[Evaluation of topical therapy of patients with osteoarthritis of small joints of the hands with Voltaren® Emulgel® 2% (diclofenac diethylamine 2%)].

AIM: To evaluate the efficacy and safety of using the drug Voltaren Emulgel 2% (diclofenac diethylaminе 2%) for 14 days in patients with osteoarthritis (OA) of small joints of the hands. MATERIALS AND METHODS: 62 patients of both sexes with hands OA were included in the study, 31 of whom (main group) used Voltaren Emulgel 2% (diclofenac diethylaminе 2%) topically, and the remaining 31 (comparison group) Voltaren Emulgel 2% (diclofenac diethylamine 2%) + oral nonsteroidal anti-inflammatory drugs. The effectiveness of therapy was assessed by using a visual analogue scale (VAS) in dynamics: joint pain and stiffness at rest, pain on movement and during palpation, by functional indices AUSCAN, FIHOA, by assessment of the effect of therapy by the doctor and the patient on a weekly basis. RESULTS AND DISCUSSION: Joint pain decreased after 2 weeks of therapy in all patients during treatment with Voltaren Emulgel 2% (diclofenac diethylamine 2%) in both groups. Significant reduction in stiffness and improvement in hand joint function was achieved after 7 days and lasted until the end of treatment. By the end of treatment, 100% of patients assessed their condition as improvement. CONCLUSION: Voltaren Emulgel 2% (diclofenac diethylamine 2%) demonstrates comparable clinical efficacy in patients with OA of the hand joints (reduced pain, stiffness and improved joint function) in monotherapy as complex therapy in combination with oral NSAIDS, while being well tolerated.

[Evaluation of a 12-week allopurinol-lowering therapy in combination with the non-steroidal anti-inflammatory drug meloxicam in patients with gout].

AIM: To evaluate a 12-week course of combined alloturinol-lowering therapy with a prophylactic anti-inflammatory dose of movalis for the frequency of exacerbations and the quality of life of patients with gout. MATERIALS AND METHODS: Allopurinol was administered orally, 1 time per day. Every 3 weeks, the dosage of the drug was increased by 50 mg to 300 mg per day under the control of the level of serum uric acid (sUA). The total daily dose of the drug movalis, used in the form of different dosage forms, was 7.515 mg. The clinical effectiveness of the treatment was evaluated after 3, 6, 9 and 12 weeks according to physical examination, the dynamics of joint pain at rest, during movement and palpation, according to the visual analogue scale (VAS) in millimeters, Likert scale, EuroQol-5D-5L questionnaire, care for oneself, habitual daily activities, the presence of anxiety and depression, assessment of satisfaction with treatment (on a scale of 1 to 5, where 1 is the complete absence of improvement or worsening, and 5 is a very good result); took into account the period of remission, as well as the time before the onset of relapse of gouty arthritis. An adverse event (AE) was recorded. RESULTS AND DISCUSSION: On the background of treatment with movalis 7.5 mg per day more than two-thirds of patients showed no worsening of the articular syndrome with an increase in the dose of allopurinol to 300 mg per day. By the 12th week of observation, a significant difference was found between the severity of gouty arthritis characteristics in the direction of improving mobility, self-care, normal daily activities, reducing soreness, reducing anxiety and depression (p0.05). In addition, the ESR and sUA levels were significantly different initially and at the final observation point (p0.05), which indicates a positive effect on the inflammatory process. A 3-month course of combination therapy was not accompanied by significant increases in blood pressure, changes in creatinine clearance in blood serum. There were no adverse events from the gastrointestinal tract. 90.9% of patients rated the treatment result as very good. AE in the form of a skin allergic rash was observed in one patient; it did not require interruption of treatment and completely stopped without consequences after completion of the course. CONCLUSION: 12 a week-long combined therapy of the allopurinol-reducing drug with the anti-inflammatory dose movalis prevents the exacerbation of the articular syndrome and improves the quality of life of patients with gout.

