Skip to main content
Erschienen in: Zeitschrift für Gerontologie und Geriatrie 6/2018

28.02.2017 | Reviews

Crystal arthritides – gout and calcium pyrophosphate arthritis

Part 3: Treatment

verfasst von: Dr. med. S. Schlee, L. C. Bollheimer, T. Bertsch, C. C. Sieber, P. Härle

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 6/2018

Einloggen, um Zugang zu erhalten

Abstract

The treatment of gout is based on several principles. Symptom control and termination of the inflammatory process are important early goals, whereas the urate level should be lowered in the long term to prevent further gout attacks and complications. The non-pharmacological approach is based on individually informing the patient on dietary measures and changes of life style. Besides physical measures, such as cold applications on the affected joint, various medications are available for treatment of an acute gout attack. The choice of drug depends on the individual risk profile. If non-steroidal anti-inflammatory drugs (NSAID) and coxibs are chosen it should be taken into account that the use is restricted in patients with renal insufficiency. Moreover, these drugs may have gastrointestinal side effects and are associated with increased cardiovascular morbidity and mortality. Colchicine has gastrointestinal side effects at high dosages but can also be used for differential diagnostics if there is a quick response to treatment. Steroids are an effective alternative and can be given orally or parenterally in patients with dysphagia. Moreover, steroids can be used in cases of renal insufficiency. After symptoms of the acute attack have subsided, urate lowering therapy should be initiated to prevent further attacks. Low-dose urate lowering therapy can be started during an acute gout attack when acute therapy is initiated. Allopurinol is still the medication of choice but its use is restricted in patients with renal insufficiency. A rare but serious side effect is allopurinol hypersensitivity syndrome. Febuxostat can be an alternative in patients who do not tolerate allopurinol. In February 2016, lesinurad, an URAT-1 and OAT-4 inhibitor, was approved in combination with allopurinol or febuxostat. Data on the effectiveness and safety of synthetic uricases and biologicals are still sparse for elderly patients. These substances are reserved for severe cases of gout.
Literatur
1.
Zurück zum Zitat Ahern MJ, Reid C, Gordon TP et al (1987) Does colchicine work? The results of the first controlled study in acute gout. Aust N Z J Med 17:301–304CrossRefPubMed Ahern MJ, Reid C, Gordon TP et al (1987) Does colchicine work? The results of the first controlled study in acute gout. Aust N Z J Med 17:301–304CrossRefPubMed
2.
Zurück zum Zitat Antman EM, Bennett JS, Daugherty A et al (2007) Use of nonsteroidal antiinflammatory drugs: an update for clinicians: A scientific statement from the american heart association. Circulation 115:1634–1642CrossRefPubMed Antman EM, Bennett JS, Daugherty A et al (2007) Use of nonsteroidal antiinflammatory drugs: an update for clinicians: A scientific statement from the american heart association. Circulation 115:1634–1642CrossRefPubMed
3.
Zurück zum Zitat Bauer J, Biolo G, Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14:542–559CrossRefPubMed Bauer J, Biolo G, Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14:542–559CrossRefPubMed
4.
Zurück zum Zitat Becker MSHJ, Espinoza L, Wells A, Macdonald P, Lloyd E, Lademacher C (2008) A phase 3 randomized, controlled, multicenter, double-blind trial comparing effiancy and safety of daily febuxostat and allopurinol in subjects with gout. Meeting of the American College of Rheumatology, San Francisco, California. Becker MSHJ, Espinoza L, Wells A, Macdonald P, Lloyd E, Lademacher C (2008) A phase 3 randomized, controlled, multicenter, double-blind trial comparing effiancy and safety of daily febuxostat and allopurinol in subjects with gout. Meeting of the American College of Rheumatology, San Francisco, California.
5.
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:R63CrossRefPubMedPubMedCentral 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:R63CrossRefPubMedPubMedCentral
6.
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
7.
Zurück zum Zitat Becker MA, Schumacher HR Jr., Wortmann RL et al (2005) Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase: A twenty-eight-day, multicenter, phase II, randomized, double-blind, placebo-controlled, dose-response clinical trial examining safety and efficacy in patients with gout. Arthritis Rheum 52:916–923CrossRefPubMed Becker MA, Schumacher HR Jr., Wortmann RL et al (2005) Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase: A twenty-eight-day, multicenter, phase II, randomized, double-blind, placebo-controlled, dose-response clinical trial examining safety and efficacy in patients with gout. Arthritis Rheum 52:916–923CrossRefPubMed
