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Дифференциальная диагностика остеоартрита и подагры: основные подходы к терапии
Дифференциальная диагностика остеоартрита и подагры: основные подходы к терапии
Погожева Е.Ю., Амирджанова В.Н., Каратеев А.Е. Дифференциальная диагностика остеоартрита и подагры: основные подходы к терапии. Consilium Medicum. 2018; 20 (12): 122–125. DOI: 10.26442/20751753.2018.12.180108
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Аннотация
В статье представлены дифференциальная диагностика подагры и остеоартрита, особенности клинической картины, данных лабораторного, инструментального обследования. Продемонстрированы алгоритм ведения пациентов с остеоартритом и обновленные рекомендации Европейской лиги против ревматизма (European League Against Rheumatism, EULAR) по лечению подагры. Обсуждаются цели и основные принципы терапии подагры и остеоартрита. Представлены данные об особенностях механизма действия, клинической эффективности и безопасности диацереина (ингибитор интерлейкина-1). Приведены данные клинических исследований препарата фебуксостат (селективный ингибитор ксантиноксидазы), показаны его эффективность в отношении контроля уровня мочевой кислоты, возможность назначения пациентам с хронической почечной недостаточностью, резистентностью к терапии аллопуринолом и аллергическими реакциями на него.
Ключевые слова: остеоартрит, подагра, дифференциальная диагностика, эффективность и безопасность, диацереин, фебуксостат.
Ключевые слова: остеоартрит, подагра, дифференциальная диагностика, эффективность и безопасность, диацереин, фебуксостат.
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The article presents differential diagnosis of osteoarthritis and gout, aspects of clinical presentation, laboratory and instrumental studies results. Algorithm on osteoarthritis management and renewed European League Against Rheumatism (EULAR) guidelines on gout treatment are presented. Aims and main principles of gout and osteoarthritis therapy are discussed. Data on mechanism of action, characteristics, clinical effectiveness and safety of diacerein (interleukine-1 inhibitor) are presented. Results of clinical studies of febuxostat (selective inhibitor of xanthinoxidase) are presented, its effectiveness in uric acid level control, possibilities of use in patients with chronic kidney disease, non-responsive or allergic to allopurinol therapy, are shown.
Key words: osteoarthritis, gout, differential diagnosis, effectiveness and safety, diacerein, febuxostat.
Key words: osteoarthritis, gout, differential diagnosis, effectiveness and safety, diacerein, febuxostat.
Полный текст
Список литературы
1. Ревматология. Клинические рекомендации. Под ред. Е.Л.Насонова. М.: ГЭОТАР-Медиа, 2017; с. 240–65. / Revmatologiia. Klinicheskie rekomendatsii. Pod red. E.L.Nasonova. M.: GEOTAR-Media, 2017; s. 240–65. [in Russian]
2. Насонов Е.Л. Ревматология. Клинические рекомендации. М.: ГЭОТАР, 2005; с. 264. / Nasonov E.L. Revmatologiia. Klinicheskie rekomendatsii. M.: GEOTAR, 2005; s. 264 [in Russian]
3. Jordan KM, Arden NK, Doherty M et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62: 1145–55.
4. Zhang W, Nuki G, Moskowitz RW et al. OARSI recommendations for the management of hip and knee osteoarthritis. Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010; 18: 476–99.
5. Bruyère O, Cooper C, Pelletier J-P et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally. A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars Arthritis Rheum 2014; 44 (3): 253–63.
6. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Остеоартроз. 2016. IDКР256. / Ministerstvo zdravookhraneniia Rossiiskoi Federatsii. Klinicheskie rekomendatsii. Osteoartroz. 2016. IDKR256. [in Russian]
7. Pelletier J, Yaron M, Haraoui B et al. Efficacy and safety of diacerein in osteoarthritis of the knee: a double-blind, placebo-controlled trial. The Diacerein Study Group. Arthritis Rheum 2000; 43 (10): 2339–48.
8. Pavelka K, Trc T, Karpas K et al. The Efficacy and Safety of Diacerein in the Treatment of Painful Osteoarthritis of the Knee. Arthritis Rheum 2007; 56 (12): 4055–64.
9. Louthrenoo W, Nilganuwong S, Aksaranugraha S et al. The efficacy, safety and carry-over effect of diacerein in the treatment of painful knee osteoarthritis: a randomised, double-blind, NSAID-controlled study. Osteoarthritis Cartilage 2007; 15 (6): 605–14.
10. Zheng W, Tang F, Li J et al. Evaluation of efficacy and safety of diacerein in knee osteoarthritis in Chinese patients. Chin Med Sci J 2006; 21 (2): 75–80.
