[Features of fibromyalgia in patients with rheumatoid arthritis]. / Osobennosti fibromialgii u patsientov s revmatoidnym artritom.

OBJECTIVE: To determine the features of fibromyalgia (FM) in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: Seventy-six patients participated in the study. The patients were divided into 2 groups: RA+FM (n=55), FM (n=21). Anamnesis of life and disease was carefully collected in all patients. The intensity (according to VAS) and phenotype (Pain DETECT, DN4) of pain syndrome (PS), the presence of symptoms of central sensitization (CSI), fatigue (FSS), signs of anxiety and depression (HADS), sleep quality (PSQI), cognitive functions (DSST) and quality of life (QoL) (EQ-5D, FIQR) were also evaluated. RESULTS: The average age of patients in the FM group was significantly lower (42 [35; 53] vs. 50 [42.5; 59], p=0.042). Patients with «pure¼ FM without RA were more often divorced and had no children (p=0.045 and p=0.02, respectively). The duration of PS in the groups did not differ (11 [7; 17] vs. 8 [5; 13] years, p=0.429), however, patients with «pure¼ FM waited longer for diagnosis (115 [40; 198] vs. 20 [5.5; 59] months, p<0.001), and they also were less likely to be recognized as disabled (p=0.003). Patients of both groups had equally severe fatigue, anxiety, depression, sleep disorders and cognitive functions compared to the norms. Patients of the FM group noted a lower QoL (according to EQ-5D, p=0.041) then in RA+FM group, despite the comparable severity of FM and the intensity of the PS in both groups. CONCLUSION: FM in patients with RA develops at a later age compared to «pure¼ FM. The clinical picture of FM with and without RA does not differ in the main manifestations, however, the QoL of patients with «pure¼ FM is lower. Accounting for fibromyalgia in the treatment of rheumatoid diseases can significantly improve the QoL of patients.

Are the Goals of Therapy Achievable in Patients with Rheumatoid Arthritis Receiving Upadacitinib in Real Clinical Practice?

The aim of the study was to evaluate the effectiveness of UPA in RA patients in real clinical practice after 3 and 6 months of therapy. The study included 63 RA patients with high activity of the disease. Activity was assessed according to the DAS28(ESR), DAS28(CRP), SDAI, CDAI; functional ability to HAQ; quality of life to the EQ-5D; disease activity according to the patient's RAPID-3 index; the level of depression and anxiety to the HADS scale. The effectiveness of therapy was evaluated after 3 (n = 45) and 6 (n = 31) months of UPA therapy. Remission or low activity of the disease by 3 months of therapy was achieved by most patients: remission of 69.8% of patients, low activity of the disease-16.3% of patients. Moderate or high activity persisted in 13.9% of patients. By the 6th month of UPA therapy, the number of remissions reached 90%, low activity 3.3%, moderate activity persisted in 6.7% of patients, high activity of the disease was not in any patient. 20% improvement in function was achieved in 71.8% of patients by the 3rd month of therapy and in 77.8% by the 6th month of treatment; the difference in average HAQ values by the 3rd month of therapy was 0.38 points, by the 6th month-0.58 points. After 3 months of follow-up, 31.1% of patients continued taking GC, by 6 months-24.2%. The dose of GC was reduced from an average of 7.23 to 5.6 mg/s. The percentage of patients requiring NSAIDs decreased from 95.2 to 35.6% and 33.3%, respectively. DMARDs continued to be received by 75.6% of patients by 3 months and 69.7% by 6 months of follow-up. Achieving remission or low activity of the disease in patients with RA receiving UPA in real clinical practice is possible in most patients. A rapid decrease in inflammatory activity is accompanied by a significant improvement in the functional state and quality of life of patients. UPA therapy reduces the need for the use of NSAIDs and reduces the dose of GC in a third of patients.

[Efficacy of combined use of glycosaminoglycan peptide complex for intramuscular administration and oral diacerein in osteoarthritis: evaluation according to an observational multicenter clinical trial].

