Том 11, № 7 (2025)

Knee joint osteoarthritis (KJ OA) is one of the most common musculoskeletal system degenerative diseases, characterized by pain, progressive joint deformity, and decreased quality of life. Myofascial pain syndrome (MFPS) often accompanies KJ OA and exacerbates its clinical manifestations; however, data on MFPS incidence and its role in KJ OA pathogenesis are limited.

The aim: to determine the incidence of MFPS in KJ OA patients, analyze MFPS association with comorbid conditions, and evaluate the efficacy of combination therapy with a medicinal product based on a bioactive marine fish concentrate and a complex based on unsaponifiable fractions of avocado and soy as a part of a complex therapy plan.

Material and methods. Open-label, prospective study included 72 patients (56 female and 16 male individuals) with Kellgren – Lawrence stage I–II KJ OA. MFPS was diagnosed according to the IASP clinical criteria (2017) and confirmed by tensoalgometry of trigger points (TP). All patients were divided into two groups basing on the presence of MFPS: Group 1 – OA + MFPS (n = 47), Group 2 – OA without MFPS (n = 25). During 12-week follow-up, pain was assessed using VAS during exercise and at rest, also WOMAC index, TP pain threshold, sleep quality (10-point scale), frequency of nonsteroidal anti-inflammatory drugs (NSAID) use, and the spectrum of comorbidities were estimated.

Results. MFPS was detected in 65.3% of patients. In participants with a combination of OA and MFPS, TP pain threshold increased from 2.1 [1.9; 2.3] to 2.8 [2.5; 3.1] kg/cm² (p <0.05). Pain intensity according to VAS during exercise decreased from 68 [62; 75] to 39 [33; 47] mm in Group 1 and from 57 [51; 63] to 36 [30; 42] mm in the Group 2. WOMAC index decreased by 30.9 and 35.4%, respectively. Sleep quality improved from 5 [4; 5] to 6 [6; 7] points in Group 1 and from 6 [5; 7] to 8 [7; 9] points in Group 2. Frequency of NSAIDs use decreased from 3.2 [2; 4] to 1.9 [1; 3] and from 2.8 [2; 3] to 1.3 [1; 2] days per week, respectively. The number of comorbid conditions was higher in the MFBS group – 2 [1; 3] versus 1 [1; 2] (p=0.018).

Conclusion. The combination of KJ OA and MFPS is found in more than a half of patients and significantly worsens the course of the disease. The inclusion of combination therapy using a medicinal product based on a bioactive concentrate of marine fish and a complex based on unsaponifiable fractions of avocado and soy in complex treatment provides a significant reduction in pain, improved function, and a reduced need for NSAIDs. Targeted correction of myofascial component is necessary in the complex treatment of knee joint OA.

Hypertrophic cardiomyopathy (HCM) is the most common hereditary myocardial disease with evident anatomical, clinical and genetic heterogeneity.

The aim: to demonstrate the diagnostic criteria for HCM in patients with and without concomitant arterial hypertension (HCM and HCM + AH), as well as the main elements of differential diagnosis in case of clinical suspicion to phenocopies / specific causes of HCM.

Material and methods. 249 patients with the HCM phenotype were examined. Diagnosis of HCM was made in accordance with Russian clinical guidelines for HCM 2025. The criterion for HCM in adults was maximum wall thickness of the left and/or right ventricle ≥ 1.5 cm, the criterion for HCM with concomitant AH was ≥ 20 mm. When LV wall thickness in patients with HCM and concomitant arterial hypertension was found to be in the “gray zone” (15–19 mm), the conclusion about probable HCM was made basing on a thorough analysis of additional characteristics of AH and HCM phenotype.

