Gout is an inflammatory, metabolically conditioned crystal-induced disease. Prevalence of
gout is on the increase. In clinical practice it is frequently wrongly diagnosed and the
therapy of acute attacks in particular is not adequate. The first part of the publication discusses diagnostic possibilities of
gouty arthritis. First of all the advantage of the analysis of synovial exudate and of direct evidence of crystals in the polarization microscope is emphasized. If the material for crystallographic analysis is not available, it is necessary to use a combination of clinical criteria as specified e.g. in the recommendations of the European League Against
Rheumatism (EULAR). The second part focuses on the
therapy of
gout which is divided into the periods of asymptomatic
hyperuricemia, acute gouty attack, intercritical and chronic tophaceous
gout. Asymptomatic
hyperuricemia is only treated when uricemia greater than 540 µmol/l occur repeatedly, or when other risk factors and comorbidities are present. In the treatment of acute gouty attack its early start is more important than the choice of a preparation. Alternatives are NSA,
colchicine or
glucocorticoids. A newly regist-ered medicine for the treatment of refractory acute
inflammation is the
IL-1 inhibitor
canakinumab. The treatment of
hyperuricemia involves regimen and diet measures, abstinence and hypouricemic
therapy. Available are the
xanthine oxidase inhibitors,
allopurinol and
febuxostat; the latter is better suited for patients with moderate
renal insufficiency. A new medicine for the treatment of severe refractory tophaceous
gout is
pegloticase.Key words:
gouty arthritis -
colchicine - nonsteroidal
antirheumatic drugs.