The paper presents the basic criteria for diagnosing complex regional pain syndromes, the most important links of their pathogenesis and the specific features of their clinical picture. Much attention is given to their treatment options, including these with nonsteroidal anti-inflammatory drugs.

The prevention and medical treatment of typical arthropathy of the foot, ankle, knee, hip, and shoulder are considered in patients with rheumatoid arthritis (RA). The methods of conservative rheumoorthopedics can yield good results at the early stages of RA, the chronic course of the disease requires repeated courses of medical rehabilitative treatment; in severe cases these methods are a preparatory stage for surgical treatment, which enhances the latter's efficiency.

The major tasks of a follow-up of patients with rheumatic cardiac defects (RCD) are formulated on the basis of the recommendations of international and national scientific associations. At the same time, a clinicianXs experience and judgments play an important role in supervising patients with chronic rheumatic heart disease and RCD.

The paper considers the immunosuppressive properties of micophenolate mofetil (MMF) and results of its use in graft rejection and rheumatic diseases. It also provides evidence suggesting the suppression of overfibrosis with the use of MMF, as well as the results of the experiments strongly confirming its antifibrotic properties. The author analyzes the results of clinical trials of MMF used in lung interstitial injury in patients with diffuse scleroderma, notes not only improvement or stabilization of lung functional tests, but also the optimization of prognosis (as evidenced by retrospective observations). Of interest are the experimental data demonstrating the suppression of pulmonary hypertension due to the antiproliferative and anti-inflammatory effects of MMF, which are indicative of the potential abilities of the agent to treat pulmonary hypertension.

Objective: to study the efficacy and tolerability of infliximab (Remicade) in the major syndromes of psoriatic arthritis (PA). Subjects and methods. The study was based on Remicade therapy in 22 patients with severe and moderate PA with polyarthritic, osteolytic and spondyloarthritic types of the joint syndrome, generalized psoriasis vulgar and erythrodermata, and pustular psoriasis. Inflammatory activity was determined by DAS 4 and the efficiency of therapy was evaluated by the ACR and EULAR criteria. The severity of psoriasis was judged from the PASI index. Inefficiency or intolerability of essential anti-inflammatory drugs (EAIDs) was observed in all the patients. Therapy with Remicade in combination with methotrexate was performed in 7 patients; the other patients took Remicade without EAIDs. The drug was intravenously injected in a dose of 5 mg/kg by the generally accepted scheme. The efficacy of the first 5 Remicade infusions was evaluated. Results. Just after the first infliximab infusion, there was a significant reduction in the intensity of joint pains and in the duration of morning stiffness, as well as in the number of tender and inflamed joints. The improvement was associated with the duration of treatment. Remicade therapy resulted in diminished inflammatory activity. Before treatment the high activity of PA, estimated from the DAS 4 index, was determined in 71,4% of the patients; and after the second infusion it was seen only in 5%. After three infusions or more, there were a larger number of patients with 70ACR scores, i.e. those with a very good effect of therapy; and after 5 infusions; the number of such patients was as high as 91%. According with the EULAR criteria, a good therapeutic effect was observed in 89% of cases. The course of psoriasis was less pronounced. PA remission occurred in every 6 and every 3 patients after the second and fifth infusions, respectively.
Conclusion. Remicade is the most effective drug among the available anti-inflammatory ones for the treatment of PA. It strongly affects the major syndromes of this disease.

Objective: to have an analgesic effect, to improve spinal mobility, and to maintain adequate bone mineral density (BMD) in patients with osteoporosis (OP) treated with Bora Bora that has a combined effect on bone tissue.
Subjects and methods. Fifteen patients (mean age 63,7+8,4 years) with OP were treated with Bora Bora as a capsule 4 times daily for 6 months. During Bora Bora treatment, another therapy for OP was not performed. The intermittent use of nonsteroidal anti-inflammatory drugs (NSAIDs) was allowed in severe pains. The patients underwent a routine clinical laboratory examination; dual-energy X-ray absorptiometry (DEXA) was used to estimate BMD; the authors determined the intensity of pain in the back and on palpation of paravertebral muscles by the VAS (visual analog scale (in mm), the range of spinal motions, the overall efficiency of treatment, and the presence of adverse reactions. Examinations were made on the day of treatment initiation, following 2 weeks, and at months 1, 2, 3, and 6 of Bora Bora therapy. Results. Increased BMD was noted in all the patients after treatment with Bora Bora (according to the data of DEXA). The effect depended on the timeliness of using the drug. The rate of BMD increase in the lumbar vertebrae was 0,5-2% higher than that in the femoral neck in 50- 70-year-old women. After 70 years of age, the rate of a bone mass increment was much less, particularly in the femoral neck. Conclusion. When Bora Bora was given, there was pain relief and increases in the range of vertebral motions and BMD. Bora Bora was shown to be well tolerated by and to be beneficial to patients with OP.

