No 4 (2017)

The article considers the modern strategy of pharmacotherapy of rheumatoid arthritis (RA), which is based on the use of standard disease-modifying anti-rheumatic drugs, primarily methotrexate and glucocorticoids, as weft as timely application of a wide range of innovative genetic engineering biological, agents - monoclonal antibodies and recombinant proteins that block the activity of «pro-inffammatory» cytokines and/or pathological activation of T- and B-fymphocytes involved in the development of immunoinflammatory process. Particular attention is paid to the new EULAR recommendations on the strategy and tactics of treatment of early arthritis, which can potentially transform into a reliable RA, being the first manifestation of a wide range of rheumatic diseases, «self-limiting» arthritis or arthritis, which for a long time remains undifferentiated. The importance of developing new approaches to the prevention of RA in high-risk groups is emphasized, and they can lead to radical improvement in prognosis.

The purpose was to clarify the prevalence of traditional risk factors (RFs) and calculate the 10-year risk of developing type 2 diabetes mellitus (DM2) in patients with rheumatoid arthritis (RA). The study included 418 patients with RA and 100 controls without inflammatory joint diseases, without a previously established diagnosis of DM1 or DM2. The presence of traditional RFs was assessed using the Finnish Type 2 Diabetes Risk Assessment Form (FINDRISK). There were an average 4 RFs per patient, and the most common modifiable RFs were abdominal obesity (AO) (64%) and insufficient physical activity (70%). At the same time, AO in RA patients was noted less frequently than in healthy controls. The prevalence of other RFs in RA patients and controls was not significantly different. The 10-year risk of developing DM2 was «moderate» in 20.1% and «high»/«very high» in 22.3% of RA patients, which is comparable to the data obtained in the control group. The prevalence of the majority of traditional RFs and the 10-year risk of developing DM2 in RA are comparable to those in controls without inflammatory joint diseases. The FINDRISK questionnaire is a simple method for identifying patients with RA who need to follow-up and change their lifestyle, as well as an additional examination to exclude subclinical DM2.

In spite of significant achievements in investigation of osteoarthritis (OA) pathogenesis no single drug can provide sufficient effect in this disease. The best result can be achieved only with the therapeutic complex based on nonpharmacological and pharmacological methods. Glucosamin and chondroitin sulfate are effective drugs for systemic OA treatment possessing analgesic properties. They are widely used in clinical practice and are able to improve symptoms of OA and retard its progression. Nonsteroidal anti-inflammatory drugs (NSAID) can provide significant improvement in most cases but often induce gastro-intestinal and cardio-vascular adverse events. Efficacy of treatment can be further improved with focaf NSAID applications, intra-articular injections of glucocorticoids and of hyaluronic acid.

Interstitial lung damage (ILD) in systemic scferoderma (progressive systemic sclerosis) adversely affects the prognosis and is one of the leading causes of death. Early diagnosis and timely treatment can improve the prognosis of the disease. Therefore, in patients with the Raynaud's phenomenon, which is debut of the disease in most patients, it is necessary to pay attention to the signs characteristic of systemic rheumatic diseases (swelling of hands, myafgia in the proximal limbs, morning stiffness, arthralgia and arthritis, erythematous or hemorrhagic eruptions, xeronosus, dysphagia, anemia, cytopenia, etc.). According to the chest MSCT, ILD is detected in 80% of patients with SS. Histological findings are similar to that of idiopathic ILD, but the histological type does not determine the prognosis. The course of ILD in SS is relatively benign, often subclinical. According to the functional pulmonary tests, restrictive ventilation disorders are the most typical, and diffusing lung capacity is reduced in 80% of patients. Pulmonary tests have a prognostic value at the first examination - the lower the norm, the worse the prognosis. It is necessary to perform chest MSCT in all patients with a newly diagnosed SS, since the quantitative (prevalence) and qualitative (frosted glass, honeycomb lung) parameters influence the choice of therapeutic tactics. Treatment of ILD is carried out onfy in patients with obvious signs of progression determined by the dynamics of the decline in functional pulmonary function tests. For the treatment of ILD, immunosuppressants are used to slow down the progression. The drugs of choice include cyclophosphamide, an alternative to which is mycophenolate mofetil. Currently, genetically engineered biological preparations are being tested, in particular, tocilizumab, rituximab, and others.

