Die Gicht weist unter den chronisch-entzündlichen Erkrankungen
eine vergleichbar „einfache” Pathophysiologie
auf und ihr wird im Studium und Weiterbildung oft nur eine geringe
Beachtung geschenkt. Demgegenüber stehen nach wie vor zahlreiche
ungelöste Probleme der Therapie und des Langzeitmanagements,
darunter auch die zunehmende Häufigkeit in einer älter
werdenden Gesellschaft. Dennoch gibt es wichtige wissenschaftliche
Fortschritte wie die Erkenntnis, dass die Gicht zwar eine Kristallarthropathie ist,
ihre Pathophysiologie aber verschiedene Stoffwechselwege immunologischer
Erkrankungen wie z. B. Interleukin-1 und das assoziierte
Inflammasom beinhaltet. Auch auf therapeutischer Ebene steht den
Patienten mit dem vor kurzem zugelassenen effektiven und nebenwirkungsärmeren
Xanthinoxidasehemmer Febuxostat eine Erweiterung des therapeutischen
Armamentariums zur Verfügung. Bereits verfügbare
Leitlinien des EULAR und BSR unterstützen den behandelnden
Arzt in Praxis in Klinik bei der Langzeitversorgung der zahlreichen
Gichtpatienten.
Abstract
Compared to other chronic inflammatory diseases, gout appears
to based on a rather „simple” pathophysiology
and therefore the amount of teaching time in medical school and
during internship is rather limited. On the other hand, several
problems in short- and long-term management still need to be solved – combined
with the problem of an increased incidence in elderly people. However,
there is significant advance in the knowledge of its pathophysiology
including the fact that gout is more than a pure „crystal
arthopathy” but rather within the spectrum of chronic inflammatory
immunologic diseases. This includes cytokines such as interleukin-1
and intracellular signaling via the inflammasome. For treatment,
the novel and effective xanthine oxidase inhibitor febuxostat has
been added to the therapeutic armamentarium. Guidelines of EULAR
and BSR support the physician in the long-term management of the numerous
gout patients.
1
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
3
Becker M A, Schumacher H R, Espinoza L R. et al .
The urate-lowering
efficacy and safety of febuxostat in the treatment of the hyperuricemia
of gout: the CONFIRMS trial.
Arthritis Res Ther.
2010;
12
R63
4
Borstad G C, Bryant L R, Abel M P, Scroggie D A, Harris M D, Alloway J A.
Colchicine for prophylaxis of acute flares when initiating allopurinol
for chronic gouty arthritis.
J Rheumatol.
2004;
31
2429-2432
6
Choi H K, Mount D B, Reginato A M.
American College of Physicians; American
Physiological Society: Pathogenesis of gout.
Ann Intern
Med.
2005;
143
499-516
7
Jordan K M, Cameron J S, Snaith M. et al .
British Society for Rheumatology and British
Health Professionals in Rheumatology Standards, Guidelines and Audit
Working Group (SGAWG): British Society for Rheumatology and British
Health Professionals in Rheumatology guideline for the management
of gout.
Rheumatology.
2007;
46
1372-1374
9
Reinders M K, Haagsma C, Jansen T L. et al .
A randomised controlled trial on the efficacy
and tolerability with dose escalation of allopurinol 300 – 600 mg/day
versus benzbromarone 100 – 200 mg/day
in patients with gout.
Ann Rheum Dis.
2009;
68
892-897
11
So A, De Meulemeester M, Pikhlak A. et al .
Canakinumab for the treatment of acute
flares in difficult-to-treat gouty arthritis: Results of a multicenter,
phase II, dose-ranging study.
Arthritis Rheum.
2010;
62
3064-3076
12
Tausche A K, Aringer M, Schroeder H E, Bornstein S R, Wunderlich C, Wozel G.
The janus
faces of allopurinol-allopurinol hypersensitivity syndrome.
Am
J Med.
2008;
121
e3-e4
13
Terkeltaub R A, Furst D E. 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.
Arthritis Rheum.
2010;
62
1060-1068
14
Unger S, Tausche A K, Kopprasch S, Bornstein S R, Aringer M, Grässler J.
Molecular
basis of primary renal hyperuricemia : role of the human urate transporter
hURAT1.
Z Rheumatol.
2007;
66
58-61
15
Zhang W, Doherty M, Pascual E. et
al .
EULAR evidence based recommendations for gout.
Part I: Diagnosis. Report of a task force of the Standing Committee
for International Clinical Studies Including Therapeutics (ESCISIT).
Ann Rheum Dis.
2006;
65
1301-1311
16
Zhang W, Doherty M, Bardin T. et
al .
EULAR evidence based recommendations for gout.
Part II: Management. Report of a task force of the EULAR Standing
Committee for International Clinical Studies Including Therapeutics
(ESCISIT).
Ann Rheum Dis.
2006;
65
1312-1324
