The paper gives an update on fibromyalgia, new classification criteria for the disease, and the most important issues in the management of this category of patients.

Osteoarthrosis (OA) is the most common joint disease affecting both men and men. There is primary and secondary OA. Up to now, the causes of primary OA remain unclear. Secondary OA is associated with the presence of joint injury in the history, with congenital anomalies of the structure, metabolic diseases, endocrinopathies, etc. It is particularly difficult to interpret coxarthrosis if there are signs offemoroacetabular impingement. Periarticular pathology plays an important role in the origin of the hip pain syndrome that accompanies or mimics the symptoms of coxarthrosis. The main goals of OA therapy are to slow down the progression of cartilage degeneration and to maintain joint function as much as possible. Combination drugs containing chondroitin sulfate and glucosamine hydrochloride are widely used to treat OA today.

In relation to the ethnicity of patients, the clinical, genetic, and therapeutic aspects of rheumatic diseases (RD), Behcet’s disease and systemic lupus erythematosus in particular, are extensively used in the literature. Ethnicity is a topical problem that must be considered when solving both the clinical and therapeutic problems in patients with RD.

The paper provides a clinical assessment and approaches to therapy for hypermobility syndrome, one of the undifferentiated forms of connective tissue dysplasia.

Objective: to evaluate bone tissue remodeling and mineral metabolism in elderly women who have not been previously examined and have received no antiosteoporotic therapy. Patients and methods. A total of 3152 women aged 65—75 years were examined using questionnaires and tests according to international validated scales and tests. The investigators measured bone density by dual-energy X-ray absorptiometry and mineral and bone mineral parameters. Results. Most patients were ascertained to have motor and physical impairments and cognitive dysfunction; 100% of cases had risk factors for osteoporosis (OP); 32.4% had a history of atraumatic fractures; 56.4% were diagnosed as having OP during standard examinations; 72.7% needed treatment in accordance with the FRAX procedure. The sensitivity of FRAX in patients (with OP without pathological fractures, OP with a history of low-energy fractures, or osteopenia with pathological fractures) requiring treatment according to these standard methods was 70.3, 71.5, and 24.3%, respectively. Conclusion. The majority of elderly (65—75-year-old) women who had not been previously examined and had received no antiosteoporotic therapy were found to have bone metabolic disturbances, a history of fractures in the presence of cognitive dysfunction, impaired motor activity, lowered quality of life, and inadequate calcium intake. At the same time, FRAX is not always the method of choice.

The paper considers basic current methods for the diagnosis of knee osteoarthrosis. It gives for the first time data on the impact of long-term theraflex therapy (a 3-year follow-up) on the progression of knee joint structural changes (X-ray joint space narrowing, osteophytosis) in patients with gonarthrosis.

The impact of a 4-week course of therapy with Uralyt-U (potassium-sodium hydrocitrate) on uric acid (UA) metabolic parameters was studied in patients with gout and nephrolithiasis. Elevated daily urinary excretion of UA was found to be directly correlated with its lower serum level after 4-week therapy with Uralyt-U (p < 0.05), resulting in improvement and normalization of UA metabolism. Uralyt-U therapy is safe and causes no worsening of the parameters of hepatic and renal function and electrolyte exchange.

Osteoporosis is a disease of great social importance. Its treatment is a complicated problem and it is associated with low compliance and a risk for adverse reactions. Ibandronate belongs to a group of bisphosphonates. The performed trials have proven the efficacy of its two formulations (a tablet once monthly and intravenous injection once every 3 months) in reducing the risk of bone fractures. At present there are data of trials of long-term therapy with this drug, which demonstrate its positive effect on bone mineral density and bone metabolism markers. The agent has been also shown to be highly safe when used long.

The main ultimate goal of secondary prevention of osteoporosis (OP) is to reduce the risk of fracture in patients with the already existing disease; the effect of pathogenetic agents develops only if they are used regularly and long. Low patient adherence to treatment minimizes all efforts to prevent OP complications. There is low-frequency prescription of pathogenetic antiosteoporotic agents to this category of patients. There is a wide range of pathogenetic antiosteoporotic drugs today. On choosing a medicine, a physician should rely on its proven efficacy and safety, as well as its convenience use for a specific patient. The data of an international clinical trial to prevent fractures during long-term therapy with strontium ranelate are given.

The paper characterizes ankylosing spondylitis (AS), one of the common spinal inflammatory diseases, in which not only sacroiliac, peripheral, and root (shoulder and hip) joints, but also the aorta, heart valve apparatus, myocardium, bronchopulmonary system, kidneys, nerve system, and the organ of vision are involved in the pathological process. It is stated that the relatively high prevalence of AS, its young onset, progressively reduced spinal mobility, and early disability in the patients require active anti-inflammatory therapy. Significant progress in the treatment of AS is associated with the introduction of gene engineering biologicals into clinical practice. At the same time symptomatic therapy (nonsteroidal anti-inflammatory drugs, glucocorticoids, simple analgesics, myorelaxants) is noted to play an important role in AS. Myorelaxants actively affect not only the major manifestations (pain and rigidity) of AS, but also the functional state of the locomotor apparatus and the outcome of the disease as a whole. By reducing muscle tone and the degree of rigidity, they contribute to increased movement amplitudes in the spine and peripheral joints. Among the drugs of this group, the central myorelaxant mydocalm is most commonly used in Russia.