Human placenta hydrolyzates contain biologically active peptides that stimulate the regeneration of damaged tissues. Anti-aging, regenerative and immunomodulating action of Laennek allows to assume that this drug has properties for prolongation of fife. The present article is devoted to the evaluation of the geroprotective action of Laennec using model organism of Caenorhabditis efegans (C. efegans) under the thermal, toxic and oxidative stress conditions. It was shown that under no stress conditions, the addition of Laennec increased the lifespan of C. elegans by 92% compared to the control. Geroprotective effect was observed in a wide range of drug dilutions - from 1: 500 to 1: 312500. Under conditions of thermal stress (t=35°C, 8 h), the survival rate of C. elegans in the presence of Laennec was 20-27% higher compared to the control. Under the conditions of prolonged toxic-oxidative stress (Paraquat 100 mM, 120 h), the addition of Laennec at the optimal dilution 1:62500 increased the average lifespan of C. elegans from 24 to 120 h. Under the conditions of prolonged oxidative stress (H2O2 100 pM, 140 hours), the addition of Laennec increased the lifespan of C. elegans from 22 to 100 h. Thus, Laennec possesses a pronounced geroprotective effect.

Several reasons for the formation of kidney stones have been established. Recommendations for identification and elimination of established risk factors for nephrolithiasis have been developed. In patients with urate nephrolithiasis, therapy aimed at dissolving of kidney stones is very promising. Blemaren is the most popular and well-known drug for the treatment of nephrolithiasis. He has several indications for the use, including dissolution of kidney stones consisting of salts of uric acid and prevention of their recurrent formation, dissolution of kidney stones consisting of calcium oxalate. Urinary tract infections in patients with nephrolithiasis belong to the group of complicated infections. This is due to the fact that stones of the urinary tract can not only violate the outflow of urine, but are also a favorable place for fixation and preservation of the pathogens. The choice of a drug for the treatment of urinary tract infections in patients with nephrolithiasis is determined by the spectrum of possible pathogens, and also should be based on the data on the resistance of pathogens. The use of medicines containing herbal ingredients, including concentrated concentrated extracts of a mixture of grasses of the goldenrod, bottelbrush, door-weed, the roots of wheatgrass, the onion shells and birch leaves, fenugreek seeds, parsley root and lovage is discussed. Indications for the use of phytotherapy are inflammatory processes in the urinary tract and urolithiasis.

The article is devoted to the review of modern concepts regarding the diagnosis and therapy of extraintestinal manifestations in ulcerative colitis and Crohn's disease. The insufficient knowledge of the genesis of extraintestinal manifestations in these diseases is noted, the leading role of the complex of genetic factors, immune response and environmental factors is emphasized. It is concluded that treatment of extraintestinal manifestations should be carried out taking into account the course of the IBD and the multidisciplinary approach, which requires close cooperation of doctors of various specialties.

The aim of the study was to find a way of prevention of myocardial infarction by improving of treatment efficiency and economy based of its clinical and economic analysis, which was undertaken on two groups of patients with angina: a first group of 34 168 patients, the second group included 17,378 patients with angina pectoris. It was found that t health survey of patients with angina pectoris at 2.3 times reduces the risk of myocardial infarction, and at 2.1 times the financial cost of treating patients with angina, accompanied by a decrease in clinical and economic indicator «cost-effectiveness» at 2.4 times. The priority groups for health survey and treatment of ambulatory patients are young and middle-aged, mate patients with angina, patients with emergency catt and undergoing inpatient treatment.