Therapy

Abstract. Anemia remains one of the most common concomitant pathologies, which has an influence at the prognosis of main disease and life quality of the patient.

The aim: to develop an algorithm using hepcidin for the differential diagnosis of chronic inflammation anemia (ACI) from true iron deficiency anemia (IDA) in patients with active rheumatoid arthritis (RA).

Material and methods. The study was prospective. 78 RA patients with high activity of the inflammatory process according to DAS28-ESR were included in the analysis. Patients were recruited sequentially upon admission to hospitalization at V.A. Nasonova Research Institute of Rheumatology. Criterion for anemia was considered to be a decrease in hemoglobin levels below 120 g/l for female and below 130 g/l for male patients. Depending on hemoglobin level, participants were divided into the main (with anemia, n = 47) and control (without anemia, n = 29) groups. All patients had an assessment of DAS28 index, estimation of clinical and biochemical blood parameters (serum iron, total iron-binding serum capacity, hepcidin, interleukin 6).

Results. Among patients with active RA and anemia (n = 47), isolated ACI was diagnosed in 57.4% of cases (n = 27). Classic IDA was diagnosed in 20 patients (42.6%). Significantly higher hepcidin values (120.3 ± 56.71 pg/ml) were determined in patients with ACI comparatively to the control group (90.4 ± 36.9 pg/ml) and RA patients with IDA. Correlation between hepcidin level and interleukin 6 level (r_IL-6 = 0.81) was obtained only in the subgroup with ACI. In patients with IDA and without anemia, such kind of correlation was not found. Based on the obtained data, an algorithm for diagnosing anemia in patients with active RA was developed.

Conclusion. The level of hepcidin is an informative indicator for differential diagnosis of the type of anemia during active inflammation. In RA patients with ACI, the highest values of hepcidin in blood serum are detected, while in IDA cases they are staying below the reference values. The study also demonstrates the importance of hepcidin – interleukin 6 correlation.

Abstract. Despite the fact that patients with simultaneous atherosclerotic lesions of various vascular beds are systematically registered in clinical practice, there is insufficient reliable data on the management of such kind of patients. It could be helpful to determine management tactics for that group of patients with a direct focus on the prevention of adverse cardiovascular events.

The aim: to develop a calculator for assessing the risk of cardiovascular events and adverse outcomes in patients with peripheral atherosclerosis during a three-year prospective observation, including data based on clinical and instrumental characteristics of endothelial function.

Material and methods. The study included 519 patients with atherosclerotic lesions of various vascular territories. The patients underwent a complex of laboratory tests and a number of instrumental tests, including (if indicated) coronary angiography, angiography of the renal, brachiocephalic and lower extremities arteries. During a prospective observation (36 months), the long-term prognosis of that group of individuals was assessed.

Results. Maximal discriminant significance according to the F-criterion when dividing patients depending on the risk of cardiovascular events and adverse outcomes developing had such indexes as the presence of hemodynamically significant peripheral atherosclerosis, value of the atherogenic index, value of glycated hemoglobin, gender of patients, age, biological vascular age and augmentation index value.

Conclusion. The developed calculator for assessing the risk of cardiovascular events and adverse outcomes developing allows us to highly accurately assess the probability of unfavorable long-term prognosis development in patients with peripheral atherosclerosis.

Abstract. Prevalence of comorbid pathology naturally increases with age in both men and women, with the percentage of arterial hypertension (AH) and chronic heart failure (CHF) especially increasing.

The aim: to identify gender characteristics of risk factors (RF), comorbidities, clinical symptoms and cognitive functions in elderly patients with AH and CHF depending on the presence of senile asthenia syndrome (SAS).

Material and methods. The study included 161 patients with AH and CHF aged 80 years and older. Taking into account the presence of SAS, patients were divided into 2 groups: 1st – persons with hypertension, CHF and SAS (n = 84), 2nd – persons with hypertension, CHF without SAS (n = 77). All participants were assessed for risk factors and concomitant pathologies, they underwent physical examination, laboratory and instrumental studies, and testing according to the MMSE scale.

Results. In “fragile” female patients, in comparison with “fragile” male patients and “strong” females, statistically significantly more severe asthenia was observed, atrial fibrillation, chronic kidney disease, anemia, higher systolic and lower diastolic blood pressure indexes, more a high score on the RSCS scale, lower exercise tolerance, and also dementia of mild degree of severity. “Strong” females more often had an obesity comparatively to “strong” male and “fragile” female patients.

Conclusion. The results of the study allow us to make a conclusion, on the one hand, about the influence of SAS at clinical manifestations in patients with AH and CHF, and on the other, about the gender peculiarities of clinical manifestations in patients with AH and CHF, depending on the SAS presence.

Current review examines aspects related to the clinical and instrumental diagnosis of various types of panniculitis. The lack of differential diagnostic criteria complicates approaches to the treatment of panniculitis in modern clinical practice.