8.
Zurück zum Zitat Choi HK, Atkinson K, Karlson EW et al (2005) Obesity, weight change, hypertension, diuretic use, and risk of gout in men: The health professionals follow-up study. Arch Intern Med 165:742–748CrossRefPubMed Choi HK, Atkinson K, Karlson EW et al (2005) Obesity, weight change, hypertension, diuretic use, and risk of gout in men: The health professionals follow-up study. Arch Intern Med 165:742–748CrossRefPubMed
9.
Zurück zum Zitat Choi HK, Atkinson K, Karlson EW et al (2004) Alcohol intake and risk of incident gout in men: A prospective study. Lancet 363:1277–1281CrossRefPubMed Choi HK, Atkinson K, Karlson EW et al (2004) Alcohol intake and risk of incident gout in men: A prospective study. Lancet 363:1277–1281CrossRefPubMed
12.
Zurück zum Zitat Cipriani S, Chen X, Schwarzschild MA (2010) Urate: A novel biomarker of Parkinson’s disease risk, diagnosis and prognosis. Biomark Med 4:701–712CrossRefPubMed Cipriani S, Chen X, Schwarzschild MA (2010) Urate: A novel biomarker of Parkinson’s disease risk, diagnosis and prognosis. Biomark Med 4:701–712CrossRefPubMed
13.
Zurück zum Zitat Clegg A, Young JB (2011) Which medications to avoid in people at risk of delirium: A systematic review. Age Ageing 40:23–29CrossRefPubMed Clegg A, Young JB (2011) Which medications to avoid in people at risk of delirium: A systematic review. Age Ageing 40:23–29CrossRefPubMed
14.
Zurück zum Zitat Dessein PH, Shipton EA, Stanwix AE et al (2000) Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: A pilot study. Ann Rheum Dis 59:539–543CrossRefPubMedPubMedCentral Dessein PH, Shipton EA, Stanwix AE et al (2000) Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: A pilot study. Ann Rheum Dis 59:539–543CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Evans TI, Wheeler MT, Small RE et al (1996) A comprehensive investigation of inpatient intravenous colchicine use shows more education is needed. J Rheumatol 23:143–148PubMed Evans TI, Wheeler MT, Small RE et al (1996) A comprehensive investigation of inpatient intravenous colchicine use shows more education is needed. J Rheumatol 23:143–148PubMed
16.
Zurück zum Zitat Fahn S, Cohen G (1992) The oxidant stress hypothesis in Parkinson’s disease: Evidence supporting it. Ann Neurol 32:804–812CrossRefPubMed Fahn S, Cohen G (1992) The oxidant stress hypothesis in Parkinson’s disease: Evidence supporting it. Ann Neurol 32:804–812CrossRefPubMed
17.
Zurück zum Zitat Fernandez C, Noguera R, Gonzalez JA et al (1999) Treatment of acute attacks of gout with a small dose of intraarticular triamcinolone acetonide. J Rheumatol 26:2285–2286PubMed Fernandez C, Noguera R, Gonzalez JA et al (1999) Treatment of acute attacks of gout with a small dose of intraarticular triamcinolone acetonide. J Rheumatol 26:2285–2286PubMed
18.
Zurück zum Zitat Hande KR, Noone RM, Stone WJ (1984) Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency. Am J Med 76:47–56CrossRefPubMed Hande KR, Noone RM, Stone WJ (1984) Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency. Am J Med 76:47–56CrossRefPubMed
19.
Zurück zum Zitat Hernan MA, Chen H, Schwarzschild MA et al (2003) Alcohol consumption and the incidence of Parkinson’s disease. Ann Neurol 54:170–175CrossRefPubMed Hernan MA, Chen H, Schwarzschild MA et al (2003) Alcohol consumption and the incidence of Parkinson’s disease. Ann Neurol 54:170–175CrossRefPubMed
20.
Zurück zum Zitat Hoskison KT, Wortmann RL (2007) Management of gout in older adults: Barriers to optimal control. Drugs Aging 24:21–36CrossRefPubMed Hoskison KT, Wortmann RL (2007) Management of gout in older adults: Barriers to optimal control. Drugs Aging 24:21–36CrossRefPubMed
21.
Zurück zum Zitat Kaneko K, Aoyagi Y, Fukuuchi T et al (2014) Total purine and purine base content of common foodstuffs for facilitating nutritional therapy for gout and hyperuricemia. Biol Pharm Bull 37:709–721CrossRefPubMed Kaneko K, Aoyagi Y, Fukuuchi T et al (2014) Total purine and purine base content of common foodstuffs for facilitating nutritional therapy for gout and hyperuricemia. Biol Pharm Bull 37:709–721CrossRefPubMed
22.
Zurück zum Zitat Khanna D, Fitzgerald JD, Khanna PP et al (2012) 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) 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
23.
Zurück zum Zitat Khanna D, Khanna PP, Fitzgerald JD et al (2012) 2012 American College of Rheumatology guidelines for management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken) 64:1447–1461CrossRef Khanna D, Khanna PP, Fitzgerald JD et al (2012) 2012 American College of Rheumatology guidelines for management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken) 64:1447–1461CrossRef
