GOUT AND HYPERURICEMIA AS ADDITIONAL FACTORS OF DETERIORATION OF CARDIAC AND RENAL PATHOLOGIES

Snigurska I. O., Bozhko V. V., Miloslavsky D. K., Starchenko T. G.

LITERATURE REVIEWS

Scentific article

Currently, purine metabolism disorders (hyperuricemia and gout) are called one of the risk factors for the development of diseases such as coronary heart disease, arterial hypertension, metabolic syndrome, kidney pathology. The article shows the basic principles of treatment of purine metabolism disorders, taking into account diet and drug therapy. Schemes of prescribing the main anti-gout drugs with the recommended doses are given. It is emphasized that the main drugs for the treatment of acute gouty arthritis are colchicine, nonsteroidal anti-inflammatory drugs and glucocorticoids, and in their ineffectiveness – interleukin-1 inhibitors. The basic principles of dietary nutrition of this category of patients are given. Pay attention to a differentiated approach to the treatment of gout/hyperuricemia, taking into account comorbid cardiac and renal pathologies. It has been shown that an important step to improve the effectiveness of the treatment of hyperuricemia/gout in clinical practice is to improve the adherence of patients to the doctor’s recommendations. It is emphasized that xanthine oxidase inhibitors remain first-line drugs for the treatment of purine metabolism disorders. The advantage of these drugs over drugs that affect the excretion of uric acid, due to their antioxidant effect, which is especially important in patients with comorbid cardiac pathology. In case of intolerance to xanthine oxidase inhibitors, uricosuric drugs are indicated. In the hypoexcretory type of gout, the use of combined drugs is possible. Patients with severe gout in whom the target serum uric acid level cannot be achieved with any of the other available drugs at the maximum dose are shown to catalyze the oxidation of uric acid to allantoin. New uricosuretics are promising, which inhibit the reabsorption of uric acid by the kidneys by blocking its vectors. There are studies on the effectiveness of pro-, pre-, and synbiotics in these patients.

hyperuricemia,gout,cardiovascular diseases,drugs that affect uric acid metabolism.

1. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda J, et al. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann. Rheum. Dis. 2020 Jan;79(1):31-38.
2. Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: revalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020 Jul;16(7):380-390. DOI: 10.1038/s41584-020-0441-1.
3. Liu H, Zhang XM, Wang YL, Liu BC. Prevalence of hyperuricemia among Chinese adults: a national cross-sectional survey using multistage, stratified sampling. J Nephrol. 2014;27(6):653-658. DOI: 10.1007/ s40620-014-0082-z.
4. Svintsitskyi AS. Suchasni pohliady na diahnostyku ta likuvannia podahry. Zdorovia Ukrainy. Tematychnyi nomer «Kardiolohiia. Revmatolohiia. Kardiokhirurhiia». 2013;1:70-73. [in Ukrainian].
5. Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007–2016. Arthritis Rheumatol. 2019;71(6):991-999. DOI: 10.1002/art.40807.
6. Kovalenko VM, Shuba NM. Natsionalnyi pidruchnyk z revmatolohii. Kyiv: MORION; 2013. 672 s. [in Ukrainian].
7. Xu L, Shi Y, Zhuang S, Liu N. Recent advances on uric acid transporters. Oncotarget. 2017;8(59):100852-100862. DOI: 10.18632/oncotarget.20135.
8. Guan S, Tang Z, Fang X, Wu X, Liu H, Wang C, et al. Prevalence of hyperuricemia among Beijing post-menopausal women in 10 years. Arch Gerontol Geriatr. 2016;64:162-166. DOI: 10.1016/ j. archger.2016.02.002.
9. Kondratiuk VI, Tarasenko OM. Hiperurykemiia ta podahra: suchasnyi stan problem. Ukrainskyi revmatolohichnyi zhurnal. 2016;65(3):30- 37. [in Ukrainian].
10. Lin KC, Lin HY, Chou P. The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. J Rheumatol. 2000;27(6):1501-1505. Available from: https://pubmed.ncbi.nlm.nih.gov/10852278.
11. Dalbeth N, House ME, Aati O, Paul Tan P, Franklin C, Horne A, et al. Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis. 2015;74(5):908-911. DOI: 10.1136/ annrheumdis-2014-206397.
12. Kim S, Chang Y, Yun KE, Lee S-J, Shin H, Ryu S. Development of Nephrolithiasis in Asymptomatic Hyperuricemia: A Cohort Study. Am J Kidney Dis. 2017;70(2):173-181. DOI: 10.1053/j.ajkd.2017.01.053.
13. Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez-Henríquez P, Hernández-Díaz C, Vargas A, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther. 2011;13(1):R4. DOI: 10.1186/ar3223.
14. Estevez-Garcia IO, Gallegos-Nava S, Vera-Perez E, Silveira L, Ventura-Ríos L, Vancini G, et al. Levels of Cytokines and MicroRNAs in Individuals With Asymptomatic Hyperuricemia and Ultrasonographic Findings of Gout: A Bench-to-Bedside Approach. Arthritis Care Res (Hoboken). 2018;70(12):1814-1821. DOI: 10.1002/acr.23549.
15. Grassi D, Desideri G, Di Giacomantonio AV, Di Giosia P, Ferri C. Hyperuricemia and cardiovascular risk. High Blood Press Cardiovasc Prev. 2014;21(4):235-242. DOI: 10.1007/s40292-014-0046-3.
16. Lv Q, Meng XF, He FF, Chen S, Su H, Xiong J, et al. High serum uric acid and increased risk of type 2 diabetes: a systemic review and metaanalysis of prospective cohort studies. PLoS One. 2013;8(2):e56864. DOI: 10.1371/journal.pone.0056864.
17. Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and coronary heart disease: a systematic review and metaanalysis. Arthritis Care Res (Hoboken). 2010;62(2):170-180. DOI: 10.1002/ acr.20065.
18. Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417,734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med. 2009;266(6):558-570. DOI: 10.1111/j.1365- 2796.2009. 02133.x.
19. Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and risk of stroke: a systematic review and meta-analysis. Arthritis Rheum. 2009;61(7):885-892. DOI: 10.1002/art.24612.
20. Stack AG, Hanley A, Casserly LF, Cronin CJ, Abdalla AA, Kiernan TJ, et al. Independent and conjoint associations of gout and hyperuricaemia with total and cardiovascular mortality. QJM. 2013;106(7):647-658. DOI: 10.1093/qjmed/hct083.
21. Vazquez-Mellado J, Garcia CG, Vazquez SG, Medrano G, Ornelas M, Alcocer L, et al. Metabolic syndrome and ischemic heart disease in gout. J Clin Rheumatol. 2004;10(3):105-109. DOI: 10.1097/01. rhu.0000129082. 42094.fc.
22. Di Giovine FS, Malawista SE, Nuki G, Duff GW. Interleukin 1 (IL 1) as a mediator of crystal arthritis. Stimulation of T cell and synovial fibroblast mitogenesis by urate crystal-induced IL 1. J Immunol. 1987;138(10):3213-3218. Available from: .
23. Di Giovine FS, Malawista SE, Thornton E, Duff GW. Urate crystals stimulate production of tumor necrosis factor alpha from human blood monocytes and synovial cells. Cytokine mRNA and protein kinetics, and cellular distribution. J Clin Invest. 1991;87(4):1375-1381. DOI: 10.1172/ JCI115142.
24. Matsukawa A, Yoshimura T, Maeda T, Takahashi T, Ohkawara S, Yoshinaga M. Analysis of the cytokine network among tumor necrosis factor alpha, interleukin-1 beta, interleukin-8, and interleukin-1 receptor antagonist in monosodium urate crystal-induced rabbit arthritis. Lab Invest. 1998;78(5):559-569. Available from: https://pubmed.ncbi.nlm.nih.gov/ 9605181.
25. Fang J, Alderman MH. Serum uric acid and cardiovascular mortality: The NHANES I epidemiologic follow up study, 1971–1992. National Health and Nutrition Examination Survey. JAMA. 2000;283(18):2404-2410. DOI: 10.1001/jama.283.18.2404.
