Commentaries on the updated American College of Rheumatology guidelines for the management of gout. Urate-lowering drugs (Part 1)

Елисеев, М. С.

doi:10.14412/1996-7012-2020-3-117-124

Sovremennaâ revmatologiâ

2020

DOI: 10.14412/1996-7012-2020-3-117-124

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Commentaries on the updated American College of Rheumatology guidelines for the management of gout. Urate-lowering drugs (Part 1)

М. С. Елисеев¹

Abstract: The emergence of updated American College of Rheumatology (ACR) guidelines for the management of gout may serve as a prerequisite for revising the draft Russian Federal Clinical Guidelines (FCGs). Despite some differences, it should be noted that both guidelines are similar in key points concerning the principles of drug correction of hyperuricemia, indications for prescription and algorithms for the use of specific medicaments. The proximity of positions can be also traced in the need for the priority use of … Show more

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Cited by 8 publications

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Evaluation of the effect of long-term use of glucocorticoids on the risk of developing diabetes mellitus in patients with gout

Zhelyabina¹,

Елисеев²,

Чикина³

2023

Obes. metabol.

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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.

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Evaluation of the effect of long-term use of glucocorticoids on the risk of developing diabetes mellitus in patients with gout

Zhelyabina¹,

Елисеев²,

Чикина³

2023

Obes. metabol.

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Association of the Q141K polymorphism of the ABCG2 gene with the effectiveness of urate-lowering therapy in patients with gout (a pilot study)

Елисеев¹,

Чикина²,

Гусева³

et al. 2021

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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 (<360 μmol/L or <300 μmol/L in patients with chronic tofus gout), up to a maximum of 900 mg/day, in patients with glomerular filtration rate <60 ml/min/1.73 m2 – up to 300 mg/day. Patients who did not reach the target UA level when using allopurinol were prescribed febuxostat 80 mg/day, which, if necessary, was increased to 120 mg/day. Monitoring of each patient was continued until the target serum UA level was reached.All patients underwent genotyping of the C>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 <300 μmol/L, in the remaining 37 – as <360 μmol/L.In 26 patients, the dose of allopurinol did not exceed 300 mg/day. In 28 (34%) patients treated with allopurinol, the target UA level was achieved, in the remaining 54 (66%) patients, allopurinol was substituted by febuxostat, and in 22 (41%) of them the UA level decreased and was below the target.The CC genotype of the ABCG2 gene was detected in 51 (62%) patients, the CA genotype in 30 (37%) and the minor genotype AA in 1 (1%).The probability of achieving the target UA level during therapy with allopurinol in carriers of homozygous CC genotype and genotypes CA or AA did not differ: 17 (33%) and 11 (35%) cases, respectively, but patients with CA and AA genotypes required a significantly higher dose of allopurinol (365±102 mg/day) than patients with the CC genotype (290±85 mg/day), p=0.002. Of the 54 patients who took febuxostat and did not reach the target UA level, 30 (56%) had the CC genotype and 24 (44%) had the CA genotype, the probability of reaching the target UA level was also comparable (p=0.22).Conclusion. The probability of reaching the target serum UA level in patients with gout taking allopurinol is not associated with the C>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.

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Current issues in the practical use of allopurinol in patients with gout and hyperuricemia

Eliseev

2024

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The cornerstone of the treatment of gout and hyperuricemia (HU) is the use of urate-lowering drugs, primarily xanthine oxidase inhibitors. Allopurinol, which has been used to treat gout for six decades, is the first line urate-lowering therapy (ULT). However, the principles of ULT prescription, and allopurinol in particular have changed several times. Allopurinol remains the most widely used and highly effective drug in the world for lowering serum uric acid levels, and its prescription in routine clinical practice must fulfil several criteria.This article outlines the key principles of allopurinol therapy, including indications for use, treatment goals, dosing regimens, evaluation of efficacy, and use in elderly patients and patients with impaired renal function. Adherence to these principles will help prevent treatment failuresin gout and HU.

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Commentaries on the updated American College of Rheumatology guidelines for the management of gout. Urate-lowering drugs (Part 1)

Cited by 8 publications

References 53 publications

Evaluation of the effect of long-term use of glucocorticoids on the risk of developing diabetes mellitus in patients with gout

Evaluation of the effect of long-term use of glucocorticoids on the risk of developing diabetes mellitus in patients with gout

Association of the Q141K polymorphism of the ABCG2 gene with the effectiveness of urate-lowering therapy in patients with gout (a pilot study)

Current issues in the practical use of allopurinol in patients with gout and hyperuricemia

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