24.
Zurück zum Zitat Kingsbury SR, Conaghan PG, Mcdermott MF (2011) The role of the NLRP3 inflammasome in gout. J Inflamm Res 4:39–49PubMedPubMedCentral Kingsbury SR, Conaghan PG, Mcdermott MF (2011) The role of the NLRP3 inflammasome in gout. J Inflamm Res 4:39–49PubMedPubMedCentral
25.
Zurück zum Zitat Macdonald TM, Ford I, Nuki G et al (2014) Protocol of the Febuxostat versus Allopurinol Streamlined Trial (FAST): A large prospective, randomised, open, blinded endpoint study comparing the cardiovascular safety of allopurinol and febuxostat in the management of symptomatic hyperuricaemia. BMJ Open 4:e005354CrossRefPubMedPubMedCentral Macdonald TM, Ford I, Nuki G et al (2014) Protocol of the Febuxostat versus Allopurinol Streamlined Trial (FAST): A large prospective, randomised, open, blinded endpoint study comparing the cardiovascular safety of allopurinol and febuxostat in the management of symptomatic hyperuricaemia. BMJ Open 4:e005354CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Muller-Ladner U, Panzner I, Kriegsmann J et al (2011) Gout – regardless of therapeutic options a “forgotten” disease. Dtsch Med Wochenschr 136:1660–1664CrossRefPubMed Muller-Ladner U, Panzner I, Kriegsmann J et al (2011) Gout – regardless of therapeutic options a “forgotten” disease. Dtsch Med Wochenschr 136:1660–1664CrossRefPubMed
28.
Zurück zum Zitat Palacios N, Gao X, O’reilly E et al (2012) Alcohol and risk of Parkinson’s disease in a large, prospective cohort of men and women. Mov Disord 27:980–987CrossRefPubMedPubMedCentral Palacios N, Gao X, O’reilly E et al (2012) Alcohol and risk of Parkinson’s disease in a large, prospective cohort of men and women. Mov Disord 27:980–987CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Richette P, Doherty M, Pascual E et al (2016) 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 0:1–14 Richette P, Doherty M, Pascual E et al (2016) 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 0:1–14
31.
Zurück zum Zitat Schlesinger N, Detry MA, Holland BK et al (2002) Local ice therapy during bouts of acute gouty arthritis. J Rheumatol 29:331–334PubMed Schlesinger N, Detry MA, Holland BK et al (2002) Local ice therapy during bouts of acute gouty arthritis. J Rheumatol 29:331–334PubMed
32.
Zurück zum Zitat Schumacher HR Jr., Boice JA, Daikh DI et al (2002) Randomised double blind trial of etoricoxib and indometacin in treatment of acute gouty arthritis. BMJ 324:1488–1492CrossRefPubMedPubMedCentral Schumacher HR Jr., Boice JA, Daikh DI et al (2002) Randomised double blind trial of etoricoxib and indometacin in treatment of acute gouty arthritis. BMJ 324:1488–1492CrossRefPubMedPubMedCentral
33.
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 73:328–335CrossRefPubMed 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 73:328–335CrossRefPubMed
34.
Zurück zum Zitat Stamp LK, Jordan S (2011) The challenges of gout management in the elderly. Drugs Aging 28:591–603CrossRefPubMed Stamp LK, Jordan S (2011) The challenges of gout management in the elderly. Drugs Aging 28:591–603CrossRefPubMed
35.
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
36.
Zurück zum Zitat Tausche AK, Aringer M, Schroeder HE et al (2008) The Janus faces of allopurinol-allopurinol hypersensitivity syndrome. Am J Med 121:e3–e4CrossRefPubMed Tausche AK, Aringer M, Schroeder HE et al (2008) The Janus faces of allopurinol-allopurinol hypersensitivity syndrome. Am J Med 121:e3–e4CrossRefPubMed
37.
Zurück zum Zitat Wallace SL, Singer JZ (1988) Review: Systemic toxicity associated with the intravenous administration of colchicine – guidelines for use. J Rheumatol 15:495–499PubMed Wallace SL, Singer JZ (1988) Review: Systemic toxicity associated with the intravenous administration of colchicine – guidelines for use. J Rheumatol 15:495–499PubMed
38.
39.
Zurück zum Zitat Zhang W, Doherty M, Pascual E et al (2011) EULAR recommendations for calcium pyrophosphate deposition. Part II: Management. Ann Rheum Dis 70:571–575CrossRefPubMed Zhang W, Doherty M, Pascual E et al (2011) EULAR recommendations for calcium pyrophosphate deposition. Part II: Management. Ann Rheum Dis 70:571–575CrossRefPubMed
Metadaten
Titel
Crystal arthritides – gout and calcium pyrophosphate arthritis
Part 3: Treatment
verfasst von
Dr. med. S. Schlee
L. C. Bollheimer
T. Bertsch
C. C. Sieber
P. Härle
Publikationsdatum
28.02.2017
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 6/2018
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-017-1199-1

Weitere Artikel der Ausgabe 6/2018

Zeitschrift für Gerontologie und Geriatrie 6/2018 Zur Ausgabe

Mitteilungen der ÖGGG

Mitteilungen der ÖGGG

Mitteilungen der DGG

Mitteilungen der DGG

Journal Club

Journal Club