Results. There were no cases of Fabry disease among the examined patients. In 7 participants with HCM phenotype aged 60 years and older, cardiac forms of amyloidosis were diagnosed in 6.2% of cases (2.8% of cases among all examined patients). 15 patients with a wall thickness from 15 to 19 mm in the absence of additional characteristics of arterial hypertension and HCM phenotype and 22 patients with HCM with an unspecified hereditary factor were referred for additional examination (magnetic resonance imaging with contrast and, accordingly, examination of the proband’s family members in the 2nd–3rd generations). HCM with a specified heredity factor was verified in 205 patients aged 18 to 87 years (58 [42; 65]) and was represented by the categories of HCM (34.6%) and HCM + AH (65.4%). Criteria for diagnosing HCM with and without AH were followed. In the group as a whole, the incidence of AH in case of non-familial HCM reached 81.3%, in non-familial HCM in the age category ≥ 45 years – 84.8%.

Conclusion. In patients aged 60 years and older, cardiac forms of amyloidosis were diagnosed by us in 6.2% of cases. The overwhelming majority of patients with HCM phenotype were diagnosed with familial and non-familial HCM. In general, the cohort of patients with HCM + AH in combination with other cardiometabolic risk factors and without them accounted for 65.4%.

Current study analyzes the problems and strategies for managing comorbid patients with bronchial asthma (BA) in primary care conditions.

The aim: to assess the prevalence and structure of comorbid pathology in patients with controlled and uncontrolled BA clinical course and to develop an algorithm for optimizing therapy based on an integrative approach.

Material and methods. 148 patients with verified diagnosis of BA were examined: 110 of them were with uncontrolled BA and 38 with controlled asthma. All the participants underwent a comprehensive clinical, laboratory, and instrumental examination, along with correction of their baseline therapy and comorbid conditions.

Results. It is shown that uncontrolled BA was significantly associated with a higher frequency and polymorphism of comorbid conditions, including key ones allergic rhinitis (odds ratio (OR) 2.884), gastroesophageal reflux disease (OR 9.066), arterial hypertension (OR 3.728), obesity (OR 4.124), and coronary heart disease (OR 2.674). An integrative management algorithm was developed and tested, including correction of basic BA therapy, targeted treatment of comorbidities, and interdisciplinary collaboration of specialists. Application of this algorithm resulted in disease control in 85.1% of patients.

Conclusion. Personalized approach implemented through an integrative management algorithm is a key condition for improving the efficacy of BA outpatient care and enables disease control in the vast majority of patients.

Fibromyalgia (FM) is a chronic pathology characterized by pain, fatigue, and cognitive impairments. Its clinical course differs in male patients, which is associated with gender stereotypes and differences in pain perception. The aim of this review is to describe FM development in male individuals, identify factors determining the severity of clinical course of the disease, and study the specifics of FM treatment in this patients’ group. The authors searched PubMed and Scopus for scientific articles using keywords fibromyalgia, gender, men, and treatment. Search covered the time period from 1996 to 2024. A total of 47 publications were retrieved from these sources. Significant gender differences in pain perception and affective disorders in case of fibromyalgia were identified. Key aspects of diagnosis and treatment adapted to men with this disease were emphasized. It is important for clinicians to consider gender aspects when diagnosing and treating fibromyalgia. Furthermore, the development of national registries for in-depth analysis of risk factors and clinical manifestations of the disease is also necessary.

The main endogenous factors in the development of pharyngitis are gastroesophageal and laryngopharyngeal reflux, chronic rhinitis, rhinosinusitis, adenoiditis, systemic vasculitis (Kawasaki or Behcet’s disease), thyroid disease. Exogenous factors that affect mucous membrane of the oropharynx include pollutants (sulfur dioxide, nitrogen dioxide, etc.), carbon dioxide, toxic production factors emitted at various industrial enterprises, in printing houses, livestock and agro-industrial farms, living conditions at home or in offices associated with the development of sick building syndrome (SBS), tobacco smoke and smoking e-cigarettes, increased vocal loads, use of inhaled glucocorticosteroids and angiotensin-converting enzyme inhibitors. The impact of these factors can change biocenosis of the mucous membrane of palatine tonsils and posterior pharyngeal wall and provoke the development of an infectious process, forming interdependent correlations.