Sarcopenia (SP) is a multi-etiological syndrome manifested by a progressive loss of muscle strength and mass. It occurs either secondary to the natural degenerative processes, or as a complication of various chronic diseases, worsening the course and prognosis of them. SP presence increases the risk of falls and fractures, leads to decrease of life quality and negatively affects its duration. Current review presents modern data on the mechanisms of the occurrence and development of muscle weakness, also a diagnostic algorithm and possible methods for SP prevention.

To assess liver condition, a wide range of biochemical tests are used, which are referred to as “liver functional tests” (LFT). They show not only the functional condition of the liver, but also the nature of damage of its main structures. Current publication provides a detailed description of screening biochemical indexes (alanine transaminase, aspartic transaminase, alkaline phosphatase, gamma-glutamyltransferase, total, conjugated and unconjugated bilirubin, prothrombin time, prothrombin index, international normalized ratio, total protein and protein fractions), as well as the main pathogenetic liver damage syndromes (cytolytic, cholestatic, mesenchymal-inflammatory, hepatocellular failure syndrome). Correct LFT interpretation allows to determine the etiology, severity, clinical course and prognosis of the disease, as well as assess the efficacy of therapy. Current review analyzes various changes in LFT taking place in clinical practice. Lliterature search was carried out in the search engines PubMed, Google Scholar, at the portal archive.org/details/hepatology, books.google.ru.

The article describes a case of gastric ulcer exacerbation in a patient with type A hemophilia and chronic viral hepatitis C (CVHC). On that specific example, the rational choice of a proton pump inhibitor and painkillers is considered, taking into account comorbid pathology, and the efficacy of modern drugs for antiviral therapy of chronic hepatitis C is analyzed, taking into account drug-drug interactions. Alternative treatment options for hemophilia A in case of concomitant pathology in a patient are also discussed.

The aim of the article is to introduce recommendations for the management of patients with systemic lupus erythematosus (SLE) in real clinical practice. Modern methods for assessing the activity of SLE, character of its clinical course, physical and laboratory diagnostic methods, and the main groups of drugs used in the treatment of this disease are presented. The material is intended for rheumatologists and therapists engaged in general medical practice.

Nonsteroidal anti-inflammatory drugs (NSAIDs) occupy a central position in the modern system of multimodal analgesic therapy, based on the complex use of drug-free methodics and pharmacological agents with different mechanisms of action. The multifaceted effect of NSAIDs determines their high therapeutic potential for such common diseases of musculoskeletal system as osteoarthritis, nonspecific back pain and pathology of periarticular soft tissues. With respect to their efficacy, NSAIDs exceed the maximum doses of paracetamol and are not inferior to opioids. When using anti-inflammatory doses of NSAIDs for 7–14 days, pain relief of ≥ 50% is observed in 40–50% of patients. However, NSAIDs can cause serious complications from the gastrointestinal tract (GIT), kidneys and, most importantly, cardiovascular system. Therefore, during their prescription, one should take into account the presence of comorbid diseases and risk factors, and use drugs with best safety profile (for a specific situation) and, if necessary, prescribe medicines to prevent gastrointestinal complications (proton pump inhibitors, rebamipide).

At the Council of experts held at the end of 2023 under RSMSIM authority, its participants considered the problem of magnesium insufficiency and deficiency in the human body, adverse consequences of such deficiency, as well as measures of their prevention and correction. Taking into account the fact that magnesium is an element necessary for the normal functioning of the body, and its deficiency is widespread, correction of such deficiency will help improve the outcomes of many diseases, quality of life, well-being and general health of patients. Due to the availability of methods for diagnosing magnesium deficiency and availability of necessary drugs, it is necessary to develop and implement into medical practice an algorithm for assessing that clinical condition by doctors of various specialties in patients of risk groups, providing its timely correction and adequate prevention. Experts expressed a consolidated opinion on the need to develop Russian clinical guidelines for diagnosis, treatment and prevention of magnesium deficiency.

Taking into account the need for long-term secondary thromboprophylaxis in patients with cancer incidence, assessing the cost-efficacy of using various therapeutic tactics in such patients is the point of particular interest.

The aim: to make a pharmacoeconomic analysis of validity of Eliquis^® (apixaban) medicine use for the secondary prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients with cancer comparatively to other oral anticoagulants’ effect.

Material and methods. The economic assessment was carried out from the perspective of the interests of healthcare of the Russian Federation. The assessment was based on data from previously performed meta-analyses, the results of which were published. Total costs for patient management for each of the compared alternative thromboprophylaxis tactics were determined by calculating the cost of drug therapy, as well as the costs of managing adverse events over 12 months. The conclusion about the most preferable thromboprophylaxis option was made in accordance with obtained data concerning the correlation between efficacy and cost of patient treatment.

Results. During the study, lowest total costs for patient management were fixed when using apixaban: they amounted to 35,082 rubles per year per person. The difference in costs took place mainly due to the cost of treatment with different drugs.

Conclusion. The results of a comparison of effects of apixaban with alternative drugs from the group of direct oral anticoagulants in the prevention of DVT and PE development due to oncologic pathology indicate that the use of this drug may be more valid from the standpoint of economic efficacy, assessed by such a pharmacoeconomic index as direct costs’ minimizing.