No 4S (2017)

This review deals with the physiological and functional characteristics of vitamin D and its major metabolites, the ways of their synthesis and activation, the points of application and the main clinical effects. Special attention is paid to the analysis of available publications devoted to the evaluation of the effect of vitamin D on the prevention of development and progression of bone metabolism disorders, autoimmune and oncological diseases, diseases of the cardiovascular, nervous and reproductive systems.

The article presents a clinical case of successful diagnosis and treatment of rheumatoid arthritis, which debuted in the elderly age. This case deserves attention in relation to the difficulties in diagnosing rheumatoid arthritis in a patient with a clinical manifestations of osteoarthrosis. The correct diagnosis often takes a long time from the onset of the disease - up to six months, a year or more. This is due to the fact that the clinical manifestations in a chronic course of the disease may coincide with the symptoms of another pathology with an articular syndrome, so, patient does not receive adequate treatment for a long time.

The article is devoted to the problem of osteoporosis (OP). The modern definition of OP, classification, risk factors, features of pathogenesis and clinical course of glucocorticosteroid-induced OP and mineral-bone disorders in chronic kidney disease are presented. Methods of diagnostics of OP are discussed. Particular attention is paid to the prevention and treatment of OP from the perspective of evidence-based medicine.

The purpose of this study was to evaluate the effect of various immunosuppressive regimens on the clinical and immunological activity and dynamics of antiphospholipid antibodies (AFA) in patients with systemic lupus erythematosus (SLE) with antiphospholipid syndrome (AFS). The study included 52 patients with active SLE, divided into two groups: the main group included 26 patients with SLE and AFA, of which 19 patients had APS; 26 patients with SLE without AFA were included in the control group. The groups were comparable by sex, age, duration and activity of the disease. Depending on the variant of therapy suppressing the activity of SLE, the patients of the main and control groups were divided into two subgroups: subgroup A received a combined pulse-therapy with methylprednisolone 1000 mg intravenously (IV) thrice and cyclophosphamide 1000 mg IVgiven as a single dose. Two patients with SLE and APS received rituximab 1000 mg IV 2 injections within 2 weeks of each other. Subgroup B received prednisolone per os at a dose of 1 mg/kg/day for 4 weeks. Subsequently, all patients were prescribed to receive combined therapy per os: prednisolone 0.5 mg/kg/day with a dose reduction of up to 0.2 mg/kg/day, plaquenil 200 mg/day, and azathioprine 100 mg/day. The evaluation of the clinical activity of SLE according to the SELENA SLEDAI scale, the level of antibodies to double-stranded DNA, complement components and AFA was carried out after 6 months of follow up. In case of the active course of SLE and SLE with AFS, the use of combined pulse therapy with methylprednisolone and cyclophosphamide, as well as rituximab, in contrast to the administration of oral suppressive doses of prednisolone in combination with plaquenil and azathioprine, leads to a significant decrease in the clinical and laboratory activity of the disease according to the SELENA SLEDAI scale, and decrease in AFA (aPS-Pt, anti-annexin IgM, and anti-β2-GP-I) levels. According to the results obtained, the use of combined pulse therapy with methylprednisolone and cyclophosphamide as well as rituximab leads to a reduction in the risk of thrombotic complications and an improvement in the prognosis of SLE.