Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow
Acute tonsillitis caused by group A β-hemolytic streptococcus (GABHS) remains an urgent problem. The paper provides evidence that suggests the resurgence of high-virulence GABHS infection and the increase in the frequency of its complications (acute rheumatic fever, toxic shock syndrome)
and that there is a need for rational antibacterial therapy for this pathology. The drugs of choice for the treatment of the acute forms of GABHS tonsillitis
are penicillins (amoxicillin, benzathine penicillin, phenoxymethylpenicillin) and first-generation cephalosporins (cefadroxil) and those for intolerance of β-lactam antibiotics are macrolides (spiramycin, azitromycin, roxithromycin, clarithromycin, josamycin, and midecamycin).
Inhibitor-protected penicillins (amoxicillin-clavulanate) or second-generation cephalosporins (cefuroxime axetil) are administered in case of chronic recurrent GABHS tonsillitis when the probability of colonization of an infection focus by β-lactamase-producing microorganisms is rather
high. The antibiotics lincosamines (lincomycin, clindamycin) are used as reserve drugs in therapy for acute and chronic GABHS tonsillitis.

Two hundred and forty-four outpatients with gonarthrosis were examined. The time course of arthrosonographic (the height of the articular cartilage, the volume of intraarticular effusion, the width of the joint cleft, and the degree of osteophytosis) changes were estimated during longterm
Teraflex therapy and in control patients. The long-term (3-year) Teraflex therapy was shown to have a restraining impact on the processes
of articular cartilage degradation and the progression of articular structural changes and to exert an anti-inflammatory effect.

Interest has recently been aroused in generic drugs because of the reduction of government expenditures on treatment. These drugs must meet
the same standards of quality, effectiveness, and safety as those for original medicines. The paper discusses the concepts of biological and pharmaceutical
drug equivalence, which permit original and generic drugs to be equalized in rights. Bioequivalence is considered using as an example
alendronate that is extensively used to treat osteoporosis.

Objective: to assess the functional status and quality of life of adult patients long suffering from juvenile arthritis (JA).
Subjects and methods. The study included 213 adult patients with JA, the majority (84.5%) of whom had been treated at the Childhood
Department, Research Institute of Rheumatology, Russian Academy of Medical Sciences, in 1968 to 2008 or sought medical advice for the first
time. Ninety-seven of the 213 patients were consulted or examined in the outpatient setting or at the clinic of the Research Institute of Rheumatology, Russian Academy of Medical Sciences. Among the patients enrolled into the study, women were prevalent (72.8%); the patientsmean age was 23.9±6.5 years (range 18 to 60 years); the disease duration was 17.4±6.8 years (range 10 to 53 years). The patients' functional
capacity was determined by O. Steinbrocker's classification (functional class - FC) and HAQ questionnaire. The patients were asked (by
mail, telephone, or personal interview) to fill in the questionnaire, by answering the questions concerning the functional and social status.
Results. A third of the patients had no functional limitations (FC 1), 36% had minimal functional limitations (FC 2); 29% needed help with self-service, and 6.2% were severely disabled. According to the questionnaire survey data, the mean HAQ score was 0.8. Half of the respondents were found
to have no functional limitations (HAQ score was 0). HAQ scores of 0.1-1.0 were observed in 33.5% of the respondents. 6.6% of the patients had the most serious problems with self-service (HAQ scores of 2.1-3.0) HAQ scores correlated with age and disease duration (p<0.001). The health status
was appraised as good or very good, satisfactory, or bad by 43.3, 39.8, and 16.9% of the patients, respectively. There was a correlation between the health status and the HAQ scores (R = 0.6; p<0,001), age (R = 0.3; p<0,001), and JA duration (R = 0.3; p<0.001). At the moment of the study, most (78.9%) patients worked or studied at the moment; 48.2% had a higher education; 6.8% could not study or work because of the disease. A third
of the examinees had families; 46 patients had children, which did not depend on the patients' health status and functional capacity.
Conclusion. Most adult patients, long suffering from JA, have a good prognosis for their functional status and quality of life. At the same time
some patients were observed to have a severer course of the disease and its outcomes with significant functional limitations; in this connection, they need treatment and a continued follow-up.

