The paper gives an update on the etiology, pathogenesis, clinical picture, diagnosis, and treatment of bacterial arthritis and infection of a prosthesized joint.

The causes, manifestations, and principles of diagnosis of acute nonspecific lower back pain (nLBP) are considered. Symptoms and complaints, the emergence of which is associated with the presence of dangerous disease, are singled out in patients with back pain. Emphasis is placed on the treatment of nLBP with currently available unselective nonsteroidal anti-inflammatory drugs and myorelaxants. It is also noted that multimodality therapy in such patients should include therapeutic exercises, reflex and manual therapy techniques (postisometric relaxation), and massage.

Objective: to define the nosological category of juvenile arthritis (JA) in patients of different ages with different disease stages and follow-up periods. Subjects and methods. Group 1 included 135 children, mainly girls (60.7%), aged 1 to 16 years (range 7.9±5.0 years) with early-onset JA, the duration of which was 2 weeks to 6 months (range 2.9±1.6 months) who were further followed up for 2 years. Group 2 comprised 97 adult patients, mainly women (80.4%) aged 18 to 60 years (range 26.8±7.9 years) who had suffered from JA since childhood. The history of the disease varied from 10 to 53 years (range 20.5±8.2 years). The diagnosis in the children was made in accordance with the working criteria developed at the Pediatric Department of the Research Institute of Rheumatology, Russian Academy of Medical Sciences, for juvenile rheumatoid arthritis (JRA) and chronic JA (CJA). That in the adults was established by the diagnostic criteria for rheumatoid arthritis (RA), spondylarthritis (SA), ankylosing spondylitis (AS), and psoriatic arthritis (PA).
Results. In the early-onset arthritis group, nonrheumatic diagnoses were made in 5 patients just in the first stage, which was a basis for their exclusion from the investigation. Reactive arthritis was diagnosed most frequently (46.3%) in the place of primary observation, the proportion of patients with this condition, when included into the study, was 4.4%; the diagnoses of JRA and CJA were established in 12.6 and 44.4% of cases, respectively. Later on, over 2 years of follow-up, the predominance (74.1%) of patients with CJA was retained. One patient with CJA developed obvious juvenile AS (JAS); JRA was verified in 3 children; acute rheumatic fever (ARF) and Kawasaki disease were in 2 cases; in 3 patients, rheumatic diagnoses (dysplastic coxarthrosis in 1 case, meniscopathy in 1, and leukoencephalitis in 1) were rejected. Ten years or more after disease onset, the adult patients with JA were diagnosed as having RA in 52% of cases; 11.5% had one of the types of SA; AS, PS, Crohn's disease- associated arthritis being in 4, 2, and 1 cases, respectively. Other diseases accounted for 11.5%. A diagnosis could not be verified in 25% of the patients; it was formulated as CJA or undifferentiated arthritis (UA). Among the patients with uveitis, the equal number (37.5%)
RA or one of the types of SA; a diagnosis could not be specified in 25%, it was formulated as CJA (UA) or other diseases. Conclusion. This investigation has demonstrated that the diagnosis of JA presents certain difficulties and requires a thorough differentiated approach. Nosologically, the evolution of JAfollows the ways various joint diseases, such as JRA (RA), JAS (AS), other types of SA, develop; however, their diagnosis may be ultimately verified in different periods of the course of disease and a follow-up. The elaboration of current diagnostic criteria for JA, including those for JRA, will facilitate early disease recognition and timely selection of adequate and the most optimal patient management tactics

Objective. The gender differences estimation of mineral bone density (MBD) dependence on the rheumatoid inflammation activity degree.
Subjects and methods. 132 patients with the significant RA diagnose are included into the research among them there are 80 males (the main
group), 28 females with retained menstrual cycle, 24 females in post-menopause. The control group (for the main) is 84 males without RA compared by the age. MBD was measured by the method of double-energetic absorptiometry with the help stationary radiological double-energetic bone densitometer Exceell XR-46 (Norland, USA).
Results. The patients with RA had the significant decreasing of T-criteria and MBD in comparison with indexes of the control group. The average meaning of densitometric indexes at the males with the 3rd activity degree were significantly lower than at the males with the 2nd activity degree. The most risk of osteoporosis (OP) development has been noted at the males and females in post-menopause at the 3rd activity degree.
RA at the males is reasonable to consider as a prognostic marker of unfavorable influence on MBD and high activity as a risk factor of OP development associated with the disease itself.

