DIFFERENTIATED APPROACH TO URATE-LOWERING THERAPY OF GOUT DEPENDING ON AGE, SEX AND COMORBIDITIES
Summary. Objectives. Gout is a major social and economic problem for society, accompanied by pain, difficulty in performing normal, daily activities — and impairs the quality of life of patients. A large number of studies conducted around the world have shown that gout and hyperuricemia are independent predictors of a high risk of comorbidities. Hyperuricemia is associated with all components of the metabolic syndrome, such as disorders of lipid metabolism, high body mass index, hypertension, impaired glucose metabolism. On the other hand, in addition to high levels of uric acid, gout is characterized by chronic inflammation, the combined effect of these factors has a pathological effect on the vessels and is an additional risk factor for atherosclerosis and associated diseases. Aim. The aim of this article was to review the literature and highlight the current approach to urate-lowering therapy for gout depending on age, sex and comorbidities. Methods. The scientific search in printed and electronic editions, scientific search databases Medline and PubMed using methods of analysis, comparison and generalization of information data is carried out. Relevant articles on the monitoring and treatment of gout and hyperuricemia have been identified and reviewed. Results. The article presents the features of gout depending on age, sex and concomitant pathology. The authors review the current recommendations of the American College of Rheumatology (ACR), the European League Against Rheumatism (EULAR), the British Rheumatology Society (BSR) for the diagnosis and treatment of gout and hyperuricemia. The article discusses the issues of treatment of asymptomatic hyperuricemia, gout depending on age, sex and comorbidities, including the possibility of using xanthine oxidase inhibitor, febuxostat. Conclusions. Gout and hyperuricemia an urgent problem in modern rheumatology, which still has many issues and areas that need further study. Especially, given the ambiguity of the effect of uric acid on the progression and course of comorbidities. The use of febuxostat in patients with gout and hyperuricemia contributes to a significant reduction in the severity of pain, slowing the progression, improving the functional state of the joints and the course of comorbid diseases due to its pleiotropic effects. Further evaluation of the use of urate-lowering therapy in patients of different age groups with comorbidities is required.
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