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Aim. To evaluate treatment adherence among patients with gout. Materials and methods. One hundred and thirty-eight patients with gout were examined in the Dzhanelidze Saint Petersburg Research Institute of Emergency Care; 89.9% of them are men and 10.1% are women. The average age of the subjects was 58.1±1.1 years, the average duration of the disease was 8.4±0.7 years. All patients answered a questionnaire in which they indicated the prescription of the disease, the number of gout attacks over the past 12 months, adherence to a low-purine diet, taking urate-lowering drugs, dose and duration of therapy, as well as contacting a rheumatologist and the regularity of observation by a specialist. All the subjects were also examined to identify tofuses, and blood was taken from them to determine the level of uric acid. Results were statistically processed, considering the differences as significant at p0.05. Results. Tophi were detected in 31.9% of patients. The average uric acid level in all examined patients was 8.1±0.2 mg/dl, while the target level of less than 6.0 mg/dl was detected only in 10.1%. Of all the respondents, only 13.0% of patients had no arthritis attacks in the last 12 months, the remaining 87.0% of patients had at least one attack during this period; 36.2% of people had never taken urate-lowering therapy; 39.1% of patients regularly received urate-lowering drugs, most of them (20.3%) took allopurinol at a dose of 100 mg/day, while only two of them had a target uric acid level of less than 6.0 mg/dl; 13.7% of respondents took allopurinol at a different dosage (50 mg/day; 150–400 mg/day); 5.1% of patients took febuxostat; 13.8% of patients independently canceled the drug after a short course of administration, 8.0% received urate-lowering therapy sporadically, 2.9% do not tolerate urate-lowering drugs. The average uric acid level in the group receiving urate-lowering therapy was 7.5±0.2 mg/dl, and in the sample without therapy – 8.5±0.3 mg/dl (p0.05); 70.3% of the surveyed patients reported that they did not follow a diet, only 13%, according to words, comply and 16.7% try to comply with the necessary restrictions in nutrition. 44.2% of patients from the group have never seen a rheumatologist, 33.3% have been treated once during the entire period of the disease, 19.6% are observed from time to time and only 2.9% of the entire group was regularly observed by a rheumatologist. When comparing groups of patients who have never seen a rheumatologist (group 1) and patients who have been examined at least once by a specialist (group 2), adherence to urate-lowering therapy and a low-purine diet is significantly higher in the second group. Conclusion. The patients we examined showed low adherence to the treatment of gout: only 39.1% of them regularly took urate-lowering therapy, while 70.4% of those receiving therapy retained arthritis attacks and 75.9% of these patients did not reach the target uric acid level. Unsatisfactory control of gout is primarily associated with an insufficient dose of urate-lowering drugs taken, the lack of individual selection of therapy according to the level of uric acid. Ways to solve the problem, in our opinion, are to increase the level of knowledge of primary care physicians about the specifics of treatment and selection of anti-inflammatory drugs, increase awareness of people with gout about their disease, as well as more actively refer such patients to a rheumatologist.

From modern perspective, hyperuricemia should be considered as a trigger of inflammatory activity in tissues and organs, leading to the formation of tophi, arthropathy, kidneys and cardiovascular system damage. Similarly, hypercholesterolemia, a proven factor in atherogenesis-far from all patients leads to the development of relevant clinical events. This commonality may be explained by the involvement of universal inflammatory mechanism. The key mediator of gout attacks is recognized as IL-1β, a product of NLRP3 (NLR family pyrin domain containing 3) inflammasome activation (complex multiprotein), responsible for local inflammatory response in synovial membrane and periarticular tissues with participation of macrophages and neutrophils. NLRP3 inflammasome activation is carried out by uric acid crystals, cholesterol exclusively after priming by lipopolysaccharides, peroxidation products and other damage factors associated with aging and comorbid conditions typical for gout and cardiovascular diseases. In addition, NLRP3 inflammasome activity is genetically determined and determines the frequency of these conditions. The discussed mechanism explains why the impact on factors associated with comorbidity is able to reduce the frequency of gout attacks along with cardiovascular outcomes. New clinically relevant pleotorpic effects of statins, sodium-glucose cotransporter-2 inhibitors, which have advantages over urates-lowering therapy in patients with asymptomatic hyperuricemia and can modify the course of gout, are demonstrated. Their anti-inflammatory properties, cardio and renoprotective effects, and tolerability advantages are emphasized. Blocking the activity of inflammasome is considered as a new universal therapeutic target for rheumatology and cardiology.

Background. Spinal gout is a rare and poorly described group of noninfectious inflammatory spinal lesions characterized by the deposition of monosodium urate crystals in the epidural space, paravertebral soft tissues, and by facet joints damage. There is no systematized data on the course of infectious spondylitis and spinal gout in the literature. The aim of the study — to present long-term outcomes of surgical treatment of chronic pyogenic spondylitis in patients with spinal gout and systematize the literature data on the issue. Methods. The clinical part of the study included 6 consecutively operated patients in the period from 2018 to 2021. The diagnosis of spinal gout and chronic pyogenic spondylitis was verified according to the results of histologic and bacteriologic studies of surgical material. Catamnesis accounted for at least 12 months. We studied the peculiarities of clinical and laboratory, radiological and histologic manifestations of the disease. Literature data systematization was carried out in the databases PubMed, Google Scholar, eLIBRARY from 2013 to 2023. Inclusion criteria: level of evidence II B-IV, catamnesis more or equal to 6 months, information on diagnostic and treatment measures. Results. The average age of the patients was 55±9 years. The duration of the diagnostic pause was 8±5 years. Multisegmented lesions of the lumbar (n = 6) spine prevailed. According to the classification of Pola E. et al. (2017) the following types of spondylitis were identified: B.3 (n = 1), C.1 (n = 1), C.3 (n = 2) and C.4 (n = 2). The clinical manifestation was dominated by chronic back pain with an intensity of 6,1±1,4 VAS scores. Neurologic disorders of the lower extremities and pelvic (ASIA scale) corresponded to types B (n = 1) and C (n = 4). The type of surgery: three-column reconstruction through combined approach in 2 cases and isolated anterior column reconstruction in 2 cases, 360° fusion in 1 case, and debridement of the epidural space and anterior column through posterior approach in 1 case. The follow-up results show the absence of recurrence of spondylitis in 4 cases, in 2 patients there were postoperative complications that required revision, after which no recurrence of spondylitis was noted. We selected 17 publications for literature review. Conclusion. The combination of chronic pyogenic spondylitis and spinal gout is a rare and poorly described pathology in the literature. Long therapeutic pause, chronic character of vertebrogenic pain syndrome in combination with increased uric acid level and formation of tophi of vertebral localization are distinctive features of the disease. Neurologic disorders with the combination of spondylitis and gout result from stenosis of the spinal canal due to two factors — epidural abscesses and tophi. Achieving local control of the combined pathology is possible with a combination of surgical intervention and long-term administration of hypouricemic drugs.

