Autoimmune reactions are of primary importance in the development of extrahepatic manifestations of viral hepatitis, among which there are rheumatic symptoms and syndromes. The incidence of clinically significant extrahepatic manifestations is shown to be relatively low, but they may be in the foreground in the clinical picture of the disease and are noted for severity. It is concluded that due to the high prevalence of hepatitis and the systemic pattern of their chronic forms, patients with extrahepatic manifestations of viral hepatitis may be encountered in the practice of a therapist and a rheumatologist. The onset of the infection caused by hepatitis viruses may be accompanied by articular lesion therefore the rheumatologist may be the first physician such a patient may resort to.

The etiology of Sjц gren's disease (syndrome) - SD, SS - is unknown; however, its frequent development in patients with hepatitis B or C or AIDS in infection with human lymphotropic virus type (HLTV-1) suggests the viral nature of the disease. A large body of data available in the literature shows the promise of studying the implication of viral infection in the development of SD and SS, at the early stages of the development in particular.

The present paper completes a series of papers on the current aspects of infective endocarditis (IE). It also presents detailed antibacterial treatment schemes for IE in relation of an isolated pathogen. The authors show it expedient to use of glucocorticoids in IE and give indications for their administration. The basic principles of antibiotic prevention of IE are considered in various IE risk groups.

Pulmonary hypertension (PH) associated with scleroderma systematica (SDS) is a menacing manifestation of this systemic disease of connective tissue, in which a rapid progression results in very poor outcomes. In SDS, PH is more frequently observed with the prolonged disease, circumscribed skin lesion, develops after a long benign course, and is one of the common causes of death. The early stage of PH can be identified by instrumental and not always accessible studies. The stage of clinical manifestations, which is frequently manifested only by dyspnea, requires a differential diagnosis from a wide range of conditions both caused by and concurrent with SDS. The need for differential diagnosis stems from the varying course and prognosis of the disease, as well as treatment policy.

Current therapy for systemic lupus erythematosus (SLE) envisages long-term treatment with cytostatic drugs, which is frequently accompanied by activation of comorbid infection, including viral one.
Objective: to determine the clinical features of SLE complicated by herpesviral infection.
Subjects and methods. Sixty-seven patients with a 1-to-7 history of SLE who received first-line therapy were examined. Results. The analysis of the history data and the results of a serological survey identified 3 groups of patients: 1) 35 patients with viral infection, of them 9 had mixed viral-and-bacterial infections; 2) 14 with bacterial infections and 3) 18 patients without viral-and-bacterial complications. The analysis of clinical symptoms established a correlation of high titers of antibodies to cytomegalovirus (CMV) and Epstein-Barr virus (EBV) with symptoms, such as fever, arthritis, lymphadenopathy, carditis, hepatomegaly and erythema migrans eruption. However, having the similar clinical manifestations, CMV and EBV infections had some organ specificity. In SLE, concomitant comorbid infection, viral infection in particular, contributed to the development of the clinical picture polymorphism with the protracted, remitting inflammatory process and the inadequate efficiency of glucocorticoid and immunosuppressive therapy.

Objective: to study bone mineral density (BMD) in elderly patients with different clinical forms of osteoarthrosis (OA).
Patients and methods. A hundred and fifty-five patients above 65 years of age, diagnosed as having OA according to the criteria developed by R. Altman were examined. In all the patients, anthropometric indices, duration of the disease, and degree of functional impairment were assessed and joint X-ray study and densitometry were made. According to the clinical form of the disease, the patients were divided into 3 groups (with signs of gonarthrosis, oligoarthrosis of the knee and hip joints, and polyosteoarthrosis).
Results. Both the clinical and anthropometric characteristics of patients facilitated the development of osteopenia. Involvement of a larger number of joints into a pathological process was followed by a significant BMD reduction in the predominant number of patients with OA. With the more progressive X-ray stage of the disease, a significantly higher BMD was observed in the distal forearm of patients from all groups. The patients aged 75 years or older who had gonarthrosis and polyosteoarthrosis showed a significant reduction in BMD as compared with those of less than 75 years of age. A greater reduction in the T test was shown to correspond to less body weight. The examinees' inactivity correlated with decreased BMD. In patients with polyosteoarthritis, early onset and longer menopause negatively affected BMD in the distal forearm. Conclusion. Reduced distal forearm BMD in elderly patients with OA is associated with patients' older age and a longer menopause, less body weight, early menopause, and no regular exercises. Progression of the X-ray stage of OA correlates with increased bone density.

