Low compliance in patients with gout is one of the reasons for inadequate disease control.Objective: to study treatment adherence in compliance with the national guidelines for the management of gout patients, which provide for the continuous use of urate-lowering drugs, a gradual increase in their dose until the target serum uric acid (UA) level is reached, prophylactic antiinflammatory therapy, and regular patient monitoring.Patients and methods. This was a prospective single-center study. By now, 60 of the 80 enrolled gout patients had completed the study. The follow-up period was at least 24 weeks, during which allopurinol or febuxostat was used at the final dose. During initiation of urate-lowering therapy, allopurinol 100 mg/day was prescribed, followed by dose titration to reach the target UA level (<360 μmol/L) for all patients or <300 μmol/L for those with severe tophaceous gout. Patients with ineffective allopurinol and/or in the presence of its associated adverse reactions were prescribed febuxostat (Azurix®) 80 mg/day; the dose was increased up to 120 mg/day as needed. To prevent acute arthritis attacks, all the patients received a nonsteroidal anti-inflammatory drug (NSAID) at minimal therapeutic doses or colchicine 0.5 mg/day, and in the presence of contraindications to their use, they took glucocorticoid (GC) 7.5 mg/day calculated with reference to prednisolone. The four-item Morisky–Green questionnaire was used to assess patient adherence to therapy.Results and discussion. At 24 weeks after the start of their follow-up, 53 (88%) of the 60 patients received urate-lowering therapy; 38 (72%) of these 53 patients achieved the target UA level. The dose of allopurinol was titrated in 19 patients; and 10 (53%) of them achieved the target serum UA levels. Due to its inefficacy, allopurinol was replaced by febuxostat in 24 patients. In this group, the target UA level was recorded in 16 (67%) patients. Seventeen patients were immediately prescribed febuxostat that could achieve the target UA level in 12 (71%) of them. All the patients enrolled in the study received prophylactic anti-inflammatory therapy: NSAIDs were used in 9 (15%) patients, colchicine and GC were given to 46 (77%) and 5 (8%), respectively. Twenty-six (49%) patients who had completed the investigation were ascertained to have a high adherence therapy. Moderate and low adherence was observed in 9 (17%) and 18 (34%) patients, respectively. High therapy adherence was noted in more than half of cases in the febuxostat group and in 40% in the allopurinol one.Conclusion. High compliance in gout patients can be achieved through the observance of the national guidelines for the treatment of this disease.
Gout is a chronic disease that requires permanent urate-lowering therapy. Allopurinol is the gold standard of this therapy. The novel drug febuxostat, a selective xanthine oxidase inhibitor, has been synthesized and introduced into clinical practice in the last 10 years. The paper reviews the literature on the main clinical trials of febuxostat, which show its efficacy that is comparable to or more higher than that of allopurinol, as well as the possibility of using this drug for reduced kidney function, allergic reaction to allopurinol or resistance to therapy with allopurinol, which considerably improves prognosis in these patients. The long-term use of febuxostat is noted to result in almost complete resorption of tophi and in termination of gouty arthritis attacks. These findings allow febuxostat to be considered as a promising and essential medication for the treatment of gout. Great hopes are pinned on the extension of its application; there are ongoing investigations regarding the possibility of using this drug for asymptomatic hyperuricemia and other conditions accompanied by higher uric acid levels.
