Authors: V.Е. Kondratiuk1, O.M. Tarasenko1, L.V. Natrus1, I.G. Ponomarova2
1O.O. Bogomolets National Medical University, Kyiv
2 Institute of Pediatrics, Obstetrics and Gynecology NAMS Ukraine, Kyiv
Objective — to evaluate thehypouricaemic effects ofthe combinationof synbiotic and allopurinol versus monotherapy with allopurinol in gout patients.
Materials and methods
130 patients (mean age (55.5 ± 9.4) years old) with gout (mean duration (7.7 ± 7.1) years) were examined. The diagnosis of gout was based on ACR criteria (2016). Control group — 25 practically healthy men of the corresponding age. Patients with gout who have not reached the target uricemia level after 6 weeks of treatment with allopurinol are included in the treatment groups. The main (n = 68) — patients who continued to take allopurinol at a dose of 300 mg per day, titrating a dose to the side of increase of 100 mg per month, additionally took the synbiotic in 1 capsule three times a day. Comparison group (n = 62) — patients receiving allopurinol monotherapy. Duration of treatment 3months. Qualitative and quantitative parameters of intestinal microbiote were analyzed on the basis of the data bacteriological inoculation of faeces. The effectiveness of therapy was assessed by levels of uricemia, C-RP, and the degree of dysbiotic changes in the intestinal microbiocenosis.
Results and discussion
After treatment of the patients in the main group with synbiotic using, the normalization of the indicators was observed due to the reduction of the concentration of opportunistic microorganisms of the Firmicutes group, obligate anaerobes, Bacteroides spp., Candida and the restoration of protective microflora — lacto- and bifidobacteria. In patients with gout after 3 months of complex treatment with the addition of a synbiotic, the transformation of the structure of the intestinal microbiota in the direction of normalization of qualitative (prevalence of mild degree of violations of microbiota in 50%of subjects) and quantitative composition, revealed a more pronounced urate-lowering effect relative to the comparison group — the target level of uricemia is achieved twice as often — in 40.3 and 21% of cases respectively. The additional inclusion of the synbiotic demonstrates an increase in the urate-lowering effect of allopurinol (a decrease in uric acid levels by 18.7 versus 13.3%, p < 0.01), which was associated with a more pronounced anti-inflammatory effect (a decrease in C-RF by 75 versus 26.3%, p < 0.01).
Conclusions
For patients with gout there is a pronounced violation of intestinal microbiota characterized by a combination of deficiency of protective microflora and an increase in obligate anaerobes, gram-positive cocci and fungi of the genus Candida. In patients with gout after 3 months of complex treatment with the addition of a synbiotic, against the background of the normalization of the qualitative and quantitative composition of intestinal microbiota, there is a more pronounced urate-lowering effect — the target level of uricemia is achieved twice as often, which is combined with a more pronounced anti-inflammatory effect.
Key words: gout, hyperuricemia, uric acid, dysbiotic changes of the intestine, hypouricemic effect, symbiotic.
Published in the journal «Ukrainian Therapeutic Journal» № 1 ’2019
