The risk and benefit of using nonsteroidal anti-inflammatory drugs (NSAIDs) are considered. The adverse reactions of NSAIDs are noted to be a serious problem, but they are predictable and preventable. Consideration of risk factors, adequate and timely treatment of comorbidity, and implementation of appropriate prophylactic measures minimize the likelihood of menacing complications. It is concluded that the benefit of the administration of NSAIDs generally overweighs the possible risk of their undesirable adverse effects.

The paper deals with the pathogenesis, clinical picture, and treatment of renal involvement in patients with systemic lupus erythematosus (SLE). It is noted that at the onset of the disease, there are signs of renal involvement in 25-50% of patients with SLE; they are further detectable in almost 60% of adults and in 80% of children. The types of renal lesion are described in SLE.
The pathogenesis of SLE as a whole is examined on a model of lupus nephritis. The morphological classification of lupus nephritis, the specific features of major nephrological syndromes, and the clinical types (active and inactive) are given. Treatment policy is stated to depend on the activity of the disease, the clinical and morphological type of lupus nephritis. Current immunosuppressive therapy can reduce the proportion of patients with terminal renal failure on the one hand and shows the prognostic value of renal involvement for the course of the disease as a whole, on the other.
New immunological involvement strategies are associated with total irradiation of the lymphoid system or marrow, followed by stem cell grafting.

Infective endocarditis (IE) is today characterized by polyetiology due to a wide range of pathogens. The paper describes the specific features of the clinical picture of the disease in relation to the etiological agent, which have, in some cases, a crucial role in the choice of empiric antibiotic therapy. Significant clinical polymorphism, obscure symptoms, and monosyndromic onset as guises all enhance the importance of the differential diagnosis of IE, at its early stages in particular. Basic approaches to differentiating IE from the diseases in which differentially diagnostic problems arise to the utmost are outlined.

An open-labeled randomized study of the efficacy and safety of Piascledine-300 in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) versus the latter was conducted in 2 matched groups of patients with lower back pain associated with spondylarthrosis. During combined therapy using Piascledine, there was a reduction in the pain syndrome particularly with the longer administration of the drug. The use of Piascledine in spondylarthrosis showed its clinical efficacy in 89,2% of patients: the indices of lumbago substantially reduced and spinal function improved, which was associated with the good tolerability of the drug.

Objective - to evaluate the effect of Blemaren on uric acid (UA) metabolic parameters in gout patients with nephrolithiasis and the possibilities of its use in combined therapy for gout.
Patients and methods. The study included 30 patients (26 males and 4 females) aged 50 years (range 36 to 61 years) who had crystal-verified gout in the presence of nephrolithiasis. All the patients took Blemaren in an initial dose of 3 g/day; the dose of the drug was adjusted depending on the urine acidity (the pH value was maintained at 6,2-6,8). Physical and laboratory studies were conducted before and a month after the drug's administration. The treatment performed before the patients ' inclusion into the study remained the same for at least 2 months. Fifteen patients received allopurinol in a dose of 100-200 mg/day.
Results. After completion of a course of Blemaren therapy, there was an 8% reduction in the mean serum UA levels, which correlated with an increase in its daily excretion (by an average of 20%). The highest increase in UA excretion was observed in 20 patients with baseline hypoex-cretion (<700 mg/day): from 226,3 (range 201,6-436,8) to 635,0 (range 272,2-705,6) mg/day (p = 0,01). UA excretion substantially unchanged in patients with normal uricosuria (>700 mg/day). Side effects that could cause the agent to be discontinued were absent. Conclusion. The Blemaren citrate formula used in gout patients with nephrolithiasis causes a significant increase in the renal excretion of UA (p = 0,01), normalizes its metabolic parameters, and shows a high safety, without worsening hepatic and renal functions and electrolyte metabolism.

Objective - to study the clinical efficacy and tolerability of two dosage forms of Ketorol (tablets and solution for injections) versus the similar formulations of diclofenac sodium in patients with osteoarthrosis (OA) in an open-labeled randomized study.
Patients and methods. The study covered 109 patients with OA (by the criteria developed by R. Altman et al.) with the knee joints being predominantly involved from 4 rheumatological centers of the Russian Federation. A study group comprised 51 female patients with gonarthrosis, treated with Ketorol (25 patients received the drug as tablets and 26 patients had it as injections) and a control group included 58 patients given diclofenac sodium (29 patients received it as tablets and 29 had it as injections). The duration of Ketorol therapy was 5 days. Both formulations for injection were used only for 2 days and then the patients were switched to tablets.
Results. Ketorol was found to be superior to diclofenac in short-term effectiveness (in relieving the pain syndrome) by 25-30%. Comparison of the results of treatment in the study and control groups showed a significantly more effective relief of the pain syndrome in those who received the drug as tablets. Both Ketorol formulations reduced the severity index by 25% whereas diclofenac did only by 15-18%. The same picture was also observed when the general condition of patients was evaluated by a physician. Analysis of WOMAK index changes indicated that by the end of the study, the percent of improvement with Ketorol use was much higher for both formulations (31% for tablets and 33% for injections) than that with diclofenac (18% and 6%). Pairwise comparison showed that the efficiency of Ketorol tablets was, in physician's opinion, much higher than that of diclofenac and the effectiveness of injections was comparable. However, the mean duration of Ketorol injections was twice greater (p = 0,003) than the similar formulation of diclofenac (426,3+153,2 min versus 288,3+173,1 min). There were no side effects of Ketorol on renal and hepatic function; no occult blood loss was found. Conclusion. The short-term use of Ketorol in severe gonarthrosis-caused pains results in a more marked improvement than that of diclofenac.

