Skip to main content
SpringerLink
Log in

Hyperurikämie und Gicht

Neues zu einer alten Krankheit

Hyperuricemia and gout

New aspects of an old disease

  • Schwerpunkt: Metabolische Knochen- und Gelenkerkrankungen
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die Gichtarthritis zählt zu den häufigsten entzündlichen Gelenkerkrankungen. Aufgrund eines zunehmenden Lebensalters und steigenden Lebensstandards ist mit einer Zunahme der Inzidenz und Prävalenz zu rechnen. Durch die Assoziation mit Erkrankungen des metabolischen Syndroms sowie mit kardiovaskulären Erkrankungen geht die Gicht oft mit einer erheblichen Krankheitslast einher. Neben konventionellen Therapeutika stehen für die Harnsäuresenkung und Anfallstherapie neue Medikamente zur Verfügung, auch für komplexe oder therapierefraktäre Patienten.

Abstract

Gouty arthritis is one of the most common arthritides. Due to increasing life expectancy and changing life style, a rising incidence and prevalence of gout can be expected. Because of associations with the diseases metabolic syndrome and cardiovascular morbidity, gout patients often suffer from significant morbidity. Besides the consequent usage of conventional therapeutics, new treatments for gout attacks and for lowering urate levels are available even for patients refractory to conventional therapy.

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
Abb. 3
Abb. 4

Literatur

  1. Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, Nuki G (2008) Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis 67:960–966

    Article  CAS  PubMed  Google Scholar 

  2. Smith E, Hoy D, Cross M, Merriman TR, Vos T, Buchbinder R, Woolf A, March L (2014) The global burden of gout: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73:1470–1476

    Article  PubMed  Google Scholar 

  3. Sivera F, Andres M, Carmona L, Kydd AS, Moi J, Seth R, Sriranganathan M, Durme C van, Echteld I van, Vinik O, Wechalekar MD, Aletaha D, Bombardier C, Buchbinder R, Edwards CJ, Landewe RB, Bijlsma JW, Branco JC, Burgos-Vargas R, Catrina AI, Elewaut D, Ferrari AJ, Kiely P, Leeb BF, Montecucco C, Muller-Ladner U, Ostergaard M, Zochling J, Falzon L, Heijde DM van der (2014) 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 73:328–335

    Article  PubMed  Google Scholar 

  4. Thiele RG, Schlesinger N (2007) Diagnosis of gout by ultrasound. Rheumatology 46:1116–1121

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  6. Naredo E, Uson J, Jimenez-Palop M, Martinez A, Vicente E, Brito E, Rodriguez A, Cornejo FJ, Castaneda S, Martinez MJ, Sanz J, Moller I, Batlle-Gualda E, Garrido J, Pascual E (2014) Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout? Ann Rheum Dis 73:1522–1528

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Ogdie A, Taylor WJ, Weatherall M, Fransen J, Jansen TL, Neogi T, Schumacher HR, Dalbeth N (2015) Imaging modalities for the classification of gout: systematic literature review and meta-analysis. Ann Rheum Dis 74:1868–1874

    Article  PubMed  Google Scholar 

  9. McQueen FM, Doyle A, Dalbeth N (2014) Imaging in the crystal arthropathies. Rheum Dis Clin North Am 40:231–249

    Article  PubMed  Google Scholar 

  10. Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Liote F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vaquez-Mellado J, Yarows SA, Taylor WJ (2015) 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 74:1789–1798

    Article  PubMed  PubMed Central  Google Scholar 

  11. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, Pillinger MH, Merill J, Lee S, Prakash S, Kaldas M, Gogia M, Perez-Ruiz F, Taylor W, Liote F, Choi H, Singh JA, Dalbeth N, Kaplan S, Niyyar V, Jones D, Yarows SA, Roessler B, Kerr G, King C, Levy G, Furst DE, Edwards NL, Mandell B, Schumacher HR, Robbins M, Wenger N, Terkeltaub R, American College of R (2012) 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res 64:1431–1446

    Article  CAS  Google Scholar 

  12. Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, Pillinger MH, Merill J, Lee S, Prakash S, Kaldas M, Gogia M, Perez-Ruiz F, Taylor W, Liote F, Choi H, Singh JA, Dalbeth N, Kaplan S, Niyyar V, Jones D, Yarows SA, Roessler B, Kerr G, King C, Levy G, Furst DE, Edwards NL, Mandell B, Schumacher HR, Robbins M, Wenger N, Terkeltaub R, American College of R (2012) 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res 64:1447–1461

    Article  CAS  Google Scholar 

  13. Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW (2010) 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 62:1060–1068