The best results in combating gout are achieved through a combination of diet and drug therapy. Urate-lowering therapy, which includes febuxostat, has been shown to be more effective and convenient than diet when it comes to achieving and maintaining target uric acid (UA) levels in gout patients. Febuxostat, a xanthine oxidase inhibitor, helps to reduce UA levels in the blood by blocking its formation. This helps prevent the deposition of urate crystals in joints and tissues and reduces the frequency and severity of gout attacks. At the same time, a diet of low purine foods may also have some effect on UA levels. Diet can improve the results of drug treatment by reducing the need for medications and minimizing the risk of side effects. However, without adequate drug therapy, diet will not produce the desired results. Therefore, febuxostat remains the preferred urate-lowering treatment option for gout, especially given its proven efficacy in these patients.

Gout manifests as acute arthritis attacks, the frequency of which varies and is unpredictable.The aim of this study was to identify factors associated with the frequency of arthritis attacks in patients with gout who have not received urate-lowering therapy (ULT).Materials and methods. A retrospective cohort study included 116 patients (6 females, 110 males) with gout, with a mean age of 50.1±12.05 years, who were not receiving ULT. The frequency of arthritis attacks in the past year and the presence of subcutaneous tophi were evaluated. Analyzed factors included alcohol consumption, smoking, body mass index (BMI), blood pressure values, comorbidities, diuretic use, and laboratory tests, including serum levels of glucose, creatinine, creatine phosphokinase (CPK), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), uric acid (UA), C-reactive protein (CRP), and estimated glomerular filtration rate (eGFR).Results. The mean disease duration was 9.2 [3.9; 15.8] years. The average number of arthritis attacks per year was 5 [2; 6], with ≥4 arthritis attacks per year observed in 40% of patients, and subcutaneous tophi present in 33.6%. A weak positive correlation was found between the frequency of exacerbations and systolic blood pressure (p4 attacks of arthritis was significant for: presence of heredity for gout – 1.955 (95% CI: 1.224–3.121; p540 µmol/L), diuretic use, and alcohol consumption.

Gout has the richest history of all rheumatic diseases. The name of this most ancient of the described diseases of the musculoskeletal system for a long time not only determined the fact of damage to the joints, but was also synonymous with severe pain. Although the disease itself is much older than humanity and dates back to prehistoric times, it was with the advent of man on Earth that gout began to influence the historical process and became an integral part of it. Since ancient times, it was noticed that famous kings, emperors, generals, admirals and philosophers, musicians and artists, scientists and writers often suffered from gout. The cause of the disease was seen in a sedentary lifestyle, overeating, and abuse of wine with significant mental stress. And now it is difficult to imagine our world without this disease, which is so closely intertwined with the history of humanity.

The prevalence of hyperuricemia (HU), which can be considered the first stage of gout formation, varies in different countries and tends to increase. Uric acid (UA), even in its dissolved form, activates damage and potentiates the death of articular cartilage cells through direct cytotoxicity and a number of other pathogenetic mechanisms. The possible association of HU and osteoarthritis may be due to a number of common pathogenetic mechanisms, but the direction of this relationship is still a debatable issue. The accumulated data suggest the need for a deeper study of the relationship between gout and HU with pathological processes leading to the development and progression of osteoarthritis and bone metabolism disorders.

The possibilities for diagnosing and treating gout have expanded significantly. However, this did not lead to solving the problem of timely diagnosis of gout, nor to improving control over it, nor to reducing mortality in patients with gout. In the article possible reasons of absence of the progress in gout control connected with the lack of usage of contemporary capabilities in diagnosis and mistakes in usage of drugs therapy is discussed. These should include the lack of conversance of medical stuff about sonography high informativity for gout diagnosis, low availability of polarizing microscopy and dual energy computer tomography; causeless ignore of prescribing prophylactic symptomatic therapy, usage of inadequate doses of drugs. Another reason may be the absence of unified concept regarding specific indications of prescribing urate-lowering drugs and choice of specific medicine.

Aim. To study the serum level of retinol-binding protein 4 (RBP4), visfatin, omentin-1 and vaspin in gout patients with different obesity phenotypes, as well as to assess the dynamics of studied parameters against the background of weight loss using an analog of glucagon-like peptide-1 (GLP-1) liraglutide.Material and methods. A total of 117 men with gout during the attack-free interval were examined. The patients were divided into 2 following groups: the 1st group consisted of 43 patients with a metabolically healthy obesity (MHO) and body mass index (BMI) ≥30 kg/m2; the second group consisted of 74 people with an metabolically unhealthy obesity (MUO) (carbohydrate metabolism disorders, hypertension (HTN) and BMI ≥30 kg/m2). The control group was represented by 38 respondents with a class 1 MHO. The blood concentrations of RBP4, omentin-1, visfatin, vaspin, serum uric acid, high-sensitivity C-reactive protein (hsCRP), HOMA-IR, anthropometric parameters were studied at the enrollment and 12 weeks later on the background of liraglutide therapy.Results. In gout patients with obesity, an increase in RBP4 and visfatin levels was revealed with a simultaneous decrease in omentin-1 and vaspin compared with patients in the control group and patients with gout with no metabolic disorders. The interrelationships of RBP4 and omentin-1 with the following metabolic syndrome components were established: BMI, increased triglycerides (TGs), increased total cholesterol, hsCRP, HOMA-IR and hyperinsulinemia, and reduced vaspin levels showed only a positive relationship with the HDL-C concentration (p

Diet has traditionally been viewed as playing a leading role in both the pathogenesis and treatment of gout. And although this thesis is controversial today, adherence to certain dietary rules for patients with gout and hyperuricemia (HU) is an integral part of therapy. The review examines the modern theoretical basis of dietary therapy for gout and HU, in particular the mechanisms of increasing serum uric acid levels and the risk of developing arthritis when certain foods are consumed and, conversely, reducing uric acid levels and the risk of gout when a diet containing a range of vitamins and foods in the supplements is followed.

The article presents a case of the lumbar spine involvement in a 37-year-old patient with gout who was observed for several years with a diagnosis of spondyloarthritis. Spinal involvement in the context of gout was confirmed by dual-energy computed tomography. This is a relatively new method for the diagnosis of microcrystalline arthritis, which makes it possible to detect urate deposits in the atypical course of the disease, especially when the axial skeleton is affected. We demonstrate the advantages of the modern gout treatment strategy of achieving and maintaining target uric acid levels by prescribing appropriate doses of xanthine oxidase inhibitors (febuxostat at a dose of 120 mg/day) while preventing arthritis flares (low-dose colchicine).

