The paper gives an update on urogenic reactive arthritis, which will be useful for practitioners during their work with patients with articular pathology.

Plasma cell dyscrasias (PCD) present certain difficulties in differentially diagnosing with autoimmune rheumatic diseases (RD) as they have some clinical and laboratory manifestations that are characteristic of the latter.
Objective: to generalize the experience in diagnosing PCD at the Research Institute of Rheumatology (RIR), Russian Academy of Medical Sciences (RAMS).
Subjects and methods. Nineteen patients admitted to the RIR, RAMS, for rheumatological referral diagnoses were diagnosed as having different types of PCD, both PCD in the presence of RD (n = 10) and primary PCD without RD (n = 9). Immunochemical studies of serum and urinary proteins and bone marrow trepanobiopsy were performed in all the patients. Histological studies were made of the minor salivary glands (n = 12), lymph nodes (n = 3), parotid salivary glands - PSG (n = 5), spleen (n = 1), cranial bones (n = 2) and humerus (n = 1). The immunophenotype of tumor lymphocytes in the biopsy and trepanobiopsy specimens were determined by an immunoflurenscence method with standard monoclonal antibody panels and the paraffin sections of biopsy specimens were examined by an immunoperoxidase technique. Biopsy and trepanobiopsy speciments and myelograms were assessed by the researchers of the N.N. Blokhin Russian Cancer Research Center, RAMS. Results. Over 10 years of follow-up, 19 patients (13 females and 6 males) were diagnosed as having different types of PCD: multiple myeloma (MM) (n = 9), extramedullary plasmacytoma of lymph nodes (n = 2), solitary plasmacytoma (SP) of bone (n = 2), Bence-Jones myeloma
(BJM) (n = 2), primary amyloidosis (PA) (n = '), lymphoplasmacytic lymphoma (n = '), Waldenström's macroglobulinemia (WM) (n = 2). In the presence of RA, '0 patients with PCD developed Sjogren's disease (SD) (n = 7), rheumatoid arthritis (RA) + SD (n = 2), RA (n = '); and 9 patients had primary PCD (MM (n = 5), BJM (n = '), WM (n = '), SP (n = '), and PA (n = ')). These 9 patients with different rheumatological diagnoses were long followed up and referred to the RIR, RAMS, to specify these.
One third of the patients had recurrent conjunctivitis, enlarged PSG and xerostomia (55%). Arthralgias, arthritis of minor and large joints, flexion contractures of hands, ossalgias, and pains in the lumbar spine and ribs were present in '0-45% of the patients. Vascular lesions, such as Reynaud's phenomenon, recurrent purpuras, lower extremity ulcerative lesions, and toe gangrenes, were observed in '0-35% of the patients with PCD. Lesions in the reticuloendothelial system, such as lymphadenopathy, splenomegaly ('5%), hepatomegaly (45%), and fever (25%), were also detected.
Conclusion. Many clinical and laboratory manifestations of primary PCD and RD are similar and only the absence of classical laboratory markers of autoimmune disease, as well as the presence of serum monoclonal immunoglobulins and urinary Bence Jones protein suggest the presence of PCD, both primary PCDs and those with RD.

Objective: to study the impact of a reduction in bone mineral density (BMD) on quality of life (QL) parameters in patients over 65 years old
with different clinical forms of osteoarthrosis (OA).
Subjects and methods. One hundred and fifty-five patients over 65 years old with the diagnosis of OA meeting the criteria by R. Altman (1996)
were examined. Anthropometric indicators, the duration of the disease, and the degree of functional failure were estimated and joint X-ray study
and densitometry were made in all the patients. According to the densitometric findings, the patients were divided into 2 groups. A study group
comprised 115 patients with osteopenic syndrome; a control group included 40 subjects with normal BMD. In each group, the investigators identified
patients with the major clinical forms of OA (from the most affected joint): gonarthrosis, oligoarthrosis, polyosteoarthrosis. The general
(SF-36) and special (WOMAC) questionnaires were used to estimate QL parameters.
Results. According to the SF-36 results, reduced BMD in patients with OA deteriorates all QL parameters; this is particularly true for the psychological
component of health. The more the number of affected joints is, the worse QL is. The osteopenic syndrome in elderly patients with
OA significantly decreases QL by the WOMAC scale that characterizes the degree of joint pain syndrome and functional performance in the
patients; its association with the clinical forms of OA has not been traced.

