The chronic inflammatory process characteristic of rheumatic arthritis (RA) leads over time to irreversible disorders caused by destruction of
the articular cartilage and bones and lesions to the ligaments and tendons. In end-stage RA, the elasticity loss and sprain of the ligaments fixing
the metacarpophalangeal articulations promotes finger subluxations and ulnar deviation. These may induce evident functional impairments
and are generally associated with severe cartilage and bone destructive changes. Chronic inflammation of the radiocarpal articulation is usually
attended by restriction of its movement. Soft tissue inflammatory edema in the carpal tunnel limited by rigid structures may result in the
compression of the median nerve located here and in the development of the carpal tunnel syndrome. As the pathological process progresses,
articular destructive changes considerably increase. There is bone erosion formation that may occasionally cause a complete destruction of the
bone epiphyses. The typical sign of end-stage RA is wrist joint ankylosing, all the wrist bones being confluent into the common bone block.

Candida genus fungi have been noted to be the most common pathogens of mycotic infections. The extensive use of antimycotics for prevention
and empirical therapy is unwarranted, which has resulted in an increase in the frequency of fluconazole-resistant pathogen strains, which is 15-0% in Russia and 50% at some hospitals. The presence of Candida in any organ and tissue has been found to be a risk factor for potentially
fatal dissemination and systemic candidiasis. The major forms and clinical manifestations of Candida lesions and the principles of their
prevention, diagnosis, and treatment are described.

The paper shows the newest aspects of the diagnosis and treatment of the most important varieties of dorsopathies: inflammatory spondylopathies
and spondylosis.

Objective: to evaluate the safety, tolerance, and efficacy of the herbal complex Urisan used in patients with gout within the Russian multicenter
study.
Subjects and methods. Thirty males aged 34 to 56 years with a valid diagnosis of gout after S.L. Wallace and a 1-7-year (mean 4,8 years)
history of the disease were examined at the Rheumatology Unit of a Kursk regional hospital. Nineteen and 11 patients were stated to have tophaceous
and nontophaceous gout, respectively. The total number of involved joints ranged from 3 to 10 (mean 4,6 joints). The study included
patients with interictal gout. All the patients took Urisan in a full dose of 2 capsules (550 mg) twice daily for a month.
Results. Prior to Urisan therapy, the mean serum level of uric acid (UA) was 569,5±102,4 ⎧mol/l; daily UA excretion averaged 4769,8 ⎧mol/l.
Urisan therapy reduced UA levels by an average of 120 ⎧mol/l and increased daily urinary UA excretion by an average of 198,8 цmol/l.
Conclusion. Urisan used against gout for 30 days causes an average 21% reduction in the serum levels of UA and a 4,1% increase in its urinary
excretion. There were no exacerbations of gout during Urisan therapy.

Nonsteroidal anti-inflammatory drugs are widely used in rheumatology in the complex therapy of pain syndrome. The paper describes the pathophysiological
mechanisms of development of acute and chronic pain. The action of cyclooxygenases (COX) (types 1 and 2) is detailed. The key role
of COX-2 in the induction and transmission is shown. The stepwise course of meloxicam relieves pain syndrome in the shortest possible time. The
presented case demonstrates the analgesic and anti-inflammatory effects of meloxicam (Movalis) in a female patient with erythema nodosum.

The paper reviews the current trials of the safety of using genetic engineering biological agents (GEBA) in patients with rheumatoid arthritis. It
is stated that before its start, GEBA therapy calls for thorough screening of patients to rule out communicable diseases (including tuberculosis)
or a high risk for infections (chronic shin ulcers, severe diabetes mellitus, persistent lung infection, and the presence of a urinary catheter), cancer,
and severe visceral diseases. The baseline liver status, a cardiovascular risk, neutropenia in response to basic anti-inflammatory drugs
(BAID) should be also borne in mind. It is noted that when patients are correctly selected and possible adverse reactions are monitored, GEBA
therapy is not worse tolerated than is BAID therapy.