The timely and accurate diagnosis of rheumatic diseases is of fundamental importance for successful etiopathogenetic treatment. Of the greatest importance are the techniques of imaging the nature, stage, and degree of pathomorphological changes in the tissues of the locomotor apparatus, and the ratio of inflammatory processes, exudation, degeneration, and alteration.
Due to the rapidity of performance, relatively low cost, no contraindications, and high resolution, the currently available joint ultrasonic methods considerably enhance a rheumatologist's therapeutic-and-diagnostic capabilities and allow the efficiency of therapy to be monitored. The paper gives illustrations from the author's sonographic collection.

The use of tumor necrosis factor (TNF) а inhibitors in combination with methotrexate remains the basic method for treating active rheumatoid arthritis (RA). This line in antirheumatic therapy is rapidly developing. A number of unsolved issues associated with the selection of patients (particularly at the early stage of RA) to be treated with TNF а antagonists, the prediction of its efficiency, the study of comparative aspects of therapy are on the agenda. The Russia's emergence of the latest TNF а inhibitor adalimumab that has unquestioned merits opens new vistas for the treatment of RA.

A patient with the articular syndrome and arterial hypertension (AH) is well known to have elevated blood pressure levels with co-administration of nonsteroidal anti-inflammatory drugs and most classes of antihypertensive agents. This effect may be attended by a higher risk for cardiovascular events. A physician's task is to choose the most optimal treatment regimen for musculoskeletal disease in patients with AH. Nimesulide may be the drug of choice in treating this group of patients.

The paper presents data on the effectiveness, safety, tolerance, major mechanisms of action, and prospects for clinically using meloxicam, a current selective nonsteroidal anti-inflammatory drug, against cyclooxygenase-2. It describes the advantages of meloxicam for injections, which begins acting promptly and shows an adequate long analgesic effect.

The paper discusses a role of a diet and therapy with the herbal complex Urisan in patients with gout. It is noted that the agent based on herbal components may be used in addition to drug therapy and diet in seasonal hyperuricuria, hyperuricemia observed after heavy strenuous and athletic activity, meat overeating, and alcohol abuse. Urisan may be recommended in subsiding gouty inflammation as a bridge to the use of allopurinol.

The paper shows whether Actovegin may be used in patients with chronic tophaceous gout and chronic skin ulcerative defects at the site of opened tophi.

Some patients with rheumatoid arthritis (RA) are unresponsive or intolerant to both synthetic first-line anti-inflammatory drugs (FLAID) and tumor necrosis factor (TNF) а inhibitors already included into all the treatment standards . Along with the conventional methods for overcoming drug resistance - switching to another FLAID or another TNF а blocker, the use of biologicals with another mechanism of action rather than suppression of TNF а gives a good account of itself. Prominent among these agents is the anti-B-cell drug rituximab. The new possibilities of the therapy, which open up the use of rituximab in patients with RA, are discussed.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in complex therapy for pain syndrome in rheumatology. The paper describes the pathophysiological mechanisms responsible for the development of chronic and acute pain. It details the action of cyclooxygenase types 1 and 2 (COG 1 and COG 2), shows the key role of COG 2 in pain induction and transmission. The data of clinical trials of meloxicam that inhibits mainly COG 2 are given. The drug is highly effective in treating rheumatic diseases, particularly in old-age group patients with osteoporosis. The combined use of different meloxicam formulations makes it possible to choose adequate, maximally individualized treatment and to relieve the pain syndrome in the shortest possible time. Among NSAIDs, meloxicam shows an optimum efficacy-safety ratio.