Gout is the most common chronic autoinflammatory disease, the development of which is associated with persistent hyperuricemia caused by both environmental and genetic factors, which leads to the deposition of sodium monourate crystals in various tissues and organs of the human body. Gout is more common in men than in women of childbearing age, due to the uricosuric effect of estrogen, however, after menopause, the incidence of gout in women increases significantly. At the onset of the disease, the first metatarsophalangeal joint, ankle and knee joints are most often involved in the pathological process. However, there are isolated reports in the literature about a rare gout lesion of the axial skeleton, for example, the sacroiliac joint, in which the nature of the pain syndrome, magnetic resonance imaging, and X-ray picture can mimic spondyloarthritis. The article presents a rare case of damage to the axial skeleton in a 57-year-old patient with gout, manifested by acute inflammatory back pain and arthritis of the lower extremities.

This review presents recent data on direct and indirect pathogenetic relationships between metabolism of purine compounds and biochemical processes in cells of the digestive system. A comprehensive analysis of available modern publications for the period from 2000 to 2022 in the Scopus, PubMed, eLIIBRARY, and Google Scholar databases was performed. The hypothesis linking the pathogenesis of hyperuricemia to “renal overload” suggests that the disease may develop due to impaired renal excretion with insufficient excretion of uric acid (UA) via the intestine. Some of the UA transport systems work actively in hepatocytes and enterocytes, which determines their formation and excretion. UA transporter proteins are divided into two categories: urate reabsorption transporters and urate excretion transporters; their expression is regulated by transcription factors, hormones, and metabolites of the intestinal microflora. The influence of intestinal microbiota on UA metabolism is associated with its involvement in purine metabolism, degradation and excretion of UA together with metabolites of intestinal flora, and suppression of gout inflammation, and is evaluated as a new therapeutic potential for gout and hyperuricemia to prevent renal damage and urolithiasis.

Objective: to analyze the association between medications intake and the development of type 2 diabetes mellitus (T2DM) in patients with gout. Material and methods. The study included 444 patients with gout without T2DM. The median follow-up time was 5.9 [2.9; 8.7] years. The primary end point was the diagnosis of T2DM. At baseline, therapy was initiated or adjusted according to current guidelines. Medication use was recorded: allopurinol, febuxostat, diuretics, glucocorticoids (GC), canakinumab, for which the odds ratio (OR) of developing T2DM was calculated. Results and discussion. T2DM occurred in 108 (24.3 %) patients enrolled in the study. 405 patients completed the study. 311 (76.7 %) patients were taking urate-lowering drugs: 263 (90.7 %) allopurinol, 48 (9.3 %) febuxostat. The mean dose of allopurinol was 153.4 ± 28.4 mg/day, and that of febuxostat was 91.6 ± 12.1 mg/day. During treatment with febuxostat, the probability of developing T2DM was lower: OR 0.433 (95 % confidence interval, CI 0.188–0.996; p = 0.044). When diuretics were used OR was 2.212 (95 % CI 1.303–3.753; p = 0.003), GC – 1.566 (95 % CI 1.003–2.445; p = 0.048). Conclusion. Febuxostat use is associated with a lower likelihood of developing T2DM.

Hyperuricemia (HU) is a condition caused by an increase in serum uric acid (UA) levels above 360 μmol/l. Often HU is asymptomatic, but under the influence of genetic and environmental factors, attacks of peripheral arthritis (gout) may occur. Remission of gout is achieved by normalization of UA serum levels, which can be determined by a colorimetric or electrochemical method, although the latter is not currently commonly used in clinical practice to control UA levels. Objective: to compare the standard colorimetric and electrochemical methods (Easy Touch GCU Meter) for monitoring UA levels. Material and methods. 30 gout patients were included in the study. This group included subjects with current/anamnestic asymptomatic HU andpatients with a confirmed diagnosis of gout (ACR/EULAR 2015 criteria). The examination included a general examination, history taking, and laboratory testing. The determination of UA level by the colorimetric method in venous blood serum was performed no later than 5 minutes after collection, and the determination of UA level in fresh whole capillary blood from the fingertip by the electrochemical method (Easy Touch GCU Meter) – immediately after collection. Results and discussion. The average values of UA blood level determined by the two compared methods differed by 13.9 μmol/l (3.9 % with respect to the colorimetric method). The high value of the correlation coefficient (r = 0.86) indicates a close linear relationship between the compared results and their good agreement. The method is also applicable in patients with achieved normouricemia. Conclusions. The method of electrochemical determination of UA level in subjects with HU and gout can be used in real clinical practice for self-monitoring.

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. 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 with 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. 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%), MI had a history in 29.7%. 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) (for all p

Treatment of such a serious systemic disease as gout is often carried out incorrectly, despite the presence of a large number of recommendations and drugs. The reluctance of some doctors to follow current recommendations for the management of patients with gout is one of the factors for poor adherence of patients to therapy. The review considers modern approaches to the treatment of gout, which provide for long-term strategies for lowering of serum uric acid level.

Gout is a chronic inflammatory arthropathy, caused by articular and periarticular sodium monourate (MUN) crystals deposition on the background of chronic hyperuricemia. Gout belongs to the group of autoinflammatory diseases characterized by activation of the innate immune system. In some cases, especially in women, with a long course of the disease and absence of adequate therapy, chronic arthritis is detected, which has little difference from that in rheumatoid arthritis (RA). At the same time, until recently, the combination of RA and gout was considered casuistry due to the inhibition of crystal formation by specific factors associated with RA, what is more mechanisms of inflammation development characteristic of these diseases are completely different. However, according to the latest data, the coexistence of these two diseases in one patient is possible, and the therapy of both, gout and RA (in some patients) can be successful when prescribing biological disease modifying antirheumatic drugs, in particular inhibitors of the interleukin 1 receptor (IL1r).The article presents a rare clinical case of chronic tophi gout in an elderly patient who was followed up for a long time with a diagnosis of RA, a significant improvement was achieved on therapy with the IL1r antagonist anakinra.

The importance of dual-energy computed tomography in the diagnosis of gout, the principles of dual-energy computed tomography, the accuracy of the methodology, and the types of artifacts are discussed in this study. The possible dependence of the presence of deposits of sodium monourate on other clinical data and the role of dual-energy computed tomography in the differential diagnosis of other crystalline arthropathies are considered. The dual-energy computed tomography has several advantages, including noninvasiveness, speed of execution, and a significant reduction in the risk of iatrogenic consequences compared with diagnostic arthrocentesis, which is the gold standard in diagnosing gout. Dual-energy computed tomography can accomplish gout detection, treatment, and differential diagnosis.

Most rheumatic diseases are characterized by sexual dimorphism both in prevalence and in the characteristics of the clinical course. Increased production of pro-inflammatory cytokines that accompanies inflammatory joint diseases may be accompanied by a decrease in the level of male sex hormones, and vice versa, the presence of hypogonadism in men increases the risk of developing certain rheumatic diseases. The review presents data on the relationship between testosterone deficiency and major inflammatory joint diseases, as well as the effect of testosterone replacement therapy on their manifestations.

