What we know about gout today


DOI: https://dx.doi.org/10.18565/therapy.2024.1.63-73

Eliseev M.S.

V.A. Nasonova Research Institute of Rheumatology, Moscow
Abstract. Gout is a chronic autoinflammatory disease that develops in individuals with hyperuricemia (HU) and is caused by inflammation at sites where urate crystals are deposited. Among the causes of the development of HU and gout, in addition to dietary habits, there are genetically determined disorders in the functioning of urate transporters in kidneys and intestines. Genesis of acute gouty arthritis is associated with a two-stage activation of NLRP3 inflammasome, inducing the synthesis of active interleukin 1β, which is clinically manifested by acute, excruciating pain in peripheral joints. Along with the peculiarities of the clinical picture, also radiation diagnostic methods are important in the early diagnosis of gout. The main aim of goat therapy is stable maintenance of serum uric acid levels in blood, achieved by regular use of urate-lowering medicines (allopurinol, febuxostat), which should be taken together with low doses of colchicine, nonsteroidal anti-inflammatory drugs or glucocorticoids in the first months of the treatment.
Keywords: treatment of gout, diagnosis of gout, urate-lowering therapy, uric acid, gout
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Literature

1. Насонова В.А., Барскова В.Г. Ранние диагностика и лечение подагры – научно обоснованное требование улучшения трудового и жизненного прогноза больных. Научно-практическая ревматология. 2004; 42(1): 5–7. (Nasonova V.A., Barskova V.G. Early diagnostic and treatment of gout – is scientifically based reguirements for improvement of labour and living prognosis of patients. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2004; 42(1): 5–7 (In Russ.)). EDN: QCWYZP.


2. Bardin T., Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol. 2014; 26(2): 186–91. https://doi.org/10.1097/BOR.0000000000000028. PMID: 24419750.


3. Елисеев М.С. Классификационные критерии подагры (рекомендации ACR/EULAR). Научно-практическая ревматология. 2015; 53(6): 581–585. (Eliseev M.S. Gout classification criteria (ACR/EULAR guidelines). Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2015; 53(6): 581–585 (In Russ.)). https://doi.org/10.14412/1995-4484-2015-581-585. EDN: WYDFDR


4. Dalbeth N., Stamp L. Hyperuricaemia and gout: Time for a new staging system? Ann Rheum Dis. 2014; 73(9): 1598–600. https://doi.org/10.1136/annrheumdis-2014-205304. PMID: 24718961.


5. Bursill D., Taylor W.J., Terkeltaub R. et al. Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout. Ann Rheum Dis. 2019; 78(11): 1592–600. https://doi.org/10.1136/annrheumdis-2019-215933. PMID: 31501138. PMCID: PMC7288724.


6. Dalbeth N., Phipps-Green A., Frampton C. et al. Relationship between serum urate concentration and clinically evident incident gout: An individual participant data analysis. Ann Rheum Dis. 2018; 77(7): 1048–52. https://doi.org/10.1136/annrheumdis-2017-212288. PMID: 29463518.


7. Черемушкина Е.В., Елисеев М.С., Северинова М.В., Желябина О.В. Сонография как метод диагностики подагры на преклинической стадии (предварительные данные пилотного исследования). Медицинский алфавит. 2023; (9): 30–34. (Cheremushkina E.V., Eliseev M.S., Severinova M.V., Zhelyabina O.V. Sonography as method for diagnosing gout at preclinical stage (Preliminary data from pilot study). Meditsinskiy alfavit = Medical Alphabet. 2023; (9): 30–34 (In Russ.)). https://doi.org/10.33667/2078-5631-2023-9-30-34. EDN: SMDPLS.


8. Chhana A., Lee G., Dalbeth N. Factors influencing the crystallization of monosodium urate: A systematic literature review. BMC Musculoskelet Disord. 2015; 16: 296. https://doi.org/10.1186/s12891-015-0762-4. PMID: 26467213. PMCID: PMC4606994.


