Zusammenfassung
Die Gicht ist die häufigste entzündliche Gelenkerkrankung des Mannes. Noch häufiger ist die Hyperurikämie, die asymptomatisch nicht medikamentös, sondern nur durch Diät behandelt wird. Erhöhte Harnsäurespiegel sind meist Folge einer renalen Ausscheidungsstörung, die überwiegend genetisch bedingt ist, aber auch erworben sein kann (Niereninsuffizienz, Diuretika). Erst mit dem meist typischen ersten Gichtanfall (Großzehengrundgelenk rot, heiß, höchst berührungsschmerzhaft) oder Nierensteinen bekommt die erhöhte Harnsäure Krankheitswert. Anfälle werden in der Regel mit NSAR oder Steroiden behandelt. Bei häufigen Anfällen, chronischer Gicht oder Gichtnephropathie ist eine zumindest 5 Jahre dauernde Urikostatikatherapie nötig, in der Regel mit Allopurinol oder demnächst mit Febuxostat. Anfangs ist zusätzlich eine Entzündungshemmung nötig. Die Kalziumpyrophosphatgicht, als zweithäufigste Erkrankung dieser Gruppe, wird durch Gelenkpunktion oder über die Chondrokalzinose diagnostiziert. Anfälle werden wie bei Gicht behandelt, eine kausale Therapie ist nur bei sekundären Formen (z. B. Hypothyreose, Hämochromatose, Hyperparathyroidismus) möglich.
Abstract
Gout is the most common inflammatory arthropathy for men. Asymptomatic hyperuricemia, which should lead to diet, but not to medication, is much more common still. Increased uric acid levels mostly result from diminished renal excretion, which is more commonly familiar than secondary (renal failure, diuretics). With the first episode of often typical (red, hot, exquisitely painful first MTP joint) acute arthritis or with urate nephrolithiasis, increased uric acid turns pathological. Attacks are treated with NSAIDs or corticosteroids. More common attacks, chronic gout, or urate nephropathy are definite indications for long-term (at least 5 years) therapy with allopurinol or febuxostat. Additional anti-inflammatory medication will be necessary during the first months. Calcium pyrophosphate deposition arthropathy, the second common crystal-induced arthritis, is diagnosed by synovial fluid analysis or for chondrocalcinosis. Treatment for attacks resembles therapy of acute gout; causal therapy is possible in case of secondary forms (e.g. hypothyroidism. hyperparathyroidism, hemochromatosis).
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Winzer, M., Gräßler, J. & Aringer, M. Kristallarthropathien – alt, aber wichtig. Z. Rheumatol. 66, 317–325 (2007). https://doi.org/10.1007/s00393-007-0177-1
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DOI: https://doi.org/10.1007/s00393-007-0177-1