Algorithm for gouty patients management in light of modern guidelines
Yakupova S.P.
Kazan State Medical University
In the past few decades, there has been an increase in the gout incidence rate. Despite the active development of new directions in the diagnosis of this disease, the formulation of this diagnosis is difficult. Perhaps this is due to insufficient equipment in the regions (polarizing microscope, ultrasound diagnosis of joints lesion, dual energy computed tomography) and / or trained specialists. In these cases, it is important to develop clinical criteria with higher sensitivity and specificity indicators that allow diagnosing gout. In 2015, the European Anti-Rheumatic League (EULAR) and the American College of Rheumatology (ACR) have attempted to develop such criteria, and in 2016 various medical communities (American College of Physicians (ACP) and EULAR) have developed strategies for managing such patients in clinical practice. In addition, in 2016 new drugs for the treatment of gout (colchicine, febuksostat) were registered in the Russian Federation. It is important to implement the algorithm of these guidelines in the work of doctors, who treat patients with gout, - rheumatologists, traumatologists, surgeons, therapists, general practitioners. On an example of a real clinical case, the article deals with the algorithm of diagnosis, the strategic directions of treatment of these patients, the principles of drug choice, the role of nimesulide in the therapy of gouty patients.
Key words: gout, gouty arthritis, diagnostic criteria, principles of therapy, nimesulide.
For citation: Yakupova S.P. Algorithm for gouty patients management in light of modern guidelines // RMJ. MEDICAL REVIEW. 2017. № 1. P. 53–56.
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2. Richette P. et al. EULAR evidence-based recommendations for the management of gout // Ann Rheum Dis. 2016. Vol. 0. P. 1–14.
3. Qaseem А., Harris R.P., Forciea М.А. For the Clinical Guidelines Committee of the American College of Physicians. Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians // Ann Intern Med. 2017. Vol. 166(1). P. 58–68.
4. Neogi T., Jansen T., Dalbeth N. et al. Gout classification criteria: an American College of Rheumatology. European League Against Rheumatism collaborative initiative // Ann Rheum Dis. 2015. Vol. 74(10). P. 1789–1798.
5. Барскова В.Г. Нимесулид в терапевтической практике // Consilium Medicum. 2011. № 2. С. 49–54 [Barskova V.G. Nimesulid v terapevticheskoj praktike // Consilium Medicum. 2011. № 2. S. 49–54 (in Russian)].
6. Bianchi M., Broggini M. A randomised, double-blind, clinical trial comparing the efficacy of nimesulide, celecoxib and rofecoxib in osteoarthritis of the knee // Drugs. 2003. Vol. 63(1). P. 37–46.
7. Castelsague J., Pisa F., Rosolen V. et al. Risk of upper gastrointestinal complication in a cohort of users of nimesulide and other nonsteroidal anti-inflammatory drugs in Friuli Venezia Giulia, Italy // Pharmacoepid and Drug Safety. 2012 (Published online in Willey Online Library, doi: 10.1002/pds.3385).
8. Чичасова Н.В., Имаметдинова Г.Р., Насонов Е.Л. Нимесулид в лечении хронических заболеваний суставов // Лечащий врач. 2008. № 4. С. 75–78 [Chichasova N.V., Imametdinova G.R., Nasonov E.L. Nimesulid v lechenii hronicheskih zabolevanij sustavov // Lechashhij vrach. 2008. № 4. S. 75–78 (in Russian)].
9. Venegoni M., Da Cas R., Menniti-Ippolito F. et al. Effects of the European restrictive actions concerning nimesulide prescription: a simulation study on hepatopathies and gastrointestinal bleedings in Italy // Ann I-st Super Sanita. 2010. Vol. 46(2). P. 153–157.
10. Каратеев А.Е., Журавлева М.В. Анализ спонтанных сообщений российских врачей о неблагоприятных реакциях, возникших на фоне приема нимесулида: гепатотоксические осложнения очень редки // Эффективная фармакотерапия. 2015. № 21. С. 4–13 [Karateev A.E., Zhuravleva M.V. Analiz spontannyh soobshhenij rossijskih vrachej o neblagoprijatnyh reakcijah, voznikshih na fone priema nimesulida: gepatotoksicheskie oslozhnenija ochen' redki // Jeffektivnaja farmakoterapija. 2015. № 21. S. 4–13 (in Russian)].
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