Clinical recommendations for diagnostics and treatment of uratosis: how primary doctors are ready for their mandatory following?


DOI: https://dx.doi.org/10.18565/therapy.2019.8.74-80

Bashkova I.B., Tarasova L.V., Busalayeva E.I., Vasilyeva N.P., Opalinskaya I.V.

1) I.N. Ulyanov Chuvashsky state university, Cheboksary; 2) Surgut State University; 3) Institute for advanced medical studies of the Ministry of Healthcare of the Chuvash Republic, Cheboksary
Recently, there has been a rapid increase in uratosis incidence in the world, but the diagnosis of the disease is late, and the curation of patients, especially by primary care physicians, does not always meet modern requirements.
The purpose of the study was to assess the readiness of primary care physicians to mandatory follow with clinical recommendations for the diagnosis and treatment of gout.
Material and methods. A survey of 100 general practitioners and district physicians of the Chuvash Republic was conducted. A specially designed anonymous questionnaire included questions on the diagnosis and treatment of gout, taking into account current clinical recommendations.
Results and conclusion. 72% of respondents consider hyperuricemia as an independent and the only sign that allows to diagnose gout. 26% find it difficult to name the normal level of uric acid in blood serum. Only every fifth doctor called the «gold standard» of diagnosis the detection of crystals of sodium monourate in synovial fluid by polarization microscopy. Every third person considers it possible to prescribe allopurinol in the acute period of the disease, 49% recommend local use of drugs, 11% recommend physiotherapy (except for cryotherapy). The duration of treatment with allopurinol is limited to achieving normouricemia of 17%. These errors lead to a worsening of the disease and reduce further adherence to treatment.
Keywords: gout, case management, primary care physicians
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Literature


  1. Krishnan E., Pandya B., Chung L., Dabous O. Hyperuricemia and the risk for subclinical coronary atherosclerosis – data from a prospective observational cohort study. Arthritis Research & Therapy. 2011; 13(2): 66–71.

  2. Wang Z., Bian L., Choi Y. Serum uric acid: a marker of metabolic syndrome and subclinical atherosclerosis in Korean men. Angiology. 2012; 63: 420–28.

  3. Pacifico L.,Cantisani V., Anania C. et al. Serum uric acid and its association with metabolic syndrome and carotid atherosclerosis in obese children. European Journal of Endocrinology. 2009; 160(1): 45–52.

  4. Маркелова Е.И., Елисеев М.С., Барскова В.Г. Артериальная гипертензия у больных подагрой: основы патогенеза, клиническое значение, диагностика. Современная ревматология. 2012; 4: 23–30.

  5. Елисеев М.С. Алгоритмы диагностики и лечения подагры. РМЖ. 2015; 7: 410–414.

  6. Склянова М.В., Калягин А.Н. Первичная медико-санитарная помощь больным подагрой. Современная ревматология. 2012; 3: 52–55.

  7. Барскова В.Г. Что должен знать терапевт о ведении больного острым подагрическим артритом. Современная ревматология. 2012; 3: 84–87.

  8. Карнакова М.В., Калягин А.Н. Изменилось ли клиническое течение подагры в последнее время? Современная ревматология. 2017; 11(1): 23–27.

  9. Карнакова М.В. Ошибки в диагностике и лечении подагры. Современные проблемы ревматологии. 2013; 5: 39–44.

  10. Приказ Министерства здравоохранения РФ от 12.11.2012 № 900н «Об утверждении Порядка оказания медицинской помощи взрослому населению по профилю «ревматология».

  11. Подагра. Клинические рекомендации. 2018 г. http://cr.rosminzdrav.ru

  12. Richette P. et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76: 29–42. doi:10.1136/annrheumdis-2016-209707

  13. Schumacher H.R. et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum 2008; 59: 1540–48.

  14. Becker M.A. et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005; 353: 2450–61.

  15. Becker M.A. et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 2010; 12: R63.

  16. Башкова И.Б., Мадянов И.В., Прокопьева Т.В. Подагра и сахарный диабет: синдром взаимоотягощения с летальным исходом. Здравоохранение Чувашии. 2015; 4: 80–81.

  17. Кобалава Ж.Д., Толкачева В.В. Мочевая кислота – независимый предиктор сердечно-сосудистых событий. Урикозурический потенциал лозартана. Клиническая фармакология и терапия. 2011; 3: 1–9.

  18. Алгоритмы диагностики и лечения подагры. Терапия. 2018; приложение 4: 10–14.


About the Autors

Inna B. Bashkova, PhD, associate professor of the Department of faculty and hospital therapy of I.N. Ulyanov Chuvash State University. Address: 428015, Cheboksary, 45 Moskovsky Prospekt. Tel.: +7 (8352) 45-26-97. E-mail: innabashkova@yandex.ru
Larisa V. Tarasova, MD, professor of the Department of internal diseases of the Medical Institute of the Khanty-Mansi Autonomous Okrug – Ugra of Surgut State University, head of the Department of faculty and hospital therapy of I.N. Ulyanov Chuvash State University. Address: 628403, Surgut, 20 Energetikov Str. Tel.: +7 (932) 433-14-06.
E-mail: tlarisagast18@mail.ru
Elena I. Busalaeva, PhD, associate professor of the Department of faculty and hospital therapy of I.N. Ulyanov Chuvash State University. Address: 428015 Cheboksary, 45 Moskovsky Prospect. Tel.: +7 (8352) 45-26-97.
E-mail: busa-elena@yandex.ru
Nina P. Vasilieva, PhD, associate professor of the Department of faculty and hospital therapy of I.N. Ulyanov Chuvash State University. Address: 428015, Cheboksary, 45 Moskovsky Prospekt. Tel: +7 (8352) 45-26-97.
E-mail: ninajur@yandex.ru
Irina V. Opalinskaya, PhD, associate professor of the Department of faculty and hospital therapy of I.N. Ulyanov Chuvash State University. Address: 428015, Cheboksary, 45 Moskovsky Prospekt. Tel.: +7 (8352) 45-26-97.
E-mail: opalinskaya_irina@mail.ru

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