Aim. To study the prevalence of hyperuricemia (HU) and gout depending on hypertension (HTN), as well as to evaluate their associations with mortality in the Russian population.Material and methods. The analysis included data obtained in two cross-sectional studies — ESSE-RF and ESSE-RF2. All study participants were surveyed using a modular designed questionnaire. Serum uric acid (UA) was determined using the uricase method. HU corresponded to a UA >420 µmol/l in men and >360 µmol/l in women. HU without gout was considered asymptomatic HU in the present study. Associations with endpoints were assessed using Cox proportional hazards models with associated hazard ratios.Results. The average prevalence of HU was 18,2%. HU, as expected, predominates among the male cohort — 22,6% vs 15,7%, respectively. The prevalence of asymptomatic HU was 4,4% higher among men compared to women. The prevalence of gout increased with age and averaged 2,6% in the entire population. A high content of UA was revealed in men in the absence of hypertension. The prevalence of HU in women with HTN was 3 times higher than in participants without hypertension. In the male cohort, in the group of hypertension without HU, all-cause and cardiovascular mortality significantly increases, and in the group with hypertension and HU, only all-cause mortality increases. In women, the cardiovascular death risk increased in HTN — hazard ratio 3,98 (95% confidence interval 1,86-8,52). At the same time, in women with HTN and HU, all-cause and cardiovascular death risk increased by 66% and 6,7 times, respectively.Conclusion. Every fifth study participant was diagnosed with HU. The prevalence of HU in hypertensive men was approximately 1,5 times higher than without hypertension. In women with HTN, HU was detected three times more often than without HTN, which may indicate a more pronounced relationship between HTN and HU in women. HU can worsen the HTN prognosis. Thus, monitoring and timely correction of UA levels in hypertensive patients become necessary to improve the prognosis.

Background. Despite advances in the field of synthetic pharmaceuticals, interest in the use of natural raw materials from representatives of the flora persists throughout the world. Currently, herbal medicine is successfully used in the treatment of both hyperuricemia (HU) and gout. Aim. To evaluate the effectiveness and safety of the herbal preparation Soveren in the prevention and treatment of HU. Materials and methods. The study included 80 patients who were divided into 2 groups: group 1 consisted of patients diagnosed with arthritis with HU (n=40), group 2 patients with gout (n=40). The natural complex of natural origin Soveren was prescribed according to the standard scheme against the background of dietary recommendations. Patients with gout also received urate-lowering therapy. Clinical efficacy and safety of treatment were assessed after 6 and 12 weeks according to the dynamics of laboratory parameters of blood and urine, the EuroQol-5D quality of life questionnaire, assessment of the health status of patients, assessment of patient satisfaction with treatment. Results. The use of the plant complex Soveren in patients with HU does not have a negative effect on the functional state of the liver and kidneys. The drug has a significant positive effect on blood levels, reducing uric acid by 1.5 times, creatinine by 1.11 times, and urea by 1.3 times. In group 2, the addition of the Soveren complex made it possible to achieve the target value of uric acid. In addition, in patients of both groups, within 3 months, the level of total protein in the urine decreased by 3 times, a decrease in the degree of leukocyturia was noted. Against the background of taking the drug in both groups, the relative density of urine increases within the normal range, and a slight acidification of urine was revealed, as well as an increase in urinary excretion of ketones. Most patients positively assessed the result of treatment. Conclusion. Our data confirm the good therapeutic effect and safety of the herbal complex Soveren in patients with HU. With the introduction of the Soveren drug into practice, doctors will have a new effective tool for monitoring the course of HU.

Along with familial Mediterranean fever (FMF), it is now considered an autoinflammatory disease and gout. The commonality of the basic mechanisms of inflammation underlying the pathogenesis of FMF and gout predetermines the possibility of using similar therapies aimed at stopping and preventing seizures (colchicine and IL-1 inhibitors). A clinical case is presented describing the presence of a combination of FMF and gout in a patient. The patient was prescribed anakinra, which proved to be effective both as a treatment for FMF and gout. The appointment of an IL-1 inhibitor fully justified expectations: already after the first injection of anakinra, the intensity of swelling and pain in the joints decreased in the patient.

Endogenous hypercortisolism is a severe endocrine disease characterized by prolonged exposure to excessive amounts of glucocorticoid hormones, accompanied by a wide range of symptoms and complications, including immunosuppression. Timely surgical treatment in most cases allows to save the patient’s life, significantly improve its quality. However, restoration of the normal concentration of glucocorticoid hormones can become a trigger factor in the development or exacerbation of autoimmune and auto-inflammatory diseases. We present a clinical case of atypical gout in a patient with hypercortisolism and a progressive increase in symptoms of the disease after successful surgical treatment for Cushing’s disease and achieving stable remission. The issues of diagnosis and treatment of this group of autoinflammatory diseases are highlighted, the leading clinical and radiological symptoms are considered, the differential diagnosis of microcrystalline (metabolic) arthritis is presented. Despite the widespread, the diagnosis and treatment of this group of diseases still cause difficulties for specialists. A competent choice of drug therapy allows to fully control diseases considered in the article, including when they are combined, and thereby improve the quality of life of the patient.

BACKGROUND: Patients with gout often take glucocorticoids (GCs) and are at high risk of developing type 2 diabetes mellitus (DM2).AIM: Evaluation of the effect of long-term use of low doses of GCs on the risk of developing DM in patients with gout based on the results of a retrospective observationMATERIALS AND METHODS: 317 out of 444 patients with gout and no DM2 who participated in a prospective study of risk factors for DM2 were included. The sample did not include patients who used GCs during the observation period to relieve an acute attack of arthritis, regardless of the method of their use (n=88) and who did not complete the study (n=39). The remaining patients were retrospectively divided into 2 groups: those who continuously took prednisolone at a dose of 5-10 mg/day for ≥180 days and did not use GCs during the observation period. Scheduled visits were carried out at least once every 2 years. During the 1st visit, patients were prescribed or corrected both urate-lowering and prophylactic antiinflammatory therapy, including low doses of GCs. The primary end point was the development of DM2, carbohydrate metabolism indicators (HbA1c levels, serum glucose levels) were compared at baseline and at the end of the study.RESULTS: Of 317 patients with gout, 76 patients (24%) were continuously taking prednisolone at a dose of 5-10 mg/day for ≥180 days, 241 patients (76%) did not receive GCs during the entire follow-up period. The average dose of prednisolone in patients of the main group was 7.9±1.2 mg/day, the duration of treatment was 206.3±20.4 days.DM2 developed during the observation period in 20% of the main group and in 22% of the comparison group (p=0.73). Patients who took GC were older than those who did not take GC (p=0.01), they were more likely to have CHF (p=0.04). There were no significant differences between the groups for the rest of the compared parameters. In patients treated with low doses of GC — a significant increase in the average level of HbA1c (p=0.002); an increase in the number of patients with glucose levels ≥6.1 mmol/l (p=0.004) by the end of the study relative to the baseline. The initial level of HbA1c in patients who developed DM2 was expectedly higher, among them smokers were more often detected (p=0.01), they had a higher level of serum UA (p=0.001). The prevalence of other risk factors for DM in those who developed and did not develop DM2 did not differ significantly.CONCLUSION: Long-term use of low doses of GC in patients with gout does not significantly increase the risk of developing DM2, but may have a negative effect on carbohydrate metabolism.

