№ 20 (2013)

The analysis of current approaches to the drug therapy of psoriatic arthritis is performed. It is stated that the main goal of treatment is the achievement of disease remission or minimal activity of its manifestations ( arthritis, spondylitis, enthesitis, dactylitis, psoriasis); other goals include slowing of radiographic progression, increasing in life expectancy and improving the quality of life of patients, reducing the risk of comorbid diseases. The approaches to the treatment of psoriatic arthritis with the use of non-steroidal anti-inflammatory drugs, intra-articular injections of glucocorticoids, disease-modifying anti-rheumatic drugs, and genetically engineered biological agents are considered. Attention is paid to the fact that methotrexate has the most favorable ratio of efficacy and tolerability The article considers the currently available information on the potentials and prospects of the use of drugs based on monoclonal antibodies: tumor necrosis factor inhibitors and other interleukins in the treatment of psoriatic arthritis.

The article considers the various aspects of the development and treatment of radicular pain, a typical clinical manifestation of nervous diseases characterized by intense pain. The relationship between radicular pain and compression factors, pathogenetic mechanisms of its formation, clinical manifestation of radiculopathy, and problems of therapy are discussed. The data on the modern treatments of radicular pain, especially non-steroidal anti-inflammatory drugs such as ketorolac ( Ketorol®) are presented.

Juvenile arthritis (JA) is a chronic inflammatory disease of the joints, which in the absence of adequate early treatment leads to severe destructive changes, severe functional impairments, disability, and in some cases - fatal outcome. Current methods of treatment of JA are based on the use of the most effective drugs to achieve the development of a stable remission and promising long-term outcomes of the disease. An integrated approach with the rational use of conventional therapy, including symptom-modifying and disease-modifying anti-inflammatory drugs, as well as the timely use of innovative genetically engineered biological agents (especially in patients refractory to conventional therapy) are the key to improving the prognosis and quality of life of patients with JA.

The article considers the features of antiepileptic therapy for patients with brain tumors (BT) in the postoperative period, and in the late periods after removal of the tumor in patients not undergoing surgical treatment. Prophylactic antiepileptic drugs (AEDs) are assigned temporarily for the prevention of attacks - during the first week after surgery; in other cases, they are appointed in accordance with the general principles of treatment of symptomatic partial epilepsy. The safety and drug-drug interactions when using AEDs on the background of radiation treatment and chemotherapy are discussed. The appropriateness of the use of new antiepileptic drugs that do not affect hepatic metabolism, such as levetiracetam, and valproate, lamotrigine and topiramate, for the relief of attacks associated with BT, is emphasized.

Cholecystectomy is one of the most common surgical procedures performed in Russia and worldwide. Following this procedure, complaints for pain and dyspepsia are presented by at least in half of patients. Postcholecystectomy syndrome (PCS) is multifactorial in its nature with both organic, i.e., structural, and functional causes underlying its pathogenesis. About half of cases of pain and dyspepsia after cholecystectomy are associated with organic diseases (stenosed distal ductus choledochus, pancreatic and gastric cancer, acute pancreatitis, etc.), while the remaining cases are caused by functional disorders, including sphincter of Oddi dysfunction. Diarrhea occurring in patients after gallbladder removal is also associated with functional gut motility disorders. Mebeverine was demonstrated to relieve pain and dyspepsia in several uncontrolled pilot studies in patients with biliary pathology. The Working Group on PCS set up among the authors of this paper addressed current aspects of the syndrome and discussed importance of the clinical trial on the effects Duspatalin® (mebeverine) on gastrointestinal spasms and pains following cholecystectomy.

The recommendations of the European Society of Hypertension 2013 kept the focus on the use of fixed combinations of antihypertensive drugs. Special attention is paid to the choice of antihypertensive drugs in the different clinical situations taking into account the evidence base. From this point of view, angiotensin-converting enzyme inhibitors with calcium antagonists can be as regarded one of the most preferred combinations. The results of clinical studies that used a combination of lercanidipine and enalapril are discussed.

The study was aimed to the evaluation aim of the short-term and long-term results of treatment of endometriosis (EM) in patients receiving therapy with triptorelin and levonorgestrel-releasing intrauterine system (LNG-IUS). The study involved 37 women aged 20 to 45 years. Pain in the lower abdomen and lumbar region was the common complaint; 27 women reported dysmenorrhea; there were 16 infertile patients. Prolonged release form of triptorelin was administered intramuscularly 1 time a month at a dose of 3.75 mg; LNG-IUS was injected into the uterus for the prevention of recurrence of EM. Evaluation of the effectiveness was performed during 4 years. Examination of 21 patients after 6-12 months and 4 years after the introduction of LNG-IUS into the uterus had no revealed cases of recurrence of EM; at the same time, the side effects of triptorelin («hot flashes», vaginal dryness, emotional lability, moderate insomnia, ostealgia), as a rule, became less pronounced or disappeared, which was considered as a remission of EM. 7 patients after treatment with triptorelin became pregnant. The results lead to the following conclusion: the combination therapy of EM using triptorelin and LNG-IUS prevents relapse of EM, prevents side effects and enhances therapeutic effects of triptorelin.