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Erschienen in: Der Internist 2/2016

01.02.2016 | Gicht | Arzneimitteltherapie

Hyperurikämie

Wann und wie behandeln?

verfasst von: Prof. Dr. M. A. Reuss-Borst

Erschienen in: Die Innere Medizin | Ausgabe 2/2016

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Zusammenfassung

Die Prävalenz der asymptomatischen Hyperurikämie und der klinisch manifesten Gicht hat in den letzten Jahren erheblich zugenommen. Grundlegende Änderungen des Lebensstils, die deutliche Zunahme der Adipositasprävalenz und des metabolischen Syndroms sowie das steigende Alter der Patienten sind wichtige Ursachen dieser Entwicklung. Daher gewinnt die Frage der medikamentösen Therapie einer Harnsäuresenkung wieder an Bedeutung, insbesondere auch, da in den letzten Jahren nach Jahrzehnten des therapeutischen Stillstands neue Medikamente für die medikamentöse Harnsäuresenkung zugelassen wurden und weitere in klinischer Prüfung sind. Europäische und amerikanische Leitlinien zur Therapie der Hyperurikämie wurden in den vergangenen Jahren aktualisiert und überarbeitet. Auch die Rolle der asymptomatischen Hyperurikämie als kardiovaskulärer Risikofaktor ist erneut Gegenstand intensiver und auch kontroverser Diskussionen. Die vorliegende Übersicht soll die aktuellen Kenntnisse einordnen helfen und einen Überblick über die empfohlenen Therapiestrategien zur Harnsäuresenkung geben.
Literatur
2.
Zurück zum Zitat Andrés M, Sivera F, Falzon L et al (2014) Treatment target and followup measures for patients with gout: a systematic literature review. J Rheumatol 92:55–62 Andrés M, Sivera F, Falzon L et al (2014) Treatment target and followup measures for patients with gout: a systematic literature review. J Rheumatol 92:55–62
3.
Zurück zum Zitat Becker MA, Schumacher HR Jr, Wortmann RL et al (2005) Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 353:2450–2461CrossRefPubMed Becker MA, Schumacher HR Jr, Wortmann RL et al (2005) Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 353:2450–2461CrossRefPubMed
4.
Zurück zum Zitat Becker MA, Schumacher HR, Espinoza LR et al (2010) The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 12:R63PubMedCentralCrossRefPubMed Becker MA, Schumacher HR, Espinoza LR et al (2010) The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 12:R63PubMedCentralCrossRefPubMed
6.
Zurück zum Zitat Briesacher BA, Andrade SE, Fouayzi H et al (2008) Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy 28:437–443PubMedCentralCrossRefPubMed Briesacher BA, Andrade SE, Fouayzi H et al (2008) Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy 28:437–443PubMedCentralCrossRefPubMed
7.
Zurück zum Zitat Bruderer S, Bodmer M, Jick SS et al (2014) Use of diuretics and risk of incident gout. A population-based case-control study. Arthritis Rheumatol 66:185–196CrossRefPubMed Bruderer S, Bodmer M, Jick SS et al (2014) Use of diuretics and risk of incident gout. A population-based case-control study. Arthritis Rheumatol 66:185–196CrossRefPubMed
8.
Zurück zum Zitat Chohan S (2011) Safety and efficacy of febuxostat treatment in subjects with gout and severe allopurinol adverse reactions. J Rheumatol 38:1957–1969CrossRefPubMed Chohan S (2011) Safety and efficacy of febuxostat treatment in subjects with gout and severe allopurinol adverse reactions. J Rheumatol 38:1957–1969CrossRefPubMed
9.
Zurück zum Zitat Feig DI, Soletsky B, Johnson RJ (2008) Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA 300:924–932PubMedCentralCrossRefPubMed Feig DI, Soletsky B, Johnson RJ (2008) Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA 300:924–932PubMedCentralCrossRefPubMed
10.
Zurück zum Zitat Goicoechea M, De Vinusa SG, Verdalles U et al (2010) Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Nephrol 5:1388–1393PubMedCentralCrossRefPubMed Goicoechea M, De Vinusa SG, Verdalles U et al (2010) Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Nephrol 5:1388–1393PubMedCentralCrossRefPubMed
11.
