Мультиморбідний пацієнт із ранньою подагрою: ефективність і безпека урат-знижувальної терапії

Patients with gout and hyperuricemia (GU) have a higher frequency of comorbid diseases compared to the age-related population indicator, which may affect the effectiveness and safety of using medical drugs for the treatment of GU. The objective: to analyze the effectiveness and safety of using various urate-lowering therapy (ULT) drugs in the treatment of patients with newly diagnosed gout on the background of concomitant diseases in real medical practice. Materials and methods. The study included 112 patients aged 37 to 62 years, who were first diagnosed with gout with a duration of pain syndrome of up to 3 months. The study was conducted at the Department of Therapy, Family Medicine, Hematology and Transfusiology of the Shupyk National Healthcare University of Ukraine on the basis of the Kyiv Regional Clinical Hospital in 2024. All patients underwent a complex of clinical, laboratory and instrumental examinations, and medical cards were analyzed to identify concomitant diseases. The study participants were divided into two comparable groups of 56 persons each. The patients in the 1st group were prescribed febuxostat, and patients in the 2nd group were prescribed allopurinol. Regardless of the selected ULT drug, all patients were prescribed anti-inflammatory therapy. Results. According to the results of the initial examination and medical documentation, comorbid diseases were detected in all patients, namely: 64.08% persons were diagnosed with arterial hypertension, 63.19% – dyslipidemia, 61.4% –overweight or obesity, 54.29% – metabolic-associated fatty liver disease, 52.51% – osteoarthritis, 36.49% – digestive tract diseases, 18.69% – ischemic heart disease, 15.13% – prediabetes or type 2 diabetes mellitus, and 15.13% – urolithiasis. The average number of identified comorbid pathologies per patient was 4.28 ± 0.14. Analysis of the effectiveness and safety of the use of ULT drugs in the treatment of the studied multimorbid patients over the next 6 months demonstrated the higher effectiveness in patients of the 1st group who took febuxostat with the same level of determined adverse events in both groups. Conclusions. During the study, it was found that patients with early gout have a significant number of concomitant pathological conditions and diseases. The increased levels of hepatic transaminases in the blood serum during treatment in patients of both groups was more often in persons with concomitant metabolic-associated fatty liver disease. Determining the impact of comorbid pathology and its pharmacotherapy on the success of gout treatment and the development of adverse events requires further research.