BACKGROUND: The combined use of intramuscular injection glycosaminoglycan peptide complex (GPC) and oral diacerein can increase the effectiveness of treatment of osteoarthritis (OA). AIM: Compare the effectiveness of combination GPC + diacerein and GPC monotherapy in the treatment of OA in clinical practice. MATERIALS AND METHODS: A retrospective evaluation of the results of a 12-week multicenter observational non-interventional study of the effectiveness of GPC (Rumalon, a course of intramuscular injections 3 times a week, №25) in patients with moderate/severe OA (n=2955) requiring regular administration of nonsteroidal anti-inflammatory drugs (NSAIDs). The analysis identified a group of patients (n=414) who received GPC in combination with diacerein 100 mg/day (Diaflex Rompharm). The therapeutic effect was compared in the groups of GPC monotherapy (n=2541) and the combination of GPC with diacerein. These groups did not differ in average age (61.411.8 and 61.911.3 years), both were dominated by women (76.3 and 70.3%), there was approximately equal intensity of pain during movement and impaired joint function: 6.11.8/6.01.6 and 4.92.1/5.11.8 (according to the numerical rating scale 010). The dynamics of pain intensity, the need for NSAIDs, and the frequency of adverse events (AE) were compared 12 weeks after the start of treatment. RESULTS AND DISCUSSION: In the majority of patients with OA both on the background of GPC monotherapy and combined use of GPC and diacerein, there was a significant improvement. The number of patients with pain reduction 50% was 54.3 and 62.8% (p0.001), NSAID administration was completely stopped in 66.7 and 77.5% (p0.001), respectively. The effectiveness of the combination of GPC and diacerein was significantly higher than that of GPC monotherapy in OA of the knee joint, hip joint, and generalized OA. AE from the gastrointestinal tract was observed in 7.8 and 8.9%, arterial hypertension in 6.3 and 4.6%, allergic reactions in 0.3 and 0.5% of patients (not significant). CONCLUSION: The application of the code of civil procedure is an effective treatment for OA. The combination of GPC and diacerein provides a more significant improvement than GPC monotherapy. GPC and diacerein (including in combination) are well tolerated and rarely cause AE.

[Control of pain in the early post-traumatic period in the outpatient practice. Results of the multi-center observational study RAPTOR (Rational Analgesia PostTraumatic: an Observational Research)].

AIM: Evaluate the frequency, nature and course of PTP, as well as the effectiveness and safety of NSAIDs in PTP in real clinical practice. MATERIALS AND METHODS: The assessment of the condition and need for NSAIDs (original meloxicam) in 1115 outpatient patients who suffered a fracture of the radius (32.2%), injury to the knee (35.2%) or ligaments of the ankle (32.6%); women/men 51.5 and 48.5%, average age 46.915.5 years. We evaluated the dynamics of pain intensity (on a numerical rating scale NRS 010) at rest and during movement, the preservation of moderate and severe pain, as well as the development of adverse drugs reactions (ADR) to NSAIDs 48 weeks after injury. RESULTS: The average intensity of pain during movement decreased from 7.031.66 to 2.211.38 (p0.001), at rest from 4.462.07 to 0.710.989 (p0.001). The number of people with pain severity 4 in the NRS in 48 weeks after the radius fracture, injury of the knee and ligaments of ankle was 21.0, 16.9 and 11.9%, with moderate or severe impairment of the injured limb 40.4, 26.2 and 16.3%, respectively. The need for taking NSAIDs up to 7 days was noted in 43.3%, 714 days-in 41.8%, more than 2 weeks or constantly in 14.9% of patients. Weak or moderate ADR were observed in 20.8% of patients, mainly dyspepsia and hypertension. Discontinuation of NSAIDs due to ADR was required in only 2.6% of patients. Pain retention 4 in NRS was associated with initially expressed pain (7 in NRS) OR 2.75 (95% CI 0.834.13; p0.001) and the presence of osteoarthritis of knee and/or hip OR 1.56 (95% CI 1.032.34; p=0.039). CONCLUSION: PTP decreases rapidly in most patients after a radius fracture, injury of the knee, and ankle ligament injury while taking the original meloxicam. However, in a significant part of patients, moderate or severe PTP persists after 48 weeks, which requires prolonged analgesic therapy and active rehabilitation.

