The paper outlines the present view of the management tactics and treatment of chronic low back pain syndrome and the aspects of differential diagnosis of this condition.

The paper considers the most common upper and lower extremity diseases in rheumatic diseases and briefly characterizes their clinical manifestations and the current principles of adequate nonsurgical treatment using novocaine blocks in a mixture of diprospan or other glucocorti-coids, as well as orthesis and therapeutic exercises. Conservative rheumoorthopedic methods have proven to be effective in most cases.

Warfarin and acetylsalicylic acid (ASA) are most frequently used to prevent thromboses of different localizations in general medical practice and in patients with antiphospholipid syndrome (APS). The mechanism of action of warfarin is associated with the ceased synthesis of blood coagulation factors VII, X, IX, and II. ASA inhibits platelet aggregation due to irreversible inactivation of СОХ 1.
Patients with antiphospholipid (aPL) antibodies and venous thromboses need long-term moderate-intensity warfarin therapy. Patients with ischemic strokes without other indications for the use of anticoagulants may be given either warfarin or ASA. In the latter case, there is no need for laboratory control or an individual dose adjustment. The primary prevention of thromboses in the presence of aPL is also performed with ASA. When pregnancy occurs, women with obstetric manifestations of APS may be given small-dose ASA in combination with heparins. To reduce the risk of hemorrhages, warfarin dosage adjustment is initiated with the minimum doses (<5 mg/day). Novel ASA formulations, such as ASA with the unabsorbed antacid magnesium hydroxide, have been developed to prevent gastrointestinal tract complications.

The author discusses the clinical and diagnostic features of chronic heart failure in patients with rheumatic heart diseases and the specific features of their management.

The paper describes adult-onset Still's disease (AOSD), a rare multisystemic disease of unknown etiology that is referred to as seronegative rheumatoid arthritis. It presents the major manifestations of AOSD: long-term fever, arthritis or persistent arthralgias, maculopapular eruption, seronegativity for rheumatoid factor, neutrophilic leukocytosis, and disease onset after 16 years of age, as well as additional signs: lymphadenopathy, hepatosplenomegaly, polyserositis, nasopharyngeal infection. It is noted that particular difficulties in the diagnosis of AOSD emerge when it is complicated by the hematophagocytic syndrome (HPS). The distinctive features of AOSD are the development of cutaneous and articular symptoms in practically 80% of patients and their absence in HPS. It is stated that of greater value in the diagnosis of HPS is examination of aspirate of the bone marrow than its biopsy. Most patients develop refractoriness to glucocorticoids and essential anti-inflammatory drugs. The positive results of using anakinra, rituximab, and tocilizumab are promising.

Due to the fact that tumor necrosis factor-а (TNF-а) inhibitors are in wide use, the problem of the safety of therapy with drugs of this group is pressing. The review discusses the data of randomized and observational clinical trials of three drugs of this group (adalimumab, infliximab, and etanercept) whether they can cause serious adverse reactions (SAR). The analysis leads to the conclusion that 10 years' experience in using TNF-а inhibitors generally suggests their satisfactory safety profile. Anti-TNF-а therapy is unassociated with the increased risk of fatal outcomes, at the same time one should be alert to tuberculosis, serious bacterial infections, and lymphoma although the frequency of SAR is generally low; the risk for the development of SAR becomes higher as the dose of TNF-а inhibitors is increased and it does not with longer survival. The currently available preventive methods and physicians' alertness to SAR help prevent their development.

Despite the advent of the new class of medications, such as gene engineering biologicals, the use of traditional essential anti-inflammatory drugs (EAID) remains the most important method of pathogenetic therapy for rheumatoid arthritis (RA). Apart from methotrexate (MT) that is the gold standard of treatment for RA, there are a number of other effective EAIDs, including cyclosporine A (CsA, Sandimmun). The review deals with the practical aspects of using CsA in RA. Particular emphasis is laid on the capacities of combined basic therapy with CsA and MT in early RA and on the use of CsA in patients with concomitant chronic viral diseases (including viral hepatitis C).

Erythema nodosum (EN) as an individual entity has been known for more than 200 years. The long-term study of the disease by rheumatologists, pulmonologists, dermatologists, and other specialists has allowed them to state a variety of etiotropic factors and polymorphism of its clinical symptomatology. Up to now, the discussion of the histopathomorphological nature of EN (vasculitis or panniculitis?) has been continued. The described case makes it possible to regard EN as a manifestation of vasculitis to a greater extent. Further clinical studies are needed depending on the stage of the disease and etiotropic factors.

The paper considers the problem of secondary amyloidosis that more frequently occurs in patients with various arthritides, both seropositive and seronegative. According to the data available in the literature, the most common manifestations of secondary amyloidosis are involvements of the kidney, liver, nervous system, and, less frequently, the lung. The authors describe their own observation of secondary amyloidosis in rheumatoid arthritis, which is accompanied by the involvement of the lung, kidney, and intestine, resulting in fatal outcome. The lifetime diagnosis of amyloidosis was histologically verified.

The paper presents the results of a study of the efficiency and safety of using the nonsteroidal anti-inflammatory drug Amelotex® (international nonproprietary name meloxicam) in patients with osteoarthrosis. A short course of therapy with the drug is demonstrated to have a good analgesic effect, to be well tolerated, and to result in better quality of life in patients with gonarthrosis.

Nonsteroidal anti-inflammatory drugs (NSAID) are prominent among the analgesics used in rheumatology.
The effects of aceclofenac are described in rheumatic diseases. It is noted that it is an available effective NSAID, which is distinguished for its balanced analgesic and anti-inflammatory activities and a good tolerability and may be recommended for both rapid analgesia in urgent situations and long-term treatment of pain in chronic diseases.

The paper gives the data of an open-labeled study of the efficacy and safety of the herbal preparation Urisan in gout. There is a decrease in the serum level of uric acid during Urisan therapy that has shown a good tolerability and a high adherence.

The incidence of osteoporosis (OP) has steadily increased in the past decades. Its official morbidity registration has been initiated in the Russian Federation since 1999. There has been a more than 3-fold rise in the total notified cases of OP among Russia's adults in the past 10 years; however, these figures are not true since patients frequently seek medical advice for the OP complications - fractures. The medications that affect different mechanisms of the disease are now of priority in the treatment of OP. Biphosphonates have occupied a prominent place in the treatment and prevention of OP over the past decade. A combination of alendronate and vitamin D3 in the same tablet is a step forward in the therapy of OP since, in addition to its pathogenetic treatment, it additionally provides the organism with vitamin D3.

The period of clinical application of leflunomide (LF) has indicated that by and large the results of its use in the routine practice are comparable with those obtained during clinical trials. The drug provides a considerable improvement in about 50-55% of patients with rheumatoid arthritis (RA) and permits a long monitoring of the disease activity. The rate of adverse reactions (AR) in the use of LF is lower than that in the administration of essential anti-inflammatory drugs (EAID). In most cases, ARs offer no serious threat to a patient and require no drug discontinuation. The duration of LF therapy is largely determined by the severity of the disease in a specific patient and by the qualification of a physician. The application of the standard LF treatment regiment takes about 6 observational months to provide a valid evaluation of the effect of the drug. If its saturated dose is not given, this interval may be much longer. The use of LF in combination with methotrexate (MT) in the patients who have benefited from MT yields better results than continued MT monotherapy and causes no significant increase in the number of AR. In the routine practice, LF has also shown good results when used in combination with biologicals. The currently gained clinical experience with LF enables the latter to be recommended for wide application in any types of RA both as basic monotherapy and in combination with other EAIDs and biologicals.