Clinical trials have provided evidence for the efficacy of tocilizumab (TCZ) used alone and in combination with basic anti-inflammatory drugs
in patients with rheumatoid arthritis (RA). TCZ therapy has been found to considerably alleviate the clinical manifestations of RA, improves
joint function and quality of life, and retards joint destruction and radiographic disease progression. TCZ has been noted to demonstrate good
results in the treatment of patients with the prolonged disease and a history of inefficient tumor necrosis factor-〈 inhibitors.

The paper provides evidence for the clinical efficacy of infliximab, its effect on the extra-articular manifestations of rheumatoid arthritis-vasculitis,
rheumatoid nodules, and cardiovascular pathology. It discusses reasons for the lower effect of therapy and the possibilities of its correction,
by increasing the dose of the agent or reducing an infusion interval.

Progression of rheumatoid arthritis (RA) leads to the generalization of a pathological process, by involving new joints and extra-articular structures,
the formation of irreversible changes, and resistance to performed therapy. The most favorable conditions for its treatment are available
at the onset of the disease in the patients who have not received basic anti-inflammatory therapy. Therefore the solution of practical issues of
medical care to patients with early-stage RA is quite urgent. It is necessary to decide as soon as possible whether basic anti-inflammatory drugs
(BAIDs) should be used in patients with verified RA or at real risk for its development. Preference is usually given to conventional BAIDs at the
first stage of therapy. Till recently methotrexate (MT) has been the gold standard treatment of such patients. However, the latest guidelines of
the American College of Rheumatology for the use of biological and non-biological BAIDs recommend that MT of leflunomide (LF) should be
given at a physician's discretion. The standard scheme for using LF in graded doses makes it possible to provide the therapeutic blood concentration
of the drug just within the first week of therapy and a noticeable clinical improvement within the first month. So LF acts much more rapidly
than other conventional BAIDs and may be of particular interest in treating RA.

Development
Bisphosphonates are a major class of drugs used to treat osteoporosis (OP) and other diseases characterized by increased bone resorption. The
literature contains indisputable evidence for the efficacy of alendronate in the registered oral dose of 70 mg once weekly in the treatment of postmenopausal
OP. Alendronate reduces a risk for vertebral and non-vertebral (peripheral) fractures, including those of the hip and forearm. Just
one-year therapy with the drug results in increased bone mineral density and decreased bone resorption, which is associated with a reduced risk
for osteoporotic fractures. Undesirable side effects of alendronate are rare, if it is correctly used, and generally appear as dyspeptic events in the
upper gastrointestinal tract. In addition to its antiresorptive effect on the bone, the combination drug (alendronate 70 mg/cholecalciferol 2800
IU) additionally elevates the serum level of vitamin D, which allows the patients to be simultaneously treated with the drugs of the two groups
(a bisphosphonate and vitamin D) recommended for use by the Russian Osteoporosis Association.

Ethoricoxib is a new-generation selective COX-2 inhibitor. It has been recently licensed in Russia for the treatment of osteoarthrosis (OA), rheumatoid
arthritis (RA), ankylosing spondylitis (AS), and acute gouty arthritis. The drug is supplied as 60-, 90-, and 120-mg tablets. It is given once daily.
It is used in a dose of 60 mg/day for long-term therapy for OA, 90 mg/day for RA, and 120 mg/day for the arrest of acute gouty arthritis (for not more
than 8 days). The high efficacy and good tolerability of ethoricoxib have been proven by numerous clinical trials and the drug is being extensively
used to treat OA, RA, AS, and acute gouty arthritis. It is also successfully used in low back pain and dysmenorrhea. A number of clinical trials have
demonstrated that ethoricoxib is well tolerated; it substantially increases quality of life and may be successfully used in the long-term therapy of rheumatic
diseases. Moreover, it may cause much fewer adverse gastrointestinal reactions than may nonselective nonsteroidal anti-inflammatory drugs.

The paper presents the currently available data on a cardiovascular risk in patients with rheumatic disease when taking meloxicam, one of the
widely used nonsteroidal anti-inflammatory drugs.

The paper describes the basic principles of diagnosis of microcrystalline arthritis by polarization microscopy. Emphasis is laid on the importance
of determination of the crystals of sodium monourate and calcium pyrophosphate for the diagnosis of microcrystalline arthritis and on the techniques
of polarization microscopy and puncture of joints.