No 2S (2018)

The questions of a reasonable choice of agents for the treatment of osteoarthritis from the standpoint of evidence-based medicine and safety are discussed. A brief historical background on the transformation of the views of leading international clinical associations and societies on the reasonability of prescribing delayed-acting symptom-modulating agents is presented. It is emphasized that the opinion of Russian scientists on this issue has remained balanced and objective, and was based on their own data and long-term experience of the use of various drugs. Information about the «points of application» of delayed-acting symptom-modifying agents is presented; the eventual results (clinical and pathogenetic) of their effects on various cells and tissues of the body are characterized. Attention is drawn to the accumulated large evidence base regarding not only the efficacy, but also the safety of the chondroitin sulfate preparations in the treatment of osteoarthritis. The results of preclinical and clinical studies of the domestic chondroitin sulfate preparation (Mucosat) with an emphasis on safety of use are reported.

Objective. Evaluation of the safety and efficacy of the combined chondroprotector (chondroitin sulfate+glucosamine hydrochloride) in patients suffering from osteoarthrosis in combination with arterial hypertension (AH). Methods. The results of a 24-week treatment with CCP of patients with osteoarthrosis of knee I-III radiographic stages are presented. The CCP tablets contained 500 mg of chondroitin sodium sulfate and 500 mg of glucosamine hydrochloride. The study included 44 patients with osteoarthrosis aged 42.7±6.6 years (13 men, 31 women). Patients are divided into two comparable groups: Group 1 - with isolated osteoarthrosis, the Group 2 - with osteoarthrosis in combination with AH. The effectiveness of the drug was assessed by visual analogue scale (VAS), WOMAC index, and patients’ needs for non-steroidal anti-inflammatory drugs (NSAIDs). Results. As a result of treatment, the efficacy of the drug was de-monstrated in both groups of patients. A significant reduction in the pain syndrome according VAS has been achieved; an improvement in the mean WOMAC score for all indicators: a reduction in morning stiffness; reduction of functional insufficiency; and overall index the total indicator, was observed. Conclusion. CCP studied has shown a good therapeutical effect in osteoarthrosis and in combination with AH. The positive therapeutic effect of CCP contributed to a reduction in the dosage of NSAIDs. The good tolerability of the drug is emphasized: with prolonged use of the drug, none of the patients discontinued participation in the study due to poor tole-rance or side effects.

Objective: to evaluate the effectiveness of intravenous drip infusion of glucocorticoid dexamethasone in the complex of treatment of the resistant form of radicular pain syndrome in patients with lumbar osteochondrosis (LO). Methods. A study included 74 LO patients with a resistant form of pain syndrome. The LO was diagnosed according to H. Hall criteria, which included a thorough clinical-neurological examination, functional-spondylographic examination, computed tomography and magnetic resonance imaging of the lumbar spine. To determine the effectiveness of the treatment, 3 scales were used: 1 - determination of the pain syndrome intensity using the visual analogue scale (VAS); 2 - general assessment of the results of treatment by a doctor; 3 - a quantitative assessment of vertebral syndrome. Patients were divided into two groups: group 1 included 37 patients who received intravenous drip infusions of dexamethasone according to the scheme along with traditional conservative therapy; Group 2 (control group) also consisted of 37patients who received only traditional conservative treatment. Results. The intensity of radicular pain syndrome (according to the VAS) in patients of Group 1 after the end of the course of treatment decreased (on average) by 93.8%, in patients of Group 2 - by 65.6%. The duration of the acute period or exacerbation in the Group 1 was 12.4 days, in the Group 2 - up to 60 days. A general assessment of the results of treatment by a doctor showed that a good effect (2-3 points) was obtained in 37 patients of Group 1; none of the patients had lack of effect and worsening. 34 (92%) patients of the Group 2 had unsatisfactory result (0-1 point). A similar result was obtained in the assessment of vertebral syndrome. Discussion. The analysis of the results of the treatment using appointed scales showed that the intensity of the pain syndrome decreased more rapidly in patients of Group 1, the residual pain syndrome did not develop, the significant effect of the therapy was noted in the majority of patients. In patients of Group 2, the intensity of the pain syndrome decreased slightly. The residual pain syndrome developed. Most patients had a moderate effect of treatment, and the vertebral effect persisted for a long time. Conclusion. Comparative analysis shows that the effectiveness of the therapy with intravenous drip infusions of dexamethasone according to the scheme is an effective way to treat the resistant form of pain syndrome in LO.

The comorbid pathology in immuno-inflammatory diseases has recently received a lot of attention because of the significant impact on the prognosis. Comorbid infections are difficult to diagnose, have their own features of the course in autoimmune pathology. The article presents a clinical example of the diagnosis of rheumatological disease on the background of verified postoperative bacterial infection. Only combination therapy with antimicrobial drugs, adequate multi-stage surgical sanitation and anti-inflammatory therapy, which was prescribed taking into account the presence of an infectious focus, allowed to reverse the systemic inflammatory response syndrome, to eliminate cutaneous manifestations and to reduce articular manifestations of the disease. Timely diagnosis and treatment of both rheumatological pathology and its bacterial complications are extremely important, because can improve the prognosis and life expectancy of patients in this category.

Background. In systemic lupus erythematosus (SLE), lung injury is not uncommon and requires therapy with cytostatics and glucocorticosteroids. With high clinical and immunological activity of SLE, an immunodeficiency state occurs, and the risk of infectious diseases, incl. tuberculosis, is increased. Description of the clinical case. A clinical case of a female patient with an interstitial lung injury is presented; differential diagnostics between tuberculous lesion and lung injury in SLE was performed. The importance of determination of the leading disease in connection with fundamentally different approaches to therapy for lupus pneumonitis and pulmonary tuberculosis is discussed. Conclusion. Lung injury in SLE in a patient with tuberculosis can cause diagnostic difficulties. Given the difference in tactics of treatment of SLE patients depending on the presence of comorbidities, immunosuppressive therapy in controversial situations should be prescribed with care.

A clinical case of development of paraneoplastic dermatomyositis on the background of esophageal cancer is described. Malignant neoplasm was diagnosed during oncology screening in a patient with a classic clinical picture of inflammatory myopathy. Individual clinical and laboratory data of patient are discussed from the point of view of the prognosis of detection of the tumor process.