.1186/s12891-019-2519-y
• 14 Colaco C, Dotel R. Coexisting polyarticular septic arthritis, gout and pseudogout. BMJ Case Reps 2018; 2018
• 15 Gutierrez M, Schmidt WA, Thiele RG. et al International Consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Rheumatology (Oxford) 2015; 54: 1797-1805 . doi:10.1093/rheumatology/kev112
• 16 Gamala M, Jacobs JWG, Linn-Rasker SF. et al The performance of dual-energy CT in the classification criteria of gout: a prospective study in subjects with unclassified arthritis. Rheumatology (Oxford) 2019; 59 (04) 845-851 . doi:10.1093/rheumatology/kez391
• 17 Neogi T, Jansen TL, Dalbeth N. et al 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2015; 74: 1789-1798 . doi:10.1136/annrheumdis-2015-208237
• 18 Kiltz U, Alten R, Fleck M. et al Evidenzbasierte Empfehlung zur Diagnostik und Therapie der Gichtarthritis im fachärztlichen Sektor. Z Rheumatol 2017; 76: 118-124 . doi:10.1007/s00393-016-0249-1
• 19 Terkeltaub RA, Furst DE, Bennett K. et al High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthrit Rheumat 2010; 62: 1060-1068 . doi:10.1002/art.27327
• 20 Bundesinstitut für Arzneimittel und Medizinprodukte. Risikoinformation für Colchicum-Dispert® und Colchysat®Bürger der Firma Bürger vom 20.11.2018. Im Internet (Stand: 08.04.2020): https://www.bfarm.de/SharedDocs/Risikoinformationen/Pharmakovigilanz/DE/RI/2018/RI-colchicin.html
• 21 Doherty M, Jenkins W, Richardson H. et al Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet 2018; 392: 1403-1412 . doi:10.1016/S0140-6736(18)32158-5
• 22 Chen CH, Chen CB, Chang CJ. et al Hypersensitivity and cardiovascular risks related to allopurinol and febuxostat therapy in asians: a population-based cohort study and meta-analysis. Clin Pharmacol Ther 2019; 106: 391-401 . doi:10.1002/cpt.1377
• 23 White WB, Saag KG, Becker MA. et al cardiovascular safety of febuxostat or allopurinol in patients with gout. NEJM 2018; 378: 1200-1210 . doi:10.1056/NEJMoa1710895
• 24 Annemans L, Spaepen E, Gaskin M. et al Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis 2008; 67: 960-966 . doi:10.1136/ard.2007.076232
• 25 Sivera F, Andres M, Carmona L. et al Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative. Ann Rheum Dis 2014; 73: 328-335 . doi:10.1136/annrheumdis-2013-203325
• 26 Major TJ, Topless RK, Dalbeth N. et al Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts. BMJ 2018; 363: k3951 . doi:10.1136/bmj.k3951
• 27 Maglio C, Peltonen M, Neovius M. et al Effects of bariatric surgery on gout incidence in the Swedish Obese Subjects study: a non-randomised, prospective, controlled intervention trial. Ann Rheum Dis 2017; 76: 688-693 . doi:10.1136/annrheumdis-2016-209958
• 28 Dalbeth N, So A. Hyperuricaemia and gout: state of the art and future perspectives. Ann Rheum Dis 2010; 69: 1738-1743 . doi:10.1136/ard.2010.136218
• 29 Perez Ruiz F, Richette P, Stack AG. et al Failure to reach uric acid target of < 0.36 mmol/L in hyperuricaemia of gout is associated with elevated total and cardiovascular mortality. RMD Open 2019; 5: e001015 . doi:10.1136/rmdopen-2019-001015