Laboratorio

GOTA (Gout, Podagra, “Enfermedad de Reyes”)

JPEG - 4.6 KB
Angelisa Bonilla de Franceschini, MD
Patóloga clínica y anatómica Director Médico Laboratorios Borinquen.
Directora Dpto. de Patología, Universidad Central del Caribe.

Se conoce como gota al grupo de desórdenes en el metabolismo de purina, caracterizado por la acumulación de cristales de urato monosódico en las articulaciones y tejidos blandos, con episodios de artritis aguda e hiperuricemia. Da lugar a los llamados tofos, que son abultamientos duros debajo de la piel o tejidos blandos de los cristales de urato y a formación de piedras en los riñones. Podagra es el ataque agudo de gota que suele presentarse en el dedo gordo del pie.

Causas

La gota es primaria en el 30% de los afectados, por causa congénita, idiopática o hereditaria como en síndrome de Lesch-Nyhan (aumento de biosíntesis de purina). En el otro 70% es secundaria y puede ser por exceso de producción en casos de leucemia, policitemia vera, linfomas, psoriasis, por aumento en la degradación de ATP como en ingesta de alcohol, infarto al miocardio, enfermedades de almacenamiento de glucógeno (I, III, V, VII), por disminución en la función renal (90% de los casos de causas secundarias) y por aumento en ácidos orgánicos. También puede estar asociada con hipertención, hipercolesterolemia familiar, obesidad, hipotiroidismo, uso de medicamentos como diureticos y otros.¹

Presentación clínica

La artritis por gota suele diagnosticarse por su presentación clínica típica: dolor súbito, enrojecimiento, hinchazón con calor en la articulación del “dedo gordo” del pie.

Pruebas diagnósticas

Aspiración de líquido articular
La prueba diagnóstica más importante y de mayor certeza médica es la aspiración de líquido de la articulación.2

El fluido es evaluado en el microscopio para ver si hay cristales de urato o evidencia de infección bacteriana. En el examen microscópico del aspirado con fuente de luz polarizada, se visualizan los cristales birefringentes en forma de aguja, adentro y afuera de los neutrófilos o macrófagos. Los cristales en el fluido, estadísticamente, se ven en el 90% de los pacientes con ataques agudo y en el 70% de los pacientes entre ataques de la condición. Podríamos observar otro tipo de cristales en el fluido como pirofosfato de calcio, que es causado por una condición completamente diferente llamada “pseudogota”.

Análisis de orina En el análisis de orina es comun observar:

  • Cristales de ácido úrico.
  • PH neutral o ácido.
  • Color amarillo, marrón-rojizo, marrón.
  • Formas variadas, romboides, platos de cuatro lados, rosetas, como piedras de afilar en forma de limón rara vez hexágonos incoloros.
  • Son solubles y no se ven en ph alcalino y con calor
  • Insolubles en ácido acético.3

Ácido úrico
El aumento de ácido úrico no establece el diagnóstico de gota y podría estar en el rango de referencia en pacientes con ataques agudos. Los valores de ácido úrico pueden estar en el rango normal de referencia cuando hay ingesta de aspirina.

Los pacientes con gota o producen mucho ácido úrico o, más comunmente, no lo pueden remover adecuadamente.

Referencias

  1. Jacques Wallach, MD; Interpretation of Diagnostic Tests.
  2. www.cdc.gov/arthritis/basics...
  3. Henry’s Clinical Diagnosis and Management by Lab Methods, 21st Ed.

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