[Hyperuricemia, gout and high cardiovascular risk - how to manage them in clinical practice].

In recent years, the relationship of hyperuricemia and gout with a high risk of cardiovascular disease has been widely discussed. Therefore, it is important to systematically examine patients in order to diagnose comorbidities, among which cardiovascular disease and its complications occupy a leading place and consider mandatory treatment of patients with hyperuricemia and gout with high cardiovascular risk with lowering drugs, which fully reflects the provisions of the latest European recommendations for the management and treatment of patients with gout.

[A rationally grounded approach to treating gout with regard to its onset and course and the presence of comorbidity according to the European League against Rheumatism (EULAR 2016) recommendations]. / Ratsional'no-obosnovannyi podkhod k lecheniiu podagry s uchetom debiuta, techeniia i sochetannoi patologii po materialam rekomendatsii Evropeiskoi antirevmaticheskoi ligi (EULAR 2016 g.).

The review analyzes in detail the management of gout, which takes into account its onset and course and the presence of comorbidity. Emphasis is placed on drug and non-drug treatments and urate-lowering therapy in patients with kidney dysfunction. Along with allopurinol, the urate-lowering drug febuxostat is first recommended in Russia. The purpose of this review is to notify physicians of the possibility of achieving the target uric acid levels when treating gout with hyperuricemia.

[The specific features of gout in the elderly].

AIM: To determine the specific feature of gout at its onset in the elderly. SUBJECTS AND METHODS: The investigation included 100 patients (74 men and 26 women) with primary gout on the basis of the criteria proposed by S. Wallace et al. (1977). The patients were divided into 2 groups: 1) 51 patients aged over 60 years; 2) 49 patients aged less than 60 years. In Groups 1 and 2, the mean age at gout onset was 66.1 +/- 4.8 and 41.6 +/- 10.0 years, respectively. A comparative retrospective analysis was made to analyze the detection rate for the site of onset gout, the pattern of arthritis, the number of tophus forms, the use of diuretics, small-dose acetylsalicylic acid (ASA), comorbidities, such as hypertension, type 2 diabetes mellitus (T2DM), obesity, chronic renal failure, coronary heart disease, chronic heart failure, and prior myocardial infarction. RESULTS: The disease duration in both groups averaged 8 years. In Groups 1 and 2, first metatarsophalangeal joint arthritis was diagnosed at its onset in 77 and 61%, respectively. In these groups, chronic arthritis was also diagnosed in 19 (37%) and 19 (39%). Examinations revealed tophi in 21 and 37% of cases in Groups 1 and 2, respectively. The administration of diuretics was recorded in 25 (49%) and 17 (35%) patients in these groups. Group 1 patients took low-dose ASA more frequently than Group 2 ones (19 (37%) and 7 (14%) patients, respectively; p = 0.013). Hypertension was identified in 23 (45%) examinees in Group 1 and 17 (40%) ones in Group 2. Both groups were matched for the number of patients with obesity (41 and 43%) and for that of patients with T2DM (15 and 10%, respectively). There were significant differences between the compared groups in the incidence of coronary heart disease, myocardial infarction, and chronic heart disease. CONCLUSION: The patients' age of gout onset does not affect substantial differences in the clinical features of gout with its comparable duration in the young and elderly patients. The main clinical features of gout are unique to both young and elderly patients. Cardiovascular diseases are more common at gout onset in the elderly.

[Statistical analysis of links between cancer and associated diseases].

We investigate dependencies between cancer morbidity and associated diseases. A statistical method that yields blocks of diseases with most significant influence on the cancer morbidity is described. Based on USA data about cause-specific mortality we select diseases which have maximum differences between distributions of associated diseases in a group of people which had cancer or died from it and a group of people which didn't have cancer. A medical interpretation of the results is discussed.

[Dorsopathy in the elderly: pathobiology and multimodality therapy in clinical practice].

