BackgroundGout is a poorly controlled disease despite the availability of effective treatment methods. One of the main reasons for its poor controll is patients’ low adherence to treatment, including due to insufficient knowledge of treatment principles.ObjectivesTo assess adherence to therapy and results of treatment in gout patients who attended schools for patients and in those who did not.MethodsAll patients with crystal-verified gout were interviewed and invited to attend School for gout pts. Totally 301 pts with gout were observed, 36 (10%) females and 264 (90%) males, mean age 54.5±12,7 y., mean disease duration 9.02±1,12 y., with the gout diagnosis verified at average 48.71[12;60 months after the onset, the target UA level <360 µmol/l initially was in 72 pts (24%).All patients were divided into 3 groups: Group 1 included 111 (36%) patients who refused to attend the school, Group 2 included 90 (30%) patients who consented but failed to come, Group 3 consisted of 100 (34%) patients who attended the School (- 100 (34%)).The data from the questionnaires were used for baseline and on-treatment assessments of the following: patient‘s attitude to the disease, patient’s compliance to treatment, satisfaction with quality of life, the fact of taking urate-lowering therapy, UA level control, achievement of the UA level of <360 µmol/l.ResultsIn all 3 groups, after the visit to the doctor, the number of the patients taking urate-lowering therapy who reached the target level of uric acid, significantly increased, the maximum values were noted in the group who attended the School for gout pts. The UA target level achievement results in Group 2, of those who agreed to attend the School but never did for various reasons, were better than in Group 1 and comparable to that in Group 3. Table 1 presents the results of questionnaire survey at baseline and after one year.Better adherence to treatment was noted in patients with poorer quality of life and a rational attitude toward their disease. The patients who report satisfaction with quality of life often decided to refuse to take their medications, visited the doctor less often and more seldom achieved the UA target level.Abstract FRI0226 – Table 1Parameters at baseline and after one yearparametersGroup 1 (patients who refused to attend the school), n=111Group 2 (patients who consented but failed to come), n=90Group 3 (patients who attended the school), n=100 baselineafter 1 yearbaselineafter 1 yearbaselineafter 1 year Did not take urate lowering therapy, n (%)86 (79%)38 * (35%)55 (62%)12 (12%)56 (56%)8 (8%)Monitored the level of UA, n (%)62 (56%)76 * (69%)68 (75%)72 (80%)62 (62%)90 (92%)Achieved the target UA level<360 µmol/l, n (%)8 (33%)56* (51%)14 (15%)62 (69%)13 (13%)87 (87%)Satisfied with the quality of life, n (%)84 (67%)85 (77%)42 (47%)75 (83%)62 (62%)95 (95%)Not satisfied with the quality of life, n (%)26 (33%)5 (5%)48 (53%)3 (4%)38 (38%)3 (3%)»*<0,05 between the baseline and one-yearConclusionsPatients’ attendance of the School for gout pts increases their adherence...

The 2018 national guidelines for the management of gout provide a consistent scheme for urate-lowering drugs; however, the possibility of achieving uric acid (UA) targets in its use has not been studied.Objective: to evaluate the effectiveness and safety of the urate-lowering therapy algorithm presented in the national guidelines for the management of gout.Patients and methods. This investigation was a prospective single-center study. It has been currently included 54 patients (91% males) with gout. The follow-up period is not less than 12 weeks of continuous use of allopurinol or febuxostat (Azurix) at the final dose.After the initiation of urate-lowering therapy, allopurinol 100 mg/day was prescribed, followed by dose titration to achieve the UA target that was defined as <360 or <300 μmol/L in patients with severe tophaceous gout. The maximum dose was 900 mg/day; it was 300 mg/day when the glomerular filtration rate was <60 ml/min/1.73 m2 . Patients with the inefficacy of allopurinol and/or the presence of its associated adverse reactions (ARs) were prescribed febuxostat 80 mg/day; the dose was increased to 120 mg/day as needed.For the prevention of acute arthritis attacks, all the patients received a nonsteroidal anti-inflammatory drug (NSAID) at the minimum therapeutic doses or colchicine 0.5 mg/day, and if these drugs were contraindicated, a glucocorticoid (GC) 7.5 mg/day, as calculated with reference to prednisone, was taken.The probability of achieving the serum UA target (<360 or 300 μmol/L) was assessed in patients with chronic tophaceous gout.Results and discussion. 12 weeks after therapy initiation, the UA target could be achieved in 39/50 (79%) patients. The target levels <360 and 360 μmol/L were recorded in 15/21 (71%) and 24/33 (73%), respectively. The UA level <360 μmol/L was noted to decrease in a total of 92% of cases. Febuxostat was given to 41 patients: to 27 (66%) due to the inefficacy of allopurinol and to 14 (34%) due to its ARs. As a result, the UA target was achieved in 30 (73%) patients, and there was a decrease in the UA level <360 μmol/L in 35 (85%).ARs were seen only in 3 febuxostat-treated patients, including 2 patients with previous allopurinol-induced ARs.For the prevention of arthritis attacks, 10 (19%) patients took NSAIDs, 41 (75%) received colchicine, and 3 (6%) used GC. There were no refusals to receive urate-lowering and preventive anti-inflammatory therapies.Conclusion. The proposed treatment regimen allows for achieving the serum UA target in 79% of patients and its decrease <360 μmol/L in 92%. Treatment with febuxostat (Azurix) is associated with its good tolerance, including in the patients who could not use allopurinol because of AR. Preventive anti-inflammatory therapy is likely to improve adherence to 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 <60 ml/min/1.73 m2, the presence of tophi, >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; p<0.05 for all cases). In addition, patients with DM2 were more likely to have subcutaneous tophi (59.3% versus 30.0%; p=0.001), among them there were more individuals (67.6% versus 31.6%; p=0.001) with frequent attacks of arthritis (>4 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 <300 μmol/L were associated with a lower risk of DM2.Conclusion. The occurrence of DM2 in gout is associated not only with well-known risk factors, but also with hyperuricemia and microcrystalline inflammation. Febuxostat therapy is associated with a lower risk of developing DM2.

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. Key words: gout, type 2 diabetes mellitus, uric acid>˂ 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.

Gout is one of the most common rheumatic diseases, the peculiarity of which is the development in conditions of prolonged hyperuricemia (HU). The rapid increase in the incidence of gout with a slight increase in the prevalence of HU actualizes the issue of diagnosing gout at the preclinical stage.Objective. To determine the frequency of ultrasound signs of urate crystal deposition in patients with asymptomatic HU (AHU) and gout.Results. 112 patients with AHU and gout were included, the mean age in both groups was 49.7 years. Ultrasound signs of deposition of sodium monourate crystals (SMC) among patients with AHU were determined in 21.1% of the patient by ultrasound of the knee joints and 17.5% of patients by ultrasound of the feet. Patients with gout showed the same US features in 38.1% and 56.3% of cases, respectively. There is a strong correlation between the detection of SMC by ultrasound and a history of arthritis attack of the respective joints.Conclusions. The detection of SMC and concomitant HU is very common among patients with AHU, which can be considered the preclinical stage of gout.