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Gastroenterologie up2date 2010; 6(1): 63-78
DOI: 10.1055/s-0029-1243930
Stoffwechselerkrankungen

© Georg Thieme Verlag KG Stuttgart · New York

Gicht

Johannes  Stephani, Guido  Adler, Götz von  Wichert
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Publication History

Publication Date:
22 March 2010 (online)

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Kernaussagen

Epidemiologie und Pathogenese

  • Als häufigste entzündliche Gelenkerkrankung der westlichen Zivilisation, deren Prävalenz und Inzidenz zuletzt stetig angestiegen sind, kommt der Gicht eine besondere gesundheits- und sozioökonomische Bedeutung zu.

  • Gichterkrankungen sind überproportional häufig mit Erkrankungen des metabolischen Syndroms assoziiert. Begünstigende Faktoren sind hoher Konsum von Fleisch- und Fischprodukten, von saccharose- und fruktosehaltigen Getränken und Nahrungsmitteln sowie Alkoholkonsum.

Symptomatik und Diagnostik

  • Die akute Gicht umfasst die Gichtarthritis sowie die Nephro- und Urolithiasis. Nach mehr als zwei Gichtattacken, bei nachgewiesenen Gichttophi oder Gelenkschäden liegt eine chronische Gichterkrankung vor.

  • Goldstandard für die Diagnose einer Gichterkrankung ist der mikroskopische Nachweis von Harnsäurekristallen, aber auch eine Arthritis loco typico (z. B. Podagra) hat – insbesondere in Verbindung mit einer Hyperurikämie und radiologischen Zeichen – eine sehr hohe Sensitivität und Spezifität.

Therapie

  • Zwar gibt es bislang noch keine S3-Leitlinien zur Diagnostik und Therapie der Gicht, jedoch wurden bereits evidenzbasierte europäische Leitlinien von der EULAR erarbeitet. Hierin werden zur Primärprävention eine Anpassung von Lifestyle-Faktoren und als Akuttherapie NSAID, Steroide oder Kolchizin empfohlen.

  • Nach wiederholtem Gichtanfall oder objektivierbaren Gewebeschäden sollte eine urikostatische und/oder urikosurische Sekundärprävention begonnen werden.

  • Insbesondere auf dem Gebiet der harnsäureinduzierten Inflammation wurden große wissenschaftliche Fortschritte erzielt, die zur Entwicklung neuer Therapieansätze geführt haben. So konnte in zwei unabhängigen Studien bereits ein Therapieerfolg mit IL-1-Antagonisten verzeichnet werden.

  • Weiterhin haben genetische Studien zahlreiche gichtassoziierte Polymorphismen identifiziert, die für Proteine mit sehr unterschiedlicher Funktion kodieren. Die Rolle dieser Proteine im Harnsäurestoffwechsel ist größtenteils noch nicht geklärt, sodass sich mit weiterführenden Erkenntnissen auch hier neue Therapieoptionen ergeben können.

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Dr. med. Johannes Stephani

Abteilung für Innere Medizin I
Universitätsklinikum Ulm

Albert-Einstein-Allee 23
89081 Ulm

Email: johannes.stephani@uniklinik-ulm.de

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