Chronic tophaceous gout: emphasis on lifestyle modification and treatment adherence

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Abstract
Aim. To illustrate a comprehensive approach to management of a patient with long-standing generalized tophaceous gout, taking into account concomitant comorbidities, as well as to analyze the factors influencing adherence to therapy and lifestyle modification.Material and methods. Patient N., 54 years old, with a 16-year history of gout, multiple tophi, hyperuricemia, stage C2 chronic kidney disease (glomerular filtration rate 69.8 ml/min/1.73 m2), dyslipidemia, grade 1 obesity, and nephrolithiasis. A comprehensive clinical, laboratory, and instrumental diagnostic evaluation was performed, and the nature of joint changes and the comorbidity degree were verified. Specialists prescribed uric acid-lowering therapy with febuxostat (80 mg/day), along with preventing therapy for recurrent gouty arthritis using colchicine (0.5 mg/day), rosuvastatin (10 mg/day), and measures for dietary and weight correction.Results. Against the background of the ongoing therapy, a sustained clinical and laboratory effect was achieved over four months: serum uric acid levels decreased to 282 µmol/L, no arthritis recurrences were recorded, and positive dynamics in the volume of tophaceous infiltration were observed. The patient demonstrates a high level of compliance, following the treatment regimen and recommendations on diet and physical activity.Conclusion. Modern management of gout requires a comprehensive approach that includes pharmacotherapy and lifestyle modification. However, in practice, only a few patients achieve target uric acid levels, indicating the need to strengthen prevention, educational programs, and improve adherence to treatment.

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