Vol 8, No 2 (2022)

Existing osteoarthritis (OA) treatments are focused primarily on symptoms. However, around 30-40% of patients are not completely satisfied with their treatment, which leads to further active research in the field. Objectives: to evaluate the efficacy, tolerability and safety of complex therapy with Rumalon and Diaflex in patients with knee OA compared with Rumalon monotherapy. Materials and methods. A total of 78 patients (71 females and 7 males, mean age 59,7±7,3 years, mean BMI - 33±5,49 kg/m2, OA duration 5-10 years) with a verified diagnosis of knee OA (stages varying II-III Kellgren-Lawrence) and VAS pain >40 mm were enrolled in the study to receive therapy for 8 months with 2 months of follow up and aftereffect evaluation. The patients were randomized to two groups. Group 1 (combined therapy, n=45) had treatment either with Rumalon (glycosaminoglycan-peptide complex) and Diaflex (diacerein) according to the standard regimen. Group 2 (monotherapy, n=33) had treatment with Rumalon according to the standard regimen as well. Treatment efficacy was evaluated via VAS knee pain while walking, WOMAC (pain, stiffness, functional limitations), EQ-5D health status, daily need for NSAIDs, treatment efficacy when evaluated by the doctor and by the patient, OMERACT-OARSI response to therapy. Patients also performed several lab tests and knee ultrasound. Results. This study results show a significant effect of both combined and monotherapy in terms of OA knee pain reduction: WOMAC pain initially in the combined treatment group was 198 (160-280) mm, post-therapy it was 110 (34-204) mm; monotherapy group was 209 (157-241) mm initially and 112 (68-178) mm after treatment, respectively. Conclusion. This Russian multicentre randomized trial has shown the beneficial effect for both combined (Rumalon and Diaflex) and monotherapy (Rumalon) regimens in patients with knee OA: there was a decrease in pain intensity, an increase in quality of life, good safety profile and an aftereffect. The advantages of combined therapy included the speed of onset of analgesic effect, better effects towards knee synovitis and a more considerable decrease in the daily need for NSAIDs.

SARS-CoV-2 infection (COVID-19) can cause a systemic inflammatory response, vascular and thrombotic complications, and a wide range of autoimmune disorders. These changes can lead to the development of various rheumatological pathologies. At the onset of the disease, according to series of studies, myalgia is observed in 50,0-84,0%, arthralgia in 13,3-90,0% of patients. After suffering COVID-19, patients could have the situation when joint pain becomes one of the leading manifestations of post-COVID syndrome: on average, it is determined in 15% of cases. Autoimmune reactions associated with SARS-CoV-2 can cause acute post-infectious arthritis, which is characterized mainly by oligoarticular lesions of the joints of the lower extremities, a benign course, and a good «response» to anti-inflammatory therapy. In some cases, COVID-19 acts as a trigger, initiating the development of chronic autoimmune rheumatic diseases, such as systemic vasculitis, systemic lupus erythematosus and rheumatoid arthritis.

The review presents data on the significance of rheumatoid factor (RF) in various rheumatic diseases. It has been shown that the determination of the IgM-RF level is used in clinical practice for the diagnosis of rheumatoid arthritis. At the same time, IgM-RF is a sensitive, but not sufficiently specific indicator found in serum and in other rheumatic diseases.

Article discusses the clinical and diagnostic difficulties of verification of variants of panniculitis. Successful diagnostics of the disease depends on a carefully collected anamnesis containing information about previous diseases, taken medicaments, underlying pathology, as well as an adequate assessment of clinical symptoms, laboratory parameters and identification of typical morphological changes. Three clinical observations of panniculites with main characteristic features of the course of the disease are presented.

Osteoporosis occupies one of the leading places in morbidity structure of people over 50 years of age, and its social significance is associated with its main complications - low-energy fractures of the vertebral bodies and peripheral skeleton bones, treatment of which leads to high financial costs in healthcare. Article considers the modern criteria for diagnosing osteoporosis, presents a mandatory and additional laboratory examination of the patient to exclude other possible causes of bone mineral density decrease, as well as recommendations for choosing an antiosteoporotic medicine depending on the clinical picture of the disease and the risk of fractures. Recommendations concerning the duration of therapy depending on the used medicament and its efficacy, as well as indications for resuming treatment after a previous withdrawal are given.

The article describes differential diagnosis of Sjogren's syndrome, in particular, various causes of the most common clinical manifestations such as sicca syndrome and sialomegaly are discussed. The possible causes of both underdiagnosis and overdiagnosis of Sjogren's syndrome are analyzed.