11. Sharma A, Rathod R, Baliga VP. An open prospective study on postmarketing evaluation of the efficacy and tolerability of diacerein in osteoarthritis of the knee (DOK). J Indian Med Assoc 2008; 106 (1): 54–6, 58.
12. Dougados M, Nguyen M, Berdah L et al. ECHODIAH Investigators Study Group. Evaluation of the structure-modifying effects of diacerein in hip osteoarthritis: ECHODIAH, a three-year, placebo-controlled trial. Evaluation of the chondromodulating effect of diacerein in oa of the hip. Arthritis Rheum 2001; 44 (11): 2539–47.
13. Assessment report for diacerein containing medicinal products. 28 August 2014 EMA/527347/2014.
14. Richette P, Doherty M, Pascual E et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76: 29–42.
15. Shibagaki Y, Ohno I, Hosoya T, Kimura K. Safety, efficacy and renal effect of febuxostat in patients with moderate-to-severe kidney dysfunction. Hypertens Res 2014; 37 (10): 919–25.
16. Whelton A, MacDonald PA, Chefo S, Gunawardhana L. Preservation of renal function during gout treatment with febuxostat: a quantitative study. Postgrad Med 2013; 125 (1): 106–14.
17. Becker MA, Schumacher HR, Wortmann RL et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005; 353 (23): 2450–61.
18. Schumacher HR, Becker MA, Wortmann RL 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): 1540–8.
19. Wortmann RL, Becker MA, Schumacher HR et al. Effect of febuxostat or allopurinol on the clinical manifestations of gout: reduction in gout flares and tophus size over time in the EXCEL trial. ACR/ARHP Annual Scientific Meeting, 2006.
20. Becker MA, Schumacher HR, Espinoza LR et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 2010; 12 (2): R63.
21. Schumacher HR, Becker MA, Wortmann RL et al. The FOCUS trial 48-month interim analysis: long-term clinical outcomes of treatment with febuxostat in subjects with gout in an ongoing phase 2, openlabel extension study [abstract no. OP0130]. Ann Rheum Dis 2006; 65 (Suppl. II): 93.
2. Nasonov E.L. Revmatologiia. Klinicheskie rekomendatsii. M.: GEOTAR, 2005; s. 264 [in Russian]
3. Jordan KM, Arden NK, Doherty M et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62: 1145–55.
4. Zhang W, Nuki G, Moskowitz RW et al. OARSI recommendations for the management of hip and knee osteoarthritis. Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010; 18: 476–99.
5. Bruyère O, Cooper C, Pelletier J-P et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally. A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars Arthritis Rheum 2014; 44 (3): 253–63.
6. Ministerstvo zdravookhraneniia Rossiiskoi Federatsii. Klinicheskie rekomendatsii. Osteoartroz. 2016. IDKR256. [in Russian]
7. Pelletier J, Yaron M, Haraoui B et al. Efficacy and safety of diacerein in osteoarthritis of the knee: a double-blind, placebo-controlled trial. The Diacerein Study Group. Arthritis Rheum 2000; 43 (10): 2339–48.
8. Pavelka K, Trc T, Karpas K et al. The Efficacy and Safety of Diacerein in the Treatment of Painful Osteoarthritis of the Knee. Arthritis Rheum 2007; 56 (12): 4055–64.
9. Louthrenoo W, Nilganuwong S, Aksaranugraha S et al. The efficacy, safety and carry-over effect of diacerein in the treatment of painful knee osteoarthritis: a randomised, double-blind, NSAID-controlled study. Osteoarthritis Cartilage 2007; 15 (6): 605–14.
10. Zheng W, Tang F, Li J et al. Evaluation of efficacy and safety of diacerein in knee osteoarthritis in Chinese patients. Chin Med Sci J 2006; 21 (2): 75–80.
11. Sharma A, Rathod R, Baliga VP. An open prospective study on postmarketing evaluation of the efficacy and tolerability of diacerein in osteoarthritis of the knee (DOK). J Indian Med Assoc 2008; 106 (1): 54–6, 58.
12. Dougados M, Nguyen M, Berdah L et al. ECHODIAH Investigators Study Group. Evaluation of the structure-modifying effects of diacerein in hip osteoarthritis: ECHODIAH, a three-year, placebo-controlled trial. Evaluation of the chondromodulating effect of diacerein in oa of the hip. Arthritis Rheum 2001; 44 (11): 2539–47.
13. Assessment report for diacerein containing medicinal products. 28 August 2014 EMA/527347/2014.
14. Richette P, Doherty M, Pascual E et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76: 29–42.
15. Shibagaki Y, Ohno I, Hosoya T, Kimura K. Safety, efficacy and renal effect of febuxostat in patients with moderate-to-severe kidney dysfunction. Hypertens Res 2014; 37 (10): 919–25.