[What factors affect the effectiveness of long - term analgesic therapy for osteoarthritis? Data analysis of the multi - center 3-month PARACELSUS study].

There are factors that can affect the effectiveness of treatment of osteoarthritis (OA). Aim to identify factors affecting the effectiveness of long - term analgesic therapy in OA. Materials and methods. The study included 6448 patients (70.9% female and 29.1% male), middle age 57.8±10.2 years, with severe pain [≥40 mm on the visual analog scale]. All patients received the preparation of avocado - soybean unsaponifiables (ASU) 300 mg/day. For pain relief at the beginning and during the study, the drug Ketoprofen lysine salt (KLS) 320 mg/day was used. The efficiency criterion was pain reduction ≥50% and satisfaction with treatment ≥4 on a 5-point scale. The influence of a number of factors on the result of treatment was evaluated. Results. For 3 months of treatment, the pain decreased from 63.7±12.0 to 14.2±11.7 mm VAS. The result was evaluated as "good" or "excellent" 81.7% of patients. Adverse reactions were rare. In total, a good response to therapy was noted in 87.4% of patients. Gender, body mass index ≥30 kg/m2, type 2 diabetes mellitus, poor effect of non - steroidal anti - inflammatory drugs (NSAIDs) and Symptomatic Slow-Acting Drugs in Osteoarthritis (SYSADOA) in history did not affect the result. The effect was lower in persons >65 years [odds ratio (OR) 0.418; 95% confidence interval (CI) 0.342-0.509, p2 by Kellgren-Lawrence (OR 0.556; 95% CI 0.298-0.738, p.

[The efficacy of meloxicam in acute back pain: results of an observational non-interventional multicenter study]. / Éffektivnost' meloksikama pri ostroi boli v spine: dannye nabliudatel'nogo neinterventsionnogo mnogotsentrovogo issledovaniia.

AIM: To evaluate the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) (meloxicam) in acute nonspecific back pain (NSBP) depending on influence of clinical and anamnestic factors. MATERIAL AND METHODS: The studied group included 2078 patients presented with an acute NSBP. All study subjects received meloxicam in a dose of 15 mg/day: 86.1% were given intramuscular meloxicam injections for the first 3-5 days and then switched to an oral meloxicam and 13.9% received an oral meloxicam throughout the therapy. Skeletal muscle relaxants (SMR) and oral or intramuscular group B vitamins were also prescribed to 52.3% and 17.4% of study patients, respectively. Pain was assessed on a 10-point numerical rank scale (NRS). The study assessed the rate of complete pain relief within a 2-weeks NSAID therapy. RESULTS: Complete pain relief was achieved in 75.2% of study patients, mean period of treatment was 8.61±5.53 days. Adverse events were observed in 4.6% of patients. Age <65 years, first NSBP episode and a history of good response to NSAIDs were associated with better treatment outcomes. A severe baseline pain (NRS score ≥7), pain persistence at rest, at nights and, especially, sciatica were associated with poorer treatment outcomes. Co-administration of SMR and group B vitamins did not increase chances for pain relief compared to the NSAID monotherapy. CONCLUSION: Meloxicam in a dose of 15 mg/day is an effective and safe therapy for the treatment of acute NSBP. The analgesic effect of NSAIDs is higher in young patients, patients with the first episode of NBC and a good response to NSAIDs in history. Treatment of patients with NSBP in the presence of severe pain, maintaining pain at rest and at night, and in case of sciatica, requires special control and integrated treatment.

[Etiopathogenetic factors of peripheral neuropathic pain in rheumatoid arthritis]. / Étiopatogeneticheskie faktory perifericheskoi neiropaticheskoi boli pri revmatoidnom artrite.

