Despite the modern development of medical technologies and the progress of the pharmaceutical industry, the issues of effective treatment and prevention of gout complications remain quite relevant. Thus, over the past 20 years, the incidence of gout in the world has more than doubled [29]. According to current data, up to 1-4% of the world's population suffers from gout, and hyperuricemia is found in 4-20% [19,75]. In Ukraine, the prevalence of gouty arthritis is 5-28 cases per 1000 men and 1-6 cases per 1000 women, and the prevalence of hyperuricemia in the population is 15-20% [10,11]. The pathogenesis of gout is based on a violation of purine metabolism, which causes an increase in the amount of uric acid (SC) in the blood. The intestinal route of urate excretion is up to 25-30% of the total daily excretion [27, 96,147,172]. Thus, the study of this mechanism of excretion of SC and ways of influencing its volume and effectiveness will expand the range of urate-lowering therapy and, accordingly, have a positive effect on the results of gout treatment.
The aim of the study was to increase the effectiveness of treatment of patients with gout by using synbiotics in complex therapy based on the study of the pathogenetic relationship between the state of the microbiocenosis of the colon and urate homeostasis.
To solve this goal, the following tasks are formulated:
1. To study the quantitative and qualitative indicators of fecal microflora in patients with primary gout.
2. To study the features of immunological disorders on the background of dysbiotic changes of the intestine (DСI) in patients with gout.
3. To study the microbiological efficacy of the use of synbiotics in patients with gout with DCI.
4. To study the clinical and laboratory efficacy of the use of synbiotics in patients with gout with DCI.
5. To evaluate the effect of adding a synbiotic to urate-lowering therapy with allopurinol on quality of life patients with gout.
6. Develop an algorithm for the treatment of patients with gout and DCI.
In the course of work the following research methods are applied:
1. General clinical - surveys, collection of complaints, medical history and life, physical examination of patients, calculation of body mass index, questionnaires on adapted and validated scale SF-36.
2. Instrumental - videogastroscopy, videocolonoscopy, ECG, respiratory hydrogen tests with lactulose and lactose loading, radiological methods of examination of joints and lung X-ray.
3. Microbiological - bacteriological examination of feces.
4. Laboratory - general clinical tests of blood and urine, biochemical analysis of blood (level of uric acid, creatinine, bilirubin and its fractions, aspartate and alanine transaminases, glucose, lipid spectrum, CRP level), calculation of glomerular filter rate (CKD-EPI), biochemical analysis of urine to detect uric acid concentration.
5. Immunological - enzyme-linked immunosorbent assay for the determination of IL-1β, IL-6, IL-8, TNF-α, IL-10 in peripheral blood serum, immunochromatographic screening test for qualitative determination in feces of calprotectin.
5. Statistical - Microsoft Office Excel 2010 and IBM Statistics Spss 22 software package.
Scientific novelty of the obtained results and their theoretical significance.
The scientific substantiation and the new decision of a scientific problem in the field of internal diseases concerning urate-lowering therapy in patients with chronic gouty arthritis and available DCH are resulted.
The existing scientific data on the quantitative and qualitative composition of the microbiota of the colon in patients with gout have been supplemented and an assessment of the detected changes in comparison with relatively healthy people has been given.
The influence of DCH on urate homeostasis and clinical and laboratory course of gout was studied for the first time.