Psoriasis is a chronic dermatosis of a multifactorial nature with a dominant role in the development of genetic factors, characterized by hyperproliferation of epidermal cells, impaired keratinization, and inflammation in the dermis. Currently, its prevalence in the population is from 0.1 to 7%, and among people hospitalized in dermatological hospitals – from 25 to 40%. In the scientific literature, the issue of considering psoriasis as a systemic disease is widely discussed, which includes damage not only to the skin, but also to other organs and systems. Thus, the indicated problems of combined pathology are relevant, require further in-depth study and search for evidence-based solutions that will improve the quality of medical care for patients with both psoriasis alone and its combined course.

Introduction and Purpose: Human health is influenced by a variety of factors, such as genetics, environment, lifestyle, and accessibility to healthcare. While some of these factors are beyond the control of the patient, lifestyle, which is considered the primary determinant of a healthy life, strongly relies on individual choices. In this paper, we aim to demonstrate the benefits of adopting a vegetarian diet as a cornerstone for maintaining good health and as a supplementary approach to treating common diseases.State of Knowledge: The vegetarian diet is primarily based on plants and includes products from animals, such as eggs and dairy. However, it excludes all types of meat and any products that require the death of animals. This diet is adopted for various reasons, including religious, socio-economic, or ethical considerations. It is recognized globally and has become a subject of scientific research for numerous scholars. Many studies investigate its influence on human health, and the results are generally positive. The diet is frequently used as a treatment, often in combination with specific pharmaceutical drugs. This approach leads to weight reduction, decreases the risk of cardiovascular diseases, and can have positive therapeutic effects on conditions like gout or chronic kidney disease. Given that some of these diseases have become increasingly problematic for public health systems, a vegetarian diet can help decrease the number of people affected by them.Conclusion: Given that cardiovascular diseases and incidents are the leading causes of death worldwide, adopting a vegetarian diet can assist patients in avoiding them by reducing their LDL levels and decreasing blood pressure. This diet demonstrates a positive therapeutic effect on patients dealing with chronic kidney disease and gout. It aids in weight reduction and helps prevent the development of metabolic syndrome, which has a variety of beneficial effects.

The main target of the novel coronavirus infection (COVID-19), spread by the SARS-CoV-2 virus, is the respiratory system. However, as data on COVID-19 accumulates, it is becoming increasingly clear that there is a complex interaction between the virus and the immune system, ranging from mild and controlled responses to severe and dysfunctional multitissue targeted autoimmune responses. A literature search was conducted on the association of major rheumatic diseases with the new coronavirus infection COVID-19 in the electronic search engines PubMed, Scopus, eLIBRARY. The literature sources found indicate that the new coronavirus infection COVID-19 certainly has a specific effect on the musculoskeletal system in general, and in particular on individual rheumatic diseases. In a number of studies, the theoretical prerequisites for an association between major rheumatic diseases and COVID-19 have received clinical confirmation.

Hyperuricemia is most often combined with lipid metabolism disorders, modifiable risk factors for coronary heart disease, stroke, abdominal obesity, type 2 diabetes mellitus, arterial hypertension, urolithiasis, chronic kidney disease. Current data indicate the presence of pro-inflammatory, pro-oxidant and vasoconstrictive effects of uric acid, which may contribute to the development of cardiometabolic disorders. Normal serum uric acid levels are 360 mmol / l) and high cardiovascular risk. The data available today allow us to consider the target serum uric acid level

Gout (podagra) is one of the most ancient articular diseases. Its accurate mechanisms and causes were delineated only during the last century. Major historical investigatory steps are described in relation to causality and pathogenesis of the disease from Hippocrates ages till the modern time. The newest genetic and epidemiologic aspects of the disease are presented in this article.

The article presents current data on the effect of drugs for the treatment of gout on the composition and function of the intestinal microbiota. The potential possibilities of pre- and probiotics use for the prevention and complex therapy of gout are discussed, therapeutic effect may be associated with their impact on the uric acid synthesis and intestinal excretion, as well as with anti-inflammatory properties. The need for further research in this area is emphasized.

Uric acid is an independent risk factor for socially important diseases, such as chronic heart failure and chronic kidney disease. The review summarizes current data on the impact of nutrition as a presumably modifiable factor into the development of hyperuricemia and gout. The authors describe biochemical mechanisms underlying hyperuricemia and present data on the influence of excessive intake of fructose, purines, and various alcohol-containing drinks on the risk of gout. Favorable impact of vitamin C supplements, coffee, cherry juice, some chemical elements (magnesium, zinc, and copper) on uric acid levels has been shown, as well as the impact of intake of low fat dairy products, polyphenols, food fibers, and omega-3 polyunsaturated fatty acids on the incidence of hyperuricemia. The information presented in the review can be used in clinical practice for preparation of an individualized nutritional plan aimed at normalization of uric acid levels. This would minimize the use of agents affecting the synthesis of uric acid and slow down the progression of chronic heart failure and chronic kidney disease.

The gut microbiota plays a key role in metabolism and immune regulation, and imbalance in microbial composition can contribute to various diseases. We present up-to-date data on the role of the gut microbiota in the occurrence of chronic hyperuricemia (HU) and gout, which is associated with the influence of the microbiota on the synthesis of purine-metabolizing enzymes and pro-inflammatory cytokines. It has been shown that the gut microbiota plays an important role in the pathophysiology of gout and can serve as a new target for therapy. Currently, the microbial index of gout is considered as a potential method for early diagnosis of the disease, possibly already at the preclinical stage. The gut microbiota can be a starting point in the study of the pathogenesis of HU and gout. This makes it necessary to assess the pathogenetic relationship between individual specific microorganisms, the microbiota as a whole, and the development of uric acid (UA) metabolism disorders that contribute to the onset of HU and its transformation into gout. It is assumed that this approach will provide a more complete understanding of the gut microbiota participation in the synthesis of UA and its extrarenal excretion, as well as of bacteria and bacterial enzymes that can be used as a probiotic coadjuvant for the treatment and prevention of gout.

Recently, hyperuricemia and its association with cardiovascular disease have been receiving more and more attention. The article talks about the role of uric acid in the body, the reasons for its increase and the impact of elevated uric acid levels on the cardiovascular system. The mechanisms of influence of hyperuricemia on the development and progression of cardiovascular diseases are presented. Medicinal and non-drug ways to reduce the level of uric acid in the blood are considered. From non-drug methods, attention is focused on the hypopurine diet, adequate drinking regimen and normalization of body weight. Separately, the effect on the level of uric acid of various drugs used in clinical practice is considered. In the light of current clinical guidelines, the issue of the need to prescribe drug therapy for asymptomatic hyperuricemia is discussed.