Fahr disease is a rare genetic pathology proceeding with brain calcification. Magnetic resonance imaging of the brain has the decisive importance in its diagnosis. Current article describes clinical cases of Fahr disease, in which the clinical picture was manifested by cognitive, motor disorders and convulsive syndrome. Idiopathic calcification of basal ganglia is a relatively rare disease, understanding of the pathogenesis and clinical picture of which has significantly expanded our knowledge of neurodegenerative pathologies.

Kidney damage in systemic lupus erythematosus (SLE) – lupus nephritis (LN) – often becomes the only manifestation of the disease. Signs of LN are varied: from mild proteinuria to rapidly progressing glomerulonephritis with impaired nitrogen-excreting function of the kidneys, which largely depends on the morphological picture. Special histological changes in the kidneys in case of LN include mesangial hypercellularity, expansion of mesangium, proliferation of endothelium, changes in the basement membranes of capillaries. Sometimes areas of necrosis of the capillary loops and crescents are detected. Most patients with SLE are females, and accordingly, they are more often diagnosed with diseased kidneys. In male individuals, LN is mostly combined with damage of other organs. Presented clinical observation demonstrates the insufficient alertness of doctors regarding SLE in male patients.

Cerebrovascular diseases are a group of brain diseases caused by acute or chronic cerebrovascular event due to cerebral vessels pathology. They are a major medical and social problem due to their widespread prevalence, high mortality and high indexes of primary disability. Primary health encounter of most patients with cerebrovascular pathology is most often made to doctors of outpatient and polyclinic services. The main attention in the article is paid to the issues of primary and secondary prevention of these diseases with consideration of both non-drug approaches, including correction of modifiable cardiovascular risk factors, and also the use of antihypertensive, lipid-correcting, antithrombotic, neuroprotective drugs and agents for the treatment of carbohydrate metabolism disorders.

Low back pain (LBP) remains one of the most common causes of temporary disability and medical attention. Effective pharmacotherapy of acute pain requires a comprehensive approach that takes into account pathogenetic heterogeneity of this syndrome. This article considers the aspect concerning current potential of combination therapy for low back pain (LBP) using nonsteroidal anti-inflammatory drugs, glucocorticosteroids, and B vitamins, which can influence key components of the inflammatory and pain process. A possibility for using a combination drug containing betamethasone, hydroxocobalamin, and diclofenac, which has a predictable pharmacological profile, a favorable efficacy-to-safety ratio during short-term use, and ease of administration is introduced. The presence of diclofenac and hydroxocobalamin, an active form of vitamin B12 in its composition, defines the advantages of this combination, expanding its potential for use it in clinical practice. It is concluded that the use of modern combination drugs for rapid relief of acute LBP and prevention of chronic pain is rational.

Shoulder pain is a common complaint with which patients seek an appointment with neurologist. It can be the result of traumatic impact, inadequate daily exertion, or a consequence of chronic diseases. Current article discusses the main causes of shoulder pain, methods of its diagnosis and modern approaches to differentiated treatment.

Arterial hypertension (AH) is one of the most significant risk factors for cognitive impairments development. Presence of high blood pressure in middle age of individual could be considered as a precondition for a decline in cognitive abilities in the future. AH leads to damage of the vascular wall, development of endothelial dysfunction, microcirculation disorders, decreased cerebral perfusion, and progression of neurodegenerative damage. One of the pathogenetic mechanisms of cognitive disorders formation is oxidative stress, which justifies the use of drugs with antioxidant action, including in case of arterial hypertension. Mexidol has direct antioxidant activity due to its ability to inactivate free radicals and increase activity of antioxidant enzymes. The results of MEMO study subanalysis indicate the advisability of using sequential therapy (parenteral administration followed by oral administration) with Mexidol + Mexidol FORTE 250 in clinical practice for patients with AH.