Meditsinskiy sovet = Medical Council | 2021
Modern facilities of pharmacological correction of hyperuricemia in rheumatic diseases: management of difficult clinical cases
Abstract
The\xa0article presents clinical cases of\xa0management of\xa0patients with low compliance with treatment, suffering from rheumatic diseases and disorders of\xa0purine metabolism.Cases report 1. The\xa0first patient with advanced gout, after taking 100\xa0mg of\xa0allopurinol, developed undesirable effects: sore throat, change in\xa0voice, cough, and therefore treatment was discontinued. After six months without therapy, the\xa0condition worsened and, in\xa0self-medication, the\xa0patient resumed taking allopurinol at a\xa0dose of\xa0300\xa0mg per day, which, as expected, resulted in\xa0a\xa0resumption of\xa0the\xa0allergic reaction and a\xa0serious exacerbation of\xa0gouty arthritis. In\xa0order to stop continuous relapses of\xa0arthritis, it became necessary to prescribe glucocorticoids. After stabilization of\xa0the\xa0state, constant administration of\xa0febucostat 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.\xa0