The lecture considers the most common causes of dorsopathy in elderly patients, by taking into account pathobiology, age markers, and aging processes. It discusses the general issues in the management of elderly patients, including advice on exercise and treatment; particular emphasis is placed on vitamin B group-containing xefocam and neurobion.

[Renal affection in gout].

The study of the problem of impairment of the kidneys in gout is important because investigation of gout nephropathy specifies the role of hyperuricemia (a known risk factor) in development of renal damage, on the one side, and emphasizes the role of early detection of hyperuricemic genesis of nephropathy allowing prognosis improvement due to administration of uricostatic treatment, on the other side. Earlier data on tubulointerstitial lesion are now supplied with information on essential glomerular damage due to endothelial dysfunction in the presence of insulin resistance often associated with gout.

[Long-term prognosis in patients with acute non-ST-segment elevation myocardial infarction depending on dynamics of tissue myocardial dopplerography].

AIM: To study long-term prognosis in patients with non-ST elevation acute myocardial infarction (AMI) with reference to changes in myocardial tissue dopplerography (MTD) in the course of treatment. MATERIAL AND METHODS: MTD echocardiography was conducted in 88 non-ST elevation AMI (mean age 58.0-9.8 years) and 34 healthy volunteers (mean age 58.0 +/- 9.8 years). Measurements were made of the velocity of systolic, early and late diastolic peaks at 4 levels of interventricular septum, anterior, lateral and inferior walls of the left ventricle (LV). MTD was repeated before the discharge from hospital. The patients were followed up for 10-18 months after the discharge. RESULTS: By MTD results the patients were divided into 3 subgroups: 1--an asymmetric decrease of MTD values--17(19.3%) patients who had a 20% reduction of the systolic and early diastolic peak velocity compared to healthy controls on one or two adjacent LV walls; subgroup 2--a diffuse decline of MTD values--61 (69.3%) patients. Their velocity of systolic and early diastolic peaks was subnormal on all the walls, all levels of estimation; subgroup 3--10 (11.4%) patients without MTD changes. These proportions changed in the course of treatment: the number of patients with a diffuse decrease of MTD values reduced to 31 (35.3%), the number of patients with an asymmetric MTD decrease rose to 37 (42%), and with unchanged MTD rose to 20 (22.7%) patients. The rate of development of congestive cardiac failure (CCF) and asymptomatic LV dysfunction in the long-term period was significantly higher in the subgroup with retained diffuse decrease of MTD values. CONCLUSION: The treatment of non-ST elevation AMI reduces the number of patients with a diffuse decrease of MTD values and elevates the number of patients with asymmetric decrease of MTD and unchanged MTD. Persistence of MTD diffuse changes is an unfavourable prognostic factor in relation to CCF and LV silent dysfunction.

[Interaction of the neurohumoral and immune mechanisms of progression of myocardial damage].

The review summarizes data on the interference of the neuroendocrine and immune mechanisms of myocardial remodeling. It shows a role of the effectors of the renin-angiotensin-aldosterone (aldosterone and angiotensin II) and sympathoadrenal (noradrenaline) systems in the activation of macrophages, the production of proinflammatory cytokines and inflammatory cell chemoattractants. It is noted that proinflammatory cytokines in turn promote the activation of these neuroendocrine systems. Natriuretic peptides exert an anti-inflammatory effect, but their production can be activated by proinflammatory cytokines.

[Neutrophil bactericidal and absorptive function in gout].

