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Clinical-Evolutionary Features, Indexes of Lipid Peroxidation and Antioxidant System in Gout


Author: Elena Deseatnicova
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Rheumatology
Year:2007
Scientific adviser: Liliana Groppa
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Valentin Gudumac
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 28 August, 2007
Approved by NCAA on the 20 September, 2007

Abstract

Adobe PDF document0.37 Mb / in romanian

Keywords

gout, tophus, urolithiasis, metabolic syndrome, indexes of lipid peroxidation, antioxidant protection

Summary

Joint syndrome and extra-joint manifestations of gout were identified on the basis of complex (clinical, biochemistry and radiological) investigations. 105 of patients were examined with gout diagnosed according to ACR criteria. The results of indexes of lipid peroxidation levels and antioxidant system indexes were compared with 2 control groups: 20 healthy individuals and 20 patients with cardiovascular pathology without asymptomatic hyperuricemia, of the same sex and age.

For gout onset at the age under 40 the most characteristic was the presence of family anamnesis of gout and an interval more than 7,44±0,64 years before the appearance of clinically visible tophi. For gout onset at the age over 50 important causes of acute attack were found to be psychoemotional stress and cold as well as polyarticular onset. A tendency towards rapid development of characteristic radiological changes and severe degree of joint insufficiency was noted in polyarticular gout onset. In chronic tophaceous gout, the involvement of non-typical joints (elbow, small hand joints) and the presence of family anamnesis of gout was characteristic. Kidney involvement was recorded in 56.2% of cases, as urolithiasis and impaired rate of glomerular filtration. Associated diseases having metabolic patterns in the pathogenesis were often registered in patients with gout: hypertension (77.6%), metabolic syndrome (62%), overweight (60%), obesity (31.5%) and diabetes mellitus (17.2%). Later onset and longer acute gout flares were noted in patients with metabolic syndrome. Discriminant function, which was proposed for diagnostics and screening of tophaceous gout with extracutaneous tophi or for the diagnosis formations of suspected for tophus in the case of non-availability of morphological diagnosis, has a high sensitivity level (84.75%) and will contribute to early and more exact diagnosis.

Abnormally high lipid peroxidation indexes and depression of antioxidant protection system were registered in patients with gout. The level of these changes correlates with the clinical form and duration of the disease, being more indicative of chronic tophaceous gout. Determining the level of lipid peroxidation indexes and the degree of activity of the antioxidant protection system in blood serum and erythrocytes can serve as an accurate method of diagnostics of oxidative stress, estimation of disease progression and evaluation of the effectiveness of applied treatment.