    Article  CAS  PubMed  Google Scholar 

  14. Culleton BF, Larson MG, Kannel WB, Levy D (1999) Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 131:7–13

    Article  CAS  PubMed  Google Scholar 

  15. Kuo CF, See LC, Yu KH, Chou IJ, Chiou MJ, Luo SF (2013) Significance of serum uric acid levels on the risk of all-cause and cardiovascular mortality. Rheumatology 52:127–134

    Article  CAS  PubMed  Google Scholar 

  16. Borstad GC, Bryant LR, Abel MP, Scroggie DA, Harris MD, Alloway JA (2004) Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol 31:2429–2432

    CAS  PubMed  Google Scholar 

  17. Stamp LK, Taylor WJ, Jones PB, Dockerty JL, Drake J, Frampton C, Dalbeth N (2012) Starting dose is a risk factor for allopurinol hypersensitivity syndrome: a proposed safe starting dose of allopurinol. Arthritis Rheum 64:2529–2536

    Article  CAS  PubMed  Google Scholar 

  18. Becker MA, Schumacher HR Jr., Wortmann RL, MacDonald PA, Eustace D, Palo WA, Streit J, Joseph-Ridge N (2005) Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 353:2450–2461

    Article  CAS  PubMed  Google Scholar 

  19. Schett G, Dayer JM, Manger B (2016) Interleukin-1 function and role in rheumatic disease. Nat Rev Rheumatol 12:14–24

    Article  CAS  PubMed  Google Scholar 

  20. Schlesinger N (2011) Difficult-to-treat gouty arthritis: a disease warranting better management. Drugs 71:1413–1439

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schlesinger N, Alten RE, Bardin T, Schumacher HR, Bloch M, Gimona A, Krammer G, Murphy V, Richard D, So AK (2012) 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 71:1839–1848

    Article  CAS  PubMed  Google Scholar 

  23. Schlesinger N, Mysler E, Lin HY, De Meulemeester M, Rovensky J, Arulmani U, Balfour A, Krammer G, Sallstig P, So A (2011) Canakinumab reduces the risk of acute gouty arthritis flares during initiation of allopurinol treatment: results of a double-blind, randomised study. Ann Rheum Dis 70:1264–1271

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  25. Diaz-Torne C, Perez-Herrero N, Perez-Ruiz F (2015) New medications in development for the treatment of hyperuricemia of gout. Curr Opin Rheumatol 27:164–169

    Article  CAS  PubMed  Google Scholar 

  26. Perez-Ruiz F, Sundy JS, Miner JN, Cravets M, Storgard C, Group RS (2016) 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. doi:10.1136/annrheumdis-2015-207919

    PubMed Central  Google Scholar 

  27. Kratzer JT, Lanaspa MA, Murphy MN, Cicerchi C, Graves CL, Tipton PA, Ortlund EA, Johnson RJ, Gaucher EA (2014) Evolutionary history and metabolic insights of ancient mammalian uricases. Proc Natl Acad Sci USA 111:3763–3768

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Sundy JS, Baraf HS, Yood RA, Edwards NL, Gutierrez-Urena SR, Treadwell EL, Vazquez-Mellado J, White WB, Lipsky PE, Horowitz Z, Huang W, Maroli AN, Waltrip RW 2nd, Hamburger SA, Becker MA (2011) Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA 306:711–720

    Article  CAS  PubMed  Google Scholar 

  29. Baraf HS, Becker MA, Gutierrez-Urena SR, Treadwell EL, Vazquez-Mellado J, Rehrig CD, Ottery FD, Sundy JS, Yood RA (2013) Tophus burden reduction with pegloticase: results from phase 3 randomized trials and open-label extension in patients with chronic gout refractory to conventional therapy. Arthritis Res Ther 15:R137

    Article  PubMed  PubMed Central  Google Scholar 

  30. Poiley J, Steinberg AS, Choi YJ, Davis CS, Martin RL, McWherter CA, Boudes PF (2016) A randomized, double-blind, active- and placebo-controlled efficacy and safety study of arhalofenate for reducing flare in patients with gout. Arthritis Rheumatol. doi:10.1002/art.39684 [Epub ahead of print]

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

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

    M. Witt

  2. Rheumaeinheit, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland

    H. Schulze-Koops

Authors
  1. M. Witt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Schulze-Koops
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Witt.

Ethics declarations

Interessenkonflikt

M. Witt und H. Schulze-Koops geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

H. Lehnert, Lübeck

M. Reincke, München

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Witt, M., Schulze-Koops, H. Hyperurikämie und Gicht. Internist 57, 656–665 (2016). https://doi.org/10.1007/s00108-016-0083-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-016-0083-1

Schlüsselwörter

Keywords

Search

Navigation