METHODS AND RISK FACTORS FOR EXAMINING PATIENTS WITH GOUT

Аннотация

Gout is a crystal-deposition disease that results from chronic elevation of uric acid levels above the saturation point for monosodium urate (MSU) crystal formation. Initial presentation is mainly severely painful episodes of peripheral joint synovitis (acute self-limiting 'attacks') but joint damage and deformity, chronic usage-related pain and subcutaneous tophus deposition can eventually develop. The global burden of gout is substantial and seems to be increasing in many parts of the world over the past 50 years. However, methodological differences impair the comparison of gout epidemiology between countries. In this comprehensive Review, data from epidemiological studies from diverse regions of the world are synthesized to depict the geographic variation in gout prevalence and incidence. Key advances in the understanding of factors associated with increased risk of gout are also summarized. The collected data indicate that the distribution of gout is uneven across the globe, with prevalence being highest in Pacific countries. Developed countries tend to have a higher burden of gout than developing countries, and seem to have increasing prevalence and incidence of the disease. Some ethnic groups are particularly susceptible to gout, supporting the importance of genetic predisposition. Socioeconomic and dietary factors, as well as comorbidities and medications that can influence uric acid levels and/or facilitate MSU crystal formation, are also important in determining the risk of developing clinically evident gout. Keywords: Gender; Gout; Risk factors; Systematic review Independent risk factors for gout. Obesity is one of the main components associated with gout in the long term . Obesity is a well-established risk factor for the Выпуск журнала №-19 Часть–3_ Февраль –2025 15 MODERN EDUCATION AND DEVELOPMENT development of diabetes, dyslipidemia, cardiovascular disease, hypertension, osteoarthritis, and gout. Epidemiological studies have shown that body mass index is independently associated with increased uric acid levels [18, 20]. Many clinical and epidemiological studies have been conducted on the association of hyperuricemia with various cardiovascular diseases. Some authors consider hyperuricemia to be an independent risk factor for the development of cardiovascular disease and an increased risk of mortality in patients . There are many studies in the literature, including epidemiological studies on the combination and interaction of hypertension and hyperuricemia. Increased blood uric acid levels are considered by many authors as a predictor of the development of hypertension. Studies conducted in sufficiently large cohorts of patients have revealed an increased risk of hypertension even in patients with relatively low blood uric acid levels (300-420 μmol/l). Hypertension developing in patients with hyperuricemia and gout can be considered secondary. This is explained by a number of factors: the deposition of uric acid crystals in the interstitial tissues leads to the formation of a giant cell reaction with excessive production of cytokines, followed by fibrosis of the interstitial tissues of the kidneys and the development of tubulointerstitial nephritis. The development of tubulointerstitial kidney damage leads to increased sodium reabsorption in the ascending limb of the loop of Henle and increased sensitivity to natriuretic hormone, leading to water and sodium retention, increased circulating blood volume, total peripheral vascular resistance, activation of the sympathetic division, the nervous system, and ultimately to the development of hypertension. In addition, glomerular hyalinosis and intimal hypertrophy may develop. Another reason for the development of hypertension against the background of hyperuricemia may be a decrease in the response of the renin-angiotensin system to angiotensin II due to a decrease in the sensitivity of angiotensin II receptors in patients . Left ventricular hypertrophy is common in patients with hypertension and hyperuricemia. Increased left ventricular myocardial mass index in patients with hypertension and established myocardial hypertrophy is closely related to uricemia Выпуск журнала №-19 Часть–3_ Февраль –2025 16 MODERN EDUCATION AND DEVELOPMENT [16]. Many studies have shown that the prooxidant effect of SC on lipid oxidation, particularly low-density lipoprotein, is an assessment of oxidative stress in patients with acute myocardial infarction and acute heart failure [3, 14]. The prooxidant effect of SC has also been found to be associated with cardiovascular disease, atherosclerosis, diabetes, lipid peroxidation, and increased endothelial dysfunction products. The effect of SC on endothelial dysfunction is associated with the development of hypertension by the expression of adhesion molecules on the surface of endothelial cells under the influence of the pro-inflammatory cytokines interleukin- 1 (IL-1) and tumor necrosis factor. In these patients, impaired