Por RAQUEL LUIZA,
É uma das mais antigas doenças descritas pela humanidade. É considerada crônica e progressiva, podendo causar sérias deformidades articulares e invalidez se não tratada corretamente.
A gota acomete cerca de 50.000 pessoas no Brasil. Sua maior incidência são homens (95%), com idades entre 30 e 50 anos.
O que é?
É uma artropatia crônica caracterizada por crises recorrentes de artrite inflamatória. Ocorre devido à oscilação dos níveis de ácido úrico, levando à deposição de cristais de urato nas articulações. A hiperuricemia ( ácido úrico maior de 7 mg/dl em homens e maior que 6 mg/dl em mulheres) pode resultar ao aumento da produção do urato, ou de uma menor excreção renal, ou de ambos.
A concentração sangüínea de ácido úrico pode ser aumentada por aumento do catabolismo das purinas (doenças mieloproliferativas, mieloma, tumores tratados com quimioterapia, hemólise), por defeitos hereditários que aumentam sua síntese ou por diminuição da excreção renal (os mais frequentes).
Em quem ocorre?
Ocorre geralmente no homem adulto, com pico de incidência na 5ª década de vida.
Fatores de risco: Alta ingestão de carne, fruto do mar e cerveja. Existe associação com síndrome metabólica.
A artrite gostosa é incomum na mulher em idade fértil e volta a ocorrer após a menopausa. No entanto , mulher com Síndrome dos Ovários Policísticos pode tegota primária mesmo na idade fértil.
Quais são os sintomas?
Na gota aguda, geralmente há artrite de início súbito com sinais inflamatórios marcantes.
Inicialmente, os ataques são monoarticulares e autolimitados,mas, à medida que o processo avança, eles se tornam mais frequentes e duradouros e se tornam mais articulares. Caracteristicamente, a primeira metatarsofalângica está inflamada e, em surtos subsequentes, os pés e joelhos, mas qualquer articulação pode ser afetada.
As manifestações podem ocorrer em três fases:
- Crises recorrentes de dor excruciante, início agudo, geralmente na madrugada ou início da manhã, que acomete principalmente a primera articulação metatarsofalangeana ( podagra). Responde rápido ao tratamento. Sem tratar, as crises são autolimitadas a 1-2 semanas.
- Período intercrítico, entre as crises, totalmente assintomático e de duração variada. No início, esse período pode durar anos.
- Artropatia crônica, estágio mais avançado com crises múltiplas e/ou persistentes e tofos visíveis ( coleções macroscópicas de cristais de urato). Se desenvolve após 10 anos ou mais da gota aguda e intermitente.
Os tofos resultam do depósito de cristais de cartilagem, sinovial, tendão e tecidos moles, devido à persistência de um nível de supersaturação de urato. São mais frequentes em tendões, bursas, ligamentos, arquetipicamente nas orelhas e, preferencialmente, em áreas de fricção e superfícies de extensão.
TOFOS : substantivo masculino [Medicina] Depósito nos tecidos, principalmente de ácido úrico e seus sais, característico da gota. Etimologia (origem da palavra tofo). Do latim tofus.
Como é realizado o diagnóstico?
O quadro clínico característico é importante.
A hiperuricemia está presente na maioria dos pacientes, mas pode não aparecer nas crises.
Deve ser feita uma artrocenteses com estudo do líquido sinovial e identificação dos cristais de urato monossódico por microscopia óptica de luz polarizada compensada.
O verdadeiro diagnóstico de gota é baseado na demonstração de cristais de urato monossódico no líquido sinovial ou tofos. Os cristais são em forma de agulha, com birefrigeração intensa (muito brilhante) e alongamento negativo quando observados em microscópio de luz polarizada e compensador vermelho de primeira ordem (paralelos ao eixo de polarização, perdem comprimento de onda, aparecendo em amarelo).
Nenhuma anormalidade óssea é encontrada na radiografia na fase inicial da doença, podendo ser notado apenas edema de partes moles na crise aguda. Com o avanço da doença, os depósitos de cristais de urato são identificados.
Tratamento
O tratamento da gota é direcionado, por um lado, para o controle do ataque agudo e, por outro, para a prevenção dos ataques subsequentes e das complicações da gota crônica.
A correção de fatores como obesidade, hipertensão, administração de diuréticos, consumo de álcool e hiperlipidemia contribuirão para o seu controle. A restrição de purinas na dieta pouco contribui para a redução dos níveis de urecemia, porém a restrição de álcool e cerveja (mesmo sem álcool), pode ser útil.
O tratamento da gota aguda inclui o uso de um dos seguintes medicamentos: antiinflamatórios não esteroidais, colchicina ou glicocorticóides.
Os agentes hipouricêmicos são indicados para a prevenção de crises posteriores e devem ser evitados até 2 a 4 semanas após a resolução da crise gotosa, pois podem precipitar uma crise aguda.
Referências
- GOLDMAN, L; AUSIELLO, D. CECIL: Tratado de Medicina Interna . 24 ed. Rio de Janeiro: Saunders.
- IMODEN, J. B.,HELLMANN, D. B., STONE, J. H. Current Reumatologia: Diagnóstico e tratamento. São Paulo: McGraw-Hill, 2008.
- LONGO, D. et al. Medicina interna de Harrison. 18 ed. Porto Alegre: AMGH, 2013.
- AZEVEDO , Valderilio Feijó, LOPES, Maicon Piana, CATHOLINO, Nathan Marostia, PAIVA, Eduardo dos Santos, ARAÚJO, Vitor Andrei, & PINHEIRO, Geraldo da Rocha Castelar. Revisão crítica do tratamento medicamentoso da gota no Brasil. Rev. Brasileira de Reumatologua, 57(4), 346-355; 2017.
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