Vol 9, No 1 (2023)

Article contains a project of clinical guidelines for the management of patients with osteoarthritis, intended for primary health care professionals – general practitioners, common practice doctors, as well as senior medical students. The project includes the main aspects concerning diagnosis and treatment of this common disease of the musculoskeletal system. The main material of the manual is presented by adapted sections from modern clinical guidelines of specialized medical societies, as well as current regulatory federal documents.

Rheumatoid arthritis (RA) is a disease with a wide comorbid background, with the most common and socially significant being cardiovascular disease, which is the main cause of mortality.

Aim: to estimate and compare comorbidity profile in groups of RA patients with and without thrombocytosis.

Material and methods. The study enrolled 240 patients with RA, of whom 120 patients with normal thrombocytosis and 120 with thrombocytosis. Laboratory tests included assessment of the levels of RF, ACPA, ESR, CRP, ferritin, TPO, IL-6, soluble P-selectin. RA activity was determined by DAS28, instrumental examination consisted in determination of radiological stage of hand and foot lesions according to Steinbroecker, besides, the frequency of comorbid pathology was evaluated.

Results. The levels of ESR, CRP, IL-6, TPO-ferritin, RF and median values of DAS28 activity by ESR and CRP were significantly higher in subjects with RA and thrombocytosis compared to patients with normal level of platelets. There were also differences in the incidence of radiological stages I and III. In turn, in patients with thrombocytosis, the incidence of some comorbidities was significantly higher.

Conclusion. RA patients with thrombocytosis have higher clinical and laboratory activity as well as radiological progression of the disease in comparison with RA patients without thrombocytosis. These peculiarities of the course of RA require more intensive treatment. Besides, wide range of comorbid pathology is more frequent in the group of RA patients with thrombocytosis and this fact should be taken into consideration in real clinical practice.

Information concerning the therapeutic equivalence of generics to original drugs obtained in the course of clinical trials, including post-registration ones, is of great practical value for physicians.

Aim of the study: to evaluate the efficacy and safety of Simcoxib^® medicine comparatively to the original celecoxib in patients with osteoarthritis (OA) of the knee joint.

Material and methods. The study included 59 patients with knee OA, randomized into two comparable groups: patients of the first group (n=30) received Simcoxib^® as therapy, examined persons from the second group (n=29) received the original celecoxib. The course of treatment for each medicine was 14 days on daily dose of 400 mg, with a further change to on-demand regimen. The observation was carried out at four time points for 28 days.

Results. Patients of both groups had a significant positive dynamics in the form of a decrease in the pain VAS score (p <0,001) and the WOMAC index (p <0,001). At the same time, the efficacy of studied medicines was similar (p ≥0,05 at each of the visits). During the study, patients in both groups had comparable values of average arterial pressure and eGFR, which did not exceed the normal values in the population. During the entire observation period, the number of adverse events did not differ between groups of patients receiving each of the medicines.

Conclusion. Celecoxib is a selective COX-2 inhibitor with proven high efficacy in the treatment of pain of various origins. At the same time, this medicine has a good safety profile in relation to the gastrointestinal tract and cardiovascular system. In the treatment of knee OA, Simcoxib^® is significantly effective in reducing VAS pain and WOMAC index and in these indexes is comparable with original celecoxib. The frequency of adverse events while Simcoxib^® intake does not exceed the same when original celecoxib use.

The prevalence of cardiovascular diseases and their predictors is a significant global public health problem. Therefore, the study about the relationship between concomitant cardiovascular diseases, their risk factors and adverse outcomes of COVID-19 is more relevant than ever.

The aim: to study the influence of cardiovascular risk predictors on the course of a novel coronavirus infection in young and middle-aged adults.

Material and methods. A retrospective analysis of 337 case histories of young and middle-aged adults (40,0±13,3 years) was carried out. Depending on the severity of the course of coronavirus infection, the subjects were divided into 4 groups: mild, moderate, severe, and the dead. Primary medical information was collected. To develop a statistical model for identifying the likelihood of a severe course and death of a novel coronavirus infection, a logistic regression analysis was used with multivariate model, followed by an assessment of the diagnostic value of the prognostic model using the ROC curve and determining the area under it.

