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Menarini's commitment is now also part of rheumatology, the branch of internal medicine that deals with medical conditions affecting the musculoskeletal system and connective tissues, in general throughout the body. The contribution of Menarini is addressed to the treatment of gout.Gout, a disease mentioned in the chronicles of all time and one of the oldest diseases to spread and ease of recognition, is now re-emerging and evolving, especially with the changes that accompany it: the patients are older and the share of women is growing , especially after menopause. Sporadic cases also increase, for conditions and behaviors that predispose to hyperuricemia.
Gout is a debilitating and progressive disease caused by deposition of monosodium urate crystals in tissues and joints than can provoke an inflammatory response.
Gout is the most common form of inflammatory arthritis in adult population and its growing popularity can be attributed to changes in diet and lifestyle, use of drugs that increase uric acid levels, increasing incidence of the metabolic syndrome and longevity. Prerequisite for the development of this disease is hyperuricaemia (increased serum uric acid), which follows the formation of monosodium urate crystals responsible for the attacks of inflammation and the formation of deposits, even in the extra-articular tissues, called tophi . The persistence of hyperuricemia can lead to significant consequences, both joints, with impaired function and disability, both kidneys, with nephrolithiasis, and also cardiovascular, being gout and hyperuricemia independent risk factors for serious cardiovascular events.
Four clinical stages can be distinguished in the natural history of gout:
- Asymptomatic Hyperuricemia - Acute gouty arthritis, which is manifested by the sudden onset of intense pain, redness, warmth and swelling at the affected joint and surrounding tissues. - Intercritical gout, characterized by periods in which patients have no other arthritic episodes, especially if they have avoided, once recognized, the underlying causes. - Gout tofacea chronic characterized by, polyarthritis, tophi and visceral commitment that can occasionally be isolated or sometimes associated with each other.
As indicated by the recommendations of the European League Against Rheumatism (EULAR), the goal of therapy in chronic gout is to promote the dissolution of urate crystals and to prevent their formation while maintaining the serum uric acid levels = 6.0 mg / dl, value below the monosodium urate saturation point. The importance of achieving and maintaining long-term target range of the uric acid becomes significant clinical benefit resulting from the feedback regarding the reduction of the frequency of acute attacks of gout and the size of tophi.
Optimal treatment of gout is aimed at solving the acute gouty attack, to prevent relapse, to prevent or correct the complications of the disease and the reduction of hyperuricemia, which can be achieved effectively only through the use of drugs (drugs that reduce serum uric acid levels). It 's important to know that gout is one of the joint disease treatable with medication: urate lowering treatment can prevent the formation of new crystals of monosodium urate and / or dissolve existing ones and also treat nephrolithiasis often associated with this disorder.
There are two categories of urate lowering drugs: uricosuric (not available in Italy in the indication of gout) and inhibitors of the formation of uric acid.
Osteoporosis is a disease characterised by bone mass reduction and hence alteration of the bone microarchitecture leading to a reduction in the resistance of the bone; this increases the risk of spontaneous fractures. There are essentially two types of osteoporosis. Post-menopausal osteoporiosis, whose main cause is the fast decrease in oestrogen which occurs in the years immediately following menopause. Senile osteoporosis, is characteristic of the elderly and is linked to an increase in parathormone, a hormone which removes calcium and phosphate from the bone.