To control infections and infectious complications is one of the most urgent challenges in medicine under present-day conditions. At the same time, rational therapy with anti-infective drugs occupies a highly importance place. In rheumatology, the necessity of using antibiotics is associated with at least two factors, such as eradication of a pathogen trigger (an infectious agent that triggers the immunopathological mechanisms of inflammation) and treatment of comorbid infection. The paper gives information on etiological agents and detailed antimicrobial therapy regimens for the major infections observed in modern rheumatology.

Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow The paper gives data on the prevalence, pathogenesis, clinical manifestations, and treatment of fibromyalgia (FM) syndrome. It is stated that the ratio of all clinical symptoms of FM syndrome should be borne in mind when treating patients with this disease. Various specialists should be attracted to the treatment of these patients. Psychotropic medications that are prescribed by a psychiatrist are indicated where there is a preponderance of psychological disorders; the duration of this therapy is variable, but not more than 2—3 months. Most patients need proper analgesia, improved sleep quality and duration, and diminished fatigability that frequently leads to lower (none) working capacity. Pregabalin (lyrica) promptly suppresses the major manifestations of FM; the onset of its action is seen just after one week of treatment; the use of the drug may be continued as long as it is effective and safe.

The paper discusses the problems of cerebrovascular disease in patients with systemic lupus erythematosus. It proposes a procedure for managing this category of patients.

Genetically engineered biological agents (GEBAs) have held a firm place in the treatment of rheumatoid arthritis (RA). Patients are selected for this treatment in accordance with international and Russian guidelines. The question as to whether GEBAs should be added to therapy with disease-modifying anti-inflammatory drugs (DMAIDs) is raised after there is an inadequate response to therapy with two DMAIDs, one of which should be methotrexate. Tumor necrosis factor-α (TNF-α) inhibitors as a first-line drug are indicated only in high RA activity. There are few predictors of the efficacy of GEBAs. It is noted that in accordance with the principles of the Treatment to Target program, RA is treated under control of monthly estimated scores in patients with high/moderate disease activity; if there is no remission (with low disease activity being an alternative aim) after three months it is decided whether to correct therapy. In routine practice, when the effect of GEBAs, which is observed in many patients in the first week of treatment, appears, physicians often begin to discontinue symptomatic drugs and at times to decrease the dose or withdraw DMAIDs, which may result in the progression of symptoms of arthritis and which may be misinterpreted as the inadequate or none effect of GEBAs. There are objective reasons for the possible inefficacy of GEBAs. The valid predictor for a response to inhibitors of TNF-α is its baseline expression by synovial membrane cells. It is also important to take into account the nature of previous GEBA therapy. All GEBAs are noted to be highly effective when applying a weighed approach to selecting and managing patients; in so doing, rapid discontinuation of symptomatic therapy should be avoided.

The paper reviews the literature on the new tumor necrosis factor-α (TNF-α) antagonist certolizumab pegol (CZP). It considers the experience in using the drug in Russia within the framework of the RAPID 2 trial. The currently obtained material suggests that CZP has extended the capacities of RA treatment. The drug may be successfully used both alone and in combination with other disease-modifying anti-rheumatic drugs and it is effective in all degrees of disease activity. The agent is noted for a particularly rapid achievement of its therapeutic effect, early exhibits antidestructive properties, and enables prediction of the long-term results of therapy at a relatively early stage of its use. It is improbable that the administration of CZP versus other TNF-α antagonists in pregnancy may be safer since it does not seem to penetrate the placental barrier. Emphasis is laid on the most convenient method for administration of the drug, namely, its subcutaneous route at large intervals. In this case there may be rare local reactions.

The paper presents questionnaires and indices to determine the degree of activity and functional impairments in patients with ankylosing spondylitis, psoriatic arthritis, and other spondyloarthritides. It describes procedures to determine spinal mobility and to calculate the extent and severity index of psoriasis.

The data of a number of questionnaires were used to analyze quality of life (QL) in juvenile arthritis adolescents studying at school versus at home. A group of those who studied at home included patients with clear medical indications for this education form and those who optionally chose this education. According to a number of indicators, QL proved to be lower in the group of patients studying at home who had no clear medical indications.

Objective: to study quality of life in Kemerovo old patients with proximal femoral fractures. Patients and methods. Quality of life in osteoporotic fractures was analyzed in 219 patients (173 women and 46 men) who had sustained the injury in January 2004 to December 2008. Results. In the patients with hip fractures, the lowest (41.94+31.16 scores) values were recorded by the physical functioning scale reflecting the degree to which their health limited the performance of physical exercises (self-service, walking, going upstairs, weight carriage, etc.). The role functioning and life activity scales showed the highest values (50.96+19.04 and 51.44+26.51 scores, respectively). The mean value of the physical component scale was 46.42+28.26 scores. That of the psychological component scale was 49.56+19.55 scores. Conclusion. The patients with proximal femoral fractures were found to have lower scores on all SF-36 dimensions.

Coronary heart disease (CHD) and its complications occupy the leading place in the pattern of the causes of untimely death in rheumatoid arthritis (RA). Objective: to study the incidence, pattern, and specific features of CHD in patients with RA. Patients and methods. An analytical cross-sectional study was conducted in 257 patients with RA (ARA, 1987). The patients’ mean age was 55.4±11.6 years; RA duration was 14.7years (range 2—20 years). Results. The incidence of CHD in RA was as much as 45.9% (n = 118), including 52.5% (n = 62) for typical angina pectoris on exertion; 25.4% (n = 30) and 22.1% (n = 26) for silent ischemia and arrhythmias, respectively. A high proportion of vertebrogenic cardialgias (48.8%; n = 100) were noted in those who complained of heart pain. The authors identified traditional risk factors, such as hypertension (OR = 12.1), smoking (OR = 10.2), early menopause (OR = 3.6), decreased glomerular filtration rate (OR = 3.5), cardiovascular heredity (OR = 3.1), overweight (OR = 2.5), a heart rate of more than 70 beats/min (OR = 2.3), atherogenic dyslipidemia (OR = 2.3), hyperglycemia (OR = 2.1), and age (OR = 1.7). Along with those, the authors also ascertained CHD predictors associating with chronic inflammation consequences: use of glucocorticoids (OR = 5.0), concomitant anemia as a common complication of RA (OR = 4.7), high DAS 28 scores (OR = 3.7), visual analog scale pain scores of > 50 mm (OR = 2.6), and RA duration of >10 years (OR = 2.2). Conclusion. The specific features of CHD in RA include the frequent detection of arrhythmias and silent ischemia. The importance of the degree of inflammatory activity along with the traditional risk factors of CHD is apparent.

A large clinical material (1693 patients with rheumatic diseases — RD, 2066 operations) was used to develop a three-level medical rehabilitation system using differentiated, including high-technology surgical methods depending on the nosology, RD stage, localization of joint diseases of the upper and lower extremities during adequate drug therapy. A positive result persisting for 1 to 20 years was achieved in 60—92% of cases.