9. Елисеев М.С., Насонов Е.Л. Применение канакинумаба при подагре. Научно-практическая ревматология. 2018; 56(S4): 41–48. (Eliseev M.S., Nasonov E.L. Therapy with canakinumab for gout. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2018; 56(S4): 41–48 (In Russ.)). https://doi.org/10.14412/1995-4484-2018-41-48.


10. Насонов Е.Л. Роль интерлейкина 1 в развитии заболеваний человека. Научно-практическая ревматология. 2018; 56(S4): 19–27. (Nasonov E.L. The role of interleukin 1 in the development of human diseases. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2018; 56(S4): 19–27 (In Russ.)). https://doi.org/10.14412/1995-4484-2018-19-27. EDN: VVDWLF.


11. Joosten L.A., Netea M.G., Mylona E. et al. Engagement of fatty acids with Toll-like receptor 2 drives interleukin-1β production via the ASC/caspase 1 pathway in monosodium urate monohydrate crystal-induced gouty arthritis. Arthritis Rheum. 2010; 62(11): 3237–48. https://doi.org/10.1002/art.27667. PMID: 20662061. PMCID: PMC2970687.


12. Yokose C., McCormick N., Chen C. et al. Risk of gout flares after vaccination: A prospective case cross-over study. Ann Rheum Dis. 2019; 78(11): 1601–4. https://doi.org/10.1136/annrheumdis-2019-215724. PMID: 31366470. PMCID: PMC7184318.


13. Vieira A.T., Macia L., Galvao I. et al. A role for gut microbiota and the metabolite-sensing receptor GPR43 in a murine model of gout. Arthritis Rheumatol. 2015; 67(6): 1646–56. https://doi.org/10.1002/art.39107. PMID: 25914377.


14. Малышев И.Ю., Пихлак А.Э., Буданова О.П. Молекулярные и клеточные механизмы воспаления при подагре. Патогенез. 2019; 17(4): 4–13. (Malyshev I.Yu., Pihlak A.E., Budanova O.P. Molecular and cell mechanisms of inflammation in gout). Patogenez = Pathogenesis. 2019; 17(4): 4–13 (In Russ.)). https://doi.org/10.25557/2310-0435.2019.04.4-13. EDN: AVOASX.


15. Dalbeth N., Choi H.K., Joosten L.A.B. et al. Gout. Nat Rev Dis Primers. 2019; 5(1): 69. https://doi.org/10.1038/s41572-019-0115-y. PMID: 31558729.


16. Singh J.A., Gaffo A. Gout epidemiology and comorbidities. Semin Arthritis Rheum. 2020; 50(3S): S11–S16. https://doi.org/10.1016/j.semarthrit.2020.04.008. PMID: 32620196.


17. Kuo C.F., Luo S.F. Gout: Risk of premature death in gout unchanged for years. Nat Rev Rheumatol. 2017; 13(4): 200–1. https://doi.org/10.1038/nrrheum.2017.27. PMID: 28250462.


18. Галушко Е.А., Насонов Е.Л. Распространенность ревматических заболеваний в России. Альманах клинической медицины. 2018; 46(1): 32–39. (Galushko E.A., Nasonov E.L. Prevalence of rheumatic diseases in Russia. Al’manakh klinicheskoy meditsiny = Almanac of Clinical Medicine. 2018; 46(1): 32–39 (In Russ.)). https://doi.org/10.18786/2072-0505-2018-46-1-32-39. EDN: YVSHGT.


19. Saseen J.J., Agashivala N., Allen R.R. et al. Comparison of patient characteristics and gout-related health-care resource utilization and costs in patients with frequent versus infrequent gouty arthritis attacks. Rheumatology (Oxford). 2012; 51(11): 2004–12. https://doi.org/10.1093/rheumatology/kes183. PMID: 22829689.


20. Taylor W.J., Fransen J., Jansen T.L. et al. Study for updated gout classification criteria: Identification of features to classify gout. Arthritis Care Res (Hoboken). 2015; 67(9): 1304–15. https://doi.org/10.1002/acr.22585. PMID: 25777045. PMCID: PMC4573373.