The prognosis for gout is largely determined by its timely diagnosis and the choice of drugs for effective urate-lowering therapy which considers the peculiarity of a particular patient’s disease course: the signs of complications, comorbid pathology, and drug tolerability. The report presents a clinical case of gout, which a 30-year-old man with acute arthritis of the right big toe experienced for the first time. The diagnosis of gout was verified by a rheumatologist only 6 years after the first attack. In addition to gout, the patient was also diagnosed with urolithiasis, obesity, hypertension, prediabetes and dyslipoproteinemia. Initially, allopurinol was prescribed, which at a dose of 300 mg/day ensured the achievement of the target level of uric acid. However, the patient stopped taking the drug and eased the frequent gouty attacks by taking nonsteroidal anti-inflammatory drugs. He turned to the rheumatologist again 2 years later. The level of uric acid in the blood was 744 umol/l, the glomerular filtration rate (GFR) was 55 ml/min. The resumption of allopurinol intake was accompanied by the development of dermatitis. Therefore, instead of allopurinol, febuxostat was prescribed, which at a dose of 120 mg/day ensured the achievement of a normal level of uric acid. At this dose, the patient has been taking the drug for the last 2.5 years. The drug tolerability is good. An improvement in kidney function (GFR – 89 ml/min) and normalization of carbohydrate metabolism were recorded associated with medication intake. Thus, febuxostat for gout is an effective drug for urate-lowering therapy. prescription is especially recommended in case of intolerance to allopurinol and kidney damage.

Colchicine is an alkaloid isolated from plants of the Colchicum genus. Colchicine has been used for thousands of years and remains one of the few drugs whose use remains relevant today. The therapeutic use of colchicine is widely known for gout, familial Mediterranean fever, Behcet’s disease, cardiovascular diseases (pericarditis, coronary heart disease, pericarditis, after coronary artery bypass grafting, etc.) and other diseases and is due to anti-inflammatory effects, which are based, including , inhibition of NLRP3 inflammasome and interleukin (IL)-1β production. The mechanisms of anti-inflammatory action of colchicine are diverse. It is primarily an inhibitor of mitosis and microtubule assembly. Colchicine destroys the structure of microtubules and reduces the elasticity and relaxation of neutrophils, thereby preventing the extravasation of neutrophils from blood vessels to the site of inflammation. Systemic inflammation is also a hallmark of coronavirus disease (COVID-19), which develops immunological disorders accompanied by the production of a large number of pro-inflammatory cytokines, including interleukin-1. Coronavirus disease 2019 (COVID-19), which has become the most urgent medical problem in the world in the last 2 years, given the mechanisms of inflammation similar to rheumatic diseases, is also considered a disease with the potential effectiveness of colchicine treatment. SARS-CoV-2 vaccines also have a trigger factor for the development of an exacerbation of arthritis. On average, colchicine use was associated with a 47% reduction in post-vaccination arthritis. This article provides an update on the mechanisms of action and current experience with colchicine in COVID-19, including in patients with microcrystalline arthritis.

It is assumed that the risk of developing type 2 diabetes mellitus (T2DM) in patients with gout is influenced by both generally accepted risk factors and factors related to gout.Objective. To evaluate the impact of various risk factors for T2DM in patients with gout.Material and methods. 444 patients (49 women, 395 men) ≥18 years old with gout and without DM were included. Duration of observation was 5.66 [2.69; 7.64] g. To identify factors associated with the risk of developing T2DM, multivariate logistic regression was used, which included: sex; T2DM in relatives; insufficient physical activity; unbalanced diet; age ≥45 years; ≥4 attacks per year; presence of tophi; BMI≥30 kg/m2 ; allopurinol, febuxostat, glucocorticoids, diuretics, metformin, colchicine; GFR˂ 60 ml/min/1.73 m2 ; serum uric acid level (sUA) ≥420 μmol/l and ≥480 μmol/l.Results. T2DM developed in 108 (24.3%) patients. According to the multivariate model, the presence of ≥4 attacks of arthritis per year increased the risk of T2DM (OR=5.23; 95% CI: 2.98–9.19; p=0.0001); presence of tophi (OR=2.61; 95% CI: 1.50–4.54; p=0.001); sUA≥480 μmol/l (OR=2.26; 95% CI: 1.02–5.00; p=0.144), diuretics (OR=2.35; 95% CI: 1.19–4.64; p=0.014). Febuxostat (OR=0.31; 95% CI: 0.11–0.84; p=0.022) and metformin (OR=0.49; 95% CI: 0.21–1.16; p=0.107) reduced the risk of developing T2DM.Conclusion. Risk of T2DM in patients with gout is associated with high incidence of arthritis attacks, MK≥480 μmol/l, hypertension, diuretic use, and febuxostat and metformin reduces risk.

The results of gout therapy in many patients remain unsatisfactory, despite the availability of drugs and recommendations for its treatment. In addition to poor adherence to treatment by patients, medical errors and other reasons influence this situation. The article considers several clinical cases demonstrating the possibilities of a rational choice of urate-lowering therapy.

Objective: to evaluate the efficacy and safety of febuxostat (Azuriks®) in the treatment of patients with gout and concomitant diseases.Patients and methods. An observational, open-label, single-centre study of the results of febuxostat use in 85 gout patients with insufficient prior allopurinol efficacy or its intolerance. The median age of patients was 56.2 [49; 59] years, among them 83.5% were men. All patients had comorbid diseases, mainly cardiovascular pathology (76.5%) and chronic kidney disease (60%). The achievement of target values of uric acid (UA) during 4 months of urate-lowering therapy and its safety were assessed.Results and discussion. After 4 months of therapy with febuxostat, 25% of patients reached the target values of UA. Exacerbations at an early stage of the use of urate-lowering therapy were rare and were characterized by a lesser severity of the articular syndrome. Normalization of purine metabolism was accompanied by a decrease in the laboratory activity index (CRP level) to values corresponding to the interictal period of gout. Febuxostat was well tolerated.Conclusion. According to the data obtained, in patients with gout and concomitant diseases, febuxostat allows reaching target UA values in a short time without dose titration, while a high safety profile is noted.

