Skip to main content

Advertisement

SpringerLink
Log in

Die Gicht richtig diagnostizieren und behandeln

Irreversible Folgeschäden vermeiden

Diagnosing and treating gout correctly

Prevention of irreversible damage

  • Originalien
  • Published:
Journal für Mineralstoffwechsel & Muskuloskelettale Erkrankungen

Zusammenfassung

Die Gicht zählt zu den häufigen Erkrankungen und ihre Inzidenz und Prävalenz nehmen weiter zu. Durch die Assoziation der Gicht mit Erkrankungen des metabolischen Syndroms sowie mit kardiovaskulären Erkrankungen geht die Gicht oft mit einer erheblichen Krankheitslast einher. Durch frühzeitige Diagnose und konsequenten Einsatz der verfügbaren Therapeutika, Lebensstilmodifikationen und Patientenschulung kann die Gicht im Prinzip geheilt werden. Irreversible Folgeschäden an Gelenken lassen sich dadurch verhindern.

Abstract

Gout is one of the more frequent diseases and the incidence and prevalence are increasing. Due to the association of gout with diseases of the metabolic syndrome and with cardiovascular diseases, gout is often accompanied by a substantial burden of disease. Gout can principally be cured by early diagnosis and consistent use of the available therapeutic drugs, life style modifications and patient education. The implementation of these measures can prevent irreversible damage to the joints.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Smith E, Hoy D, Cross M, Merriman TR, Vos T, Buchbinder R, et al. The global burden of gout: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(8):1470–6.

    Article  Google Scholar 

  2. Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis. 2008;67(7):960–6.

    Article  CAS  Google Scholar 

  3. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431–46.

    CAS  Google Scholar 

  4. Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64(10):1447–61.

    Article  CAS  Google Scholar 

  5. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29–42.

    Article  CAS  Google Scholar 

  6. Kiltz U, Alten R, Fleck M, Kruger K, Manger B, Muller-Ladner U, et al. [Full version of the S2e guidelines on gouty arthritis: Evidence-based guidelines of the German Society of Rheumatology (DGRh)]. Z Rheumatol. 2016;75 Suppl 2:11–60.

    Article  Google Scholar 

  7. Ankli B, Kyburz D, Hirschmann A, Hugle T, Manigold T, Berger CT, et al. Calcium pyrophosphate deposition disease: a frequent finding in patients with long-standing erosive gout. Scand J Rheumatol. 2017:1–4.

    Google Scholar 

  8. Sivera F, Andres M, Carmona L, Kydd AS, Moi J, Seth R, 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(2):328–35.

    Article  Google Scholar 

  9. Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology (Oxford). 2007;46(7):1116–21.

    Article  CAS  Google Scholar 

  10. Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez-Henriquez P, Hernandez-Diaz C, Vargas A, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther. 2011;13(1):R4.

    Article  Google Scholar 

  11. Naredo E, Uson J, Jimenez-Palop M, Martinez A, Vicente E, Brito E, et al. Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout? Ann Rheum Dis. 2014;73(8):1522–8.

    Article  Google Scholar 

  12. Das S, Ghosh A, Ghosh P, Lahiri D, Sinhamahapatra P, Basu K. Sensitivity and specificity of ultrasonographic features of gout in intercritical and chronic phase. Int J Rheum Dis. 2017;20(7):887–93.

    Article  CAS  Google Scholar 

  13. Johnson TR, Weckbach S, Kellner H, Reiser MF, Becker CR. Clinical image: Dual-energy computed tomographic molecular imaging of gout. Arthritis Rheum. 2007;56(8):2809.

    Article  Google Scholar 

  14. Jacques T, Michelin P, Badr S, Nasuto M, Lefebvre G, Larkman N, et al. Conventional Radiology in Crystal Arthritis: Gout, Calcium Pyrophosphate Deposition, and Basic Calcium Phosphate Crystals. Radiol Clin North Am. 2017;55(5):967–84.

    Article  Google Scholar 

  15. Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789–98.

    Article  CAS  Google Scholar 

  16. Billy CA, Lim RT, Ruospo M, Palmer SC, Strippoli GFM. Corticosteroid or Nonsteroidal Antiinflammatory Drugs for the Treatment of Acute Gout: A Systematic Review of Randomized Controlled Trials. J Rheumatol. 2017.

    Google Scholar 

  17. Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW. 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. Arthritis Rheum. 2010;62(4):1060–8.

    Article  CAS  Google Scholar 

  18. Schlesinger N. Difficult-to-treat gouty arthritis: a disease warranting better management. Drugs. 2011;71(11):1413–39.

