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УДК. 577.121:616-002.78
CLINICAL FEATURES OF THE COURSE OF GOUT
K.R. Abdushukurova
Samarkand state medical university, Samarkand, Uzbekistan
ORCID: 0000-0002-9555-8095
Kazimov Sukhrob Bohodirovich
Samarkand State Medical University, Samarkand, Uzbekistan
Abstract
To identify the frequency and nature of clinical and laboratory signs of metabolic
syndrome in patients with gout. 49 male gout patients were examined in the
rheumatology department. Thus, the acute variant of gouty arthritis was noted in
42.9%, prolonged – in 22.4% and chronic – in 34.7% of patients. Tofuses were found
in 26.5% of patients. Very often, the comorbid course of gout and metabolic syndrome
is due to a hereditary predisposition, the methods of prevention of which in gout can
be the preservation of motor activity, dietary correction of div weight, as well as
timely basic treatment.
Key words:
gouty arthritis, metabolic syndrome, obesity.
КЛИНИЧЕСКИЕ ОСОБЕННОСТИ ТЕЧЕНИЯ ПОДАГРЫ
К.Р. Абдушукурова
Самаркандский государственный медицинский университет, Самарканд,
Узбекистан
ORCID: 0000-0002-9555-8095
Казимов Сухроб Боходирович
Самаркандский государственный медицинский университет, Самарканд,
Узбекистан
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Аннотация
Выявить частоту и характер клинических и лабораторных признаков
метаболического синдрома у больных подагрой. В ревматологическом
отделении были обследованы 49 больных подагрой мужского пола. Так, острый
вариант подагрического артрита был отмечен у 42,9%, затяжной – у 22,4% и
хронический – у 34,7% пациентов. Тофусы были обнаружены у 26,5% больных.
Очень часто коморбидное течение подагры и метаболического синдрома
обусловлено наследственной предрасположенностью, методами профилактики
которого при подагре могут служить сохранение двигательной активности,
диетическая коррекция массы тела, а также своевременное проведение базисного
лечения.
Ключевые слова:
подагрический артрит, метаболический синдром,
ожирение.
PODAGRA
KASALLIGINING KLINIK KO'RINISHLARI
K.R. Abdushukurova
Samarqand davlat tibbiyot universiteti, Samarqand, O‘zbekiston
ORCID: 0000-0002-9555-8095
Kazimov Suxrob Bohodirovich
Samarkand State Medical University, Samarkand, Uzbekistan
Аnnotatsiya
Podagra bilan og'rigan bemorlarda metabolik sindromning klinik va laboratoriya
belgilarining chastotasi va xarakterini aniqlash. Revmatologiya bo'limida podagra
bilan og'rigan 49 nafar erkak bemor tekshirildi. Shunday qilib, podagra artritining o'tkir
shakli bemorlarning 42,9 foizida, uzoq muddatli - 22,4 foizida va surunkali - 34,7
foizida qayd etilgan. Bemorlarning 26,5 foizida tofi topilgan. Ko'pincha podagra va
metabolik sindromning komorbid kursi irsiy moyillik bilan bog'liq bo'lib, uning oldini
olish usullari gut holatida jismoniy faollikni saqlash, tana vaznini dietani tuzatish,
shuningdek, asosiy davolashni o'z vaqtida amalga oshirishni o'z ichiga olishi mumkin.
Kalit so'zlar:
podagra artriti, metabolik sindrom, semizlik.
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Gout is a systemic disease in which uric acid crystals (urates) are deposited in
various tissues due to a violation of purine metabolism and hyperuricemia. The disease
is also accompanied by the main clinical and laboratory signs of MS, most often
hypercholesterolemia, hypertension, obesity and type 2 diabetes mellitus (DM)
[1,2,5,6]. Disorders of purine, fat and carbohydrate metabolism in gout may be
accompanied by pathological changes in the connective tissue of the joints,
contributing to the development and chronization of the inflammatory process in joints.
However, the peculiarities of changes in clinical, laboratory symptoms and functional
parameters of joints in patients with gout with concomitant metabolic syndrome (MS)
have not been sufficiently studied.
The aim of the study
was to identify the frequency and nature of clinical and
laboratory signs of metabolic syndrome in patients with gout and to assess their
relationship with the age of patients, the duration of the disease, the severity index of
the underlying disease and impaired function of the lower extremities.
Materials and methods of research.
