The dissertation is devoted to the solution of the actual problem of modern medicine – the theoretical generalization and innovative solution of an actual scientific task in the field of clinical medicine regarding the optimization of management patients with gout by establishing the multifactorial nature of immunological and metabolic interactions with comorbidity and their role in disease progression. Further investigation of the comorbidity structure in patients with gout has revealed conditions related to dysmetabolic, cardiovascular, gastrointestinal, renal, pulmonary patterns, and depression. A high prevalence of comorbidity according to mRDCI was demonstrated and showed that 45.59 % of patients with gout having an mRDCI score of 3-4. Significant associations were established between greater mRDCI and higher BMI, lower physical functioning assessed by HAQ-DI, reduced quality of life according to SF-36, increased gout activity, dyslipidemic changes, hyperuricemia, decreased eGFR, reduced renal clearance of UA, and daily urine UA excretion. We have been also to establish that mRDCI in gout is associated with chronic systemic inflammation characterized by elevated circulating levels of pro-inflammatory cytokines (IL-6, IL-8, IL-1β, leptin), decreased concentration of anti-inflammatory cytokines (IL-10, adiponectin), and the A/L ratio. The adipokine imbalance was found to be related to the interleukin profile in gouty subjects, and a decrease in the A/L ratio was associated with increased serum levels of IL-6 and IL-8, as well as a decrease in IL-10. In the population of Ukrainian patients with gout, it has been shown that 40.3 % of gouty subjects had a moderate severity of COVID-19, 28.7 % had a mild course, 21.7 % had a severe course, and 9.3 % had a critical course. It was observed that higher values of mRDCI and uncontrolled serum UA levels were determinants of a more severe clinical course of COVID-19. Significant predictors of comorbidity development were identified, including delayed diagnosis of gout, disease duration, gout activity, frequency of serum UA monitoring in the preceding year, HAQ-DI, MCS of SF-36, BMI, eGFR, serum LDL-C levels, CRP, IL-6, IL-8, and the A/L ratio. These findings allowed to propose original mathematical model for predicting the comorbidity risk groups in gouty subjects.