Zurück zum Zitat Hande KR, Noone RM, Stone WJ (1974) Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency. Am J Med 76:47–56CrossRef Hande KR, Noone RM, Stone WJ (1974) Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency. Am J Med 76:47–56CrossRef
12.
13.
Zurück zum Zitat Jansen TL, Richette P, Perez-Ruiz F et al (2010) International position paper on febuxostat. Clin Rheumatol 29:835–840CrossRefPubMed Jansen TL, Richette P, Perez-Ruiz F et al (2010) International position paper on febuxostat. Clin Rheumatol 29:835–840CrossRefPubMed
14.
Zurück zum Zitat Johnson RJ, Kang DH, Kivlighn S et al (2003) Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 41:1183–1190CrossRefPubMed Johnson RJ, Kang DH, Kivlighn S et al (2003) Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 41:1183–1190CrossRefPubMed
15.
Zurück zum Zitat Johnson RJ, Titte S, Cade JR et al (2005) Uric acid, evolution and primitive cultures. Semin Nephrol 25:3–8CrossRefPubMed Johnson RJ, Titte S, Cade JR et al (2005) Uric acid, evolution and primitive cultures. Semin Nephrol 25:3–8CrossRefPubMed
16.
Zurück zum Zitat Khanna D, Fitzgerald JD, Khanna PP 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) 64:1431–1446CrossRef Khanna D, Fitzgerald JD, Khanna PP 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) 64:1431–1446CrossRef
17.
Zurück zum Zitat Kuo CF, Grainge MJ, See LC et al (2013) Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan. Ann Rheum Dis 74:369–374PubMedCentralCrossRefPubMed Kuo CF, Grainge MJ, See LC et al (2013) Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan. Ann Rheum Dis 74:369–374PubMedCentralCrossRefPubMed
18.
Zurück zum Zitat Kuo CF, Grainge MJ, Mallen C et al (2014) Eligibility for and prescription of urate-lowering treatment in patients with incident gout in England. JAMA 312:2684–2686CrossRefPubMed Kuo CF, Grainge MJ, Mallen C et al (2014) Eligibility for and prescription of urate-lowering treatment in patients with incident gout in England. JAMA 312:2684–2686CrossRefPubMed
19.
Zurück zum Zitat Kuo CF, Grainge MJ, Mallen C et al (2015) Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis 74:661–667PubMedCentralCrossRefPubMed Kuo CF, Grainge MJ, Mallen C et al (2015) Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis 74:661–667PubMedCentralCrossRefPubMed
20.
Zurück zum Zitat Kydd AS, Seth R, Buchbinder R et al (2014) Uricosuric medications for chronic gout. Cochrane Database Syst Rev 11:CD010457PubMed Kydd AS, Seth R, Buchbinder R et al (2014) Uricosuric medications for chronic gout. Cochrane Database Syst Rev 11:CD010457PubMed
21.
Zurück zum Zitat Levy GD, Rashid N, Niu F et al (2014) Effect of urate-lowering therapies on renal progression in patients with hyperuricemia. J Rheumatol 41:955–962CrossRefPubMed Levy GD, Rashid N, Niu F et al (2014) Effect of urate-lowering therapies on renal progression in patients with hyperuricemia. J Rheumatol 41:955–962CrossRefPubMed
22.
Zurück zum Zitat Lu N, Dubreuil M, Zhang Y et al (2015) Gout and the risk of Alzheimer’s disease: a population-based, BMI-matched cohort study. Ann Rheum Dis. doi:10.1136/annrheumdis-2014-206917 Lu N, Dubreuil M, Zhang Y et al (2015) Gout and the risk of Alzheimer’s disease: a population-based, BMI-matched cohort study. Ann Rheum Dis. doi:10.1136/annrheumdis-2014-206917
23.
Zurück zum Zitat Mazzali M, Hughes J, Kim YG et al (2001) Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension 38:1101–1106CrossRefPubMed Mazzali M, Hughes J, Kim YG et al (2001) Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension 38:1101–1106CrossRefPubMed
24.
Zurück zum Zitat Noman A, Ang DS, Ogston S et al (2010) Effect of high-dose allopurinol on exercise in patients with chronic stable angina: a randomised, placebo-controlled crossover trial. Lancet 375:2161–2167PubMedCentralCrossRefPubMed Noman A, Ang DS, Ogston S et al (2010) Effect of high-dose allopurinol on exercise in patients with chronic stable angina: a randomised, placebo-controlled crossover trial. Lancet 375:2161–2167PubMedCentralCrossRefPubMed
25.