49 male gout patients were examined in the
rheumatology department. The average age of the patients was 50.6±1.6 years, the
duration of the disease was 9.4±1.7 years. The diagnosis of the disease was established
according to criteria developed by S.L. Wallace [6]. The examination included the
determination of anthropometric indicators: div weight, div mass index (BMI),
waist circumference (WC). Blood sampling for the study of the lipid spectrum was
performed after a 14-hour fast. The content of total cholesterol (TCH), lipoprotein
cholesterol and the method of kits from «Vital Diagnosticum», total lipids (TL) from
«Lahema», low density lipoprotein cholesterol were calculated by W. Friedwald et. al.,
very low-density lipoprotein cholesterol according to the formula (TG/5 content).
Statistical processing of the obtained data was carried out using the STATISTICA 6.0
application software package. Simple descriptive statistics and nonparametric
correlation analysis using the Spearman method were used.
The results of the study and their discussion.
At the time of inclusion in the
study, all patients showed signs of arthritis, the variant of which was determined by the
longest duration of the last exacerbation over the past year. Thus, the acute variant of
gouty arthritis (duration of exacerbation no more than 3 weeks) was noted in 42.9%,
prolonged (duration of exacerbation from 3 to 12 weeks) - in 22.4% and chronic
(arthritis lasting more than 3 months) – in 34.7% of patients. Tofuses were found in
26.5% of patients. Lesions of the metatarsophalangeal joint of the big toe were found
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in 51%, foot joints in 28.6%, ankle and knee joints in 24.5% of patients. In 30.6% of
patients, joint damage was monoarticular in nature, in 69.4% – oligoarticular. I degree
of joint functional insufficiency was found in 63.2% of patients, and II degree in 36.7%
of patients. The incidence of urolithiasis in the examined patients was 65.3% (n=32),
while clinical signs, including a history of renal colic, were noted in 10.2% (n=5) of
them.
The div mass index in patients with gouty arthritis ranged from 19 to 38.
According to WHO recommendations, in 14 (28.5%) patients, BMI corresponded to a
normal indicator (18.5-24.9), in 20 (40.8%) – overweight (25-29.9, pre-obesity), in 9
(18.4%) – first degree obesity (30-34.9) and in 6 (12.2%) – obesity of the second degree
(35-40).
To assess the severity of the dysfunction of the lower extremities, an integral
indicator was used, which is calculated as an arithmetic mean of the value of 6 expert
signs - movement, additional support, performing household functions, self-service,
using public transport, performing professional duties. Severity of the dysfunction of
the lower extremities more than 20% is regarded as severe and corresponds to III and
more disability groups (in accordance with the expert estimates). According to the
severity of the dysfunction of the lower extremities in 20 (40.8%) patients, it
corresponded to 0-20%, in 19 (38.8%) patients – 21-40%, in 10 (10.4%) patients - 41-
60%.
Among the patients of gouty arthritis, the main 3 clinical factors of MS (obesity,
hypertension, diabetes mellitus) were diagnosed in 49.0% of patients (the first group):
30.6% - obesity of I and II degrees, 26.5% – hypertension and 12.2% - type 2 diabetes.
In 32.6% of patients, one clinical form of MS was detected, in 12.2% - a combination
of two forms (hypertension and obesity of the II degree - in 8.2%, hypertension and
type 2 diabetes - in 4.1%), in 4.1% – three forms (hypertension, obesity of the II degree
and type 2 diabetes). The second group consisted of patients (25 patients) without
clinical forms of MS.
In gouty arthritis, there was an increase in lipid profile indicators - laboratory
criteria of MS. Thus, in gouty arthritis patients, the total lipid content ranged from 4.8
to 10.6 g/l, the average content was 8.55±0.03 g/l. In 32.7% of patients, the total lipid
level was in the range of 4.8-8.4 g/l (normal level), in 67.3% - above 8.4 mmol/l
(elevated level). In patients of the first group, the level of total lipids (9.60±0.04 g/l)
was 1.28 times higher than in patients of the second group (7.50±0.05 g/l, P<0.02). The
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cholesterol content in gouty arthritis was 5.2-10.2 mmol/l (on average - 7.2±0.05
mmol/l): in 34.7% of patients - 5.2-6.5 mmol/l (borderline level), in 38.8% – 6.6-8.0
mmol/l (elevated level), in 26.5% – above 8.0 mmol/l (high risk of MS).
