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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">mrj</journal-id><journal-title-group><journal-title xml:lang="ru">Современная ревматология</journal-title><trans-title-group xml:lang="en"><trans-title>Modern Rheumatology Journal</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1996-7012</issn><issn pub-type="epub">2310-158X</issn><publisher><publisher-name>IMA-PRESS, LLC</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.14412/1996-7012-2021-3-91-97</article-id><article-id custom-type="elpub" pub-id-type="custom">mrj-1155</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>В ПОМОЩЬ ПРАКТИКУЮЩЕМУ ВРАЧУ</subject></subj-group></article-categories><title-group><article-title>Первое назначение лекарственной терапии на амбулаторном приеме: принципиальный подход</article-title><trans-title-group xml:lang="en"><trans-title>Initial drug prescription in outpatient department: principal approach</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1391-0711</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Каратеев</surname><given-names>А. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Karateev</surname><given-names>A. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Андрей Евгеньевич Каратеев</p><p>Россия, 115522, Москва, Каширское шоссе, 34А</p></bio><bio xml:lang="en"><p>Andrey Evgenyevich Karateev</p><p>34A, Kashirskoe Shosse, Moscow 115522, Russia</p></bio><email xlink:type="simple">aekarat@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>V.A. Nasonova Research Institute of Rheumatology</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2021</year></pub-date><pub-date pub-type="epub"><day>24</day><month>06</month><year>2021</year></pub-date><volume>15</volume><issue>3</issue><fpage>91</fpage><lpage>97</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Каратеев А.Е., 2021</copyright-statement><copyright-year>2021</copyright-year><copyright-holder xml:lang="ru">Каратеев А.Е.</copyright-holder><copyright-holder xml:lang="en">Karateev A.E.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://mrj.ima-press.net/mrj/article/view/1155">https://mrj.ima-press.net/mrj/article/view/1155</self-uri><abstract><p>Одна из важнейших задач врача при первой встрече с пациентом – добиться его расположения и доверия. Далеко не всегда в ходе первого визита удается поставить точный диагноз и назначить патогенетическую терапию, ведь для этого нередко требуется серьезное дополнительное обследование. Однако продемонстрировать свои знания и уверенность, оказать психологическую поддержку и облегчить страдания пациента совершенно необходимо, особенно в случае ревматического заболевания, сопровождающегося выраженной болью. Такому пациенту незамедлительно должна быть назначена адекватная анальгетическая терапия. Основным инструментом для контроля боли при заболеваниях суставов и позвоночника являются нестероидные противовоспалительные препараты. При этом их назначение должно быть обдуманным и взвешенным, с учетом клинической картины и коморбидной патологии.</p><p>В статье представлены два типичных клинических наблюдения, иллюстрирующих формирование диагностической и терапевтической концепции на амбулаторном приеме.</p></abstract><trans-abstract xml:lang="en"><p>One of the primary tasks for a doctor when meeting a patient for the first time is to gain his affection and trust. It is not always possible during the first visit to make an accurate diagnosis and prescribe pathogenetic therapy, because this often requires a deep additional examination. However, it is imperative to demonstrate knowledge and confidence, provide psychological support and alleviate the suffering of the patient, especially in the case of rheumatic disease accompanied by severe pain. Such a patient should be immediately prescribed adequate analgesic therapy. The main tool for controlling pain in diseases of the joints and spine are non-steroidal anti-inflammatory drugs. Moreover, their prescription should be deliberate and balanced, taking into account the clinical picture and comorbid pathology.</p><p>The article presents two clinical observations, illustrating the formation of a diagnostic and therapeutic concept at an outpatient appointment.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>ревматические заболевания</kwd><kwd>диагностика</kwd><kwd>контакт с пациентом</kwd><kwd>выбор терапии</kwd><kwd>нестероидные противовоспалительные препараты</kwd></kwd-group><kwd-group xml:lang="en"><kwd>rheumatic diseases</kwd><kwd>diagnostics</kwd><kwd>contact with the patient</kwd><kwd>choice of therapy</kwd><kwd>non-steroidal anti-inflammatory drugs</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Fowler JB, Khan YR, Fischberg GM, Mahato D. A Cultural Shift Away from Cognitive-behavioral Empathy. 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