Features of the clinical course and pathogenesis of gout in women in the presence of poly- and comorbidity (literature review and own research)

Voloshyna L.O. , Dogolic O.I. , Voloshina O.V.

Summary. The aim of the work is to highlight the clinical and pathogenetic features of gout in women, their course in the context of time dependencies of the formation of poly- and comorbidity phenomena, based on the analysis of the literature and own research. Materials and methods. An analysis of available printed and electronic sources from scientific databases and own dynamic observations of 45 cases of gout in women was conducted using methods of comparison, generalization, descriptive and routine statistics. Results. It was established that in addition to the natural onset in the postmenopausal period, gout in women is formed against the background of significant manifestations of polymorbidity. Among polymorbid processes, the dominant phenomena are osteoarthritis, less significant are arterial hypertension, cardiovascular diseases of atherosclerotic genesis, including heart failure, obesity, infrequently — diabetes mellitus and chronic kidney disease. Each of these diseases has its own pathogenesis. With the predominance of osteoarthritis, the articular symptoms of gout are often subtle, so diagnosis is sometimes delayed. The importance of timely determination of serum uric acid levels and glomerular filtration of the kidneys as early markers of hyperuricemia, gout and gouty nephropathy is emphasized. It has been found that from the initial period of gout, its course tends to be torpid with mild gouty attacks, but early (in the next 2–4 years) the appearance of tophi elements. During the following years, a moderate deterioration of the course of all diseases was characteristic, which already indicated their comorbid dependence. This phenomenon was regarded by the authors as a negative effect of hyperuricemia, and the manifestations of gout — as a new comorbid «layering» with the effect of mutual burden on the complex of diseases that arose in the pre-gout period. In the prognostic aspect, the greatest negative impact on the course and results of gout treatment was observed in chronic kidney disease, heart failure and diabetes. With increasing age of patients, duration, ВЛАСНІ СПОСТЕРЕЖЕННЯ 4 8 УКРАЇНСЬКИЙ РЕВМАТОЛОГІЧНИЙ ЖУРНАЛ • № 3 (105) • 2026 severity of gout and comorbid diseases, treatment results worsen, the construction of effective treatment complexes becomes more difficult, and the threat of forced polypharmacy increases. It is necessary to coordinate the treatment process between a rheumatologist, cardiologist, endocrinologist and nephrologist. Conclusions. Gout in women has age-related differences, is formed against the background of a significant duration of polymorbid diseases, which from the moment of gout pathogenetically acquire signs of comorbidity due to the negative impact of hyperuricemia and the effect of mutual aggravation of the course of the entire complex of diseases. Comorbid diseases have different prognostic effects on the course of gout, the most negative — heart failure, chronic kidney disease and diabetes mellitus.