Results. It was shown that a more severe course of COVID-19 and death were observed in middle-aged individuals with increased BMI, pulse rate and blood pressure at admission. Higher glucose and cholesterol values were associated with increased severity of COVID-19. The presence of cardiovascular diseases, hypertension, and a history of diabetes mellitus prevailed in the group of the deceased and, accordingly, can be considered as predictors of an unfavorable course. Based on the identified risk factors, a mathematical model was developed for predicting a severe course and the development of a lethal outcome against the background of a novel coronavirus infection.

Conclusion. Timely drug correction of blood pressure levels, maintaining the target level of glycemia, triglycerids, low-density lipoproteins, weight loss should be one of the main goals for the timely prevention of adverse outcomes of COVID-19. Moreover, if a patient with COVID-19 is at risk of severe course and death, the therapy of cardiovascular risk factors should be immediately prescribed and/or, if necessary, adjusted.

There are a number of clinical indexes that can modify the primary pretest probability (PTP) of coronary heart disease (CHD), including risk factors (RFs) for cardiovascular disease (CVD) and coronary artery (CA) calcification.

The aim of the study was to analyze the RFs for CVD in patients with various PTPs for CHD.

Material and methods. The study included 141 patients (81 males and 60 females) aged 40–75 years old (medium age 62,6±8,3 years) with suspected CHD. All participants underwent PTP calculation, standard physical examination and laboratory examination, and the presence of CVD RFs was analyzed. According to PTP results, 2 groups were formed: with low (<15%) and intermediate (≥15%) PTP. MSCT coronary angiography was performed to assess the lesion of the CA, the calcium index (CI) was calculated using the Agatston scale.

Results. Among patients with low PTP (n=84), the presence of 0–1 RF was observed in 36,9% of patients with non-obstructive coronary stenosis (1st subgroup) and only in 5,3% of patients with stenosis ≥50% (2nd subgroup). In the 2nd subgroup, the presence of 3–4 risk factors was found in 52,6% of patients, while in the 1st subgroup it was only in 21,5% (p=0,01). In this group, CI <100 was found in 84,6% of patients of the 1st subgroup, the opposite picture was obtained among patients of the 2nd subgroup: CI >100 was detected in 89,5% of patients. In the 2nd group with intermediate PTT (n=57), there was a predominance of 3–4 RFs in patients with CA stenosis ≥50% compared with persons without significant stenosis (45,8% and 18,2%, respectively, p=0,03). Extremely high CI (≥400) was observed in 58,3% of patients with obstructive stenosis, while 72,8% of patients with stenosis <50% did not have significant coronary calcification (including 36,4% of people had CI=0).

Conclusion. Patients with low PTP of CHD and one RF, as a rule, do not have obstructive CA stenosis, and in the presence of 3–4 RF, significant coronary stenosis are much more common. CI ≥100 may serve as an indication for further examination of the patient with a low probability of CHD, and CI <100 is associated with the absence of obstructive coronary stenosis in both low and intermediate PTP of CHD.

Approaches to the long-term therapy of giant cell arteritis (GCA) are still remaining underdeveloped. Glucocorticoids (GCS) retain the position of the «gold standard» for the treatment of this disease, but their use in many cases is complicated by the formation of steroid resistance (need for high doses of GCS), steroid dependence (inability to reduce dosages) and a wide range of complications. The role of traditional basic anti-inflammatory medicines (BAMs) in GCA treatment remains uncertain due to the lack of their efficacy and inconclusive evidence base. Current review presents data on the possibility of using targeted synthetic BAMs and genetically engineered biological medicines as second-line remedies in the treatment of GCA with an emphasis on steroid-sparing effect achieving.

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is one of the little-studied interdisciplinary problems of modern therapy. The article presents a clinical observation in which a 42-year-old female patient had a development of systemic lupus erythematosus with urticarial syndrome and sarcoid-like granulomas as a variant of ASIA after implantation of silicone breast implants and multiple intradermal injections of adjuvants. The data of the abovementioned observation are compared with the data of scientific publications, which consider the complex pathogenetic mechanisms of the formation of the immune response after the placement of adjuvants into human tissues.

Acute gouty arthritis is characterized by expressed inflammatory symptoms and severe pain syndrome, requiring immediate medical relief. Article discusses the general points of anti-inflammatory medicines (non-steroidal anti-inflammatory drugs, glucocorticosteroids, colchicine) use acute gouty arthritis treatment against the background of associated risks in comorbid patients.