AIM: To study neutrophil bacterial and absorptive functions and the specific features of their impairments in gout. SUBJECTS AND METHODS: The study included 48 male patients with a valid diagnosis of gout (mean age, 59.7 +/- 10.3 years; duration of the disease, 9.2 +/- 2.1 years; blood uric acid (UA), 520 +/- 80 micromol) (Group 1); 25 apparently healthy volunteers (mean age 55.1 +/- 6.2 years; blood UA, 350 micromol/l) (Group 2). Neutrophil functional activity was estimated from the phagocytic-nitroblue tetrazolium reduction (NBT test) and myeloperoxidase (MPO) activity, the determination of non-enzyme cationic proteins (CP) and their spontaneous and induced indices. Neutrophil phagocytic function was also studied. RESULTS: In Group 1, the content of active oxygen forms (AOF) was increased, on average, to 113.3 +/- 8.65 conventional units (CI) versus 88.22 +/- 5.23 CI in Group 2; p < 0.05). In 34 (70.8%) of the 48 male patients with gout, spontaneous MPO activity was significantly reduced as compared with that in Group 2: 348.4 +/- 13.6 and 509.2 +/- 12.2 CI, respectively (p < 0.01). In Group 1, the level of CP was noticeably decreased to 60.1 +/- 2.06 CI whereas in Group 2, it was 84.91 +/- 5.36 CI (p < 0.05). In gouty patients, the CP stimulation index averaged 0.70 +/- 0.13; in Group 2, it was significantly higher--1.2 +/- 0.05 (p < 0.05). CONCLUSION: In the majority of gouty patients, neutrophil functional activity suffers due to its lower phagocytic function, which suppresses the body's antioxidant defense and contributes to the chronic pattern of an inflammatory process.

[The role of mediator mechanisms in inflammation immunopathogenesis in cardiovascular diseases and osteoporosis].

General pathophysiological mechanisms of inflammation are reviewed on the models of atherosclerosis, calcinating aortic stenosis, cardiac failure and osteoporosis widely encountered at old age.

[Tissue dopplerography of the myocardium in diagnosis of myocardial involvement in patients with rheumatoid arthritis].

UNLABELLED: Inflammatory rheumatoid damage of the heart is in most cases oligosymptomatic but it can lead to development of heart failure and cause lethal outcomes. AIM OF THE STUDY: To detect asymptomatic myocardial involvement in patients with rheumatoid arthritis (RA) with the help of tissue dopplerography (TDG) of the myocardium which allowed to evaluate velocity of myocardial movement. MATERIAL AND METHODS: TDG was carried out in 22 patients with verified RA (age 33-66, mean age 45,2 +/- 7,4 years) and in 20 healthy volunteers (age 29 - 58, mean age 44,6 +/- 8,4 years). Modules of velocities of systolic and early diastolic peaks in every left ventricular (LV) wall at basal level and at levels of upper, middle and lower thirds were calculated in all patients. RESULTS: Velocities of systolic and early diastolic peaks on some LV segments correlated with C-reactive protein and ESR (r from 0.29 to 0.46). CONCLUSIONS: Velocities of systolic and early diastolic peaks in patients with RA are diffusely lowered. A correlative relationship takes place in patients with RA between TDG parameters (velocities of systolic and early diastolic peaks) and markers of activity of systemic inflammation. This reflects participation of inflammatory process in development of asymptomatic diffuse myocardial damage in RA.

[Possibilities of diagnosis of non-ST elevation acute coronary syndrome in old subjects].

Diagnosis of non-ST elevation acute coronary syndrome (NSTEACS) in old subjects poses substantial difficulties because in a row of cases clinical picture and changes on electrocardiogram are nonspecific. In this paper we discuss possibilities of diagnosis of NSTEACS with the help of determination of markers of myocardial necrosis (including cardiac troponins and fatty acid transporting protein) and C-reactive protein in the blood. Data on changes of heart rhythm variability are also presented.

[Long-term prognosis in patients with rheumatoid arthritis depending on baseline variability of cardiac rhythm].

