Gout

Urički artritis ili giht je sistemska bolest koja se očituje nakupljanjem kristala mononatrij urata (skr. MSU; engl. monosodium urate) u sinovijalnoj tekućini, na hijalinoj hrskavici zgloba, u tetivama i okolnim mekim tkivima što uzrokuje upalnu reakciju. Prema učestalosti je najčešća upalna artropatija i zahvaća oko 1% opće populacije. Prevalencija gihta iz godine u godinu raste zbog promijenjenih prehrambenih i životnih navika. Muškarci oboljevaju 4 do 10 puta češće od ţena. Razliĉiti faktori dovode do stvaranja MSU kristala. Glavni čimbenik rizika je hiperuricemija, koja može biti posljedica ili povećane proizvodnje uričke kiseline ili njenog smanjenog izlučivanja. Klinički razlikujemo 4 faze gihta. Prva faza je asimptomatska hiperuricemija, tijekom kojem nema simptoma niti znakova. Druga faza je akutni oblik gihta koji se očituje akutnom upalom jednog ili više zglobova. Predilekcijska mjesta za giht nalaze se na donjim ekstremitetima, a najčešće zahvaćen zglob je prvi metatarzofalangelani zglob. Akutni napad najčešće spontano prolazi za 5 do 10 dana, nakon čega slijedi faza remisije, tj. interkritičko razdoblje. Interkrtičko razdoblje je treća faza karakterizirana odsutnošću simptoma te može trajati nekoliko godina. U neliječenih pacijenata bolest moţe progredirati i dovesti do destrukcije zgloba uz stvaranje palpabilnih tofa. Kroniĉni oblik često dovodi deformacije zgloba i smanjenja njegova funkcije. U dijagnostici gihta najčešće se koristi aspirat zglobne tekućine, koji se analzira pod polarizirajućim mikroskopom. Prisutnost patognomičnih MSU kristala potvrđuje dijagnozu. U liječenju akutnih napada najčešće se koriste NSAR i kolhicin, dok je za dugoročno liječenje važno održavati serumsku razinu urata unutar referentnih vrijednosti.Gout is a crystal-induced deposition disease caused by the saturation and precipitation of monosodium urate (MSU) crystals in the synovial fluid, surface of the hyaline cartilage, tendons and soft tissue. This common condition affects up to 1% of the population. The prevalence is increasing every year due to different eating habits and lifestyle changes. Men are affected 4 to 10 times more often than women. Several factors are required for MSU crystals to form. The main underlying factor is hyperuricemia, which is a consequence of either excessive production of uric acid or lack of its clearance. Gout undergoes four stages during its course, starting with asymptomatic hyperuricemia. In this stage patients have no symptoms or signs. The second stage is an acute gouty attack characterized by acute inflammation of one or multiple joints. Gout has a predilection for lower extremities such as the first metatarsophalangeal joint, which is the most commonly affected place. Acute flares usually resolve spontaneously in 5 to 10 days. When the acute attack subsides, patients enter into a remission phase known as the intercritical period. This is the third stage and is characterized by the absence of symptoms and can last for many years. Untreated disease progresses into destruction of joints with formation of palpable tophi. This chronic tophaceous gout can lead to severe loss of function. Gout is mainly diagnosed by identification of the pathognomonic MSU crystals obtained by joint fluid aspiration and detected under polarized microscopy. NSAIDs and colchicine are used in the management of acute flares. In the long term it is important to keep serum uric acid levels below the deposition threshold, either by dietary modification or using serum uric acid lowering drugs