Prospects for prescription of urate-lowering therapy in patients with asymptomatic hyperuricemia and gout

Gout is a chronic disease characterized by attacks of arthritis, most often of the lower extremities, which develop under conditions of prolonged hyperuricemia caused by environmental and/or genetic factors. In the last decade, there has been an increase in the prevalence of both hyperuricemia and gout, which causes concern not only among rheumatologists, but also among doctors of related specialties. This is due to the fact that uric acid, deposited not only in joints, but also in other organs and tissues, contributes to the development of cardiovascular and metabolic diseases, as well as chronic kidney disease and osteoarthritis. It has been proven that even asymptomatic hyperuricemia, and not just hyperuricemia as a component of clinical gout, contributes to a more severe course of these comorbid pathologies. Probably, the maintenance of a chronic systemic inflammatory process, oxidative stress and the formation of endothelial dysfunction play a decisive role in the nosogenesis of polypathology. Accumulated scientific evidence suggests that achieving target levels of uric acid (less than 360 μmol/L in the case of atophus gout and less than 300 μmol/L in the case of tophi gout) leads to a reduction in the incidence of cerebral, cardiovascular, and renal events. Prescribing urate-lowering drugs to patients with hyperuricemia and at risk for type 2 diabetes mellitus and osteoarthritis also appears promising. Among the urate-lowering drugs registered in the Russian Federation, febuxostat shows the highest efficiency and safety, and also has a nephroprotective effect, which is especially important in patients with a decrease in glomerular filtration rate.

The article examines in detail the effect of febuxostat on various organs and systems in patients with gout and asymptomatic hyperuricemia.

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