16. Whelton A, MacDonald PA, Chefo S, Gunawardhana L. Preservation of renal function during gout treatment with febuxostat: a quantitative study. Postgrad Med 2013; 125 (1): 106–14.
17. Becker MA, Schumacher HR, Wortmann RL et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005; 353 (23): 2450–61.
18. Schumacher HR, Becker MA, Wortmann RL 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): 1540–8.
19. Wortmann RL, Becker MA, Schumacher HR et al. Effect of febuxostat or allopurinol on the clinical manifestations of gout: reduction in gout flares and tophus size over time in the EXCEL trial. ACR/ARHP Annual Scientific Meeting, 2006.
20. Becker MA, Schumacher HR, Espinoza LR et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 2010; 12 (2): R63.
21. Schumacher HR, Becker MA, Wortmann RL et al. The FOCUS trial 48-month interim analysis: long-term clinical outcomes of treatment with febuxostat in subjects with gout in an ongoing phase 2, openlabel extension study [abstract no. OP0130]. Ann Rheum Dis 2006; 65 (Suppl. II): 93.
2. Насонов Е.Л. Ревматология. Клинические рекомендации. М.: ГЭОТАР, 2005; с. 264. / Nasonov E.L. Revmatologiia. Klinicheskie rekomendatsii. M.: GEOTAR, 2005; s. 264 [in Russian]
3. Jordan KM, Arden NK, Doherty M et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62: 1145–55.
4. Zhang W, Nuki G, Moskowitz RW et al. OARSI recommendations for the management of hip and knee osteoarthritis. Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010; 18: 476–99.
5. Bruyère O, Cooper C, Pelletier J-P et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally. A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars Arthritis Rheum 2014; 44 (3): 253–63.
6. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Остеоартроз. 2016. IDКР256. / Ministerstvo zdravookhraneniia Rossiiskoi Federatsii. Klinicheskie rekomendatsii. Osteoartroz. 2016. IDKR256. [in Russian]
7. Pelletier J, Yaron M, Haraoui B et al. Efficacy and safety of diacerein in osteoarthritis of the knee: a double-blind, placebo-controlled trial. The Diacerein Study Group. Arthritis Rheum 2000; 43 (10): 2339–48.
8. Pavelka K, Trc T, Karpas K et al. The Efficacy and Safety of Diacerein in the Treatment of Painful Osteoarthritis of the Knee. Arthritis Rheum 2007; 56 (12): 4055–64.
9. Louthrenoo W, Nilganuwong S, Aksaranugraha S et al. The efficacy, safety and carry-over effect of diacerein in the treatment of painful knee osteoarthritis: a randomised, double-blind, NSAID-controlled study. Osteoarthritis Cartilage 2007; 15 (6): 605–14.
10. Zheng W, Tang F, Li J et al. Evaluation of efficacy and safety of diacerein in knee osteoarthritis in Chinese patients. Chin Med Sci J 2006; 21 (2): 75–80.
11. Sharma A, Rathod R, Baliga VP. An open prospective study on postmarketing evaluation of the efficacy and tolerability of diacerein in osteoarthritis of the knee (DOK). J Indian Med Assoc 2008; 106 (1): 54–6, 58.
12. Dougados M, Nguyen M, Berdah L et al. ECHODIAH Investigators Study Group. Evaluation of the structure-modifying effects of diacerein in hip osteoarthritis: ECHODIAH, a three-year, placebo-controlled trial. Evaluation of the chondromodulating effect of diacerein in oa of the hip. Arthritis Rheum 2001; 44 (11): 2539–47.
13. Assessment report for diacerein containing medicinal products. 28 August 2014 EMA/527347/2014.
14. Richette P, Doherty M, Pascual E et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76: 29–42.
15. Shibagaki Y, Ohno I, Hosoya T, Kimura K. Safety, efficacy and renal effect of febuxostat in patients with moderate-to-severe kidney dysfunction. Hypertens Res 2014; 37 (10): 919–25.
16. Whelton A, MacDonald PA, Chefo S, Gunawardhana L. Preservation of renal function during gout treatment with febuxostat: a quantitative study. Postgrad Med 2013; 125 (1): 106–14.
17. Becker MA, Schumacher HR, Wortmann RL et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005; 353 (23): 2450–61.
18. Schumacher HR, Becker MA, Wortmann RL 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): 1540–8.
19. Wortmann RL, Becker MA, Schumacher HR et al. Effect of febuxostat or allopurinol on the clinical manifestations of gout: reduction in gout flares and tophus size over time in the EXCEL trial. ACR/ARHP Annual Scientific Meeting, 2006.
20. Becker MA, Schumacher HR, Espinoza LR et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 2010; 12 (2): R63.
21. Schumacher HR, Becker MA, Wortmann RL et al. The FOCUS trial 48-month interim analysis: long-term clinical outcomes of treatment with febuxostat in subjects with gout in an ongoing phase 2, openlabel extension study [abstract no. OP0130]. Ann Rheum Dis 2006; 65 (Suppl. II): 93.
