Part II of the paper completes the section on medical measures for rheumatoid arthritis and outlines the principles of conservative orthopedic treatment of rheumatic diseases: ankylosing spondylitis, osteorthrosis, and soft tissue diseases.

The paper presents the rheumatological aspects of the neck pain syndrome and the current view of the management and treatment of patients with cervicalgias.

Objective: to estimate the concentration of anti-cyclic citrullinated peptide antibodies (CCPA), the frequency of their increase, and their diagnostic value in children with early juvenile arthritis (JA).
Subjects and methods. Sera from 80 patients (36 girls and 44 boys) aged 1,5 to 16 years (mean age 8,5+5,03 years) who had early JA were tested for CCPA. The diagnosis of juvenile rheumatoid arthritis (JRA) and juvenile chronic arthritis (JCA) was made in 19 and 57 patients, respectively; the duration of JA being < 3 months in 4. The systemic type of JA was present in 8 (10%) children; the polyarticular and oligoar-ticular types in 37 (46,2%) and 35 (43,8%) children, respectively. The duration of the disease in all children did not exceed 6 months. A comparison group comprised 54 adult patients with early rheumatoid arthritis (RA), 27 with undifferentiated arthritis (UDA), and 37 apparently healthy children. The concentration of CCPA was measured by immunoassay using the commercial оAxis Shield Diagnosticsп kits (United Kingdom), the upper normal range being 5 U/ml.
Results. The higher levels of CCPA were revealed in 7 (8,8%) children with early JA. Their frequency was higher than that in healthy children; however, it was lower than that in adult patients with RA and comparable with UDA. CCPAs were detected more frequently in JCA and rheumatoid factor (RF)-positive patients. Higher concentrations were observed in patients with RF-positive polyarticular JA. There were correlations of CCPA with the number of swollen and tender joints, RF.
Conclusion. In patients with early JA, the detection rate of CCPA is significantly higher than that in healthy children and comparable with that of RF. CCPAs have a high specificity for the diagnosis of JRA (an independent nosological entity within JA) are a risk factor of polyarthritis. The early detection of CCPA alone or in combination with RF in JA patients may serve the basis for the early use of active, frequently aggressive therapy.

Objective: To evaluate the efficacy of leflunomide versus methotrexate in patients with rheumatoid arthritis.
Subjects and methods. The study included 24 patients receiving leflunomide who underwent the determination of changes in the articular syndrome: the Ritchie index, the number of tender and swollen joints, pain, and the total activity of the disease, by using the visual analogue scale, morning stiffness in minutes. Therapeutic efficiency was evaluated by the EULAR criteria on the basis of changes in the Disease Activity Score (DAS) 4 and by using the criteria for a response to therapy ACR 20/ACR 50/ACR 70.
Results. A rapid development of a clinical effect was noted in the use of leflunomide: the parameters of the articular syndrome improved at 3-month follow-up. According to the EULAR criteria, just after 1-month leflunomide treatment; good and satisfactory effects were achieved in 12,5 and 28% of the patients, respectively; and according to the ACR, there was a 50% improvement in 51% of the patients and 20% improvement in 22%. The patients treated with leflunomide showed a significantly reduced increment in the number of new erosions whereas those who took methotrexate caused only a reduction in the rate of increment.
Conclusion. The new basic drug leflunomide is as effective as the gold standard methotrexate, at the same time it allows clinical improvement to be more rapidly achieved. Leflunomide also slows down the rate of progression of erosive arthritis and it is well tolerated.

Objective: to compare the data of knee joint X-ray and arthroscopic studies in the presence of rheumatoid synovitis.
Subjects and methods. Sixty-seven patients who had undergone 72 arthroscopic synovectomic operations on 72 joints for chronic knee-joint synovitis in the presence of rheumatoid arthritis (RA) were examined. Preoperative knee-joint X-ray study was carried out with the standard projections in all the patients. In most cases, the magnitude of X-ray changes corresponded to grade 1 according to the Larsen classification. The degree of articular cartilage destruction was intraoperatively estimated. Repeated X-ray films were made 6 and 30-36 months after arthroscopy. Results. It has been fount that in 72,2% of cases, the true articular cartilage changes detectable by arthroscopic revision were ascertained to coincide in their magnitude with the X-ray changes determined by the Larsen classification or to exceed them.
Conclusion. In knee-joint RA, arthroscopic revision can provide the fullest information on the severity of pathological changes; however, X-ray study aids to a certain degree in the prediction of arthroscopic findings, including those of articular cartilage pathology.

Objective: to evaluate the efficiency and tolerability of a 10-day course of therapy with different doses of meloxicam in patients with osteoporosis and back pain.
Subjects and methods. The study covered 60 women (mean age 70±7 years), who were randomized to 3 groups: those who received meloxicam in doses of 15 and 7,5 mg and controls.
Results. During 10-day therapy, there was a significant reduction in the intensity of back pain when meloxicam was given in doses of
both 7,5 mg and 15 mg/day (p < 0,001) as compared with the baseline level and in the control group (p < 0,05). At the same time, the pain syndrome became insignificantly lower in the control group following 10 days (p > 0,05). In the first 2 groups, movement restriction significantly reduced, as well as physical activity increased and health improved, as rated by the Oswestry and EQ-5D questionnaires. Improvement was recorded in 27 (67,5%) patients, a satisfactory effect was seen in 10 (25%), there was no effect in 3 (7,5%) women.
Conclusion. The treatment was generally well tolerated.