Zurück zum Zitat Pascual E, Sivera F (2007) Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout. Ann Rheum Dis 66:1056–1058PubMedCentralCrossRefPubMed Pascual E, Sivera F (2007) Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout. Ann Rheum Dis 66:1056–1058PubMedCentralCrossRefPubMed
26.
Zurück zum Zitat Perez-Ruiz F, Calabozo M, Pijoan JI et al (2002) Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Rheum 47:356–360CrossRefPubMed Perez-Ruiz F, Calabozo M, Pijoan JI et al (2002) Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Rheum 47:356–360CrossRefPubMed
27.
Zurück zum Zitat Perez-Ruiz F, Herrero-Beites AM, Carmona L (2011) A two-stage approach to the treatment of hyperuricemia in gout: the “dirty dish” hypothesis. Arthritis Rheum 63:4002–4006CrossRefPubMed Perez-Ruiz F, Herrero-Beites AM, Carmona L (2011) A two-stage approach to the treatment of hyperuricemia in gout: the “dirty dish” hypothesis. Arthritis Rheum 63:4002–4006CrossRefPubMed
28.
Zurück zum Zitat Rees F, Jenkins W, Doherty M (2013) Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study. Ann Rheum Dis 72:826–830CrossRefPubMed Rees F, Jenkins W, Doherty M (2013) Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study. Ann Rheum Dis 72:826–830CrossRefPubMed
29.
Zurück zum Zitat Reinders MK, Haagsma C, Jansen TL et al (2009) 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 68:892–897CrossRefPubMed Reinders MK, Haagsma C, Jansen TL et al (2009) 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 68:892–897CrossRefPubMed
30.
Zurück zum Zitat Richette P, Pascual E, Doherty M et al (2015) Updated Eular evidence-based recommendations for gout. Part II: management. Ann Rheum Dis 73(Suppl 2) Richette P, Pascual E, Doherty M et al (2015) Updated Eular evidence-based recommendations for gout. Part II: management. Ann Rheum Dis 73(Suppl 2)
31.
Zurück zum Zitat Sarawate CA, Patel PA, Schumacher HR et al (2006) Serum urate levels and gout flares: analysis from managed care data. J Clin Rheumatol 12:61–65CrossRefPubMed Sarawate CA, Patel PA, Schumacher HR et al (2006) Serum urate levels and gout flares: analysis from managed care data. J Clin Rheumatol 12:61–65CrossRefPubMed
32.
Zurück zum Zitat Schumacher HR Jr, Becker MA, Wortmann RL et al (2008) Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum 59:1540–1548CrossRefPubMed Schumacher HR Jr, Becker MA, Wortmann RL et al (2008) Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum 59:1540–1548CrossRefPubMed
33.
Zurück zum Zitat Sezai A, Soma M, Nakata K et al (2013) Comparison of febuxostat and allopurinol for hyperuricemia in cardiac surgery patients (NU-FLASH Trail). Circ J 77:2043–2049CrossRefPubMed Sezai A, Soma M, Nakata K et al (2013) Comparison of febuxostat and allopurinol for hyperuricemia in cardiac surgery patients (NU-FLASH Trail). Circ J 77:2043–2049CrossRefPubMed
34.
Zurück zum Zitat Shoji A, Yamanaka H, Kamatani N (2004) A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 51:321–325CrossRefPubMed Shoji A, Yamanaka H, Kamatani N (2004) A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 51:321–325CrossRefPubMed
35.
Zurück zum Zitat Sivera F, Andres M, Carmona L et al (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 73:328–335PubMedCentralCrossRefPubMed Sivera F, Andres M, Carmona L et al (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 73:328–335PubMedCentralCrossRefPubMed
36.
Zurück zum Zitat Sriranganathan MK, Vinik O, Bombardier C et al (2014) Interventions for tophi in gout. Cochrane Database Syst Rev 10:CD010069PubMed Sriranganathan MK, Vinik O, Bombardier C et al (2014) Interventions for tophi in gout. Cochrane Database Syst Rev 10:CD010069PubMed
37.
Zurück zum Zitat Stack AG, Hanley A, Casserly LF et al (2013) Independent and conjoint associations of gout and hyperuricemia with total and cardiovascular mortality. QJM 106:647–658CrossRefPubMed Stack AG, Hanley A, Casserly LF et al (2013) Independent and conjoint associations of gout and hyperuricemia with total and cardiovascular mortality. QJM 106:647–658CrossRefPubMed
38.
