Gut Hastalığının Klinik Prezentasyonları ve Tanısı
Özet
Gut, monosodyum ürat (MSÜ) kristallerinin eklem ve eklem dışı yapılarda birikmesiyle karakterize, hiperürisemi ile ilişkili kronik ve inflamatuar bir hastalıktır. Tarihsel süreçte "kralların hastalığı" olarak da bilinen gut, dünya genelinde insidansı ve prevalansı artan, özellikle erkeklerde ve yaş ilerledikçe daha sık görülen bir artrit türüdür. Hastalığın patogenezi; hiperürisemi gelişimi, MSÜ kristallerinin birikimi, akut inflamatuar ataklar ve tofüs oluşumu ile kronikleşme olmak üzere dört evreden meydana gelir. Klinik olarak hastalık; ani başlayan, şiddetli ağrı, kızarıklık ve şişlikle karakterize akut ataklar, semptomsuz interkritik dönemler ve eklem deformasyonuna yol açabilen kronik tofüslü gut evreleriyle seyreder; ayrıca renal ve kardiyovasküler komorbiditelerle güçlü ilişki gösterir. Tanıda altın standart, sinovyal sıvıda veya tofüste çift kırılımlı iğne şeklindeki MSÜ kristallerinin polarize ışık mikroskobuyla gösterilmesidir. Akut dönemlerde periferik kanda inflamatuar belirteçler artarken, radyografi kronik dönemdeki erozyonları saptamada, ultrasonografi ise çift kontur görünümünü saptamada etkilidir; Çift Enerji Bilgisayarlı Tomografi (ÇEBT) ve MRG ise derin dokulardaki birikimleri ayırt eder. Birinci basamak sağlık hizmetlerinde tanıyı kolaylaştırmak adına klinik, laboratuvar ve radyolojik parametreleri içeren, 8 ve üzeri puanın gut kabul edildiği 2015 ACR/EULAR sınıflama kriterleri ve çeşitli tanısal algoritmalar kullanılmaktadır.
Gout is a chronic and inflammatory disease associated with hyperuricemia, characterized by the accumulation of monosodium urate (MSU) crystals in articular and periarticular structures. Historically known as the "disease of kings," gout is a type of arthritis with an increasing worldwide incidence and prevalence, observed more frequently in men and with advancing age. The pathogenesis of the disease consists of four stages: the development of hyperuricemia, deposition of MSU crystals, acute inflammatory attacks, and chronicity characterized by tophus formation. Clinically, the disease presents with acute attacks characterized by sudden-onset severe pain, erythema, and swelling, symptom-free intercritical periods, and chronic tophaceous gout stages that can lead to joint deformation; it also shows a strong association with renal and cardiovascular comorbidities. The gold standard in diagnosis is the demonstration of negatively birefringent, needle-shaped MSU crystals in synovial fluid or tophi using polarized light microscopy. While inflammatory markers in peripheral blood increase during acute periods, radiography is effective in detecting erosions in the chronic phase, and ultrasonography is effective in detecting the double-contour appearance on cartilage; Dual-Energy Computed Tomography (DECT) and MRI distinguish accumulations in deep tissues. To facilitate diagnosis in primary care settings, the 2015 ACR/EULAR classification criteria, a scoring system including clinical, laboratory, and radiological parameters where a score of 8 or higher is classified as gout, and various diagnostic algorithms are utilized.
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