Subjects and methods. Four hundred and ninety-five patients with various RDs were interviewed by a questionnaire. A comparison group comprised 250 patients with non-RDs and 150 physicians.
Results. The patients with RD frequently reported to have nasopharyngeal infection. The latter was accompanied by an exacerbation of articular syndrome in more than half of the patients with RD. The rate of pneumonias experienced by patients with systemic lupus erythematosus (SLE) (10/55) engages our attention. Urogenital tract infections (mainly cystitis and pyelonephritis) are more typical of patients with rheumatic arthritis (RA) and those with osteoarthrosis (OA), respectively. The clinical manifestations of herpes simplex virus type 1 (HSV-1) recurred most frequently in patients with SLE and those with OA and less in patients with RA. The percentage of HSV-1 recurrences was high in the medical staff. Conclusion. The findings suggest that it is necessary to thoroughly collect medical history data especially in patients who need aggressive immunosuppressive therapy as activation of latent infection makes management of these patients difficult

Objective: to study the safety and efficacy of Urisan and Prolit in patients with gout.
Subjects and methods. The study enrolled 45 patients who met the Wallace classification criteria for gout, were in the attack-free interval and received no antihyperuricemic therapy. The patients' mean age was 51.2±10.6 years (range 30 to 68 years); the disease duration (median and interquartile range) was 7.0 (6.0; 10.0) years. Intradermal and subcutaneous tophi were present in 33% of the patients. The diagnosis was verified by the detection of sodium monourate crystals in 93%.
The patients were divided into 3 groups: 1) those who took Urisan as 2 capsules twice daily; 2) those who received Prolit as 5 capsules thrice daily; 3) those who used Urisan and Prolit in the above doses for a month. Blood biochemical tests for the levels of uric acid (UA), creatinine, urea, aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl transpeptidase, general clinical urinolysis, and daily uricosuria analysis were carried out before and after therapy. Prior to and a month following therapy, the patient's status (the presence of arthritides) was assessed and adverse reactions were recorded.
Results. The drugs were well tolerated and no adverse reactions occurred in all the three groups. No disease exacerbations were seen during the study. The values of hepatic and renal functions substantially unchanged. Administration of Urisan resulted in a considerable increase in urine pH (p=0.004). Urine pH was also increased, but statistically insignificantly in Group 3 patients (p=0.09) and decreased in Group 2. Blood UA levels became lower in all the groups.
Conclusion. Urisan and Prolit have antihyperuricemic, anti-inflammatory, and litholythic effects and may be recommended for combined therapy of gout.

Recently there has been a considerable increase in the number of patients with lingering recurrent and chronic pain syndromes of various origin. Forty-one patients with dorsopathies were examined. Two types of pain were identified; these were vertebrogenic and nonvertebrogenic pains. The appropriateness of this identification was confirmed by instrumental studies. Treatment was performed using a selective nonsteroidal antiinflammatory drug (Amelotex). Pain syndrome relief was noted during the therapy

The involvement of immune mechanisms in the pathogenesis of psoriatic arthritis (PA) is noted to give grounds to use immunoactive compounds (disease- modifying agents - basic anti-inflammatory drugs -BAIDs), such as cyclosporin A (CsA), in this disease. The data available in the literature permit a high assessment of CsA as one of the BAIDs in the treatment of PA and psoriasis. CsA is stated to monitor the course of this disease, acts on inflamed peripheral joints, decreases the clinical and laboratory activity of PA, positively affects the PA-afflicted skin, and can induce remission of psoriasis.

The paper gives the data of current studies, which suggest the dual mechanism of action of strontium ranelate on bone remodeling in postmenopausal osteoporosis (OP): the drug made bone rearrangement balance shift toward a predominance of the processes of new bone formation. Long-term studies dealing with the use of strontium ranelate to treat postmenopausal OP have supported its safety and efficacy. Strontium ranelate is stated to be the drug of choice in treating his pathology, the duration of the therapy may be as long as 8 years. Indications for its use may be further extended after clinical trials.

It has been noted that off-label indication for Rituximab (RTX) in rheumatological care indubitably requires its confirmation in the randomized clinical trials. A particular cautious approach should be taken in extending the indications for therapy with gene-engineering biologicals because of the intricacy and interaction of different immunoregulatory mechanisms. Nonetheless, it is stated that much clinical experience with RTX used in most severely ill therapy-resistant patients may serve as a basis for its prescription in a number of most complex inflammatory rheumatic diseases (RDs). There is new evidence for the use of RTX in various RDs differing in their clinical picture, course, and pathogenesis, such as spondyloarthritis, systemic lupus erythematosus, systemic vasculitis.

The problem of adverse reactions caused by the use of bisphosphonate is discussed. Gastrointestinal reactions that are observed in 20-30% of patients and a main reason for refusal to be treated are noted to be of considerable importance for real clinical practice. This aspect of bisphosphonate intolerability is being thoroughly investigated since some representatives of this drug group are able to induce very serious specific complications, such as esophageal ulcers, in addition to nonspecific symptoms (dyspepsia or gastralgia). The administration of novel drugs and formulations, careful consideration of risk factors in their prescription, clear use instructions, and timely monitoring the patients' status seem to assist in substantially reducing the risk of such reactions.