Zurück zum Zitat Stamp LK, O’Donnell JL, Zhang M et al (2011) 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 63:412–421CrossRefPubMed Stamp LK, O’Donnell JL, Zhang M et al (2011) 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 63:412–421CrossRefPubMed
39.
Zurück zum Zitat Stamp LK, Merriman TR, Barclay ML et al (2014) Impaired response or insufficient dosage? Examining the potential causes of “inadequate response” to allopurinol in the treatment of gout. Semin Arthritis Rheum 44:170–174PubMedCentralCrossRefPubMed Stamp LK, Merriman TR, Barclay ML et al (2014) Impaired response or insufficient dosage? Examining the potential causes of “inadequate response” to allopurinol in the treatment of gout. Semin Arthritis Rheum 44:170–174PubMedCentralCrossRefPubMed
40.
Zurück zum Zitat Sundy JS, Baraf HS, Yood RA et al (2011) Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA 306:711–720CrossRefPubMed Sundy JS, Baraf HS, Yood RA et al (2011) Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA 306:711–720CrossRefPubMed
41.
Zurück zum Zitat Tausche AK, Jansen TL, Schröder HE et al (2009) Gicht – aktuelle Aspekte in Diagnostik und Therapie. Dtsch Arztebl Int 106:549–555PubMedCentralPubMed Tausche AK, Jansen TL, Schröder HE et al (2009) Gicht – aktuelle Aspekte in Diagnostik und Therapie. Dtsch Arztebl Int 106:549–555PubMedCentralPubMed
42.
Zurück zum Zitat Tausche AK, Christoph M, Forkmann M et al (2014) As compared to allopurinol, urate-lowering therapy with febuxostat has superior effects on oxidative stress and pulse wave velocity in patients with severe chronic tophaceous gout. Rheumtol Int 34:101–109CrossRef Tausche AK, Christoph M, Forkmann M et al (2014) As compared to allopurinol, urate-lowering therapy with febuxostat has superior effects on oxidative stress and pulse wave velocity in patients with severe chronic tophaceous gout. Rheumtol Int 34:101–109CrossRef
43.
Zurück zum Zitat Tayar JH, Lopez-Olivo MA, Suarez-Almazor ME (2012) Febuxostat for treating chronic gout. Cochrane Database Syst Rev 11:CD008653PubMedCentralPubMed Tayar JH, Lopez-Olivo MA, Suarez-Almazor ME (2012) Febuxostat for treating chronic gout. Cochrane Database Syst Rev 11:CD008653PubMedCentralPubMed
44.
Zurück zum Zitat Taylor TH, Mecchella JN, Larson RJ et al (2012) Initiation of allopurinol at first medical contact for acute attacks of gout: a randomized clinical trial. Am J Med 125:1126–1134CrossRefPubMed Taylor TH, Mecchella JN, Larson RJ et al (2012) Initiation of allopurinol at first medical contact for acute attacks of gout: a randomized clinical trial. Am J Med 125:1126–1134CrossRefPubMed
45.
Zurück zum Zitat Wei L, Mackenzie IS, Chen Y et al (2011) Impact of allopurinol use on urate concentration and cardiovascular outcome. Br J Clin Pharmacol 71:600–607PubMedCentralCrossRefPubMed Wei L, Mackenzie IS, Chen Y et al (2011) Impact of allopurinol use on urate concentration and cardiovascular outcome. Br J Clin Pharmacol 71:600–607PubMedCentralCrossRefPubMed
46.
Zurück zum Zitat Ye P, Yang S, Zhang W et al (2013) Efficacy and tolerability of febuxostat in hyperuricemic patients with or without gout: a systematic review and meta-analysis. Clin Ther 35:180–189CrossRefPubMed Ye P, Yang S, Zhang W et al (2013) Efficacy and tolerability of febuxostat in hyperuricemic patients with or without gout: a systematic review and meta-analysis. Clin Ther 35:180–189CrossRefPubMed
48.
Zurück zum Zitat Zhu Y, Pandya BJ, Choi HK (2011) Prevalence of gout and hyperuricemia in the US general population. The National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 63:3136–3141CrossRefPubMed Zhu Y, Pandya BJ, Choi HK (2011) Prevalence of gout and hyperuricemia in the US general population. The National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 63:3136–3141CrossRefPubMed
Metadaten
Titel
Hyperurikämie
Wann und wie behandeln?
verfasst von
Prof. Dr. M. A. Reuss-Borst
Publikationsdatum
01.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Innere Medizin / Ausgabe 2/2016
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-015-0001-y

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