Relationship between the use of non-steroidal anti-inflammatory drugs and the formation of damage to the cardiovascular system and kidneys in patients with gout


DOI: https://dx.doi.org/10.18565/therapy.2021.1.24-31

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

1) North-West State Medical University named after I.I. Mechnikov of the Ministry of Healthcare of Russia, Saint Petersburg; 2) Clinical Rheumatology Hospital No. 25, Saint Petersburg; 3) ТеchLab Ltd, Saint Petersburg
Abstract. Aim: to study the frequency and course of arterial hypertension (AH), as well as the occurrence of acute myocardial infarction (AMI) and chronic kidney disease (CKD) in patients with gout before the study and 30 days later, against the background of treatment with various non-steroidal anti-inflammatory drugs (NSAIDs).
Material and methods. Based on the GALENOS cloud electronic storage system («ТеchLab» Ltd), St. Petersburg maintains a city register of patients with gout and asymptomatic hyperuricemia. The analysis of NSAIDs application in patients with gout was carried out based on the register data for the period from 2000 to 2019 years.
Results. The study included clinical data from 119 patients with primary gout. Diclofenac was received by 68 patients: 37 (54,41%) of them received it as the only NSAIDs; in 31 (45,59%) patients diclofenac was alternated with other NSAIDs. The comparison group included 51 patients with primary gout who received NSAIDs from different groups. The incidence of AH, AMI and CKD in the studied groups of patients did not statistically differ (p >0,05), but reliably exceeded the population (p<0,001). NSAIDs intake index (Dugados index) was 4,66% for diclofenac and 4,38% for other drugs (p>0,05). In the group of patients who received only diclofenac, an increase in blood pressure was found in 2 (5,41%) patients, AMI developed in 1 (2,7%) of patients, 1 (2,7%) had an initial manifestation of CKD. Among patients who alternated taking diclofenac with other NSAIDs, the increase of blood pressure was revealed in 3 (9,68%) patients, in 10 (32,26%) patients the initial manifestations of CKD were observed. In the comparison group in 2 (3,92%) patients initial manifestations of CKD were registered. All groups surveyed did not differ in the frequency of the primary AMI (p >0,05). The frequency of AH and initial manifestations of CKD de novo was significantly higher in the group of patients who alternated taking diclofenac with other NSAIDs than in the comparison group (p <0,05).
Conclusions. AH, AMI and CKD in gout patients were equally common in groups of patients receiving diclofenac and other NSAIDs, exceeding the prevalence of these diseases in the population. The frequency of AH and the initial manifestations of CKD were found to be significantly higher in patients who alternated taking diclofenac with other drugs from the NSAIDs group. The prevalence of AH, AMI and CKD in patients was significantly higher prior to the study, indicating the greatest contribution of hyperuricemia and inflammatory process in gout to the development of cardiovascular and renal damage.
Keywords: gout, non-steroidal anti-inflammatory drugs, diclofenac, comorbid conditions
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About the Autors

Vadim I. Mazurov, MD, professor, Academician of RAS, principal scientific advisor of North-West State Medical University named after I.I. Mechnikov of the Ministry of Healthcare of Russia, head of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald of North-West State Medical University named after I.I. Mechnikov of the Ministry of Healthcare of Russia, head of Autoimmune Center of Clinical Rheumatology Hospital No.25, Honored worker of science of the Russian Federation. Address: 191015, Saint Petersburg, 41 Kirochnaya Str. E-mail: maz.nwgmu@yandex.ru. ORCID: 0000-0002-0797-2051. SPIN-code: 6823-5482
Inna Z. Gaydukova, MD, professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald of North-West State Medical University named after I.I. Mechnikov of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya Str. Tel: +7 (903) 329-03-59. E-mail: ubp1976@list.ru. ORCID: 0000-0003-3500-7256. SPIN-code: 3083-7996
Roman A. Bashkinov, postgraduate student of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald of North-West State Medical University named after I.I. Mechnikov of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya Str. Tel.: +7 (981) 838-82-66. E-mail: bashkinov-roman@mail.ru. ORCID: 0000-0001-9344-1304. SPIN-code: 5169-5066.
Alexandra Yu. Fonturenko, rheumatologist of Clinical Rheumatology Hospital No. 25. Address: 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya Str. E-mail: aleksa.fonturenko@mail.ru. ORCID: 0000-0003-4860-0518. SPIN-код: 5613-9035
Marianna S. Petrova, PhD, associate professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald of North-West State Medical University named after I.I. Mechnikov of the Ministry of Healthcare of Russia, deputy chief physician of Clinical Rheumatology Hospital No. 25, head of the City Clinical Center for Gout in Saint Petersburg. Address: 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya Str. E-mail: podagra@bk.ru. ORCID: 0000-0001-5261-6614
Oksana V. Inamova, PhD, assistant of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald of North-West State Medical University named after I.I. Mechnikov of the Ministry of Healthcare of Russia, chief physician of Clinical Rheumatology Hospital No. 25. Address: 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya Str. E-mail: b25@zdrav.spb.ru. ORCID: 0000-0001-9126-3639. SPIN-code: 8841-5496
Anna I. Krylova, PhD, radiologist of Clinical Rheumatology Hospital No. 25. Address: 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya Str. E-mail: vanya-krylov@mail.ru. Author-ID: 357691
Ivan M. Nagirnyak, projects leader of ТеchLab Ltd. Address: 191186, Saint Petersburg, 17 Ital`yanskaya Str. E-mail: nagir@inbox.ru. ORCID: 0000-0002-3492-9067

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