The article provides an overview of new and promising drugs aimed at anti-inflammatory and urate-lowering therapy of gout, both already registered and used in clinical practice, and at the stages of implementation or clinical research and demonstrating their high efficacy and safety. Modern views and approaches to the treatment of gout, reflected in foreign and domestic clinical recommendations, are shown. Emphasis is placed on the safety and efficacy of colchicine in gouty arthritis and its cardioprotective properties in comorbid patients suffering from gout in combination with cardiovascular pathology. Information is provided on the effectiveness of new anti-inflammatory drugs for symptomatic therapy of gout: kanakinumab, according to the experience of which our country occupies a leading position in Europe. The efficacy and safety of anakinra allows us to consider the drug as an effective alternative to the traditional approach to antiinflammatory therapy of gout. Rilonacept provides doctors with more potential treatment algorithms in a population of patients with gout that is difficult to treat with traditional treatment. The historical data on the use of adrenocorticotropic hormone as an anti-inflammatory agent in gout are given. Information on reserve, new and promising urate-lowering drugs is provided. The focus is on the safety and efficacy of febuxostat, based on the results of recent large randomized clinical trials. Other drugs that reduce the level of uric acid in the blood plasma are considered: uricosuric agents (probenecid, benzbromarone, sulfinpyrazone, lezinurad, verinurad, dotinurad and archalophenate), xanthine oxidase inhibitors (allopurinol and topiroxostat), pegylated uricase preparations (pegloticase and rasburicase), which can be considered in the future as reserve drugs with the possibility of combined applications with the main means for urate-lowering therapy.

The development of type 2 diabetes mellitus (DM) (DM2) in patients with gout can be influenced by both conventional and directly linked to gout risk factors (RFs).Objective: to identify RFs for the development of DM2 in patients with gout, including those directly associated with gout, based on long-term prospective follow-up data.Patients and methods. The study included 444 patients with gout older than 18 years (49 women, 395 men) who did not have DM. The followup period ranged from 2 to 8 years. The studied RFs for DM2 were: gender, age, family history of DM2, obesity, alcohol consumption >20 units per week, insufficient physical activity, unbalanced nutrition, history of hyperglycemia, coronary heart disease (CHD), arterial hypertension (AH), chronic heart failure, antihypertensive drugs, diuretics, glucocorticoids (GCs), urate-lowering therapy, serum levels of cholesterol, triglycerides, CRP, uric acid (UA), glucose, creatinine, glomerular filtration rate 4 attacks of gout per year, ≥5 affected joints during the disease.Results and discussion. DM2 developed in 108 (24.3%) patients. These patients were older, had a family history of DM, more often received antihypertensive therapy, diuretics, and glucocorticoids (49.1; 73.1; 27.8 and 47.2%, respectively) than patients who did not develop DM2 (25.6; 50.5; 14.8 and 36.4%, respectively; p4 attacks per year). UA levels >480 and 600 μmol/l were also significantly more frequent (p=0.0002) in patients with DM2 (71.3 and 34.3%, respectively).According to logistic regression data, factors that increase the risk of developing DM2 were: family history of DM, a history of hyperglycemia, CHD, AH, intake of GCs, antihypertensive drugs, the presence of tophi, >4 exacerbations of gout per year. Febuxostat use and UA

BACKGROUND: Gout is associated with a high incidence of type 2 diabetes mellitus (T2DM).AIM: To calculate the risk of T2DM on the FINDRISС scale, to assess the sensitivity and specificity of the scale in patients with gout based on the results of prospective follow-up.MATERIALS AND METHODS: A prospective single-center study included 444 patients with gout over 18 years of age (49 women, 395 men) without diabetes. The duration of follow-up ranged from 2 to 8 years. Initially, the risk of developing diabetes mellitus 2 was calculated according to the Russian version of the FINDRISС scale. The risk of developing T2DM was assessed as «low» with a total score (CC) 25 kg / m2 — 85.6% of patients, taking antihypertensive drugs — 81.3% of patients, age over 45 years in 70.5% of patients. The sensitivity and specificity of the FINDRISС scale were 52.8% and 66.3%, respectively. According to these data, the quality of the model was assessed as moderate. 9% vs 31.1% (p = 0.014)), serum MK level ≤300 μmol / L. Developed type 2 diabetes 33.3% of patients with moderate / high / very high risk 18.1% of patients with low or slightly increased risk (p = 0.0002).CONCLUSION: The FINDRISС scale can have sufficient sensitivity (52.8%) and specificity (66.3%) and can be used to calculate the risk of T2DM in patients with gout.

The association of hyperuricemia (HU) with cardiovascular disease (CVD), diabetes, metabolic syndrome, and kidney disease has been demonstrated in numerous studies. НU is the main pathogenetic factor in the development of gout and is associated with an increase in overall and cardiovascular mortality. НU is included in the list of factors determining cardiovascular risk. According to epidemiological studies, there is a high prevalence of HU in the world and its increase in recent decades. A number of factors have been identified that contribute to the increased risk of НU. Non-modifiable factors include gender, age, genetic factors, and modifiable factors include diet and lifestyle. Nutritional unbalances, increased life expectancy, increased prevalence of obesity, and increased use of drugs (especially diuretics) are seen as contributing factors to the rise in НU. The review was carried out to summarize the available information on the effect of dietary habits, individual foods and nutrients on serum uric acid (SUA) levels and the risk of developing HU. The review presents the results of scientific studies demonstrating the relationship of НU with the consumption of foods rich in purines (offal, red meat, fish, seafood, legumes), alcohol consumption, drinks sweetened with fructose, coffee, dairy products, vegetables and fruits. Diet correction is an important and necessary step in the prevention and treatment of НU. The article reviews the basic principles of dietary management in HU and provides dietary recommendations for patients. For effective prevention and treatment of НU, a mandatory correction of the diet is required.

Introduction The most common pаthologicаl condition аssociаted with gout is hypertension (HT). The mаin orgаn responsible for this process is the kidneys. The development of chronic tubulointerstitiаl nephritis in the course of gout leаds to ischemiа of the renаl pаrenchymа, аctivаtion of the renin-аngiotensin-аldosterone system (RааS), sodium аnd wаter retention in the body, which leаds to the development of hypertension. The kidneys, on the other hаnd, аre responsible for the metаbolism аnd excretion of uric аcid from the body, so their dаmаge аccordingly leаds to the deteriorаtion of this process. In pаtients with gout, the level of uric аcid determines the severity of gouty аrthritis, dаmаge to blood vessels аnd joints. Therefore, it is extremely importаnt to know the specifics of uric аcid metаbolism in pаtients with gout, since the effectiveness of the prescribed hypouricemic therаpy depends on it. Aim of the study The аim of the study wаs to аnаlyze the metаbolism of uric аcid in pаtients with gout аnd concomitаnt аrteriаl hypertension, аnd to determine the impаct of concomitаnt metаbolic disorders on the excretory function of the kidneys. Conclusion The results of the conducted reseаrch prove thаt: 1. Pаtients with gout with concomitаnt hypertension hаve more pronounced metаbolic disorders thаn pаtients with gout without hypertension. This is mаnifested by impаired cаrbohydrаte tolerаnce, аn increаse in totаl cholesterol, triglycerides аnd а decreаse in HDL levels. 2. Pаtients with gout аnd hypertension hаve deeper renаl dysfunction, which is mаnifested by а tendency to decreаse GFR аnd increаse creаtinine levels compаred to pаtients with gout without hypertensive syndrome. 3. Violаtion of uric аcid metаbolism in pаtients with gout аnd аrteriаl hypertension is mаnifested by аn increаse in the reаbsorption process аnd а decreаse in the filtrаtion process of uric аcid, which results in higher rаtes of uricemiа.