In patients with the main clinical factors of MS (obesity, hypertension and type 2
diabetes), the average cholesterol content was 8.6±0.7 mmol/l, which was significantly
higher than in patients without clinical manifestations of MS (6.2±0.4 mmol/l, P<0.02).
The degree of increase in total lipids and cholesterol in blood serum had a direct
correlation with the degree of hyperuricemia (r=0.65; r=0.54) and the duration of the
disease (r=0.72; r=0.62).
In gouty arthritis, the low-density lipoprotein cholesterol level averaged
4.40±0.01 mmol/l: in 38.8% of patients – from 1.8 to 3.6 mmol/l (normal level), in
40.0% of patients – from 3.6 to 4.5 mmol/l (elevated level), in 20.0% of patients –
above 4.6 mmol/ll (high level). The average content of very low density lipoprotein
cholesterol is 0.49± 0.01 mmol/l: in 36.7% of patients – from 0.2 to 1.6 mmol/ l (normal
level), in 61.2% of patients – above 1.6 mmol/ l (elevated level). In patients of the first
group, the content of low-density lipoprotein cholesterol (4.80±0.02 mmol/l) and very
low density lipoprotein cholesterol (0.54±0.03 mmol/l) was 1.20 and 1.22 times higher
than in patients of the second group (P1 and P2<0.05).
The gout severity index (SI) was calculated using the following formula: tofuses
(0-no, 1-yes) + number of tofuses /40 + number of affected joints during examination
/28 + number of affected joints for the entire duration of the disease / 28 + number of
exacerbations over the past year /12 + duration of the last exacerbation (in weeks)/52
+ age of the patient (number of full years)/65 + uric acid level (mmol/l)/420 = IT (in
points).
Patients with clinical indicators of MS were older in age (54.6±3.2 and 47.1±2.7
years, P<0.05) and had a greater number of affected joints (4.6±0.2 and 2.5±0.7,
P<0.02). The number of subcutaneous tofuses (37.5 and 16.0%), the incidence of
arthritis over the past year (3.8±0.3 and 2.2±0.1 times, P<0.02), the duration of the last
exacerbation (3.6±0.2 and 1.2±0.1 weeks, P<0.02) and the gout severity index (3.7±0.2
and 2.3±0.2 b, P<0.02) in patients with MS were higher than in patients without MS.
Anamnestic examination of patients with hypercholesterolemia and concomitant
clinical factors of MS most often revealed a hereditary predisposition (the presence of
gout, hypertension, coronary heart disease, DM in parents), frequent errors in nutrition
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and the absence of basic (allopurinol, uricosuric drugs) treatment of the underlying
disease.
Conclusions.
As
is
known,
hyperlipidemia,
hypercholesterolemia,
hypertriglyceridemia, abdominal obesity, impaired glucose tolerance and insulin
resistance combined with arterial hypertension (AH) constitute a metabolic syndrome
[3,4,7,8,9]. Gout, a disease caused by impaired purine metabolism and hyperuricemia
in 49.0% of patients, is accompanied by the main clinical forms of MS. Very often, the
comorbid course of gout and MS is due to a hereditary predisposition. The inclusion of
hyperuricemia among the factors of MS and the presence of a direct correlation
between clinical and laboratory indicators of gout and MS determines the inclusion of
gout in the clinical criteria of MS. It can be assumed that the methods of preventing
MS in gout can be the preservation of motor activity, dietary correction of div weight
by reducing the calorie content of food and reducing its volume, as well as timely basic
treatment.
List of literature:
1. Barskova V.G., Eliseev M.S., Chikalenkova N.A. The main factors of sexual gout
diformism (estrogens and diuretics compared with alcohol and genetics). // Ter.
archive. - 2021. - No. 5. - pp.57-61
2. Barskova V.G., Nasonova V.A., Yakushin I.A. On the severity of the course of
female gout. // Ter.arch. - 2015. - No. 5. - pp.58-62.
3. Barskova V.G., Nasonova V.A., Kogan K.M., Zolotareva G.D., Kudaeva F.M.
Gout diagnosis and treatment. Methodological recommendations // Moscow: Intel
Tech. - 2016. - 22 p.