Objective: to study mortality rates in proximal femur fractures in an old-age group of Kemerovo after 6, 12, and 24 months.
Subjects and methods. Mortality rates were analyzed in 432 patients (328 women and 104 men) after osteoporotic fractures with the minimum
amount of trauma injury, sustained in January 2004 to December 2008. The rates were followed up at 0-6, 6-12, and 12-24 months.
Results. Ninety-five (22.0%) of the 432 patients died in the first 6 months of injury; 42 (12.5%) patients of 337 patients died at 6-12 months, and 47 (16.2%) patients of the remaining 290 followed-up survivors died at 12-24 months. In the first 6 months, the mortality rates were found
to be significantly higher than those in the following 6-12 (p<0.0001) and 12-24 (p<0.05) months.
Conclusion. Osteoporotic fractures of the proximal femur are characterized by the high mortality rates reaching the maximum in the first 12
months following fracture.

The prevalence of bone demineralization is a distinguishing characteristic of primary osteoporosis (OP). The paper describes in detail the Xray
symptoms of OP in different parts of the skeleton and in spongy and cortical bone tissues. It gives the calculation of the cortical index and the index of vertebral bodies on the basis of X-ray morphometry of the vertebral column, as well as the Singh semiquantitative method for the assessment of the trabecular bone structure of the proximal femur. Dual-energy X-ray absorptiometry is a method for the early diagnosis of OP.
The main determinants of bone mineralization are described and the approaches to correctly interpreting the results of densitometry and to assessing the risk of bone fractures are presented.

I.M. Sechenov First Moscow State Medical University
The given data available in the literature offer new possibilities for the use of leflunomide in rheumatology. The conducted trials enable leflunomide
to be considered as a promising agent in the treatment of inflammatory diseases of the joint and vertebral column. The encouraging results
of preliminary studies of the efficacy of leflunomide in Crohn's disease, Wegener's granulomatosis, and systemic lupus erythematosus need to be confirmed in large-scale randomized controlled studies.

Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow
The study of the pathogenesis of primary osteoarthrosis (OA) allows it to be considered as a chronic inflammatory disease in which proinflammatory
cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-α(TNF-α), the expression of which is observed in the subchondral
bone, cartilage, and synovium even in the absence of clinical signs of inflammation, are of great importance.
The severity of OA and its site depend on IL-1 gene polymorphism.
The mechanism of action of IL-1 in OA is to activate osteoclasts, to enhance the expression of calcium, and to modulate pain mediators, resulting
in cartilaginous plate and subchondral bone destructions.
The inhibition of IL-1 generation and activity requires the use of diacerein, the mechanism of whose action is to suppress the synthesis of cytokines
and to reduce the number of their receptors onto the surface of chondrocytes, which lowers their sensitivity to IL-1. The drug intracellularly blocks
nuclear factor NFκB activation, by diminishing the expression of the genes responsible for the production of other proinflammatory cytokines.
Clinical trials have provided evidence for the symptomatic and structure-modifying activities of diacerein that has, in addition, an aftereffect, i. e. the effect is retained even after the drug is discontinued.

Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow
The paper describes the basic mechanisms of action of nimesulide, a selective nonsteroidal anti-inflammatory drug. It demonstrates the rate of its anti-inflammatory and analgesic activities, efficacy and safety in the treatment of rheumatic diseases.

The paper considers the possibilities of suppressing rheumatoid arthritis (RA) activity and progression in the use of infliximab. It discusses its place in the treatment of patients with early- and extended-stage RA with regard to the current international recommendations.

2 fevralya ushla iz zhizni Valentina Aleksandrovna Nasonova, akademik RAMN, doktor meditsinskikh nauk, professor, blestyashchiy klinitsist, sozdatel' rossiyskoy shkoly revmatologov.
«Lyubov'», «schast'e obshcheniya» - eti slova chashche vsego prikhodilos' slyshat' v dni proshchaniya s
Valentinoy Aleksandrovnoy. Ee budut pomnit' vsegda, ee svetlyy obraz budet zhit' v pamyati
uchenikov i kolleg, vsekh, kto znal etogo prekrasnogo vracha i cheloveka.