Febuxostat as an effective drug of choice for urate-lowering therapy for gout (case report)

Abstract

The prognosis for gout is largely determined by its timely diagnosis and the choice of drugs for effective urate-lowering therapy which considers the peculiarity of a particular patient’s disease course: the signs of complications, comorbid pathology, and drug tolerability. The report presents a clinical case of gout, which a 30-year-old man with acute arthritis of the right big toe experienced for the first time. The diagnosis of gout was verified by a rheumatologist only 6 years after the first attack. In addition to gout, the patient was also diagnosed with urolithiasis, obesity, hypertension, prediabetes and dyslipoproteinemia. Initially, allopurinol was prescribed, which at a dose of 300 mg/day ensured the achievement of the target level of uric acid. However, the patient stopped taking the drug and eased the frequent gouty attacks by taking nonsteroidal anti-inflammatory drugs. He turned to the rheumatologist again 2 years later. The level of uric acid in the blood was 744 umol/l, the glomerular filtration rate (GFR) was 55 ml/min. The resumption of allopurinol intake was accompanied by the development of dermatitis. Therefore, instead of allopurinol, febuxostat was prescribed, which at a dose of 120 mg/day ensured the achievement of a normal level of uric acid. At this dose, the patient has been taking the drug for the last 2.5 years. The drug tolerability is good. An improvement in kidney function (GFR – 89 ml/min) and normalization of carbohydrate metabolism were recorded associated with medication intake. Thus, febuxostat for gout is an effective drug for urate-lowering therapy. prescription is especially recommended in case of intolerance to allopurinol and kidney damage.

Keywords

• gout
• uric acid
• hyperuricemia
• urate-lowering therapy
• allopurinol, febuxostat