Difficulties and Mistakes in the Management of the Patient with Gout

S.A. Trypilka, I.Yu. Golovach

Abstract


The issues of the most frequent mistakes and difficulties in the early gout diagnosis and further patient management are discussed in the article. It is known that the diagnosis of gout is made in the first year of the disease only in 1/4 ca­ses, on the average 7–8 years pass until the disease is revealed. Only in one out of 4–5 cases gout is correctly verified in early stages. The reasons of the late diagnostics are the features of the course of gout with periods of absence of a symptom (intermittent gout), diagnostic errors at the first patient encounter, early conduction of X-ray examination without revealing the typical signs of the disease, the lack of joint puncture and verification of uric acid crystals in the synovial fluid. Ano­ther cause of diagnostic errors is the determination of the level of uric acid in the blood serum during acute attack. Late diagnosis of gout leads to a series of further diagnostic and tactical mistakes. First of all, this includes the prescription of non-steroidal anti-inflammatory drugs and glucocorticoids without the correct diagnosis. Current recommendations for the management of patients with gout emphasize that the use of glucocorticoids to treat gout is possible only for short cour­ses, their long-term use is not allowed due to the high risk of side effects in this group of patients, who often have comorbidities. Another tactical error is the prescription of urate-lowering drugs in the period of acute arthritis without dose titration and without prescription of anti-inflammatory therapy. The paper presents a clinical case of the late diagnosis of gout involving inefficient treatment with the long-term use of glucocorticoids and absence of administration of urate-lowering drugs resulting in serious side effects — development of diabetes mellitus and hypertension. A detailed analysis of the clinical errors is conducted; recommendations on the rational tactics in this case are presented.

Keywords


gout; tophaceous gout; diagnostics; mistakes; glucocorticoids; urate-lowering therapy; febuxostat

References


Барскова В.Г., Насонова В.А., Якунина И.А. и др. Ретроспективный анализ причин поздней диагностики подагры // Клиническая геронтология. 2004; 6: 13-17.

Башкова И.Б., Мадянов И.В. Трудности при ведении пациентов с подагрой // РМЖ. 2015; 23(25): 1508-1514.

Головач І.Ю., Чіпко Т.М., Лазоренко О.О. та ін. Випадок діагностики діуретик-індукованої тофусної подагри у жінки у пременопаузальний період // Український ревматологічний журнал. 2011; 3(45): 67-71.

Карнакова М.В. Ошибки в диагностике и лечении по­дагры // Современные проблемы ревматологии. 2013; 5 (5): 39-44.

Михневич Э.А. Ошибки и проблемы назначения аллопуринола пациентам с подагрой // Здравоохранение (Минск). 2014; 3: 27-31.

Федорова А.А., Барскова В.Г., Якунина И.А., Насонова В.А. Кратковременное применение глюкокортикоидов у больных с затяжным и хроническим подагрическим артритом. Часть III: Частота развития нежелательных реакций // Научно-практическая ревматология. 2009; 2: 38-41.

Якунина И.А., Ильиных Е.В., Удельнова И.А. и др. Частота выявления симптома «пробойника» при рентгенологическом исследовании дистальных отделов стоп больных с подагрой: связь с длительностью болезни и течением артрита // Научно-практическая ревматология. 2003; 2: 222-231.

Becker M.A., Schumacher H.R. Jr, Wortmann R.L. et al. Febu­xostat compared with allopurinol in patients with hyperuricemiaand gout // N. Engl. J. Med. 2005; 353: 2450-2461. DOI: 10.1056/NEJMoa050373.

Jacobs J.W., Bijlsma J.W. Gout and diuretics; still an issue // Ned. Tijdschr. Geneeskd. 2007; 151(8): 458-460. PMID: 17378300.

Khanna D., Fitzgerald J.D, Khanna P.P. et al. American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia // Arthritis Care Res. 2012; 64(10): 1431-1446. doi: 10.1002/acr.21772.

Oren B., Rich M., Belle M. Chlorothiazide (Diuril) as a hyperuricacidemic agent // JAMA. 1958; 168: 2128-2129.

Urano W., Yamanaka H., Tsutani H. et al. The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis // J. Rheumatol. 2002; 29: 1950-1953. PMID: 1223389.




DOI: https://doi.org/10.22141/2224-1507.4.24.2016.94625

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