Hyperurikämie und Gichtosteoarthropathie (Arthropathia urica)

Zusammenfassung

Die Gichtosteoarthropathie ist eine metabolische System-krankheit, der eine Hyperurikämie zugrunde liegt. Sie nimmt im höheren Alter zu und ist auch sonst in der Bevölkerung im Zunehmen begriffen. Männer sind häufiger befallen. Risikofaktoren wie hohes Körpergewicht, Alkoholkonsum, purinreiche Kost, Bluthochdruck, Medikamente und andere Faktoren begünstigen die Hyperurikämie und die Gicht. Eine Einteilung in vier Stadien bzw. Verlaufsformen ist weltweit akzeptiert: Asymptomatische Hyperurikämie, akuter Gichtanfall, interkritische Phase und chronische (tophöse) Gicht. Die akute Gicht kann sich als Mon- oder Oligoarthritis, aber auch als polyartikuläre und chronische Arthritis manifestieren. Epidemiologie, Physiologie und Pathophysiologie der Hyperurikämie und Gichtosteoarthropathie werden kurz besprochen. Klinik, Verlauf und Röntgenveränderungen werden dargestellt und an Hand von Aufnahmen dokumentiert. Die Rolle der Entzündungsmediatoren für den akuten Gichtanfall und dessen spontaner Resolution wird diskutiert. Weiterhin werden diätetische und medikamentöse Behandlung mit Bezug zu Urikosurika, Urikostatika und Anfallsprophylaxe kurz aufgelistet. Urolitiasis und Gichtnephropathie werden im Text lediglich erwähnt. Sie werden an anderer Stelle besprochen.

Summary

The osteoarthropathy of gout is a systemic disease of metabolism. The incidence increases with advancing age but also seems to be rising in the population. Men are more frequently affected than women. Risk factors like overweight, alcohol abuse, purine rich food, high blood pressure, and other factors enhance hyperuricemia and gout. Widely accepted is the classification into four stages: Asymptomatic gout, acute gouty attack, intercritical phase, and chronic (topohaceous) gout. Acut gout can occur as mono- or oligoarticular, but also as polyarticular and chronic arthritis. Epidemiology, physiology, and pathophysiology of hyper-uricemia and osteoarthropathy of gout are briefly discussed. Clinical presentation, course of the disease and x-rays are discussed and supported by typical clinical and roentgenologic pictures. The role of mediators of inflammation in the acute gouty attack and its spontaneous resolution are mentioned. Dietetic and medicamentous treatment including uricosuric, uricostatic agents and substances to prevent attacks are briefly listed. Urolithiasis and gouty nephropathy are presented elsewhere.

Schlüsselwörter

Hyperurikämie - Gichtosteoarthropathie - Epidemiologie - Entzündungsmediatoren - Klinik - Röntgenbild - Therapie

Keywords

Hyperuricemia - osteoarthropathy of gout - epidemiology - mediators of inflammation - clinical presentation - x-rays - treatment

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