References

mrj

Современная ревматология

Modern Rheumatology Journal

1996-70122310-158X

IMA-PRESS, LLC

10.14412/1996-7012-2021-2-83-88

mrj-1127

Research Article

КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ

CLINICAL GUIDELINES

Комментарии к обновленным рекомендациям Американской коллегии ревматологов по лечению подагры. Образ жизни (часть 2)

Comments on the updated recommendations of the American College of Rheumatology (ACR) for the treatment of gout. Lifestyle (part 2)

https://orcid.org/0000-0003-1191-5831

Елисеев

М. С.

Eliseev

M. S.

Максим Сергеевич Елисеев

115522, Москва, Каширское шоссе, 34А

Maxim Sergeevich Eliseev

34A, Kashirskoe Shosse, Moscow 115522

elicmax@rambler.ru

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation

2021

23042021

1528388

2021

Елисеев М.С.

Eliseev M.S.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://mrj.ima-press.net/mrj/article/view/1127

В статье обсуждаются обновленные рекомендации ACR по лечению подагры, касающиеся образа жизни. Факторы, относящиеся к образу жизни, прежде всего особенности питания, в течение многих лет сохраняли ведущее значение в лечении больных подагрой, даже после появления действенных лекарственных средств. Авторы обновленных рекомендаций АСR впервые предложили пересмотреть роль факторов внешней среды в генезе подагры и объективно оценить возможности ее немедикаментозного лечения. С одной стороны, независимо от активности заболевания, подтверждается необходимость ограничения употребления алкоголя, пуринсодержащих продуктов, фруктозосодержащих напитков, а также снижения массы тела при ожирении и признается нецелесообразным применение витамина С. С другой стороны, эти рекомендации носят условный характер. Их новая версия значительно отличается как от предыдущей, так и от других международных и национальных рекомендаций, включая рекомендации по диагностике и лечению подагры, используемые в Российской Федерации.

Updated ACR recommendations for the treatment of gout concerning lifestyle are discussed. Factors related to a lifestyle, above all food habits, for many years were of leading importance in the treatment of patients with gout, even after application of effective drugs. The authors of the updated ACR recommendations for the first time offered to reconsider the role of environmental factors in the genesis of gout and objectively assess the possibility of its non-drug treatment. On the one hand, regardless of the activity of the disease, the need for restrictions of the alcohol, purine-rich products and fructose-containing beverages, as well as the decrease of body weight in obese patients and vitamin C usage unviability are confirmed. On the other hand, these recommendations are conditional. Their new version of ACR recommendations is significantly different from both its previous version and other international and national recommendations, including recommendations on the diagnosis and treatment of gout used in the Russian Federation.

подаграгиперурикемиямочевая кислотадиетаалкоголь

gouthyperuricemiauric aciddietalcohol

References1

Sivera F, Andres M, Carmona L, et al. Multinational evidence based ecommendations 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 Feb;73(2):328-35. doi: 10.1136/annrheumdis-2013-203325. Epub 2013 Jul 18.

Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012 Oct;64(10):1431-46. doi: 10.1002/acr.21772.

Hui M, Carr A, Cameron S, et al. The British Society for Rheumatology Guideline for the Management of Gout. Rheumatology (Oxford). 2017 Jul 1;56(7): 1246. doi: 10.1093/rheumatology/kex250.

Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017 Jan;76(1):29-42. doi: 10.1136/annrheumdis-2016-209707. Epub 2016 Jul 25.

Владимиров СА, Елисеев МС, Ильиных ЕВ и др. Подагра. Клинические рекомендации. http://cr.rosminzdrav.ru/#!/recomend/174.

Vladimirov SA, Eliseev MS, Il'inykh EV, et al. Gout. Clinical guidelines. http://cr.rosminzdrav.ru/#!/recomend/174.

FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020 Jun; 72(6):744-60. doi: 10.1002/acr.24180. Epub 2020 May 11.

Major TJ, Topless RK, Dalbeth N, Merriman TR. Evaluation of the diet wide contribution to serum urate levels: metaanalysis of population-based cohorts. BMJ. 2018 Oct 10;363:k3951. doi: 10.1136/bmj.k3951.

McCormick N, Rai SK, Lu N, et al. Estimation of Primary Prevention of Gout in Men Through Modification of Obesity and Other Key Lifestyle Factors. JAMA Netw Open. 2020 Nov 2;3(11):e2027421. doi: 10.1001/jamanetworkopen.2020.27421.