21. Елисеев М.С., Мукагова М.В., Смирнов А.Н. с соавт. Атипичная подагра: тофусное поражение позвоночника. Научно-практическая ревматология. 2013; 51(5): 586–589. (Eliseev M.S., Mukagova M.V., Smirnov A.V. et al. Atypical gout: Spinal tophaceous injury. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2013; 51(5): 586–589 (In Russ.)). https://doi.org/10.14412/1995-4484-2013-1553. EDN: RWUMWV.


22. Елисеев М.С., Чикаленкова Н.А., Барскова В.Г. Клинические особенности подагры у женщин: результаты сравнительного исследования. Научно-практическая ревматология. 2014; 52(2): 178–182. (Eliseev M.S., Chikalenkova N.A., Barskova V.G. Clinical features of gout in women: The results of a comparative study. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2014; 52(2): 178–182 (In Russ.)). https://doi.org/10.14412/1995-4484-2014-178-182. EDN: SMYQVN.


23. Елисеев М.С. Алгоритм диагностики и лечения подагры. РМЖ. 2015; 23(7): 410. (Eliseev M.S. Algorithm for the diagnosis and treatment of gout. Russkiy meditsinskiy zhurnal = Russian Medical Journal. 2015; 23(7): 410–414 (In Russ.)). EDN: UBHVCX.


24. Flynn T.J., Cadzow M., Dalbeth N. et al. Positive association of tomato consumption with serum urate: Support for tomato consumption as an anecdotal trigger of gout flares. BMC Musculoskelet Disord. 2015; 16: 196. https://doi.org/10.1186/s12891-015-0661-8. PMID: 26286027. PMCID: PMC4541734.


25. Rothenbacher D., Primatesta P., Ferreira A. et al. Frequency and risk factors of gout flares in a large population-based cohort of incident gout. Rheumatology (Oxford). 2011; 50(5): 973–81. https://doi.org/10.1093/rheumatology/keq363. PMID: 21228059.


26. Garcia-Maturano J.S., Torres-Ordaz D.E., Mosqueda-Gutierrez M. et al. Gout during the SARS-CoV-2 pandemic: Increased flares, urate levels and functional improvement. Clin Rheumatol. 2022; 41(3): 811–18. https://doi.org/10.1007/s10067-021-05994-z. PMID: 34822044. PMCID: PMC8613459.


27. Чикина М.Н. Профилактика приступов артрита при назначении уратснижающей терапии у больных подагрой. Научно-практическая ревматология. 2018; 56(6): 760–766. (Chikina M.N. Prevention of arthritis attacks in the use of urate-lowering therapy in patients with gout. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2018; 56(6): 760–766 (In Russ.)). https://doi.org/10.14412/1995-4484-2018-760-766. EDN: WNBZMO.


28. Shiozawa A., Szabo S.M., Bolzani A. et al. Serum uric acid and the risk of incident and recurrent gout: A systematic review. J Rheumatol. 2017; 44(3): 388–96. https://doi.org/10.3899/jrheum.160452. PMID: 28148699.


29. Елисеев М.С., Барскова В.Г., Денисов И.С. Динамика клинических проявлений подагры у мужчин (данные 7-летнего ретроспективного наблюдения). Терапевтический архив. 2015; 87(5): 10–15. (Eliseev M.S., Barskova V.G., Denisov I.S. Dynamics of clinical manifestations of gout in men (data from 7-year retrospective surveillance). Terapevticheskiy arkhiv = Therapeutic Archive. 2015; 87(5): 10–15 (In Russ.)). https://doi.org/10.17116/terarkh201587510-15. EDN: UKTAJL.


30. Neogi T., Jansen T.L., Dalbeth N. et al. 2015 Gout classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015; 67(10): 2557–68. https://doi.org/10.1002/art.39254. PMID: 26359487. PMCID: PMC4602275.