Objective: to evaluate the efficiency of basic therapy for rheumatoid arthritis (RA) depending on the time of its start and the choice of a starting
regimen.
Subjects and methods. The study included 258 patients with verified RA, who were divided into groups by the time of basic therapy initiation. All
the patients were estimated for changes in the articular syndrome (Ritchie articular index, the number of painful joints, that of inflamed joints,
pain and total disease activity assessment by the visual analogue scale, morning stiffness in minutes, and the number of erosions by hand and foot
X-ray films). Therapeutic effectiveness was evaluated by the EULAR criteria on the basis of DAS 4 changes and the number of erosions.
Results. The study group showed significant clinical and laboratory improvements at the early start of basic therapy as compared with the controls.
Assessment using the EURLAR criteria indicated better short-term results in leflunomide-treated patients; overall, a greater percentage of
improvements were noted in the study group than in the control one. The study group exhibited a total significantly less increase in the number
of erosions as did subgroups with different basic therapy options, but not the sulfasalazine subgroup.
Conclusion. Basic therapy initiated at the time of diagnosis of RA permits disease activity and progression to be more effectively controlled than
delayed therapy

Objective: to study the efficiency of combined use of CompligamV (a vitamin B complex group) and Amelotex (meloxicam) in the complex treatment
of osteoarthrosis (OA).
Subjects and methods. Thirty patients (25 women and 5 men) aged 49 to 83 years with a disease history of 2 to 20 years (mean 6.8 years) mainly
with involvement of knee, ankle, and shoulder joints, X-ray stage II-IV disease (after A. Larsen). OA was complicated by reactive synovitis
of the knee and ankle joints in 48.3% of the patients.
The minimal course of therapy for OA was 15 days: Amelotex (15 mg, intramuscular) and CompligamV were concurrently administered for the
first 5 days; CompligamV therapy was continued on the 6th to 15th days.
Therapeutic effectiveness was evaluated from clinical changes ranging in 0 to 5 scores by the Oswestry questionnaire (rest pain, movement pain, and limited
active and passive movements). A clinical relevant effect was stated when the scores in each section were decreased by 6 scores or more. Furthermore,
the data from the health status scale, the pain intensity scale, and the risk for gastrointestinal complications were assessed by the Singh index.
Results. There were clinical improvements (reduced signs of arthritis, increased exercise endurance, relieved pain syndrome) during combination
therapy with Amelotex and CompligamV.
Conclusion. The rapid onset and long duration of the action of combination therapy with Amelotex and CompligamV positively affected the
patients' status and could reduce the cost of treatment

Objective: to evaluate the efficacy and tolerability of adalimumab alone and in combination with basic anti-inflammatory drugs (BAIDs) in
patients with rheumatoid arthritis (RA), by taking into account the specific features of the course of the disease.
Subjects and methods. The study enrolled 30 patients with a verified diagnosis of RA, its high activity by DAS 28, and ineffective previous therapy
with standard BAIDs. At the beginning of the study, 20 (66.7%) patients continued taking BAIDs. According to therapy, the patients were
divided into 3 groups: 1) 10 (33.3%) patients received subcutaneous adalimumab injections only; 2) 12 (40%) took adalimumab+methotrexate
(MT); 3) 8 (26.7%) had adalimumab+leflunomide. The patient groups were matched for age, the duration and activity of RA (by DAS 28),
its X-ray stage and seropositivity.
Nine (37.5%) patients took oral glucocorticoids (GCs) and 25 (83.3%) received non-steroidal anti-inflammatory drugs (NSAIDs). Two (8.3%)
patients had previously been prescribed biological therapies.
Adalimumab was subcutaneously injected every 2 weeks for 24 weeks. The quantitative parameters of articular syndrome and blood and urine
biochemical and clinical analyses were used to evaluate therapeutic effectiveness. The effect of therapy was evaluated by the ACR and EULAR
(DAS 28) criteria. The efficiency of therapy was evaluated 12 and 24 weeks after therapy.
Results. The clinical and laboratory effect of adalimumab was noted in 29 (96.7%) of the 30 patients. All the assessed parameters of articular
syndrome became significantly lower (p<0.001) by week 12 of therapy and to a greater extent by week 24.
Evaluation of the efficiency of adalimumab therapy by the ACR criteria showed that following 12-week therapy, the parameters were decreased
by 20% in 87% of the patients and 50% in 16.7%; after 24 weeks, 23.3, 70 and 96.7% achieved very good (ACR 70), good (ACR 50), and satisfactory
(ACR 20) effects.
Estimation of the time course of changes in the disease activity index (DAS 28) revealed that adalimumab significantly reduced disease activity.
Therapeutic effectiveness was also shown as reduced needs for NSAIDs and GCs. Positive clinical and laboratory changes during adalimumab+
MT combination therapy were also demonstrated to be significantly higher than those during adalimumab monotherapy or adalimumab
+ leflunomide combination therapy.
Conclusion. Adalimumab is an effective disease-modifying biological agent. Its benefits may include the rapid development (on days 4-5 on average) and
long retention (for 6 months or more) of an effect, a good safety profile (adverse reactions occurred only in 16.7% of the patients), and easiness-to-use.