Yang HJ, Liu M, Kim MJ, Park S. The haplotype of SLC2A9_rs3733591, PKD2_rs2725220 and ABCG2_rs2231142 increases the hyperuricaemia risk and alcohol, chicken and processed meat intakes and smoking interact with its risk. Int J Food Sci Nutr. 2020 Aug 17;1-11. doi: 10.1080/09637486.2020.1807474. Online ahead of print.

Ralston SH, Capell HA, Sturrock RD. Alcohol and response to treatment of gout. Br Med J (Clin Res Ed). 1988 Jun 11;296(6637):1641-2. doi: 10.1136/bmj.296.6637.1641-a.

Gibson T, Kilbourn K, Horner I, Simmonds HA. Mechanism and treatment of hypertriglyceridaemia in gout. Ann Rheum Dis. 1979 Feb;38(1):31-5. doi: 10.1136/ard.38.1.31.

Барскова ВГ, Елисеев МС, Насонова ВА, Насонов ЕЛ. Алкоголь и клиническая картина у больных подагрой. Современная ревматология. 2007;1(1):37-42. doi:10.14412/1996-7012-2007-437

Barskova VG, Eliseev MS, Nasonova VA, Nasonov EL. Alcohol and the clinical picture of gout. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2007;1(1): 37-42. (In Russ.). doi:10.14412/1996-7012-2007-437

Neogi T, Chen C, Niu J, et al. Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. Am J Med. 2014 Apr;127(4):311-8. doi: 10.1016/j.amjmed.2013.12.019. Epub 2014 Jan 17.

Choi HK, Atkinson K, Karlson EW, et al. Alcohol intake and risk of incident gout in men: a prospective study. Lancet. 2004 Apr 17;363(9417):1277-81. doi: 10.1016/S0140-6736(04)16000-5.

Zhang Y, Chen C, Choi H, et al. Purinerich foods intake and recurrent gout attacks. Ann Rheum Dis. 2012 Sep;71(9):1448-53. doi: 10.1136/annrheumdis-2011-201215. Epub 2012 May 30.

Holland R, McGill NW. Comprehensive dietary education in treated gout patients does not further improve serum urate. Intern Med J. 2015 Feb;45(2):189-94. doi: 10.1111/imj.12661.

Flynn TJ, Cadzow M, Dalbeth N, et al. Positive association of tomato consumption with serum urate: support for tomato consumption as an anecdotal trigger of gout flares. BMC Musculoskelet Disord. 2015 Aug 19;16:196. doi: 10.1186/s12891-015-0661-8.

Ellmann H, Bayat S, Araujo E, et al. Effects of Conventional Uric AcidLowering Therapy on Monosodium Urate Crystal Deposits. Arthritis Rheumatol. 2020 Jan;72(1): 150-6. doi: 10.1002/art.41063. Epub 2019 Dec 10.

Stirpe F, Della Corte E, Bonetti E, et al. Fructose-induced hyperuricaemia. Lancet. 1970 Dec 19;2(7686):1310-1. doi: 10.1016/s0140-6736(70)92269-5.

Choi JW, Ford ES, Gao X, Choi HK. Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2008 Jan 15;59(1):109-16. doi: 10.1002/art.23245.

Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010 Nov 24;304(20):2270-8. doi: 10.1001/jama.2010.1638. Epub 2010 Nov 10.

Желябина ОВ, Елисеев МС. Диета при подагре и гиперурикемии. Научно-практическая ревматология. 2017;55(4):436-45.

Zhelyabina OV, Eliseev MS. Diet for gout and hyperuricemia. Nauchno-prakticheskaya revmatologiya. 2017;55(4):436-45. (In Russ.).

Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008 Feb 9;336(7639):309-12. doi: 10.1136/bmj.39449.819271.BE. Epub 2008 Jan 31.

Nguyen UD, Zhang Y, Louie-Gao Q, et al. Obesity Paradox in Recurrent Attacks of Gout in Observational Studies: Clarification and Remedy. Arthritis Care Res (Hoboken). 2017 Apr;69(4):561-6. doi: 10.1002/acr.22954.

Dessein PH, Shipton EA, Stanwix AE, et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis. 2000 Jul;59(7):539-43. doi: 10.1136/ard.59.7.539.

