The paper provides the present views of the epidemiology, pathogenesis, diagnosis, and classification of pyrophosphate arthropathy (PPA). It describes a morphological study of the structure of the knee joint after total prosthetics in a patient diagnosed as having osteoarthrosis. Reasons for low detection rates of the disease are considered. Difficulties in the laboratory and instrumental diagnosis of PPA are analyzed in detail.

Paget's disease is a chronic local bone disease included into a group of metabolic osteopathies in which rearrangement foci emerge in one or several bones. The disease is characterized by the appearance of ostealgia, skeletal deformity, or, for example, hearing loss occurring with skull lesion or hip or knee arthrosis and, less frequently, sarcoma or giant cell tumor. There is evidence that bisphosphonates may control the activity of Paget's disease as they inhibit the function of osteoclasts. The use of these drugs reduces the intensity of osteoalgia and the level of biochemical markers for bone resorption and osteogenesis and can decelerate or reverse the early osteolytic phase of the disease. It is promising to use of zolendronic acid (Aclasta, 5 mg), a new heterocyclic amino-containing bisphosphonate that has a significantly higher efficacy than previously used antiresorptive agents.

Interstitial lung diseases (ILD) are a common manifestation of scleroderma systematica (SSD) that along with pulmonary arterial hypertension remains the leading cause of death in this nosological entity. As of now, cyclophosphanum remains the only immunosuppressant recommended by the European League against Rheumatism for the treatment of ILD in SSD. The paper analyzes the papers providing evidence for the efficacy of cyclophosphanum in ILD in patients with SSD. It also considers the regimens and duration of treatment with cyclophosphanum, ways of evaluating its efficacy and effects on extrapulmonary manifestations of SSD. It is concluded that cyclophosphanum has a positive, predominantly stabilizing, effect on the course of ILD in SSD.

The paper gives data on the efficacy and safety of colchicine in a number of rheumatic diseases (gout, Behcet's disease) and Mediterranean fever. It also discusses its toxicity

The paper describes approaches to using cyclosporin A (CsA) in juvenile arthritis (JA). It shows the benefits of combination basic therapy with CsA and methotrexate included into a treatment regimen mainly for systemic JA and JA involving the eye (uveitis) versus monotherapy with the above drugs. Attention is drawn to that the oral dose of glucocorticoids may be decreased when CsA is incorporated into the treatment regimen. CsA is shown to be of value as the drug of choice for the therapy of such a menacing complication of systemic JA as the macrophage activation syndrome

It is shown that to achieve clinical remission and to prevent further joint destruction and functional impairments in patients with rheumatoid arthritis (RA), it is important to identify as soon as possible the signs permitting one to detect patients with rapidly progressive RA (or those who have a poor prognosis as a rapid progression of joint destruction). These are precisely the patients in whom the early detection of markers for rapid progression may give grounds to immediately prescribe aggressive therapy using genetic engineering biologicals, which boosts chances of modifying the course of the disease

The paper presents data of a large number of clinical trials meeting the principles of evidence-based medicines, which have dealt with the evaluation of the efficacy of ibandronate in postmenopausal osteoporosis (OP). The administration of its registered formulations (150 mg weekly oral and 3 mg quarterly intravenous) is shown to reduce the risk of both vertebral and nonvertebral fractures, including proximal femoral fractures. It is emphasized that adequate patient adherence to antiosteopotic therapy to achieve an acceptable annual cumulative dose is one of the most important goals of effective therapy for OP

Aim: to evaluate the impact of long-term Teraflex therapy on symptoms and quality of life in patients with early stages of gonarthrosis (GA) during a 3-year follow-up.
Subjects and methods. Two hundred and forty-four outpatients were examined. A study group included 104 patients who were given Teraflex from the moment of their inclusion into the study. One hundred and forty patients treated with diclofenac formed a control group. The time course of changes in clinical parameters (the Lequesne index, WOMAC index, and walking and rest visual analog scale (VAS) pain scores) and quality of life were estimated in patients in long Teraflex-treated and control patients.
Long-term Teraflex therapy showed a positive effect on the symptoms of the disease. There were positive changes in all clinical parameters just
months after daily use of the drug. The significance of the difference between VAS pain scores, the Lequesne index, WOMAC index, and baseline values remained following 1, 2, and 3 years of the follow-up. That between the baseline value and all the clinical parameters remained only for VAS pain scores in the control group just after 2 years of therapy. Three years following therapy, the values of all clinical parameters became close to the baseline values. Long-term therapy with repeated courses of Teraflex had a positive impact on the quality of life indices of all SF-36 scales. The most significant increase in the indices versus the baseline values was noted at 1- and 2-year follow-up and for a number of parameters at 3-year follow-up.
Conclusion. Long-term Teraflex therapy used in early stages of GA was effective against the symptoms of the disease and improved the quality of life in the patients.