AIM: The study of outcomes of rheumatoid arthritis (RA) depending on cardiac rhythm variability (CRV). MATERIAL AND METHODS: A total of 78 patients with RA of I--III degree of activity aged 38-83 years (mean age 60.3 +/- 10.8 years) were examined using 24-h AP and ECG monitoring. Follow-up was 2-4 years. RESULTS: A clear correlation was seen between RA activity and CRV. CONCLUSION: In patients with high activity of RA, CRV decline reflect severity of inflammation. In low RA activity, low CRV may point to the presence of IHD. Low CRV in RA activity of degree I-II may indicate high risk of sudden cardiac death and acute myocardial infarction within 2-4 years.

[Blocker of angiotensin-1 receptor antagonist losartan. Part III. Experience in therapy for chronic heart failure and after acute myocardial infarction]. / Blokator AT1-angiotenzinovykh retseptorov lozartan. Chast' III. Opyt ispol'zovaniia dlia lecheniia bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu i posle ostrogo infarkta miokarda.

This is the third part in a series of papers dealing with various aspects of clinical pharmacology of the first AT(1)-receptor antagonist losartan and its therapeutic use in hypertension, diabetic nephropathy, chronic heart failure, and acute phase of myocardial infarction. This part contains review of literature data concerning the use of losartan for the treatment of chronic heart failure and high risk patients after myocardial infarction. Efficacy and safety of losartan in these conditions was demonstrated in two major randomized trials. In one of these trials effects of the drug were studied in patients with chronic heart failure and in the second one therapy with losartan was started in acute period of myocardial infarction.

[Angiotensin I receptor antagonist losartan. Part II. Effects in arterial hypertension and diabetic nephropathy]. / Blokator AT1-angiotenzinovykh retseptorov lozartan. Chast' II. Opyt ispol'zovaniia dlia lecheniia gipertonicheskoi bolezni i diabeticheskoi nefropatii.

This is the second part in a series of papers dealing with various aspects of clinical pharmacology of the first AT1-receptor antagonist losartan and its therapeutic use in hypertension, diabetic nephropathy, chronic heart failure, and acute phase of myocardial infarction. This part contains review of literature data concerning the use of losartan for the treatment of hypertension and diabetic nephropathy including results of two major randomized trials which for the first time demonstrated ability of losartan to improve long term prognosis in patients with hypertension and diabetic nephropathy.

[Angiotensin1-receptor antagonist losartan. Part I. Basic clinical pharmacology]. / Blokator AT1-angiotenzinovykh retseptorov lozartan. Chast' I. Osnovy klinicheskoi farmakologii.

This is the initial part in a series of papers dealing with various aspects of clinical pharmacology of the first AT(1)-receptor antagonist losartan and its therapeutic use in hypertension, diabetic nephropathy, chronic heart failure, and acute phase of myocardial infarction. Mechanisms of action, pharmacological effects of losartan and other AT(1)-receptor antagonists, as well as data on pharmacokinetics of losartan, its long term tolerability and safety are reviewed in this communication.

[Dynamic changes in synovitis activity after intra-articular administration of xefocam in patients with rheumatoid arthritis (according to clinical and device examinations)]. / Dinamika aktivnosti sinovita posle vnutrisustavnogo vvedeniia ksefokama bol'nym revmatoidnym artritom (dannye klinicheskogo i instrumental'nykh metodov issledovaniia).

AIM: To assess efficacy of intraarticular administration of lornoxicam (xefocam) in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: Xefocam was injected into the knee joints of 58 patients with RA once a week for 3 weeks in a dose 8 mg. The treatment efficacy was evaluated by changes in the severity of arthralgias, pain in the joints at palpation, circumference of the knee joints at the level of the upper edge of the patella, ultrasound and thermography of the knee joints. RESULTS: Xefocam relieved arthralgia (in 44 patients at least by 30%), pain in the joints at palpation and joint circumference. Ultrasound investigation registered a significant thinning of the synovial membrane and amount of exudates. CONCLUSION: If local steroid therapy is not definitely indicated, intraarticular administration of xefocam can be effectively used for suppression of moderate inflammation in the joints in RA patients.