Цель исследования -оценить влияние различных факторов риска на развитие артериальной гипертонии у больных подагрой. Материал и методы. В исследование включено 286 мужчин с диагнозом подагра, соответствующим критериям S.L. Wallace. Всем пациентам проведено стандартное клиническое обследование, определялся уровень общего холестерина, холестерина липопротеинов низкой плотности, триглицеридов, холестерина липопротеинов высокой плотности, С-реактивного белка, мочевой кислоты, креатинина. Оценивались факторы риска сердечно-сосудистых заболеваний: отягощенный семейный анамнез по сердечно-сосудистым заболеваниям, индекс массы тела (ИМТ), наличие абдоминального ожирения, сахарного диабета, курение, злоупотребление алкоголем, малоподвижный образ жизни. Рассчитывалось отношение шансов (ОШ) развития артериальной гипертонии у больных подагрой и 95% доверительный интервал (ДИ). Результаты. В зависимости от наличия артериальной гипертонии больные были разделены на две группы: в первую вошли 244 (85%) пациента с артериальной гипертонией, во вторую -42 (15%) пациента без данного заболевания. В первой группе пациенты были старше, имели большую длительность подагры и большее количество пораженных суставов, чем во второй (медиана возраста составила соответственно 52,3 [44,5; 61,1] и 41,9 [38,3; 50,1] года (p<0,01), длительности болезни -6,7 [3,9; 13,7] и 4,5 [3; 7,9] года (p<0,01), суставного счета -8 [4; 12] и 5 [3; 9] (p<0,01)). В I группе по сравнению со II чаще встречался отягощенный семейный анамнез раннего развития артериальной гипертонии (68,3 и 48,8% соответственно), абдоминальное ожирение (55,3 и 33,3%), нефролитиаз (71 и 54,7%), внутрикостные тофусы (48 и 21%), (p<0.05). Также у больных I группы был выше индекс массы тела (30,2 [27,4; 33,1] и 27,9 [26,3; 30,5] кг/м 2 ) и уровень СРБ (12,7 [5,84; 19,2] и 7,8 [3,7; 16,4] мг/л), (p<0,05 во всех случаях). Не выявлено различий сывороточного уровня мочевой кислоты, липидного профиля, частоты курения и сахарного диабета. Влияние факторов риска оценивалось с помощью вычисления отношения шансов (ОШ) и графиков форестплот. У больных подагрой выявлена связь с развитием артериальной гипертонии следующих параметров:
Cardiovascular risk (CVR) in patients with calcium pyrophosphate crystal deposition disease (CPPD) has not been studied, and the optimal method for assessing it has not been established yet.Objective: Evaluation of CVR and comparison of results using Adult Treatment Panel III (ATP III) and Reynolds Risk Score (RRS) scales in patients with CPPD, gout, rheumatoid arthritis (RA) and in the control group.Materials and methods: Cross-sectional, single-center study performed by case-control method. There are 42 patients with CPPD in main group, 42 patients with gout and RA in the comparison groups are, 42 healthy volunteers in the control group. The survey included measurements of anthropometric measures, blood pressure (BP), serum glucose, creatinine, cholesterol (TC), high density lipoproteins (HDL), low density lipoproteins (LDL), C-reactive protein (CRP). CVR was assessed on ATP III and RRS scales, comparison of its evaluation results was carried out between groups and between scales within groups.Results and discussion: Most of the parameters in the compared groups did not differ. However, HDL CS levels were significantly higher in patients with CPPD and in the control group than in RA and gout (p<0.05). In addition, in patients with gout and RA, systolic BP was higher than in CPPD and in control (p<0.05).CRP in CPPD was lower than in gout and RA and was not significantly different from this indicator in the control group. Its median was 3.8 [1.0; 12.4], 8.5 [4.1; 12.9] (р <0.05), 8.6 [4.1; 20.6] (р<0.05), 1.5 [0.8; 2.6] mg/l (p>0.05). The CRP > 5 mg/L in CPPD and in the control group was greater than in RA (p<0.05) and gout (p<0.05), but CRP≥5 mg/L was determined in 18 patients (43%) with CPPD and only in 3 (7%) people in the control group (p<0.05). A high and very high risk of cardiovascular disease (CVD) on the ATP III scale in CPPD was noted in 5 (12%) in gout – in 7 (17%), in RA – in 9 (21%) and in the control group – in 8 (19%) cases. Its frequency in all groups was comparable.A high and very high risk of CVD for RRS was identified in 9 (21%), 14 (33%), 12 (29%) and 7 (17%) cases, respectively.Conclusions: CVR under CPPD, RA and gout is comparable and quite high. The RRS scale may be a more objective method of assessing CVD risk in patients with CPPD, gout and RA.