AIM: To determine a neuropathic component of pain and define its causes in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: One hundred and eighty-three patients with confirmed RA, mean age 46,5±11,7 years, RA duration from 3 month to 30 years, were studied. Rheumatology, neurological, using the DN4 questionnaire, examinations and stimulation electromyography were used. Results and сonclusion. Signs of neuropathic pain (NP) assessed with the DN4 were identified in 73 (43%) patients with RA. These patients were older, had longer RA duration as well as higher clinical stage of disease and reduced functional abilities. There were no correlation between NP and disease activity. Peripheral nervous system (PNS) lesions were seen in 96% patients with NP: sensory motor neuropathy (55%), tunnel syndrome (14%), mononeuropathy (19%) and their combinations (4%), cervical myelopathy (4%). PNS lesions is the main etiopathogenetic factor of peripheral NP in RA. This finding opens new perspectives for complex treatment, including group B vitamins, of chronic pain in RA.

[Evaluation of the efficacy of pregabalin in the therapy of chronic pain in patients with knee osteoarthritis]. / Otsenka éffektivnosti pregabalina v terapii khronicheskoi boli u patsientov s osteoartrozom kolennykh sustavov.

AIM: To evaluate the efficacy of pregabalin in the therapy of chronic pain in patients with knee osteoarthritis (KOA). SUBJECTS AND METHODS: The study enrolled 60 patients with KOA and neuropathic pain component (NPC) (Douleur Neuropathique en 4 questions (DN4) questionnaire scores, >4) who were randomized into two groups to receive aceclofenac or aceclofenac + pregabalin for 5 weeks. All the patients underwent clinical and neurological examinations, assessment of the functional WOMAC index, pain intensity at rest and during movement, and diagnosis of neuropathic pain (NP) (DN4 and Pain DETECT questionnaires). RESULTS: Both groups were observed to have positive changes in the studied parameters; however, combination therapy using an anticonvulsant drug (pregabalin) showed a more pronounced positive effect against not only NPC, but also the functional activity (WOMAC) and severity of pain (visual analogue scale). CONCLUSION: Combination therapy using pregabalin in KOA patients having the signs of NP is more effective than monotherapy with nonsteroidal anti-inflammatory drugs (aceclofenac).

[Differential diagnosis between mechanical and inflammatory lower back pain, therapy options]. / Differentsial'naia diagnostika vospalitel'noi i mekhanicheskoi boli v spine.

The article presents the differential diagnosis between mechanical and inflammatory lower back pain based on clinical and paraclinical evidence. The results of comparative studies of amtolmetinum guacilum (AMG) and celecoxib, as well the CORONA study of its efficacy and cardiovascular safety in ankylosing spondylitis, are also discussed.

[Central regulation of pain in patients with joint disease and approaches to therapy]. / Tsentral'naia reguliatsii boli u patsientov s zabolevaniem sustavov i podkhody k terapii.

The paper reviews investigations studies that have demonstrated that chronic pain syndrome is mixed in rheumatic diseases. The nervous system is involved in its pathogenesis with different frequency and different mechanisms. Under the influence of afferent pain impulses from damaged joints, there are changes in the excitability of spinal cord neurons, which is called central sensitization (CS). A number of patients have enhanced CS and clinical manifestations as neuropathic sensitive phenomena. The mixed model of the development of chronic pain in joint diseases and its presence along with nociceptive (inflammatory) and neuropathic pain components may explain the discrepancy between joint inflammatory and structural changes and pain intensity, the presence of distant pain and sensitive disorders in the areas outside the joint, and sometimes the efficiency of anti-inflammatory therapy. The presence of the neuropathic pain component serves as a rationale for combined therapy by adding centrally acting drugs, such as anticonvulsants.

[Neurogenic mechanisms of chronic joint pain].

