The thesis work is devoted to a new solution of the actual problem of rheumatology, which consists in improving the diagnostics and treatment of gout patients by studying the blood levels of adipokines and TLR type 4 in patients with gout, development of criteria for the efficacy of treatment and determining the predictors of resistance to standard therapy. The Gout Impact Scale (GIS) questionnaire was translated and validated for the first time. Its validity was proven on the basis of identified connection between the questionnaire categories and the SF-36 Quality of Life (QoL) score, the functional capacity score under the Health Assessment Questionnaire (HAQ), and clinical indicators, such as the number of attacks in the last year, the number of affected joints, and the number of tophi. The assessment of adipokinee status showed that patients with gout presented 2.18 times higher leptin levels, 2.53 times lower adiponectin level, and 1.24 times lower logarithmic ratio of adiponectin and leptin serum levels (lg A/L) compared to a control group. Patients with tophi presented with more distinct changes of adipokine profile. The imbalance of adipokine products in gout patients was associated with a greater number of affected joints (r = -0.23), the number of exacerbations of gouty arthritis during the year (r = -0.24), and the severity of pain under VAS (r = -0.35; p <0.01). TLR4 serum levels also appeared significantly higher in the group of patients compared with practically healthy individuals (p<0.01). The increase of TLR4 concentration in gout patients correlated with the duration of the disease (r = 0.44), the number of affected joints (r = 0.48), the severity of pain under VAS (r = 0.49), and disadipokinemia (r = -0.54; p <0.001). It was also established that TLR4 levels and lg A/L were independent predictors of increased GAS severity with coefficients (r = 0.24; 0.42; p<0.001). Patients with gout demonstrated a deterioration in the quality of life score under SF-36 questionnaire and an increased influence of the disease under GIS. The growth of the disease severity under GAS was associated with a decrease in the quality of life. After 52 weeks of standard therapy, the patients demonstrated a recurrence of clinical and laboratory parameters. Among patients administered Allopurinol, 42.4 % of patients managed to reach target UA level, while among patients receiving Febuxostat, the proportion of such patients was 68.7 %. In order to evaluate continuous treatment of gout patients and determine the percentage of responders, we proposed using such criteria as a 20 % reduction in the number of exacerbations during the last year, a 20 % reduction in the number of involved joints, and a 20 % decrease of serum UA. The relationship between the changes of these criteria and the reduction of GAS complex activity index was established. According to the criteria, a total decrease in the number of exacerbations during the last year, the number of involved joints, and UA level by 20 % was observed in 27 patients with the share of responders equal to 55.1 %. According to the results of ROC analysis, the most statistically significant predictor of clinical response to standard pharmacotherapy in patients with gout was an increase in the integral index of dysadipokineemia - lg A/L >2.42 (81 % - sensitivity and 81 % - specificity). The adiponectin level >2.0 mkg/ml (77 % - sensitivity and 77 % - specificity) turned out to be less significant predictor of the responder's status. At the same time, the level of leptin >7.3 ng/ml with a sensitivity of 77.3 % and a specificity of 66.7 % appeared to be the predictor of a non-responder status. We proposed using the criteria for evaluation of the efficacy of continuous therapy in gout patients.
