Diagnóstico y tratamientoDiagnóstico y tratamiento de la gotaGout: Diagnosis and treatment
Section snippets
Identificación de cristales (patrón oro)
La identificación de cristales de UMS en líquido sinovial o en material aspirado de tofos sigue constituyendo el patrón oro para el diagnóstico de gota, como afirman las recomendaciones y guías de práctica clínica1, 2, 3; esto también deriva de entender la gota como una enfermedad por depósito de cristales de UMS.
Su identificación resulta sencilla y fiable tras un corto entrenamiento. Se precisa un microscopio óptico equipado con 400-600 aumentos, que permiten una adecuada visualización de los
Objetivos
El depósito de cristales de UMS en pacientes con gota es reversible. Por tanto, la estrategia de tratamiento tiene como objetivo (irrenunciable) la eliminación de los depósitos de UMS (tabla 1). Sin cristales, no existe inflamación (ni ataques agudos, ni inflamación subclínica mantenida), por lo que la gota se puede considerar curada. El único método conocido para disolver los depósitos es reducir la uricemia por debajo de su punto de saturación de manera mantenida. En pacientes gotosos la
Conclusiones
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El diagnóstico de la gota se debe realizar en base a la identificación de cristales de UMS en una muestra de líquido sinovial o en un aspirado de tofo.
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El objetivo del tratamiento de la gota es la disolución de los depósitos de cristales. Para conseguirlo debemos reducir la uricemia < 6 mg/dl. En pacientes seleccionados se deben considerar objetivos de tratamiento más estrictos (< 5 mg/dl), ya que a menor uricemia, mayor rapidez de disolución de los cristales.
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Las opciones iniciales de tratamiento
Conflicto de intereses
FS ha recibido honorarios por material educativo y por ponencias de Menarini y ha participado en advisory board para AstraZeneca. MA ha recibido honorarios por ponencias de Menarini y ha participado en advisory board para AstraZeneca. NQ declara no tener ningún conflicto de intereses.
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