4. Fursov A.N., Chernavsky S.V., Potekhin N.P., etc. The evolution of metabolic
syndrome: from polymetabolic disorders to the formation of nosological forms of
diseases. // Klin. med. - 2012. - No.2. - pp.70-73
5. Gurgenyan S.V., Vatinyan S.H., Zelveyan P.A. Metabolic syndrome and
coronary heart disease. // Ter. archive. - 2014. - No. 3. - pp.106-109
6. Khurs E.M., Andreev P.V., Poddubnaya A.V., etc. Vegetative imbalance in the
pathogenesis of metabolic syndrome. // Klin. med. - 2010. - No.6. - pp. 39-42
7. Markova T.N., Kichigin V.A., Madyanov I.V. and others. Hormonal aspects of
the formation of obesity and metabolic syndrome in ethnic groups (using the example
of the population of the Chuvash Republic). // Ter. archive. - 2014. - No.5. - pp.73-77
МЕДИЦИНА, ПЕДАГОГИКА И ТЕХНОЛОГИЯ:
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8. Rheumatology: national guidelines. Edited by E.L. Nasonov, V.A. Nasonova. //
M.: GEOTAR-Media. - 2010. - 720 p.
9. Simonenko V.B., Medvedev I.N., Tolmachev V.V. Pathogenetic aspects of
arterial hypertension in metabolic syndrome. // Klin. med. - 2017. - No.1. - pp.49-50
10. Rustamovna A. K., Maksudovna A. G. EFFECT OF COVID-19 INFECTION
ON CARDIOVASCULAR DISEASE //World Bulletin of Public Health. – 2024. – Т.
34. – С. 33-37.
11. ABDUSHUKUROVA K. R. REVMATOID ARTRIT KASALLIGINI
DAVOLAS SAMARADORLIGINI BAHOLASH //Центральноазиатский журнал
междисциплинарных исследований и исследований в области управления. –
2024. – Т. 1. – №. 8. – С. 189-193.
12. Абдушукурова К. Р., Хамраева Н. А. Особенности Лечения
Параклинических Проявлений Ревматоидного Артрита //Central Asian Journal of
Medical and Natural Science. – 2023. – Т. 4. – №. 6. – С. 256-262.
13. Абдушукурова К. Р., Шоимова О. Р. ИММУНОПАТОГЕНЕТИЧЕСКИЕ
ОСНОВЫ РЕВМАТОИДНОГО АРТРИТА: ОБЗОР ЛИТЕРАТУРЫ //Eurasian
Journal of Medical and Natural Sciences. – 2024. – Т. 4. – №. 4-1. – С. 58-70.
14. Ravshanova M. et al. Clinical and Immunological Characteristics of Patients
with Rheumatoid Arthritis on Synthetic DMARDS Therapy //Frontiers of Global
Science. – 2024. – Т. 2. – №. 1. – С. 41-47.
15. Абдушукурова К. ПРИМЕНЕНИЕ АСПИРИНА У БОЛЬНЫХ
РЕВМАТОИДНЫМ АРТРИТОМ В СОЧЕТАНИИ С ИШЕМИЧЕСКОЙ
БОЛЕЗНЬЮ СЕРДЦА //Журнал кардиореспираторных исследований. – 2020. –
Т. 1. – №. 3. – С. 49-51.
16. Rustamovna A. K., Amrillayevich A. I. ИММУНОПАТОГЕНЕТИЧЕСКИЕ
ОСНОВЫ РЕВМАТОИДНОГО АРТРИТА: ОБЗОР ЛИТЕРАТУРЫ //JOURNAL
OF BIOMEDICINE AND PRACTICE. – 2024. – Т. 9. – №. 2.
17. Абдушукурова К. Р., Нусратова Ш. Ф. ГЕРИАТРИЧЕСКИЕ
ОСОБЕННОСТИ РЕВМАТОИДНОГО АРТРИТА //Eurasian Journal of Medical
and Natural Sciences. – 2024. – Т. 4. – №. 4-1. – С. 156-163.
18. Абдушукурова К. Р., Хамраева Н. А. РЕВМАТОИД АРТРИТ
КАСАЛЛИГИДА
АРТЕРИАЛ
ГИПЕРТЕНЗИЯ
ФЕНОТИПЛАРИНИНГ
СУТКАЛИК БУЗИЛИШЛАРИ //" XALQ TABOBATI VA ZAMONAVIY
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TIBBIYOT, YANGI YONDASHUVLAR VA DOLZARB TADQIQOTLAR”. –
2023. – Т. 7. – С. 34-38.
19. Nurmamadovna I. N., Abdurasulovna A. K. Features Antihypertensive Therapy
Obesity //The American Journal of Medical Sciences and Pharmaceutical Research. –
2020. – Т. 2. – №. 11. – С. 28-31.