The place of aceclofenac in a group of nonsteroidal anti-inflammatory drugs and its efficacy in osteoarthrosis are discussed.

The possibility of recovering the functional status is now considered as an integral part of the development of new treatment strategies for chronic
diseases, including osteoporosis (OP). The possibility to optimize the treatment of OP, by exerting a more physiological effect on bone and
simultaneously reducing the increased bone resorption and formation, is highly urgent. The system of osteoprotegerin (OPG), receptor activator
of nuclear factor-κ B and its ligand has been confirmed to play a central role in the regulation of bone metabolism. At the same time, there
is strong evidence that OPG performs a key function in bone metabolism regulation, by suppressing the differentiation of osteoclasts (OC) and
reducing their activity. The synthesis of OPG decreases with age in postmenopausal and glucocorticoid-induced OP. Thus, more effective bone
protection needs to elevate the level of OPG, by stimulating its synthesis. Bivalos facilitates the replication of osteoblasts and the higher expression
of OPG, resulting in a reduction in the differentiation and activity of OC. Thus, Bivalos positively uncouples the interrelated processes of
bone metabolism. A combination of the bone-forming and antiresorptive effects of the agent leads to the recovery of bone balance in favor of
bone formation. Strontium ranelate should be presently considered as a first-line safe and effective agent for the long-term treatment of women
with postmenopausal OP.

The paper provides a rationale for using Teraflex with a manifest symptom-modifying effect in patients with osteoarthritis (OA). It is noted that
the use of agents that are potentially able to modify cartilage metabolic processes attracts attention above all due to the possibility of achieving
a permanent reduction in the magnitude of pain and inflammation in OA and their safety in its treatment. Teraflex components, such as chondroitin
sulfate and glucosamine, are shown to have the effect, while slower, that is comparable with that of nonsteroidal anti-inflammatory drugs
(NSAIDs) on pain and articular function, on the one hand, and to be capable to affect the course of the disease and its outcome, by slowing
down the progression of the disease, on the other. It is stated that the long-term (1-2-year) use of Teraflex in patients with a not more than
36-month history of OA makes it possible to improve quality of life and to reduce needs for NSAIDs. Therapeutic effectiveness can be enhanced
by combining the oral and topical formulations of Teraflex.

The paper depicts the aspects of symptomatic therapy for chronic inflammatory diseases of joints and the mechanisms of action of nonsteroidal
anti-inflammatory drugs. It gives the data available in the literature on the efficacy of Voltaren (diclofenac sodium) and pharmacodynamic differences
of original Voltaren and its generics.

The paper presents the data available in the literature on the efficacy and tolerability of basic tumor necrosis factor α inhibitors (TNF α) etanercept,
adalimumab, infliximab in the treatment of psoriatic arthritis (PsA) and their effects on the major manifestations of this disease - cutaneous
and articular syndromes. It generalizes the authors experience in treating PA with infliximab. The value of TNF α inhibitors in the complex
therapy of PsA and indications for their use in this disease are analyzed