Modern facilities of pharmacological correction of hyperuricemia in rheumatic diseases: management of difficult clinical cases

The article presents clinical cases of management of patients with low compliance with treatment, suffering from rheumatic diseases and disorders of purine metabolism.

Cases report 1. The first patient with advanced gout, after taking 100 mg of allopurinol, developed undesirable effects: sore throat, change in voice, cough, and therefore treatment was discontinued. After six months without therapy, the condition worsened and, in self-medication, the patient resumed taking allopurinol at a dose of 300 mg per day, which, as expected, resulted in a resumption of the allergic reaction and a serious exacerbation of gouty arthritis. In order to stop continuous relapses of arthritis, it became necessary to prescribe glucocorticoids. After stabilization of the state, constant administration of febucostat with positive clinical and laboratory dynamics was recommended.

Cases report 2. The second patient with rheumatoid arthritis (RA) developed analgesic nephropathy, secondary hyperuricemia, and typical gouty attacks in the background of high activity of the underlying disease, existing kidney pathology and inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs). Frequent exacerbations of arthritis prompted the patient to finally see a rheumatologist. The adjusted therapy made it possible to reduce RA activity, reach the recommended level of uric acid, and reduce the drug load on the kidneys with almost complete withdrawal of NSAIDs. Thus, in modern conditions, rheumatologists have in reserve all the necessary means for the pharmacological correction of hyperuricemia, even in difficult clinical cases. Febucostat is the drug of choice for correcting uric acid levels in case of intolerance to allopurinol, as well as in the development of secondary gout against the background of renal failure. In addition, it should be noted that the effectiveness of the treatment of rheumatic diseases largely depends on the patient’s compliance. To increase adherence to therapy, regular patient schools are recommended. 

1. Vladimirov S.A., Eliseev M.S., Ilinyh E.V., Marusenko I.M., Chichasova N.V., Jakupova S.P. Gout: Clinical Guidelines. Moscow; 2018. (In Russ.) https://legalacts.ru/doc/klinicheskie-rekomendatsii-podagra-utv-minzdravom-rossii/.

2. Richette P., Doherty M., Pascual E., Barsukova V., Becce F., CastañedaSanabria J. 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.

3. Ilyinykh E.V., Vladimirov S.A., Eliseev M.S. Febuxostat in the Therapy of Gout: From Theory to Practice. Sovremennaja revmatologija = Mod Rheumat J. 2017;11(4):83–88. (In Russ.) https://doi.org/10.14412/1996-7012-2017-4-83-88.

4. Mizuno T., Hayashi T., Hikosaka S., Shimabukuro Y., Murase M., Takahashi K. et al. Efficacy and Safety of Febuxostat in Elderly Female Patients. Clin Interv Aging. 2014;9:1489–1493. https://doi.org/10.2147/CIA.S70855.

5. Eliseev M.S., Shayakhmetova R.U. Experience with Febuxostat in a Patient with Severe Disabling Gout. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2017;11(3):81–84. (In Russ.) https://doi.org/10.14412/1996-7012-2017-3-81-84.

6. Novikova A.M., Eliseev M.S. Treatment of Gout with Reduced Kidney Function. Ehffektivnaya farmakoterapiya = Effective Pharmacotherapy. 2020;16(13):24–29. (In Russ.) https://doi.org/10.33978/2307-3586-2020- 16-13-24-29.

7. Yamanaka H., Tamaki S., Ide Y., Kim H., Inoue K., Sugimoto M. et al. Stepwise Dose Increase of Febuxostat is Comparable with Colchicines Prophylaxis for the Prevention of Gout Flares during the Initial Phase of Urate-Lowering Therapy: Results from FORTUNE-1, A Prospective, Multicentre Randomised Study. Ann Rheum Dis. 2017;77:270–276. https://doi.org/10.1136/annrheumdis-2017-211574.

8. Eliseev M.S. Gout. In: Nasonov E.L. (ed.) Rheumatology. Russian clinical guidelines. Moscow: GEOTAR-Media; 2017, pp. 253–264. (In Russ.).

9. Shupina M.I., Nechaeva G.I., Loginova E.N. Modern Possibilities of Gout Therapy. Lechaschi Vrach Journal. 2017;10:81–86. (In Russ.) Available at: https://www.lvrach.ru/2017/10/15436819.

10. Dalbeth N., Jones G., Terkeltaub R., Khanna D., Kopicko J., Bhakta N. et al. Lesinurad, A Novel Selective Uric Acid Reabsorption Inhibitor, in Combination with Febuxostat, in Patients with Tophaceous Gout. Arthritis Rheumatol. 2017;69(9):1903–1913. https://doi.org/10.1002/art.40159.