    Article  CAS  Google Scholar 

  19. Schlesinger N, Alten RE, Bardin T, Schumacher HR, Bloch M, Gimona A, et al. Canakinumab for acute gouty arthritis in patients with limited treatment options: results from two randomised, multicentre, active-controlled, double-blind trials and their initial extensions. Ann Rheum Dis. 2012;71(11):1839–48.

    Article  CAS  Google Scholar 

  20. So A, De Smedt T, Revaz S, Tschopp J. A pilot study of IL-1 inhibition by anakinra in acute gout. Arthritis Res Ther. 2007;9(2):R28.

    Article  Google Scholar 

  21. Krishnan E, Pandya BJ, Chung L, Dabbous O. Hyperuricemia and the risk for subclinical coronary atherosclerosis – data from a prospective observational cohort study. Arthritis Res Ther. 2011;13(2):R66.

    Article  Google Scholar 

  22. Stamp LK, Taylor WJ, Jones PB, Dockerty JL, Drake J, Frampton C, et al. Starting dose is a risk factor for allopurinol hypersensitivity syndrome: a proposed safe starting dose of allopurinol. Arthritis Rheum. 2012;64(8):2529–36.

    Article  CAS  Google Scholar 

  23. Ramasamy SN, Korb-Wells CS, Kannangara DR, Smith MW, Wang N, Roberts DM, et al. Allopurinol hypersensitivity: a systematic review of all published cases, 1950-2012. Drug Saf. 2013;36(10):953–80.

    Article  CAS  Google Scholar 

  24. Becker MA, Schumacher HR, Jr., Wortmann RL, MacDonald PA, Eustace D, Palo WA, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005;353(23):2450–61.

    Article  CAS  Google Scholar 

  25. Taylor TH, Mecchella JN, Larson RJ, Kerin KD, Mackenzie TA. Initiation of allopurinol at first medical contact for acute attacks of gout: a randomized clinical trial. Am J Med. 2012;125(11):1126–34 e7.

    Article  CAS  Google Scholar 

  26. Perez-Ruiz F, Sundy JS, Miner JN, Cravets M, Storgard C, Group RS. Lesinurad in combination with allopurinol: results of a phase 2, randomised, double-blind study in patients with gout with an inadequate response to allopurinol. Ann Rheum Dis. 2016;75(6):1074–80.

    Article  CAS  Google Scholar 

  27. Sundy JS, Baraf HS, Yood RA, Edwards NL, Gutierrez-Urena SR, Treadwell EL, et al. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA. 2011;306(7):711–20.

    Article  CAS  Google Scholar 

  28. Bardin T, Richette P. Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options. BMC Med. 2017;15(1):123.

    Article  Google Scholar 

  29. Anzai N, Jutabha P, Amonpatumrat-Takahashi S, Sakurai H. Recent advances in renal urate transport: characterization of candidate transporters indicated by genome-wide association studies. Clin Exp Nephrol. 2012;16(1):89–95.

    Article  CAS  Google Scholar 

  30. Sircar D, Chatterjee S, Waikhom R, Golay V, Raychaudhury A, Chatterjee S, et al. Efficacy of Febuxostat for Slowing the GFR Decline in Patients With CKD and Asymptomatic Hyperuricemia: A 6-Month, Double-Blind, Randomized, Placebo-Controlled Trial. Am J Kidney Dis. 2015;66(6):945–50.

    Article  CAS  Google Scholar 

  31. Stamp LK, O’Donnell JL, Zhang M, James J, Frampton C, Barclay ML, et al. Using allopurinol above the dose based on creatinine clearance is effective and safe in patients with chronic gout, including those with renal impairment. Arthritis Rheum. 2011;63(2):412–21.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rheumazentrum Bad Aibling – Erding, Gestütring 19, 85435, Erding, Deutschland

    Matthias Witt

Authors
  1. Matthias Witt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthias Witt.

Ethics declarations

Interessenkonflikt

Der Autor erklärt, dass er sich bei der Erstellung des Beitrags von keinen wirtschaftlichen Interessen leiten ließ. Der Autor gibt an, dass kein Interessenkonflikt besteht.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Witt, M. Die Gicht richtig diagnostizieren und behandeln. J. Miner. Stoffwechs. Muskuloskelet. Erkrank. 25, 98–104 (2018). https://doi.org/10.1007/s41970-018-0045-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41970-018-0045-2

Schlüsselwörter

Schlüsselwörter

Search

Navigation