Objective: to evaluate the efficiency of antiviral therapy in patients with herpetic infection-complicated rheumatoid arthritis (RA) who receive the basic therapy.
Subjects and methods. One hundred and thirty patients with recurrent herpesvirus infection were enrolled in the prospective comparative study. The patients were divided into 3 groups: 1) in addition to the basic therapy, the patients received Panavir®; 2) those who took Acyclovir; and 3) those who had the basic therapy alone. In 90 of the 130 examinees, high titers of antiviral IgG antibodies to cytomegalovirus and Epstein-Barr virus were found in 60 and 48,8%, respectively. The interferon-deficiency syndrome was diagnosed in 72 (80,0%) patients. Results. Virostatic therapy may be recommended for patients with RA concurrent with recurrent herpesvirus infection.

Objective: to evaluate the clinical efficacy and safety of Amelotex (the international non-proprietary name of meloxicam) in patients with osteoarthrosis (OA) and recurrent synovitis.
Subjects and methods. The open randomized study included 40 patients with knee-joint OA of predominantly X-ray stages II and III, who were found to have synovitis. A study group comprised 20 patients receiving Amelotex and a control group consisted of 20 patients taking diclofenac. Amelotex was intramuscularly injected in a dose of 1,5 ml once daily for 5 days; diclofelac was intramuscularly used in a dose of 3 ml in the same regimen. No other treatment was performed during therapy with both Amelotex and diclofenac.
Results. The use of 5-day therapy with intramuscular Amelotex in gonarthrosis patients has demonstrated its symptom-modifying action that is reflected by reductions in the pain syndrome and swelling of the joint, an increase in the volume of its movements, and a lower WOMAC index, which is comparable with that in the treatment with diclofenac.
Conclusion. The results of the study suggest the good tolerability of Amelotex and its clinical efficacy in patients with OA.

Objective: to evaluate the safety of long-term use of Urisan.
Subjects and methods. The safety of long-term (6-month) use of Urisan in 30 patients with the significant diagnosis of gout was studied. Results. Urisan was generally well tolerated. The findings suggest the drug has neither nephro- and hepatotoxicity nor negative effect on carbohydrate and lipid metabolism.
Conclusion. The herbal complex Urisan has proved to be an effective and safe agent for long-term therapy in patients with gout.

Erythema nodosum (EN) is a dermatosis of unclear etiology, which is characterized by vascular lesion of the skin; it shows itself as hard painful nodes occurring in the derma or subcutaneous fat on the shins and thighs. EN has been described in many chronic infectious processes with some features of its clinical course. In most cases, the disease is regarded as a nonspecific immunoinflammatory response to a wide spectrum of etiological factors, including that in gestation, which presents certain problems in curing the patient. The example given below supports the need for timely testing for infectious markers in pregnancy and, in case of evolving EN, for using not only nonsteroidal anti-inflammatory drugs, but also pathogenetic treatment.

The paper deals with the clinical experience in using Remicade®, a tumor necrosis factor-a (TNF-а) inhibitor, in patients with chronic tophaceous gout resistant to therapy with glucocorticoids and nonsteroidal anti-inflammatory drugs. The agent is noted to have a good long-acting clinical effect in reducing the number of tender and swollen joints, as confirmed by the theoretical rationale for the use of anticytokine agents, TNF- а inhibitors in particular, in gouty patients.

The paper provides the clinical characteristics of etoricoxib (Arcoxia), a new selective cyclooxygenase-2 inhibitor having unique properties, which permits it to be distinguished among other nonsteroidal anti-inflammatory agents.

Scleroderma systematica (SDS) is a disease in which vascular diseases underlie the pathogenesis and presented by diverse clinical manifestations. Raynaud's syndrome and digital ulceration are the most common symptom of the diseases, which influences the quality of life in patients and requires continuous drug therapy. The paper discusses the recent European guidelines for the management of this manifestation of SDS. The proposed recommendations cannot unfortunately be realized in full measure now due to the unavailability of some drugs. The authors give their clinical experience with therapy for the vascular manifestations of SDS.

Vitamin D deficiency is one of the substantiated risk factors of osteoporosis. This vitamin is required to provide intestinal calcium absorption, bone metabolism regulation, and neuromuscular functions in the body. Vitamin D deficiency results in increased bone metabolism, causing bone loss progression and increasing the risk of fractures. Moreover, patients with vitamin D deficiency have a higher probability of fallings and loss of muscle mass, increasing in turn the risk of fractures. The combined formulation of alendronate and vitamin D as tablets is as effective as the mono-formulation of alendronate, but, furthermore, it has an additional advantage associated with the guaranteed vitamin D intake. At the same time the bioavailability of each component does not differ from the similar index when these agents are used alone.