________________________________________________
2. Nasonov E.L. Revmatologiia. Klinicheskie rekomendatsii. M.: GEOTAR, 2005; s. 264 [in Russian]
3. Jordan KM, Arden NK, Doherty M et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62: 1145–55.
4. Zhang W, Nuki G, Moskowitz RW et al. OARSI recommendations for the management of hip and knee osteoarthritis. Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010; 18: 476–99.
5. Bruyère O, Cooper C, Pelletier J-P et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally. A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars Arthritis Rheum 2014; 44 (3): 253–63.
6. Ministerstvo zdravookhraneniia Rossiiskoi Federatsii. Klinicheskie rekomendatsii. Osteoartroz. 2016. IDKR256. [in Russian]
7. Pelletier J, Yaron M, Haraoui B et al. Efficacy and safety of diacerein in osteoarthritis of the knee: a double-blind, placebo-controlled trial. The Diacerein Study Group. Arthritis Rheum 2000; 43 (10): 2339–48.
8. Pavelka K, Trc T, Karpas K et al. The Efficacy and Safety of Diacerein in the Treatment of Painful Osteoarthritis of the Knee. Arthritis Rheum 2007; 56 (12): 4055–64.
9. Louthrenoo W, Nilganuwong S, Aksaranugraha S et al. The efficacy, safety and carry-over effect of diacerein in the treatment of painful knee osteoarthritis: a randomised, double-blind, NSAID-controlled study. Osteoarthritis Cartilage 2007; 15 (6): 605–14.
10. Zheng W, Tang F, Li J et al. Evaluation of efficacy and safety of diacerein in knee osteoarthritis in Chinese patients. Chin Med Sci J 2006; 21 (2): 75–80.
11. Sharma A, Rathod R, Baliga VP. An open prospective study on postmarketing evaluation of the efficacy and tolerability of diacerein in osteoarthritis of the knee (DOK). J Indian Med Assoc 2008; 106 (1): 54–6, 58.
12. Dougados M, Nguyen M, Berdah L et al. ECHODIAH Investigators Study Group. Evaluation of the structure-modifying effects of diacerein in hip osteoarthritis: ECHODIAH, a three-year, placebo-controlled trial. Evaluation of the chondromodulating effect of diacerein in oa of the hip. Arthritis Rheum 2001; 44 (11): 2539–47.
13. Assessment report for diacerein containing medicinal products. 28 August 2014 EMA/527347/2014.
14. Richette P, Doherty M, Pascual E et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76: 29–42.
15. Shibagaki Y, Ohno I, Hosoya T, Kimura K. Safety, efficacy and renal effect of febuxostat in patients with moderate-to-severe kidney dysfunction. Hypertens Res 2014; 37 (10): 919–25.
16. Whelton A, MacDonald PA, Chefo S, Gunawardhana L. Preservation of renal function during gout treatment with febuxostat: a quantitative study. Postgrad Med 2013; 125 (1): 106–14.
17. Becker MA, Schumacher HR, Wortmann RL et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005; 353 (23): 2450–61.
18. Schumacher HR, Becker MA, Wortmann RL 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): 1540–8.
19. Wortmann RL, Becker MA, Schumacher HR et al. Effect of febuxostat or allopurinol on the clinical manifestations of gout: reduction in gout flares and tophus size over time in the EXCEL trial. ACR/ARHP Annual Scientific Meeting, 2006.
20. Becker MA, Schumacher HR, Espinoza LR et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 2010; 12 (2): R63.
21. Schumacher HR, Becker MA, Wortmann RL et al. The FOCUS trial 48-month interim analysis: long-term clinical outcomes of treatment with febuxostat in subjects with gout in an ongoing phase 2, openlabel extension study [abstract no. OP0130]. Ann Rheum Dis 2006; 65 (Suppl. II): 93.
Авторы
Е.Ю.Погожева*, В.Н.Амирджанова, А.Е.Каратеев
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А.Насоновой». 115522, Россия, Москва, Каширское ш., д. 34А
*lifequality@yandex.ru
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А.Насоновой». 115522, Россия, Москва, Каширское ш., д. 34А
*lifequality@yandex.ru
________________________________________________
E.Yu.Pogozheva*, V.N.Amirdzhanova, A.E.Karateev
V.A.Nasonova Research Institute of Rheumatology. 115522, Russian Federation, Moscow, Kashirskoe sh., d. 34A
*lifequality@yandex.ru
V.A.Nasonova Research Institute of Rheumatology. 115522, Russian Federation, Moscow, Kashirskoe sh., d. 34A
*lifequality@yandex.ru
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