Achieving the target serum uric acid (UA) level is a priority in the treatment of gout.Objective: to study the relationship of the ABCG2 gene polymorphism (rs2231142) with the efficacy of allopurinol and febuxostat in patients with gout.Patients and methods. The study included 82 patients with gout over 18 years of age with serum UA level >360 μmol/L who did not take uratelowering therapy.All patients were prescribed allopurinol 100 mg daily, followed by its titration until the target UA level was reached (A polymorphism (rs2231142) of the ABCG2 gene. We compared the probability of achieving the target UA level, the mean values of a decrease in the serum UA level, and the mean doses of urate-lowering drugs in patients with different genotypes (CC, CA, AA) of the ABCG2 gene.Results and discussion. The target UA level in 45 (55%) of 82 patients was defined as A polymorphism of the ABCG2 gene, but the presence of CA and AA genotypes is identified with a higher dose of the drug. The C>A (rs2231142) polymorphism of the ABCG2 gene does not affect the ability to achieve the goal of therapy when using febuxostat in patients with allopurinol ineffectiveness.

Fatty acids (FA) are present in all types of organisms and play an important role in energy metabolism. The length and number of double bonds in the FA of membrane phospholipids determine the viscosity, the activity of transport systems and enzymes, and also the susceptibility to lipid peroxidation. The review discusses the influence of free unsaturated FAs with short and long chains on various inflammatory mechanisms, including atherosclerosis. It has been shown that FAs can reduce endothelial activation and affect the metabolism of eicosanoids. A new model of fundamental factors determining the variability of the timing, degree and duration of acute inflammatory reactions in the deposition of urate crystals in tissues, in which FAs play an important role is considered, using gout as an example. In the future, the study of FAs will expand the understanding of the pathophysiology of chronic inflammation in various diseases, metabolic disorders and atherosclerosis and enable the development of new treatment strategies.

For a long time, there has been scientific debate about the appropriateness of prescribing drugs to lower the level of uric acid in patients without clinical manifestations of gout. Long-term hyperuricemia is known to be the cause of gout and gouty arthritis. However, an increased level of uric acid is often found in a number of other diseases (metabolic syndrome, kidney disease, cardiovascular disease, psoriasis). Clinical evidence suggests that uric acid-lowering therapy slows the progression of cardiovascular disease and chronic kidney disease. And, if in rheumatological practice this issue still remains a subject of discussion, then the cardiological community by 2019 has clearly defined the indications for starting urate-lowering therapy. The Consensus on the Management of Patients with Hyperuricemia and High Cardiovascular Risk strongly recommends that the practitioner prescribe drugs to control hyperuricemia in hypertensive patients. The need to control the level of uric acid is reflected in the relevant sections of the Clinical Guidelines for the Management of Patients with Arterial Hypertension, 2020. This article provides a review of the literature on the etiology, pathophysiology, pharmacotherapy of hyperuricemia in patients with cardiovascular and rheumatic diseases. A separate section is devoted to scientific studies of the effects of colchicine in advanced therapy for CVD and RD. A clinical case of observation of a patient with newly diagnosed psoriatic arthritis, hyperuricemia, high cardiovascular risk is presented. The peculiarity of this clinical case is the onset of the disease after orthopedic surgery on the knee joints, high comorbidity and poor tolerance of standard basic therapy. The use of colchicine stabilized the patient’s condition. Thus, in clinical practice, it is necessary to take into account the role of hyperuricemia in the pathogenesis of inflammation in cardiovascular pathology. Colchicine may be the drug of choice for patients with hyperuricemia at high cardiovascular risk.

Introduction. To date, there is no consensus regarding the gender characteristics of the course of gout. There is little data on the possible difference between men and women in response to uric acid-lowering therapy.Aim. To compare the clinical characteristics of the course of gout and evaluate the differences in response to urate-lowering therapy (ULT) with allopurinol and febuxostat in men and women.Material and methods. The retrospective cohort study included 279 men and 83 women diagnosed with gout (ACR/EULAR, 2015). The comparative analysis of the clinical characteristics of gout, as well as responses to the intake of xanthioxidase (XO) inhibitors in representatives of different sexes, was carried out. We compared the gender characteristics of obtaining a positive response to ULT, defined as achieving a target serum uric acid (sUA) level of < 360 μmol / l within 6 months of treatment, while taking allopurinol and febuxostat.Results. By the age at which the onset of gout took place, women were older than men, the duration of the disease in them was shorter. Men showed a shorter duration of the first attack of arthritis. Chronic arthritis was diagnosed in 56% of men and 35% of women (p < 0.05). The process involved the joints of both the lower and upper extremities. However, more often the joints of the lower extremities were affected in men, and in the upper extremities in women. Tophus were detected in 35% of patients, of whom 30.3% were men, 4.7% were women (p < 0.05). Allopurinol was prescribed to 216 men and 54 women, and febuxostat was prescribed to 63 men and 29 women. After six months, the proportion of women who achieved the target sUA was 57.5% and 65.8%, the proportion of men – 60.4% and 76.2% for allopurinol and febuxostat, respectively.Conclusion. The clinical manifestations of gout in men and women differ. Due to the pronounced increase in the level of uric acid, men develop more severe joint damage due to the tendency to chronicity. However, the study did not reveal gender differences in the response to XO inhibitors, which indicates that there is no need to choose therapy depending on the patient’s gender.

The main direction of drug therapy for gout and other diseases associated with hyperuricemia is the long-term use of drugs aimed at correcting the level of uric acid. However, in addition to the urate-lowering effect, these drugs may have other beneficial pleiotropic effects. The article will discuss the additional effects of xanthine oxidase inhibitors, as well as drugs used to treat gout-related diseases that have urate-lowering effects.

Gout and diabetes mellitus are metabolic diseases, the pathogenesis of which is based on an excess of organic molecules in the body, in the first case — uric acid (UA), in the second — glucose. It is assumed that UA can also be involved in the pathogenesis of type 2 diabetes mellitus (T2DM), while insulin resistance and hyperglycemia affect purine metabolism. Both diseases are associated with an increased risk of cardiovascular events. In addition, chronic microcrystalline inflammation, which is absent in asymptomatic hyperuricemia, but is an obligatory component of gout, is probably an independent factor in T2DM, arterial hypertension, and cardiovascular events. The treatment of both diseases is strategically similar: in gout, the goal is to achieve a normal blood MC level, in T2DM — to normalize glycemia, and the frequent combination of these metabolic diseases requires taking into account the effect of drug therapy on concomitant diseases. Most modern antihyperglycemic drugs can affect purine metabolism, which is confirmed by the results of a number of foreign works. At the same time, the effect of T2DM therapy on purine metabolism and gout has not been adequately covered in the domestic literature, which was the purpose of this review.