No 9 (2011)

Neuropathic pain (NP) is widespread in the population, and treatment of patients with NP is a significant medical problem. According to epidemiological studies in the Russian Federation and other countries, up to 80% of patients with NP receive irrational therapy. The article presents algorithms for treatment of NP in various neurological diseases in agreement with the European Federation of Neurological Societies guidelines 2010.

In the clinical practice, the physician in any specialty meets patients suffering from gout, and the most severe manifestation of disease is articular attack. Data for etiology, clinical diagnosis and principles of treatment of this pathology are presented. Among the analgesics used for pain relief in gout, nonsteroidal anti-inflammatory agents, such as reversible inhibitors of cyclooxygenase type-2, have a special place. Currently, Nimesulide is the most widely used non-steroidal anti-inflammatory drug for pain relief in acute gouty arthritis. The article discusses the indications and approach to use of nemisulide, as well as the most common side effects against the background of its application.

The article discusses possible advantages of different non-steroidal anti-inflammatory drugs (NSAIDs) in terms of the effectiveness of therapy and reduction of side effects. According detailed examination and numerous clinical trials, aceclofenac (Aertal) can be considered as candidate for the role of the reference preparation among the traditional NSAIDs. Widespread use of NSAIDs requires a correct assessment of risk of unwanted side effects, administration of drugs with proven efficacy and safety, and comprehensive assessment of drug interactions. All of these factors are the basis of rational pharmacotherapy with NSAIDs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common drugs that have analgesic, anti-inflammatory and antipyretic activities. NSAID meloxicam, cyclooxygenase-2 inhibitor, has a favorable pharmacokinetic profile allowing its administration 1 time per day, cumulative effect and ability to accumulation in the joint cavity. According to data from randomized trials, meloxicam demonstrates high efficacy in patients with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis, and is characterized by well tolerability and high safety.

The article discusses the modern approaches to diagnosis and treatment of persistent idiopathic facial pain (PIFP). According to International Classification of Headache II edition (2004), diagnostic criteria of PIFP are the following: daily facial pain for most of the day, the pain initially limited to definite area of one half of the face; a dull ache of uncertain localization; absence of sensitivity disorders and other neurological symptoms; absence of clinically significant findings on the laboratory and neuroimaging examination. PIFP is one of types of psychogenic pain. Treatment of this type of facial pain is less efficient and requires a multidisciplinary approach

Intraarticular injections of alflutop and hyaluronic acid (GLA) are alternatives to the use of oral chondroprotectors (CP). This provides the required concentration in the target joint, and lead to the more frequent use of this method of drug administration in the treatment of osteoarthrosis of the knee (OK). The study was aimed to evaluation of effectiveness of combined treatment with oral CP in combination with intraarticular injections of GLA or parenteral HP in 72 patients with OK. Combined therapy with oral CP and intra-articular injections of CP and GLA preparations led to marked decrease in the severity of pain syndrome. Furthermore, functional state of the knee joint has improved against the background of using of GLA preparation. Positive results of combined therapy at the late periods can be explained by potentiation of effect oral CP by drugs introduced into the joint.

The article presents the results of comparative evaluation of therapeutic effects of sulfasalazine (SS), methotrexate (MT) and leflunomide (LF) in 151 patients with early rheumatoid arthritis (ERA) within 12 months of observation. Therapy with SS in ERA was not sufficiently effective. Therapy with MT and LF significantly reduced the clinical and laboratory activity and improved quality of life of patients with ERA at 12 months of observation. In 16 patients with moderate and high degrees of disease activity, despite previous therapy with SS, MT, and LF, combination therapy with infliximab and MT within 24 weeks led to significant improvement of clinical parameters of disease and quality of life. There was a positive correlation between functional index of health assessment HAQ and the number of RA patients with anxiodepressive disorders.