Diagnosis and treatment of gout in real clinical practice: The role and place of febuxostat

Introduction. Despite fairly well-developed approaches to the diagnosis and treatment of gout, the situation with timely detection and adequate treatment of this disease remains far from ideal. First of all, this concerns the level of primary care provision.

Aim. To present a clinical description and evaluate the treatment features of patients with gout in primary health care.

Materials and methods. An open, uncontrolled, non-randomized, one-time study included 125 patients (112 of them men) with gout who sought therapeutic admission to a first-level polyclinic during a calendar year. Clinical and anamnestic, physical, basic biochemical data, risk factors for gout, concomitant pathology, and drug therapy were retrospectively evaluated.

Results. Gout was more common in men (89.6%) than in women (10.4%). Moreover, in every 3^rd man (35.7%), the disease debuted before the age of 40. The diagnosis of gout was officially established on average 4 years after the first symptoms of the disease appeared. In almost every 4^th case (24.0%), gout was diagnosed when not only subcutaneous but also intraosseous topuses were already recorded on radiographs. Only 15 patients (12.0%) had the disease verified due to the detection of sodium monaurate crystals in the synovial fluid. Such diseases and conditions as arterial hypertension (72.8%), disorders of fat (63.2%) and carbohydrate (26.4%) metabolism, kidney damage (48.8%), non-alcoholic fatty liver disease (30.4%) were often diagnosed in patients with gout. Urate-lowering therapy was prescribed only to 89 patients (71.2%) with gout, while the target values of uricemia were achieved only in 33.7% of cases. The effectiveness of achieving target uric acid levels when using febuxostat was about 2 times higher than allopurinol (70.6% versus 29.8%, рχ² = 0.004).

Conclusion. Thus, in real clinical practice, there is a delayed diagnosis of gout, insufficient use of available instrumental research methods, pronounced comorbidity of patients, insufficient coverage of patients with urate-lowering therapy and low effectiveness in achieving the target values of uric acid in the blood.

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