26. Verdecchia P, Schillaci G, Reboldi G, Santeusanio F, Porcellati C, Brunetti P. Relation between serum uric acid and risk of cardiovascular disease in essential hypertension. The PUIMA study. Hypertension. 2000;36(6):1072-1078. DOI: 10.1161/01.hyp.36.6.1072.
27. Bickel C, Rupprecht HJ, Blankenberg S, Rippin G, Hafner G, Daunhauer A, et al. Serum uric acid as an independent predictor of mortality in patients with angiographically proven coronary artery disease. Am J Cardiol. 2002;89(1):12-17. DOI: 10.1016/s0002-9149(01)02155-5.
28. Lehto S, Niskanen L, Ronnemaa T, Laakso M. Serum uric acid is a strong predictor of stroke in patients with non-insulin-independent diabetes mellitus. Stroke. 1998;29(3):635-639. DOI: 10.1161/01.str.29.3.635.
29. Dahlof B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet. 2002;359(9311):995-1003. DOI: 10.1016/S0140- 6736(02)08089-3.
30. Hoieggen A, Alderman MH, Kjeldsen SE, Julius S, Devereux RB, de Faire U, et al. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney Int. 2004;65(3):1041-1049. DOI: 10.1111/j.1523-1755.2004.00484. x.
31. Sanchez-Lozada LG, Tapia E, Avila-Casado C, Soto V, Franco M, Santamaría J, et al. Mild hyperuricemia induces glomerular hypertension in normal rats. Am J Physiol Renal Physiol. 2002;283(5):F1105-F1110. DOI: 10.1152/ajprenal.00170.2002.
32. Mazzali M, Kanellis J, Han L, Feng L, Xia Y-Y, Chen Q, et al. Hyperuricemia induces a primary arteriolopathy in rats by a blood pressureindependent mechanism. Am J Physiol Renal Physiol. 2002;282(6):F991-F997. DOI: 10.1152/ajprenal.00283.2001.
33. Waring WS, Webb DJ, Maxwell S. Effect of local hyperucemia on endothelial function in the human forearm vascular bed. Br J Clin Pharmacol. 2000;49:511. Available from: https://www.researchgate.net/publication/ 236883919.
34. Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis J, Watanabe S, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension. 2003;41(6):1183-1190. DOI: 10.1161/01.HYP. 0000069700.62727.C5.
35. Baker JF, Krishnan E, Chen L, Schumacher HR. Serum uric acid and cardiovascular disease: recent developments, and where do they leave us? Am J Med. 2005;118(8):816-826. DOI: 10.1016/j.amjmed.2005.03.043.
36. Torres-Jiménez R, Puig JG. Gout & Other Crystal Arthropathies. USA: Saunders; 2012. Chapter 3, Purine Metabolism in the Pathogenesis of Hyperuricemia and Inborn Errors of Purine Metabolism Associated With Disease; p. 36-50.
37. Brucato A, Cianci F, Carnovale C. Management of hyperuricemia in asymptomatic patients: A critical appraisal. Eur J Intern Med. 2020;74:8- 17. DOI: 10.1016/j.ejim.2020.01.001.
38. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75(6):1334-1357. DOI: 10.1161/ HYPERTENSIONAHA.120.15026.
39. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. DOI: 10.1093/eurheartj/ehy339.
40. Borghi C, Tykarski A, Widecka K, Filipiak KJ, Domienik-Karłowicz J, Kostka-Jeziorny K, et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk. Cardiol J. 2018;25(5):545-563. DOI: 10.5603/CJ.2018.0116.
41. Berzin OV, Kondratiuk VI. Kardiovaskuliarni zakhvoriuvannia pry podahri. Ukrainskyi naukovo-medychnyi molodizhnyi zhurnal. 2018;3- 4(108):66-68. [in Ukrainian].
42. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29-42. DOI: 10.1136/annrheumdis-2016-209707.
43. Richette P, Doherty M, Pascual E. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis. 2020;79(1):31-38. DOI: 10.1136/annrheumdis-2019-215315.
44. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. DOI: 10.1002/acr.24180.
45. Jutkowitz E, Choi HK, Pizzi LT, Kuntz KM. Cost-Effectiveness of Allopurinol and Febuxostat for the Management of Gout. Ann Intern Med. 2014;161(9):617-626. DOI: 10.7326/M14-0227.
46. Schumacher HRJr, Becker MA, Wortmann RL, Macdonald PA, Hunt B, Streit J, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum. 2008;59(11):1540-1548. DOI: 10.1002/art.24209.
47. Sivera F, Andres M, Carmona L, Kydd ASR, Moi J, Seth R, et al. Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative. Ann Rheum Dis. 2014;73(2):328-335. DOI: 10.1136/annrheumdis-2013-203325.
48. Higgins P, Dawson J, Lees KR, McArthur K, Quinn TJ, Walters MR. Xanthine oxidase inhibition for the treatment of cardiovascular disease: a systematic review and meta-analysis. Cardiovasc Ther. 2012;30(4):217-226. DOI: 10.1111/j.1755-5922.2011.00277.x.
49. Kanji T, Gandhi M, Clase CM, Yang R. Urate lowering therapy to improve renal outcomes in patients with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol. 2015;16:58. DOI: 10.1186/s12882-015-0047-z.
50. Nomura J, Busso N, Ives A, Matsui C, Tsujimoto S, Shirakura T, et al. Xanthine oxidase inhibition by febuxostat attenuates experimental atherosclerosis in mice. Sci Rep. 2014;4:4554. DOI: 10.1038/srep04554.
51. White WB, Saag KG, Becker MA, Borer JS, Gorelick PB, Whelton A, et al. Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout. N Engl J Med. 2018;378(13):1200-1210. DOI: 10.1056/NEJMoa1710895.
52. Deeks ED. Lesinurad: A Review in Hyperuricaemia of Gout. Affiliations expand. Drugs Agin. 2017 May;34(5):401-410. DOI: 10.1007/ s40266-017-0461-y.

«Bulletin of problems biology and medicine» Issue 3 (166), 2022 year, 87-99 pages, index UDK 616.72-002.78-06:616.1:616.61

10.29254/2077-4214-2022-3-166-87-99