The paper describes a procedure for capsular endoscopy (CE), a new high-technology method of evaluating the small bowel, and reports on its use in rheumatological care. Small bowel involvement is noted to be frequently encountered in rheumatic diseases, such as Behcet's disease, diffuse scleroderma, and seronegative spondylitis. According to the data of clinical trials, CE is effective in timely detecting this visceral abnormality. At the same time, CE is actually the only accurate method of diagnosing drug-induced enteropathy, a potentially menacing disease that frequently occurs with the use of nonsteroidal anti-inflammatory drugs.

Baker's cyst (BC), a fluid-expanded synovial sac in the popliteal space, frequently occurs in arthrosis, arthritis, and traumatic knee joint injury. The outcomes of BC may be suppuration, rupture, or a chronic pattern. Knowledge of the causes of this abnormality, its clinical picture and the specific features of its ultrasound diagnosis assists in elaborating the treatment policy of this disease.

The paper outlines the specific features of the clinical picture and diagnosis of chronic gouty arthritis. It describes difficulties in treating chronic gout when one has to face the so-called vicious circle, to which is contributed by comorbidity that is present in most patients. A way out of this clinical difficulty is proposed to use the herbal complex Urisan that has antihyperuricemic and inflammatory properties.

It is shown that of great importance in osteoarthrosis (OA) is the use of hyaluronic acid preparations and oral chondroprotectors that produce not only symptomatic, but also structurally modifying effects. Combined therapy using these agents makes it possible to enhance the efficiency of the therapy for OA and to reduce a risk of drug-induced complications due to the decreased requirements for nonsteroidal anti-inflammatory drugs. The data showing the benefits of a low molecular-weight hyaluronic acid preparation (Hyalgan®) and an agent based on the unsaponifiable compounds of avocado and soybean (Piascledine®) and evidence for their efficacy and safety are given.

The paper presents data on the prospects for clinical use of the nonsteroidal anti-inflammatory drug Amelotex® (meloxicam) in patients with osteoarthrosis. It also gives the results of a study showing a good efficacy and tolerability of Amelotex® in patients with gonarthrosis.

Arthroplasty is stated to be one of the most effective surgical treatments for rheumatic diseases (RD). However, the problem is that the bad quality of bone tissue has a negative impact on the outcome of surgery. The authors have studied the time course of changes in bone mineral density (BMD) after total hip arthroplasty in 81 patients with RD. All the patients underwent dual-energy X-ray densitometry by a special orthopedic program. BMD was measured in 7 areas of a femoral prosthetic component as described by T.A. Gruen et al. and that was in 3 areas of an acetabular component as proposed by J.L. DeLee и J. Charnley. The first (initial) measurement was carried out a fortnight after surgery; later measurements were made following 3, 6, and 12 months. It was established that there was a progressive BMD loss after surgery; following 3 months all the areas virtually exhibited a BMD reduction that peaked by month 6. BMD loss around the endoprosthetic acetabular component was about 20 %. The use of bisphosphonates, such as ibandronate (Bonviva), one of the most potent drugs of this group, is shown to be most promising in preventing BMD loss around the prosthesis.

The variously faceted and clinically important problem of immunogenicity of recombinant biologicals that have become an integral part of therapy for inflammatory rheumatic diseases is considered.

It is noted that nonsteroidal anti-inflammatory drugs (NSAIDs) hold a special position in the treatment of osteoarthrosis (OA). Most conventional NSAIDs are considered to enhance cartilage degeneration. Whether NSAIDs have a negative effect on the progression of OA is the subject of wide speculation. Experiments have established that NSAIDs affect the metabolism of the hyaline cartilage in a different manner in relation to the stage of OA and the duration of treatment. The negative effect of NSAIDs on the articular cartilage gives grounds to recommend their short-term use in OA and only on its exacerbation or severe joint pains and in the inefficiency of simple analgesics. At the same time there is evidence that some NSAIDs, aceclofenac (Aertal) in particular, are able to restrain the apoptosis of chondroblasts and chondrocytes and to stimulate their production of proteoglycans. It has been ascertained that in OA aceclofenac stimulated chondroblasts and chondrocytes to elaborate adequate proteoglycans, glycosaminoglycans, and hyaluronic acid, i.e. it produces a chondroprotective effect.

The paper considers the tolerability of Voltaren versus other nonsteroidal anti-inflammatory drugs, including generics. A wealth of clinical experience in using Voltaren leads to the conclusion on its good tolerability and significant anti-inflammatory and analgesic activities.