31. Владимиров С.А., Елисеев М.С., Раденска-Лоповок С.Г., Барскова В.Г. Дифференциальная диагностика ревматоидного артрита и подагры. Современная ревматология. 2008; 2(4): 39–41. (Vladimirov S.A., Eliseev M.S., Radenska-Lopovok S.G., Barskova V.G. Differential diagnosis of rheumatoid arthritis and gout. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2008; 2(4): 39–41 (In Russ.)). https://doi.org/10.14412/1996-7012-2008-505. EDN: LDGCRZ.


32. Барскова В.Г., Елисеев М.С., Владимиров С.А. Диагностика микрокристаллической патологии суставов методом поляризационной микроскопии (трактовка и методические рекомендации к исследованию). Современная ревматология. 2010; 4(1): 84–88. (Barskova V.G., Eliseev M.S., Vladimirov S.A. Diagnosis of microcrystalline joint diseases by polarization microscopy: interpretation and guidelines for their study. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2010; 4(1): 84–88 (In Russ.)). https://doi.org/10.14412/1996-7012-2010-594. EDN: MBFNUX.


33. Chen J., Liao M., Zhang H., Zhu D. Diagnostic accuracy of dual-energy CT and ultrasound in gouty arthritis: A systematic review. Z Rheumatol. 2017; 76(8): 723–29. https://doi.org/10.1007/s00393-016-0250-8. PMID: 28058498.


34. Барскова В.Г., Мукагова М.В., Северинова М.В. с соавт. Диагностика подагры. Сибирский медицинский журнал (Иркутск). 2012; 112(5): 132–135. (Barskova V.G., Mukagova M.V., Severinova M.V. et al. Diagnosis of gout. Sibirskiy meditsinskiy zhurnal (Irkutsk) = Siberian Medical Journal (Irkutsk). 2012; 112(5): 132–135 (In Russ.)). EDN: PBUYXV.


35. Schlesinger N., Detry M.A., Holland B.K. et al. Local ice therapy during bouts of acute gouty arthritis. J Rheumatol. 2002; 29(2): 331–34. PMID: 11838852.


36. Елисеев М.С. Обновленные рекомендации EULAR по лечению подагры. Комментарии к некоторым позициям. Научно-практическая ревматология. 2017; 55(6): 600–609. (Eliseev M.S. Updated EULAR guidelines for the management of gout. Comments on certain items. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2017; 55(6): 600–609 (In Russ.)). https://doi.org/10.14412/1995-4484-2017-600-609. EDN: YPXRAX.


37. FitzGerald J.D., Dalbeth N., Mikuls T. et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020; 72(6): 744–60. https://doi.org/10.1002/acr.24180. PMID: 32391934. PMCID: PMC10563586.


38. Елисеев М.С., Чикина М.Н., Желябина О.В. Открытое 6-месячное исследование эффективности титрования дозы аллопуринола у пациентов с подагрой в рамках стратегии «лечение до цели». РМЖ. 2022; (6): 17–22. (Eliseev M.S., Chikina M.N., Zhelyabina O.V. Open 6-month study on the efficacy of dose titration of allopurinol in patients with gout as part of the «treat to target» strategy. Russkiy meditsinskiy zhurnal = Russian Medical Journal. 2022; (6): 17–22 (In Russ.)). EDN: LLFCTA.


39. Stamp L.K., Chapman P.T., Barclay M.L. et al. A randomised controlled trial of the efficacy and safety of allopurinol dose escalation to achieve target serum urate in people with gout. Ann Rheum Dis. 2017; 76(9): 1522–28. https://doi.org/10.1136/annrheumdis-2016-210872. PMID: 28314755.


40. Елисеев М.С., Желябина О.В., Чикина М.Н., Тхакоков М.М. Эффективность фебуксостата у пациентов с подагрой в зависимости от функции почек. РМЖ. Медицинское обозрение. 2022; 6(3): 140–147. (Eliseev M.S., Zhelyabina O.V., Chikina M.N., Thakokov M.M. Febuxostat efficacy in patients with gout depending on kidney function. Russkiy meditsinskiy zhurnal. Meditsinskoe obozrenie = Russian Medical Journal. Medical Review. 2022; 6(3): 140–147 (In Russ.)). https://doi.org/10.32364/2587-68212022-6-3-140-147. EDN: CMIOLK.