The past decade is marked by a rise in the detection rates of gout. The paper gives data on its incidence, risk factors, the frequency of diagnostic errors, the specific features of the course of male gouty arthritis, and the effectiveness of Gout school activities

Objective: to study the efficiency of combination therapy with Amelotex®and Compligam B®in patients with osteoarthrosis with the signs of knee joint synovitis.
Subjects and methods. The efficiency of combination therapy with Amelotex®and Compligam B®was studied in 40 patients. During a Phase I trial, Amelotex®was administered in a dose of 1,5 ml (15 mg) as periarticular blocks, by alternating intramuscular Compligam B®in a dose of
2,0 ml. In a Phase II trial, the intramuscular injection of these drugs was alternated. Electroneuromyography (ENMG) was performed and the levels of proinflammatory cytokine interleukin-1β (IL-1β) and IL-8 were determined over time (before and on 10 and 20 days of therapy). Quality of life was assessed by a 100-mm visual analog scale before and after therapy.
Results. The early sign of therapeutic efficiency was a significant reduction in the magnitude of knee joint pain, which was observed just after completion of the Phase I trial. Diminished limb cacesthesia and crepitation were most important after the end of Phase II. Synovitis cases significantly reduced in number. Recovered peripheral nerve function was objectively supported by an increase in ENMG parameters, such as the amplitude of M responses in the peroneal nerve and sensor fiber action potential in the sural nerve. After termination of the therapy, IL-1β levels became significantly lower. Quality of life improved, as shown by VAS scores.
Conclusion. The findings suggest that combination therapy with Amelotex® and Compligam B® shows clinical effectivene

Objective: to evaluate the efficacy, safety, and tolerance of the herbal complex Urisan used in patients with gout.
Subjects and methods. Thirty allopurinol-untreated patients with a verified diagnosis of gout (by the ACR criteria) were followed up during a relapse-free interval. Subjective appraisals of the tolerance of Urisan were provided by a physician and a patient. General clinical examination, anthropometry, monitoring blood pressure and uric acid (UA) in blood and urine, and lipid metabolism were made to define the efficiency of therapy before and after it.
Results. Urisan exhibited a positive effect in reducing the blood levels of UA (p< 0,003). For more detailed evaluation of the effect of Urisan on hyperuricemia, the patients were divided into 3 groups in accordance with the baseline level of UA; positive changes were observed in all the groups. Significantly lower UA levels were seen in Groups 1 and 2 (p< 0,007 and p< 0,04, respectively). The remedy was found to have no effect on UA excretion. Its tolerance was good.
Conclusion. Urisan has a positive effect, by lowering hyperuricemia despite the latter's baseline values

Antifosfolipidnyy sindrom (AFS) - zabolevanie, kharakterizuyushcheesya retsidiviruyushchimi arterial'nymi i/ili venoznymi trombozami, trombotsitopeniey i akusherskoy patologiey pri nalichii antifosfolipidnykh antitel. Klinicheskie proyavleniya AFS ochen' raznoobrazny i napryamuyu zavisyat ot lokalizatsii tromboza. V stat'e obsuzhdaetsya neobkhodimost' provedeniya kompleksnoy patogeneticheskoy i simptomaticheskoy terapii AFS, privoditsya teoreticheskoe obosnovanie primeneniya preparata Aktovegin. Avtory predstavlyayut sobstvennyy klinicheskiy opyt terapii sosudistykh narusheniy pri AFS

The pain syndrome holds a central position in the clinical picture of rheumatoid arthritis (RA). Articular inflammation is an essential, but not the only, factor that determines the occurrence of pain. Extraarticular soft tissue pathology can play an important role in the formation of pain perceptions in RA. The pain that increases on movement with involvement of affected structures, as well as local tenderness on palpation and dysfunction of an altered segment are the major clinical manifestations of extraarticular soft tissue involvement in RA. Swelling in the area of appropriate tendons and synovial bursae can be seen when superficially located anatomic formations are involved. Magnetic resonance imaging and ultrasonography permit more accurate determination of the site and pattern of an involvement. The pain and functional impairments associated with extraarticular soft tissue pathology determine a need for additional therapy that can correct the existing disorders and improve the quality of life in patients. The major components of this treatment are sparing routine and systemic and local drug therapy. Diclofenac sodium is one of the most universal agents that allow simultaneous monitoring of various pathogenetic mechanisms of the disease. Local glucocorticoids may be used if the sparing routine and nonsteroidal anti-inflammatory drugs fail to control the pain syndrome effectively.

The data available in the literature on experience in using antimalarial drugs in the treatment of systemic lupus erythematosus are summarized. A major emphasis is placed on therapy with hydroxychlorochine (plaquenil) versus chlorine. Possible mechanisms of action of the drug and its effect on the course of the disease itself and concomitant abnormalities are described. Data on the toxicity of the drug and its safe use in pregnancy and lactation are also discussed

The paper gives data on the effects of nonsteroidal anti-inflammatory drugs on the cardiovascular system in patients with rheumatoid arthritis and osteoarthrosis. The use of selective COX-2 inhibitors (Naiz) versus diclofenac is not shown to elevate blood pressure

Osteoporosis (OP) is a serious problem to patients who have long taken glucocorticoids. In the past two decade, much knowledge has been accumulated about the epidemiology of the disease and drugs with proven efficacy for its prevention and treatment have emerged. However, a large number of studies suggest that there is a serious shortage in care to patients with glucocorticoid-induced OP, which calls for effective measures to bring the real level of its prevention and treatment in compliance with the current clinical guidelines