Dalbeth N, Chen P, White M, et al. Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study. Ann Rheum Dis. 2014 May;73(5):797-802. doi: 10.1136/annrheumdis-2013-203970. Epub 2013 Nov 19.

Stamp LK, O'Donnell JL, Frampton C, et al. Clinically insignificant effect of supplemental vitamin C on serum urate in patients with gout: a pilot randomized controlled trial. Arthritis Rheum. 2013 Jun;65(6):1636-42. doi: 10.1002/art.37925.

Juraschek SP, Miller ER III, Gelber AC. Effect of oral vitamin C supplementation on serum uric acid: a meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken). 2011 Sep;63(9):1295-306. doi: 10.1002/acr.20519.

Stein HB, Hasan A, Fox IH. Ascorbic acid-induced uricosuria. A consequency of megavitamin therapy. Ann Intern Med. 1976 Apr;84(4):385-8. doi: 10.7326/0003-4819-84-4-385.

Huang HY, Appel LJ, Choi MJ, et al. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum. 2005 Jun;52(6):1843-7. doi: 10.1002/art.21105.

Choi HK, Gao X, Curhan G. Vitamin C intake and the risk of gout in men: a prospective study. Arch Intern Med. 2009 Mar 9; 169(5):502-7. doi: 10.1001/archinternmed.2008.606.

Елисеев МС. Обновленные рекомендации EULAR по лечению подагры. Комментарии к некоторым позициям. Научно-практическая ревматология. 2017; 55(6):600-9.

Eliseev MS. Updated EULAR guidelines for the treatment of gout. Comments on some positions. Nauchno-prakticheskaya revmatologiya. 2017;55(6):600-9. (In Russ.).

Nardin M, Verdoia M, Pergolini P, et al. Novara Atherosclerosis Study Group (NAS). Serum uric acid levels during dual antiplatelet therapy with ticagrelor or clopidogrel: Results from a single-centre study. Nutr Metab Cardiovasc Dis. 2016 Jul;26(7):567-74. doi: 10.1016/j.numecd.2016.03.001. Epub 2016 Mar 15.

Zhang P, Wang H, Chen XH, et al. Effect of low-dose aspirin on serum uric acid levels in Chinese individuals over 60: subanalysis of a multicentre randomized clinical trial. Eur Rev Med Pharmacol Sci. 2020 Mar;24(5): 2719-24. doi: 10.26355/eurrev_202003_20544.

Waldman B, Ansquer JC, Sullivan DR, et al. FIELD investigators. Effect of fenofibrate on uric acid and gout in type 2 diabetes: a post-hoc analysis of the randomised, controlled FIELD study. Lancet Diabetes Endocrinol. 2018 Apr;6(4):310-8. doi: 10.1016/S2213-8587(18)30029-9. Epub 2018 Feb 26.

Pascart T, Latourte A, Flipo RM, et al. 2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy. Joint Bone Spine. 2020 Oct;87(5):395-404. doi: 10.1016/j.jbspin.2020.05.002.

Perez Ruiz F, Richette P, Stack AG, Karra Gurunath R, Garcia de Yebenes MJ, Carmona L. Failure to reach uric acid target of < 0.36 mmol/L in hyperuricaemia of gout is associated with elevated total and cardiovascular mortality. RMD Open. 2019 Oct 13;5(2): e001015. doi: 10.1136/rmdopen-2019-001015.

White WB, Saag KG, Becker MA, et al. Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout. N Engl J Med. 2018 Mar 29;378(13):1200-10. doi: 10.1056/NEJMoa1710895. Epub 2018 Mar 12.

Mackenzie IS, Ford I, Nuki G, et al. FAST Study Group. Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial. Lancet. 2020 Nov 28; 396(10264):1745-57. DOI: 10.1016/S0140-6736(20)32234-0.

Елисеев МС, Барскова ВГ, Денисов ИС. Динамика клинических проявлений подагры у мужчин (данные 7-летнего ретроспективного наблюдения). Терапевтический архив. 2015;87(5):10-5.

Eliseev MS, Barskova VG, Denisov IS. Dynamics of clinical manifestations of gout in men (data from a 7-year retrospective follow-up). Terapevticheskii arkhiv. 2015;87(5): 10-5. (In Russ.).

The authors declare that there are no conflicts of interest present.