Study On The Effect Of Different Types Of Uric Acidlowering Drugs On Gout Attack

Research Background The team found in the early stage that adenine nucleoside triphosphate(adenosine triphosphate,ATP)is one of the important pathogenic signal the onset of gout,play an important role in the incidence of gout.Due to the different effects of drugs inhibiting uric acid production and promoting uric acid excretion on ATP,it is suggested that drugs inhibiting uric acid production and promoting uric acid excretion have different effects on the incidence of gout.Objective To compare the effects of drugs that inhibit uric acid production(viz.,the xanthine oxidase inhibitors febuxostat and allopurinol)and promote uric acid excretion(viz.,benzbromarone)on gout,and demonstrate the role of ATP in the pathogenesis of gout.Methods A case-control study was conducted to collect gout patients.The patients were divided into four groups according to the uric acid-lowering condition: the febuxostat group(40mg Qd),the allopurinol group(0.1g Bid),the benzbromarone group(50mg Qd),and the control group(no uric acid lowering treatment),measure the patients' blood uric acid concentration changes before and after uric acid treatment in a month,observe whether the patients would suffer gouty arthritis within one month.and make a statistical analysis.The gout patients complied with the standard that the number of gout attacks did not exceed three times,as well as no less than one time within the past six months,and did not take uric acid drugs for half a year were selected.And patients with other chronic inflammatory and infectious diseases were excluded.Results A total of 198 patients with gout in the Department of Rheumatology and Immunology of Anhui Provincial Hospital were collected,all of whom were male.According to the patients taking uric acid-lowering drugs,they were divided into four groups: febuxostat group(40 mg Qd,n=70);allopurinol group(0.1 g Bid,n=20);benzbromarone group(50mg Qd,n=54);control group(no uric acid-lowering treatment,n=54).The statistical results are as follows:(1)The levels of serum uric acid in febuxostat group,allopurinol group and benzbromarone group were significantly decreased after uric acid-lowering treatment compared with those before treatment(febuxostat group: 404.73±90.46 vs 551.16±87.42,allopurinol group:373.90±33.11 vs 530.15±66.22,benzbromarone group: 389.98±82.32 vs541.69±101.61)within one month,the difference was statistically significant(P<0.05),there was no significant difference in the level of uric acid before uric acid-lowering treatment among the three groups(P>0.05),and there was no significant difference in the extent of uric acid decline in each treatment group(P>0.05).(2).Comparison of gouty gout attacks in one month: The recurrence rate of gout patients in febuxostat group was 37.1%,and the allopurinol group was 30.0%,the benzbromarone group was 11.1%,the rate of gout in patients with untreated uric acid was 14.8%,and the recurrence rate of gout patients treated by drugs that inhibited uric acid production(febuxostat group and allopurinol group)was 35.6%.The gout attacks in the febuxostat group and the allopurinol group were significantly higher than those in the benzbromarone group and the untreated uric acid group.There was a statistically significant difference between the febuxostat group and the benzbromarone group(P< 0.05);the gout in the febuxostat group was statistically significant compared with the untreated uric acid-treated group(P<0.05);the uric acid-producing group(febuxostat and allopurinol group)had a more gout attack than patients treated by drugs that promoted uric acid excretion(benzbromarone group,the difference was statistically significant(P<0.05).There was no significant difference inthe gout in the benzbromarone group compared with the untreated uric acid group(P>0.05).Conclusion Under the same base level and the same uric acid-lowering intensity,the drugs that inhibit uric acid production can induce gout attacks during the process of uric acid lowering,while the drugs that promote uric acid excretion has less effect on the recurrence of gouty arthritis.Given that the drugs which inhibit uric acid production can affect ATP levels,this trial supports the role of ATP in the pathogenesis of gout.