41. Richette P., Doherty M., Pascual E. et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017; 76(1): 29–42. https://doi.org/10.1136/annrheumdis-2016-209707. PMID: 27457514.


42. Pascart T., Latourte A., Flipo R.M. et al. 2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy. Joint Bone Spine. 2020; 87(5): 395–404. https://doi.org/10.1016/j.jbspin.2020.05.002. PMID: 32422338.


43. Neilson J., Bonnon A., Dickson A., Roddy E. Guideline Committee. Gout: Diagnosis and management-summary of NICE guidance. BMJ. 2022; 378: o1754. https://doi.org/10.1136/bmj.o1754. PMID: 36041743.


44. Чикина М.Н., Елисеев М.С., Желябина О.В. Практическое применение национальных клинических рекомендаций по лечению подагры (предварительные данные). Современная ревматология. 2020; 14(2): 97–103. (Chikina M.N., Eliseev M.S., Zhelyabina O.V. Practical application of national clinical guidelines for the management of gout (preliminary data). Sovremennaya revmatologiya = Modern Rheumatology Journal. 2020; 14(2): 97–103 (In Russ.)). https://doi.org/10/14412/1996-7012-2020-2-97-103. EDN: JENNNH.


45. Sarawate C.A., Patel P.A., Schumacher H.R. et al. Serum urate levels and gout flares: Analysis from managed care data. J Clin Rheumatol. 2006; 12(2): 61–65. https://doi.org/10.1097/01.rhu.0000209882.50228.9f. PMID: 16601538.


46. Чикина М.Н., Елисеев М.С., Желябина О.В. Сравнение эффективности и безопасности различных противовоспалительных препаратов при инициации уратснижающей терапии у пациентов с подагрой (предварительные данные). Современная ревматология. 2021; 15(2): 50–56. (Chikina M.N., Eliseev M.S., Zhelyabina O.V. Comparison of the efficacy and safety of various anti-inflammatory drugs in urate-lowering therapy initiation in patients with gout (preliminary data). Sovremennaya revmatologiya = Modern Rheumatology Journal. 2021; 15(2): 50–56 (In Russ.)). https://doi.org/10.14412/1996-7012-2021-2-50-56. EDN: JQJBLA.


47. National Institute for Health and Care Excellence (NICE). Gout: Diagnosis and management. NICE guideline. 2022. URL: https://www.nice.org.uk/guidance/ng219/resources/gout-diagnosis-and-management-pdf-66143783599045 (date of access – 11.01.2024).


48. Wan H., Zeng L., Xiao R. et al. Colchicine linked with risk reduction for myocardial infarction in gout patients: Systematic review and meta-analysis. Z Rheumatol. 2022; 81(6): 501–6. https://doi.org/10.1007/s00393-022-01232-2. PMID: 35794279.


49. Major T.J., Topless R.K., Dalbeth N., Merriman T.R. Evaluation of the diet wide contribution to serum urate levels: Meta-analysis of population based cohorts. BMJ. 2018; 363: k3951. https://doi.org/10.1136/bmj.k3951. PMID: 30305269. PMCID: PMC6174725.


50. McCormick N., Rai S.K., Lu N. et al. Estimation of primary prevention of gout in men through modification of obesity and other key lifestyle factors. JAMA Netw Open. 2020; 3(11): e2027421. https://doi.org/10.1001/jamanetworkopen.2020.27421. PMID: 33231639. PMCID: PMC7686865.


About the Autors

Maxim S. Eliseev, MD, PhD (Medicine), head of the Department of microcrystalline arthritis, V.A. Nasonova Research Institute of Rheumatology. Address: 115522, Moscow, 34a Kashirskoe Highway.
E-mail: elicmax@yandex.ru
ORCID: https://orcid.org/0000-0003-1191-5831


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