Objectives To study the prevalence of radiological osteoarthritis and chondrocalcinosis (CC) of hand in patients with Calcium pyrophosphate deposition (CPPD) and its correlation with clinical manifestations. Methods 60 pts with CPPD were included in the study. Arthritis of different localizations was observed in all pts. Hand involvement occurred in 35 (58,3%) pts. Diagnosis CPPD was confirmed by the identification of CPP crystals in synovial fluid of the knees and radiological and/or ultrasound signs of chondrocalcinosis. All pts underwent bilateral posteroanterior hand radiographs. Two radiological signs were estimated: CC and radiological hand osteoarthritis at Kellgren-Lawrence grade (KLG)≥2. Results Mean age of pts was 58,8±11,4years, 60%>men and 40% - women. Radiological typical CC was identified in 53,3% pts. Bilateral CC was defined in 25% pts. Results of X-ray for hand-joint groups are submitted in the table 1. Table 1 KLG ≥2ChondrocalcinosisArthritis DIP27- 43%2-15%12% PIP25-38%5-12%17-23% Thumb IP25-34%27-32% MCP2-18%2-15%13-25% Thumb base28-30%5-13% Wrist17-22%38%33-38% Trapezio scaphoid17%2% Radiological OA (KLG≥2) have been observed more frequently in the distal joints of the hands, than in the wrist (d=0,025), while the CC prevailed in the wrist (d=0,0067). Radiological HOA and CC did not correlate with hand arthritis on the moment of investigation. Correlation between radiological grades HOA and age of patients has been taped (d <0,05). The X-ray pattern testifies to more expressed changes in the DIP of the right hand, than the left (p=0,0422). Conclusions More than half pts with CPPD developed arthritis of the hand joints (58%) with most common localization in the wrist. Radiological OA and CC were common signs in60 ptswith CPPD, either. Radiological HOA have been more expressed in the distal joints of the hands and CC in the wrist. Nevertheless, there were no statistical correlation between radiological grade HOA, CC and development of hand arthritis in pts with CPPD. Disclosure of Interest None Declared
Background:Gout is associated with increased risk of cardiovascular disease (CVD) morbidity and mortality. Therefore, an association between coronary heart disease (CHD) and gout deserves careful examination.Objectives:The aim of this study was to determine the prevalence of CHD and factors associated with CHD in patients (pts) with gout.Methods:286 male patients fulfilling Wallace proposed criteria for gout were included: age 51.2 [42.8;59.4] years (ys), disease duration – 6.2 [3.8;12.1] ys. All patients underwent standard clinical examination, screening traditional risk factors (TRF) of CVD, blood chemistry test with estimation of serum uric acid, serum creatinine, C-reactive protein (CRP), as well as lipid profile. Carotid intima-media thickness (cIMT) was measured using a high-resolution B-mode ultrasound machine. CHD included history of angina pectoris and/or myocardial infarction. We estimated the adjusted odds ratio (OR) and 95% confidence interval (95% CI).Results:CHD was found in 111 out of the 286 pts (38.8 %). Compared to individuals with CHD, participants without CHD were older (56.7[52.1; 61.1] vs 46.2[40.6; 53.4] ys), had longer duration of gout (9.3[4.7; 15.1] vs 5.6[3.3; 9.7] ys), higher number of joints involved during disease course (8[6; 15] vs 6[4; 10]), duration of smoking (24[10; 40] vs 20[10; 28]), higher serum creatinine level accordingly, (for all p<0.05). The frequency of family history of CHD (63% vs 46.8%), intraosseous tophi (61.3% vs 33.1%), was higher in pts with CHD compared pts without CHD accordingly, (for all p<0.01). Prevalence of arterial hypertension, diabetes mellitus, nephrolithiasis, heart failure and renal failure was greater in pts with CHD than pts without CHD (p<0.001). Gout pts with CHD had a significantly higher cIMT compare to those without CHD - 0.95[0.8;1.08]/0.8[0.7;0.9] accordingly, p<0.001. We didn’t find differences of lipid profile, serum uric acid, and CRP level in gout pts with/without CHD.Abdominal obesity (OR, 5.5; 95% CI, 2.2-13.6), body mass index >30 kg/m2 (OR, 5.8; 95% CI, 1.8-18.5), family history of CHD (OR, 2.7; 95% CI, 1.3-5.4), disease duration of gout more 10 ys (OR, 2.6; 95% CI, 1.3-5.1), age of gout onset < 35 ys (OR, 3.0; 95% CI, 1.5-6.1), intraosseous tophi (OR, 3.1; 95% CI, 1.4-7.0), C-RP (OR, 2.2; 95% CI, 1.1-4.7), renal failure (OR, 18,8; 95% CI, 1.1-312.9), increased the risk for CHD in patients with a gout.Conclusion:The prevalence of CHD was 38.8% among individuals with gout. Our study showed that both TRFs of CVD and the severity of gout and a history of renal failure contribute to the development of CHD in patients with gout.Disclosure of Interests:None declared.
The paper discusses the results of clinically using the interleukin-1_ inhibitor canakinumab in a patient with chronic tophaceous gout, IgA nephropathy, and chronic kidney disease with resistance to traditional anti-inflammatory drugs (colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and high-dose glucocorticoids) and a history of failed urate-lowering therapy. It demonstrates the possibility of safely using subcutaneous canakinumab 150 mg that is superior to therapy with high-dose prednisone (40-80 mg/day) and NSAIDs. Canakinumab has also reduced the risk of exacerbations of arthritis when choosing urate-lowering therapy.
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