To study pathogenetic features of chronic joint pain, we examined 183 patients with rheumatoid arthritis (RA) and 80 patients with osteoarthrosis (OA). The presence of mixed pain syndrome was found. A neuropathic component of pain (NCP) was observed in some patients with nociceptive pain (43 and 30% with RA and OA, respectively). Patients with RA had tunnel syndromes (14%), polyneuropathies (55%), mononeuropathies (19%) and sensitive specific disorders, characteristic of NCP, which were localized in anatomic zones corresponding to affected nerves. No signs of the damage of the somatosensory nervous system were found in patients with OA. Neuropathic pain was concomitant to secondary hyperalgesia which covered the zones localized far from the affected joint that allowed to suggest the involvement of dysfunctional mechanisms in the pathogenesis of chronic pain in OA. The study opens new possibilities for pharmacotherapy.

[Changes in the level of short-chain volatile fatty acids and their aldehydes in oral air and fluid during inflammation of oral tissues]. / Izmenenie soderzhaniia korotkotsepochechnykh letuchikh zhirnykh kislot i ikh al'degidov v zhidkosti i vozdukhe rta pri vospalenii tkanei rotovoi polosti.

It is shown that volatile short-chain fatty acids (propionate, butyrate and acetate) of bacterial and tissue origin are important factors of pathogenesis of oral tissue inflammation. A comparative biochemical study using chromato-mass-spectrometry, gas adsorptive and gas-liquid chromatography of oral media in healthy subjects has discovered that in gingivitis and parodontitis these media contain higher concentrations of short-chain fatty acids and lower ones of relevant aldehydes in intensification of the inflammatory process. The ratios of acetate/acetaldehyde, propionate/acrolein, butyrate/butyraldehyde increase considerably with intensification of parodontic inflammation making these values suitable for assessment of inflammation severity.

[Volatile compounds in air and oral saliva in healthy people, and in periodontitis and gingivitis patients]. / Letuchie soedineniia v vozdukhe i sliune rotovo polosti zdorovykh liudei, pri parodontite i gingivite.

21 healthy persons, 7 patients with chronic generalized periodontitis and 4 patients with chronic generalized gingivitis aged between 18 and 42 years were examined. Air from the oral cavity was collected with a special device; liquid samples were collected by washing the oral cavity with sterile water. Chemical compounds of the air and the washed liquid were analyzed by chromato-mass-spectrometry, gas-adsorption and gas-liquid chromatography. The content of dimethyl sulphide, dimethyl disulphide increased in the oral air and such volatile short chain fatty acids (VSCFA) as butyrate, propionate, acetate rose, but their aldehydes (butyraldehyde, acrolein, acetaldehyde decreased in oral fluid during periodontitis. The concentration of these compounds were found to be between the levels in control persons and during periodontitis. The content of pentane decreased in oral air. That depended on the intensity of inflammation and vessel disturbances. The results suggest that VSCFA produced by Porphyromonas, Prevotella, Fusobacterium and other periodontopathic bacteria, penetrate the oral mucosa and severely harm the periodontal tissue. The increase of dimethyl sulphide contributed to oral malodor during periodontal inflammation.

[The evaluation of periodontal status by the chemical composition of the oral media]. / Otsenka sostoianiia parodonta po khimicheskomu sostavu sred polosti rta.

Twelve patients aged 21-38 years with gingivitis and periodontitis and 9 subjects with intact periodontium were examined. Air from the oral cavity was collected with a special device, liquid samples were collected by gargling with sterile water. Chemical composition of the air and washings was analyzed by chromato-mass-spectrometry, gas adsorption and gas liquid chromatography. Inflammation of periodontal tissues was associated with a sharp increase in the oral air concentration of methylethylketone. The concentrations of isovaleric, n-valeric, and n-enanthic aldehydes increased appreciably. Ethanol predominated over n-butyl alcohol. The levels of dimethylsulfide and isoprene increased several times. In the washings from the oral cavity, the content of microorganism's vital activity products (fatty acids) was increased. Possible metabolic mechanisms of the detected shifts are discussed.