The authors describe a case of Whipple's disease (WD) in a 56-year-old male patient followed up for 2 years. The diagnosis was established on the evidence that there was a low-density retroperitoneal or mesenteric infiltrate at computed tomography and PAS-positive macrophages in the biopsy specimens of the duodenal retrobulbar mucosa. Arthropathy had developed within 10 years before the occurrence of intestinal symptoms, subsided with their progression, and recurred after their regression. On the basis of this observation and the data available in the literature, the authors discuss the relationships of arthropathy to the abdominal manifestations of WD.

The authors have analyzed the efficiency of and clinicoeconomic prospects for the use of strontium ranelate, by taking account epidemiological data and management costs for postmenopausal osteoporosis (OP). Strontium ranelate both stimulates the formulation of bone tissue and suppresses its resorption, by generating a new bone tissue and ensuring early and long-term prevention of fractures. It is noted that strontium ranelate is now the only drug for the treatment of OP, by physiologically affecting bone metabolism. Furthermore, it is an agent with proved efficacy in OP patients over 80 years of age. The authors show that it is clinically and economically expedient to use strontium

The author consecutively considers the introduction of intermittent use of ibandronate (I), by determining its single dose and annual cumulative dose. She presents data on the adequate antiresorptive activity of intermittent treatment, shows it necessary to design an intravenous dosage form of the drug and gives detailed data on the efficacy of parenteral I. The fact that the agent may be used in secondary (steroidal) osteoporosis is provided. There is evidence that the risk of extravertebral and all clinical fractures reduces when I is intravenously injected in a dose of 3 mg quarterly and orally administered in a dose of 150 mg monthly.

There is a host of pharmaceutical formulations of diclofenac, which ensures that it can be used orally, rectally, intrarectally, or topically. Objective - to comparatively analyze the pharmacokinetic parameters and time course of changes in the serum concentration of diclofenac potassium after oral administration in a dose of 50 mg as sachets or sugar-coated tablets.
Results. There is evidence that patients tolerate both its sachets and tablets equally well, as confirmed by subjective and objective observations. There are neither marked side effects nor considerable changes in laboratory tests and in the values of vital functions. Diclofenac potassium as early-action tablets (50 and 100 mg) exerts a very good analgesic effect in treating migraine since the plasma concentration of the drug peaks on an average of an hour of administration (range 0,33-2 hours) and the analgesic effect developed following 60-90 min. Conclusion. By comparing the rate of absorption, it may be concluded that diclofenac potassium as sachets will produce a much rapider analgesic effect. Thus, the high solubility of diclofenac potassium and its very good absorbability (as sachets in particular) make the drug a superior analgesic that has a rapid analgesic activity.

The paper gives data on the basic mechanisms of action of nimesulide, a nonsteroidal anti-inflammatory drug that has anti-inflammatory, analgesic, and antipyretic activities in a broad spectrum of morbid states. It shows the rate of effect occurrence after administration of different nimesulide formulations in gouty arthritis and considers the aspects of its safety and tolerability in rheumatic diseases.

It is noted that within recent years the severity of rheumatoid arthritis has noticeably diminished, as evidenced by the studies performed. This transformation is largely caused by the emergence of new first-line anti-inflammatory drugs (FLAIDs), leflunomide (LF, Arava) in particular. The experience gained during its 10-year wide clinical application shows that LF is as good as with methotrexate (MT) in the therapeutic potential and tolerance and supposedly can compare well with this agent in future. LF provides a significant clinical improvement in much earliest periods and has a more positive effect on patients 'functional status than MT. LF slows down articular destruction to a greater extent than MT given in combination with folic acid. By and large LF is well tolerated and causes adverse reactions less frequently than other FLAIDs.

According to the data of recent studies, the topical formulations of nonsteroidal anti-inflammatory drugs (NSAIDs) used in rheumatic diseases are of the greatest importance in the treatment of osteoarthrosis. Comparative studies have demonstrated that ketoprofen-containing gel has some advantage over other NSAIDs. Topical formulations based on ketoprofen (Fastum® gel) are effective, fast-acting, and able to aid patients in relieving pain and improving the quality of life.

Novyy preparat dlya lecheniya revmatoidnogo artrita (RA) - Aktemra (totsilizumab) - prodemonstriroval prevoskhodstvo nad sushchestvuyushchim standartom terapii (metotreksat): posle 6 mes priema preparata nablyudaetsya bolee znachitel'noe snizhenie vyrazhennosti simptomov zabolevaniya (pripukhlost' i boleznennost' sustavov) u patsientov, stradayushchikh RA1. Bolee togo, pri ispol'zovanii Aktemry primerno v 3raza bol'she patsientov (po sravneniyu s metotreksatom) dostigli remissii (po kriteriyam DAS 28 <2,6)2 - osnovnoy tseli terapii etogo poka neizlechimogo zabolevaniya1. Etot rezul'tat chrezvychayno vazhen, poskol'ku RA yavlyaetsya dlitel'nym invalidiziru-yushchim zabolevaniem i sushchestvuyushchie lekarstvennye sredstva dayut lish' nebol'shuyu nadezhdu na dostizhenie remissii; po sushchestvu,
ostro neobkhodimy novye varianty terapii RA. Uil'yam M. Berns - glava podrazdeleniya Farma kompanii «Rosh»: «Dannye poslednikh issledovaniy yavlyayutsya obnadezhivayushchey novost'yu dlya patsientov, stradayushchikh ot razrushitel'nykh effektov RA. My verim, chto Aktemra - pervyy i edinstvennyy biologicheskiy preparat, demonstriruyushchiy preimushchestvo pered sushchestvuyushchimi standartami lecheniya RA, - oblegchit sostoyanie mnogikh bol'nykh. Krome togo, Aktemra predostavlyaet bol'she shansov dlya dostizheniya ranney i prodolzhitel'noy remissii».