Vol 7, No 10 (2021)

Material and methods. The clinical course of IRD was analyzed in 324 patients who underwent new coronavirus infection (NCI) from March 2020 to February 2021 and were treated at Clinical Rheumatology Hospital No.25 (Saint Petersburg) for exacerbation of the underlying disease. Results. The risk factors of severe COVID-19 course in IRD were: age older than 60 years, presence of comorbid conditions (CHD, CHF, COPD), use of glucocorticoids in dose more than 12,5 mg/ day and erythrocyte sedimentation rate values s40 mm/h before development of NCI. The use of immunosuppressive therapy and biological therapy had no effect on the worsening of the course of the viral infection in patients with IRD. The development of postcovid syndrome (asthenia, dyspnea, weight loss, memory loss) was noted in 1/4 of the patients. Postcovid articular syndrome was characterized by the formation of arthritis associated with viral infection in 3,6% of patients, transformation of undifferentiated arthritis (UDA) into specific nosological forms in 49% (more often into early rheumatoid arthritis), and exacerbation of joint syndrome in 83,4% of patients with advanced stage rheumatoid arthritis. In patients with diffuse connective tissue disease, a significant increase in immunological activity due to antinuclear antibodies (maximum 1:163840) was noted. Along with the results of the study, the article presents clinical cases of the development of arthritis associated with a viral infection and death in systemic scleroderma and interstitial lung damage after COVID-19. Conclusion. In the cohort of patients with IRD observed at Clinical Rheumatology Hospital No. 25 (Saint Petersburg), COVID-19 had moderate and severe course in half of patients, initiated the development of pneumonic complications in 68,6% of patients, arthritis associated with viral infection in 3,6%, UDA transformation into IRD in 49% and exacerbation of the main disease in the overwhelming number of patients. Patients with diffuse connective tissue disease with interstitial lung damage have a high risk of adverse outcome of NCI and require dynamic monitoring by primary care physicians.

Topical NSAIDs are an effective alternative to systemic forms of this class of medicines in patients with knee joints osteoarthritis (OA), concomitant pathology and high risk of developing unwanted reactions to the treatment. The purpose of current work is to assess the frequency and efficacy of the use of topical NSAIDs in patients with knee joints OA and concomitant pathology. Material and methods. The frequency and duration of the use of topical NSAIDs in patients with primary knee joints OA for the period 2000-2020 was estimated according to the register of rheumatic diseases of St. Petersburg. A collection of information about the severity of pain in the knee joints is carried out on a numerical rating scale for a month preceding the appeal to the doctor. The number and occurrence of comorbide conditions and the intensity of pain in patients receiving and not receiving treatment with topical NSAIDs was studied, also satisfaction of patients with treatment was taken into account. Results and conclusion. During the retrospective snapshot analysis of clinical cards, 1224 patients with knee joints OA found that the most frequently medicine used in real practice of topical NSAIDs is a Voltaren Emulgel. Topical NSAIDs more often than oral shapes, are used by patients having comorbide pathology. By that doing, the residual intensity of pain in joints and satisfaction with the treatment of individuals using only topical NSAIDs are comparable to those when taking only oral NSAIDs or combinations of topical and oral NSAIDs.

The prevalence of rheumatoid arthritis (RA) is estimated at 0,46% of the world population. In addition to the musculoskeletal system, the disease may have various extra-articular manifestations, including cardiovascular pathology. According to the literature, cardiovascular pathology is the main cause of death among patients with RA, reaching 39,6%. Apart from traditional risk factors of cardiovascular diseases (CVD), chronic systemic inflammation, characteristic for RA, is an independent predictor of cardiovascular pathology. This fact is reflected in modern scales of cardiovascular risk (CVR) calculation, which include the presence of systemic inflammation (including in RA) to avoid underestimating their impact on cardiovascular risks. The prevalence of elevated blood platelet levels in patients with RA is unknown. The role of thrombocytosis in the course of RA and its contribution to the formation of CVD and increased risk of CVR remains incompletely understood. This review presents data from the international literature, which studied the impact of platelets and platelet elevation in patients with RA on the course of the inflammatory process and the impact on cardiovascular organs.

Ketonemia is one of the factors presumably responsible for improving cardiovascular outcomes in studies of SGLT2 inhibitors. The purpose of this review is to compare traditional and modern ideas about the features of normal myocardial energy metabolism and pathology, the possibilities of metabolic support of failing heart, the physiology of ketogenesis, the role of ketone bodies in the body and the effect of ketones on various pathological processes. The role of substrate shifts of oxidative phosphorylation in the heart failure development is analyzed. The mechanisms of action of existing drugs to optimize the metabolism of damaged myocardium are discussed. The main stages of ketone bodies metabolism are presented, with their effect on energy metabolism and the functional state of a healthy and failing heart being highlighted. Recent advances in the study of the regulatory functions of ketones at the systemic and cellular levels are disclosed, taking into account possible receptor, epigenetic and other «noncanonical» effects. A brief description of the role of ketone bodies in brain metabolism is given, with contemporary opinions concerning the mechanisms of ketone-mediated neuroprotection to be discussed. Actual data about the mechanisms of influence of SGLT2 inhibitors on the course of cardiovascular diseases and the characteristics of the drug-induced ketonemia are presented.

The most typical manifestations of celiac disease are gastrointestinal symptoms. At the same time, in some patients, extraintestinal manifestations of the disease come at the first line. The aim of the presented work is to describe a case of atypical celiac disease in a female patient born in 1978 with a late onset (at age 37), damages of musculoskeletal system and nervous system. Presented data allow us to conclude that the diagnosis and treatment of celiac disease can cause difficulties in case of the late onset of the disease and predominance of extraintestinal symptoms (damage of nervous and/or musculoskeletal systems). Currently, the only treatment for intestinal and extraintestinal symptoms of celiac disease is a gluten-free diet, which can lead to remission even in the case of the most severe disease course.

This review considers current trends in the field of vaccine prophylaxis of pneumococcal infection, presented by experts at the XVI National Congress of Internists. Much attention is paid to assessing its relevance for Russian patients.

Article reviews current international data on the pathogenesis and prevalence of Long-COVID symptoms. According to the results of All-Russian survey of physicians organized by Russian Scientific Medical Society of Internal Medicine (RSMSIM), it was shown that neurological, pulmonological and gastroenterological symptoms are found in most COVID-19 convalescents during appointments to doctors of various specialties. The aim of the review is to provide a description of possible approaches to pharmacotherapy of post-COVID symptoms in accordance with the frequency of Long-COVID symptoms occurrence in patients in Russian clinical practice.

The article presents and analyzes the data of a large-scale German study on the possibilities and effectiveness of the use of phytotherapy for acute respiratory viral infections (ARVI) treatment in routine clinical practice. The study included over 1 million patients who consulted general practitioners, pediatricians, and ENT doctors for acute upper and lower respiratory tract infections between January 1, 2015 and March 31, 2019. The results of the study allow us to conclude that the rational prescription of certain herbal remedies for ARVI treatment can significantly reduce the need for prescribing antibiotics in the further course of the disease, as well as reduce the duration of temporary disability of patients.

Thiazid/thiazid-like diuretics are the first line remedies for arterial hypertension treatment. The available data confirm the reduction of morbidity and mortality, also advantages of volume control and natriuresis, in particular, for reducing the risk of heart failure when using diuretics. At the same time, this group includes rather heterogeneous medicaments, among which the thiazid-like diuretic indapamide occupies a special place. The optimal balance of efficacy and safety makes it to be the medicine of choice for both monotherapy and also combined therapy for various groups of patients with arterial hypertension.