Therapy of gouty arthritis from data of the St. Petersburg City register of gout (2016-2018 years): modern realities


DOI: https://dx.doi.org/10.18565/therapy.2019.8.110-117

Mazurov V.I., Gaydukova I.Z., Petrova M.S., Inamova O.V., Fonturenko A.Yu., Bashkinov R.A., Nagirnyak I.M., Shapovalov A.A.

1) North-Western State medical University named after I.I. Mechnikov, Saint-Petersburg; 2) Clinical Rheumatology Hospital No. 25, City Center of gout, Saint-Petersburg; 3) TechLab Ltd, Saint-Petersburg
Despite the fact that the treatment of gout has been carried out for a long time, the achievement of target levels of uric acid (UA) in the blood is not observed in all cases, which is associated with the appointment of inadequate doses of urate-lowering drugs, low adherence of patients to therapy, as well as the problem of comorbidity.
The purpose. Based on the data of the register of patients with gout in St. Petersburg for 2016–2018 to assess the effectiveness of treatment of gouty arthritis (GA) in real clinical practice.
Materials and methods. Based on the data of the St. Petersburg city register of patients with gout for 2016–2018, the analysis of drug therapy of GA was carried out.
Results. The register included 1393 patients, average age 60,48±9,71 years, 89% male and 11% female. At the beginning of hospitalization and before discharge from the hospital, the mean UA levels of patients with GA were 545±115 and 432,3±66,7 mkmol/l, erythrocyte sedimentation rate 25,5±15,1 and 17,6±10,2 mm/h, C-reactive protein 20,7±21,1 and 12,3±10,3 mg/l, respectively (p <0,01 for all).
Nonsteroidal anti-inflammatory drugs (NSAIDs) were used in 1269 (87,65%) patients, glucocorticosteroids (GCS) – in 959 (55,99%) patients, combined use of NSAIDs and GCS – in 700 (50,17%) patients. Urate-lowering therapy (ULT) was represented by allopurinol in 1207 (86,64%) patients and febuxostat in 47 (3,37%) patients. Blemaren citrate mixture was used in 479 (34.39%) patients. Colchicine was taken by 107 (7,68%) patients. The average dose of allopurinol was 200 mg per day, and febuxostat – 80 mg per day. 113 (8,11%) patients underwent extracorporeal methods of treatment. Intravenous laser irradiation was performed in 189 (13,57%) patients.
Conclusion. The data of real clinical practice demonstrate the adequacy and effectiveness of the hospital stage of treatment of exacerbation of GA, provided by the use of a full range of methods of anti-inflammatory and ULT, including extracorporeal detoxification and physiotherapy methods. At the same time, there is an obvious need to strengthen measures to control hyperuricemia at the outpatient stage by increasing patient adherence to treatment (including through patient training), by changing the profile of the prescribed ULT with a more uniform appointment of all available drugs and with the use of titration of doses of reducing drugs.
Keywords: gout, gouty arthritis, nonsteroidal anti-inflammatory drugs, glucocorticosteroids, allopurinol, febuxostat, plasmapheresis, laser irradiation of blood
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About the Autors

Vadim I. Mazurov, MD, professor, Academician RAS, Director of Research Institute of rheumatology of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia, head of St. Petersburg Center of autoimmune disease, Chief scientific adviser of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia, head of the Department of therapy, rheumatology, temporary incapacity and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia, Honoured worker of science of Russia. Address: 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (921) 951-71-88. E-mail: maz.nwgmu@yandex.ru. ORCID ID https://orcid.org/0000-0002-0797-2051
Inna Z. Gaydukova, MD, professor of the Department of therapy, rheumatology, temporary incapacity and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia. 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (903) 329-03-59. E-mail: ubp1976@list.ru.
ORCID ID https://orcid.org/0000-0003-3500-7256
Marianna S. Petrova, PhD, associate professor of the Department of therapy, rheumatology, temporary incapacity and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia, deputy Chief physician of Saint Petersburg City clinical rheumatology hospital No. 25, head of City center of gout. Address: 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (999) 044-90-95.
E-mail: podagra@bk.ru. ORCID ID https://orcid.org/0000-0001-9126-3639
Oksana V. Inamova, PhD, assistant of the Department of therapy, rheumatology, temporary incapacity and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of RussiaChief physician of Saint Petersburg City clinical rheumatology hospital No. 25. Address: 190068, St. Petersburg, 30 Bolshaya Pod`yacheskaya Str. Tel.: +7 (812) 310-28-14. E-mail: b25@zdrav.spb.ru.
ORCID ID https://orcid.org/0000-0001-9126-3639
Alexandra Yu. Fonturenko, resident of the Department of therapy, rheumatology, temporary incapacity and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia. Address: 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (911) 740-38-09.
E-mail: aleksa.fonturenko@mail.ru. ORCID ID https://orcid.org/0000-0003-4860-0518
Roman A. Bashkinov, postgraduate student of the Department of therapy, rheumatology, temporary incapacity and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia, rheumatologist of Saint Petersburg City clinical rheumatology hospital No. 25, head of City center of gout. Адрес: 190068, St. Petersburg, 30 Bolshaya Pod`yacheskaya Str. Tel.: +7 (981) 838-82-66. E-mail: bashkinov-roman@mail.ru. ORCID: https://orcid.org/0000-0001-9344-1304
Alexandr A. Shapovalov, Director of TechLab Ltd. Address: 191186, St. Petersburg, 17 Ital`anskaya Str.
Tel.: +7 (981) 242-73-55. E-mail: shapovalov@teh-lab.ru. https://orcid.org/0000-0002-0736-0944
Ivan M. Nagirnyak, projects leader of TechLab Ltd. Address: 191186, St. Petersburg, 17 Ital`anskaya Str.
Tel.: +7 (981) 913-15-22. E-mail: nagir@teh-lab.ru. https://orcid.org/0000-0002-3492-9067

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