medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-11-154-162medsovet-5765Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYКлинический разбор: терапия подагры у коморбидного пациентаClinical discussion: gout therapy in a comorbid patienthttps://orcid.org/0000-0003-1191-5831ЕлисеевМ. С.EliseevM. S.

Елисеев Максим Сергеевич, к.м.н., заведующий лабораторией микрокристаллических артритов

115522, Москва, Каширское шоссе, д. 34А

Maxim S. Eliseev, Cand. of Sci. (Med.), Head of the Laboratory of Microcrystal Arthritis

34А, Kashirskoe Shosse, Moscow, 115522

elicmax@yandex.ruhttps://orcid.org/0000-0002-3667-722XНовиковаА. М.NovikovaA. M.

Новикова Александра Михайловна, младший научный сотрудник лаборатории микрокристаллических артритов

115522, Москва, Каширское шоссе, д. 34А

Aleksandra M. Novikova, Junior Researcher at the Laboratory of Microcrystal Arthritis

34А, Kashirskoe Shosse, Moscow, 115522

aleksandra.novicova@yandex.ruНаучно-исследовательский институт ревматологии им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202007082020011154162Copyright © Елисеев М.С., Новикова А.М., 20202020Елисеев М.С., Новикова А.М.Eliseev M.S., Novikova A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5765

Накопленные на сегодняшний день данные свидетельствуют о том, что крайне редкой представляется ситуация, когда у пациента с подагрой есть только его основное заболевание и нет сопутствующей патологии. Одна из частых ситуаций – сочетание с другим микрокристаллическим артритом – болезнью депонирования кристаллов пирофосфата кальция. Кроме того, заболевания почек (в том числе хроническая почечная недостаточность), сердечно-сосудистой системы, желудочно-кишечного тракта, а также метаболические нарушения, напрямую ассоциированные с подагрой или опосредованно связанные с приемом лекарственных препаратов, необходимых для контроля заболевания, не только оказывают влияние на качество и продолжительность жизни пациента, но и создают сложности для его курации. Назначение лекарственной терапии, как симптоматической, так и патогенетической, в таких случаях предполагает оценку всех сопутствующих рисков, а выбор препаратов, помимо эффективности, должен основываться на профиле их безопасности в зависимости от коморбидной патологии. В настоящей статье разобраны основные принципы и подходы к терапии подагры и болезни депонирования кристаллов пирофосфата кальция при наличии сопутствующих заболеваний (артериальная гипертензия, хроническая болезнь почек, хроническая сердечная недостаточность, ожирение, дислипидемия и др.) на примере 50-летнего пациента. Показаны возможности комбинированной симптоматической терапии, включающей колхицин, нестероидные противовоспалительные препараты и глюкокортикоиды. Также обсуждена необходимость и тактика выбора превентивной профилактической терапии приступов артрита и применение фебуксостата при наличии противопоказаний к назначению или неэффективности аллопуринола.

The data accumulated to date suggests that it is extremely rare for a gout patient to have only his or her main disease and no accompanying pathology. One of the frequent situations is a combination with another microcrystal arthritis, a disease of calcium pyrophosphate crystals deposition. In addition, diseases of the kidneys (including chronic renal failure), cardiovascular system, gastrointestinal tract, as well as metabolic disorders directly associated with gout or indirectly related to taking medications necessary to control the disease, not only affect the quality and longevity of life of the patient, but also create difficulties for its curation. The prescription of drug therapy, both symptomatic and pathogenetic, in such cases involves an assessment of all the associated risks, and the choice of drugs, in addition to efficiency, should be based on their safety profile in relation to comorbid pathology. This article analyzes the main principles and approaches to the treatment of gout and the disease of calcium pyrophosphate crystals deposition in the presence of concomitant diseases (arterial hypertension, chronic kidney disease, chronic heart failure, obesity, dyslipidemia, etc.) on the example of a 50-year-old patient. The possibilities of combined symptomatic therapy including colchicine, non-steroidal anti-inflammatory drugs and glucocorticoids are shown. The necessity and tactics of choice of preventive prophylactic therapy for arthritis attacks and use of phebuxostat in the presence of contraindications for prescription or ineffectiveness of allopurinol are also discussed.

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The authors declare that there are no conflicts of interest present.