Adult Still’s disease is a rare multisystem autoinflammatory pathology of unknown nature (a special form of seronegative rheumatoid arthritis) characterized by daily sudden rises in body temperature above 39 °C, arthralgia or arthritis, rapidly disappearing skin rash, leukocytosis with a predominance of neutrophils. Article presents modern viewpoints about clinic, diagnosis, and treatment of this autoinflammatory disease.

The review provides a detailed description of the skin manifestations of rheumatic diseases, and considers the pathogenesis of their development. Changes in the skin and its appendages are described in detail in rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus, polyarteritis nodosa, systemic sclerosis, dermatomyositis and others, including rare pathologies of the musculoskeletal system. Correct interpretation of skin symptoms, which are typical for these diseases, can improve the efficiency of diagnosis and treatment, prevent complications and disable patients. Of particular relevance in identifying changes in the skin and skin appendages in rheumatic diseases is one of the physical methods – examination of the patient.

Combination of osteoarthritis (OA) with hyperuricemia (HU) in patient is a common clinical situation.

The aim of the study was to evaluate the symptom-modifying effect of combination therapy, including an injection course of bioactive concentrate of small marine fish (Alflutop^®) and complex urate-lowering therapy (ULT) in OA patients with asymptomatic HU.

Material and methods. The study included 55 patients: complex therapy of 30 of them included an injection course of Alflutop^®, 25 others received a standard course of medicines from the oral SYSADOA group. At the second stage, a comparative estimation of the efficacy of combination therapy depending on the duration of observation was performed.

Results. As a result of the performed therapy in both groups, there was a positive development of OA clinical course. At the same time, in patients of the first group, there was fixed a significant pain decrease according to VAS (p=0,000071), while in the second group, the decrease in this index did not reach any statistical significance (p=0,055927). Use of Alflutop^® as a component of combination therapy by patients with OA with asymptomatic HU caused a decrease in the need for NSAIDs by 73,7% (p=0,000183). At the same time, in the group of patients treated with oral SYSADOA, NSAID dose reduction was achieved only in 58,8% (p=0,001566) of cases. Use of complex therapy contributed to a significant decrease in the level of uric acid (UA) in the blood serum of the observed individuals from both groups. Along with this, the achievement or preservation of the target values of UA in the blood serum was significantly (p=0,022438) more often observed in the participants of the first group. During an intragroup analysis of patients who received an injection course of Alflutop^®, it was found that the reduction in VAS of pain did not reach statistical significance at the observation point corresponding to the 7–9th months of the study (p=0,065288).

Conclusion. Combination therapy, including an injection course of Alflutop^® and a complex ULT, leads to decrease of pain syndrome and the need of NSAIDs use in OA patients with asymptomatic HU. At the same time, the efficacy of therapy is more significant in the first 6 months after the start of treatment.

The article discusses the basic principles of anti-inflammatory therapy of the most common joint diseases. The characteristics of the main classes of anti-inflammatory drugs are considered in detail: the mechanisms of their action, dosage forms, indications for their appointment, possible adverse reactions. Algorithms for step-by-step selection of therapy for diseases that occur in the daily work of an outpatient practitioner-rheumatoid arthritis, gout, osteoarthritis, ankylosing spondylitis-are presented. Approaches to prescribing different classes of drugs are determined on the basis of available domestic and international clinical guidelines and the results of randomized controlled clinical trials.

9 декабря 2022 г. в дистанционном формате прошел традиционный, уже седьмой по счету, день Европейской федерации внутренней медицины (EFIM), на который были зарегистрированы 78 делегатов из 29 национальных обществ, входящих в состав EFIM. Российское терапевтическое сообщество было представлено президентом РНМОТ, академиком РАН А.И. Мартыновым и ученым секретарем Общества, доцентом В.А. Кокориным.

26 января в Санкт-Петербурге состоялся Конгресс терапевтов Северо-Западного федерального округа «Диалоги о внутренней медицине». Конгресс прошел в гибридном формате, сочетавшем очную научную дискуссию и интерактивную онлайн-трансляцию в режиме реального времени.

1 января 2023 г. исполнилось 75 лет Константину Александровичу Шемеровскому, отличнику здравоохранения, д.м.н., профессору кафедры поликлинической терапии и пропедевтики Санкт-Петербургского медико-социального института.