编号 7 (2014)

The article presents the summary data on risk factors for osteoporosis, including the role of heredity, gender, age, dietary habits, and physical activity; the influence of alcohol and tobacco smoking is analyzed. In addition, the data on the impact of occupational hazards, such as fluorine, aluminum, cadmium, phosphorus, as well as local and overall vibration, is discussed.

The article presents a review of modern methods of medical treatment of acute and chronic vestibular vertigo. The role of pharmacotherapy of the most common diseases of the vestibular system, such as benign paroxysmal positional vertigo, Meniere's disease, vestibular neuronitis, migraine-associated vertigo, is discussed. The most effective approaches to the symptomatic and pathogenetic treatment of vestibular disorders are considered.

Despite the existing arsenal of glucocorticoids and cytotoxic drugs, systemic lupus erythematosus (SLE) is a disease with high mortality, significant organ damage and poor quality of life. Appeared genetically engineered biological agents for blocking the function of B lymphocytes give new prospects in the management of patients with SLE: relief of life-threatening situation (rituximab), reduction of the development of side effects of conventional therapy (belimumab and epratuzumab). These drugs can improve the quality of life of patients with SLE.

In the treatment of inflammatory and degenerative diseases of the joints, nonsteroidal anti-inflammatory drugs (NSAIDs) occupy a central place; development of unwanted side effects with their systemic administration, however, imposes some restrictions on their use. Therefore, interest to the local application of NSAIDs and other drugs is increased. For example, complaints of pain in muscles and joints (pain on movement and «weather-dependent» pain, stiffness in muscles, rigidity of ligamentous apparatus) require the use of preparations containing irritants and derivants, particularly Apisarthron - therapeutic combination of bee venom, methyl salicylate, and allyl isothiocyanate.

The article discusses the problem of comprehensive approach to the treatment of patients with osteoarthrosis (OA), the need for simultaneous use of drugs for the relief of pain and inflammation in the joints, and protracted use of chondroprotectors and orthopaedic appliances, physiotherapy and rehabilitation treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the drugs of choice in the treatment of pain in OA. Knowledge and observance of the fundamental principles when choosing NSAIDs allow to prevent the occurrence of major adverse reactions. Lornoxicam (Xefocam) is one of the modern NSAIDs with proven efficacy and safety for the treatment of patients with OA. The clinical case of patient with OA for a long time is presented.

The article presents the results of pharmacoeconomic analysis of the use of genetically engineered biological products (GIBPs) in the treatment of psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Analysis of clinical research and recommendations for the treatment of PsA and AS has revealed no significant differences in efficacy and safety of the GIBPs used. It is shown that the introduction of modern GIBPs in the treatment regimens for PsA and AS allows to significantly improve the effectiveness of treatment for severe stages of the diseases. Pharmacoeconomic «cost minimization» analysis has demonstrated that the use of drug etanercept can solve problems on the optimization of medical care for patients with this nosology, and significantly reduces the costs of health care system compared to other GIBPs without loss of efficiency and safety of the treatment.

The article presents the results of retrospective study on the evaluation of therapeutic drug monitoring (TDM) of anticonvulsants in a real clinical practice. The results of TDM of 614 patients were selected; 295 patients have received the valproic acid, and 319 patients have received carbamazepine. The analysis of TDM of valproate in routine clinical practice has demonstrated the importance of this method for optimization of pharmacotherapy of adult patients with epilepsy. The average therapeutic dose range in actual practice, providing therapeutic levels of valproic acid concentrations, which did not differ for different drugs and dosage forms, was identified. The results TDM of carbamazepine showed that carbamazepine dosage ranges, providing therapeutic, sub- and extratherapeutic concentrations, are extremely broad and practically coincide, despite the higher frequency of achieving the therapeutic concentrations compared with valproate. Therefore, the number of cases of non-achievement of therapeutic concentrations were 2.5 times less, and the number of overdoses - more than 10 times compared with the use of valproate.