In current clinical practice, joint replacement is one of the progressive and permanently developed surgical treatments in patients with locomotor injury of any genesis. However, the upward trend in the number of replacements is inevitably accompanied by the rising number of patients with periprosthetic joint infection. The polymorphism of its clinical picture and the nonspecificity of diagnostic tests lead to a frequent delay in the diagnosis of prosthetic joint infection (PJI) and thus late treatment. This paper gives an update on the etiology, epidemiology, clinical presentation, and diagnosis of PJI. Emphasis is laid on the value of a multimodal approach to PJI treatment Р a combination of surgery and etiotropic antibiotic therapy. The choice of a treatment modality is determined by patient status, comorbidity, and the magnitude and duration of the infectious process.

The paper describes a wide range of diseases that can involve one joint – monoarthritis. It characterizes different types of acute and chronic monoarthritis and its causes. Criteria for the differential diagnosis of different monoarticular lesions, a clinical algorithm, and current treatment policy in such patients are presented.

The paper presents the results of an investigation of the biochemical markers of bone metabolism in males with rheumatoid arthritis (RA). The higher values of bone formation markers suggest that RA patients have increased bone metabolism rates and high bone mass rates, which determine the development of osteoporosis.

The paper gives the results of testing the efficacy of Arthrocare®(diacerein) in the treatment of osteoarthrosis (OA). The patients included into the investigation were divided into 2 groups. Group 1 took Arthrocare®and nonsteroidal antiinflammatory drugs (NSAIDs) as needed; Group 2 received NSAIDs only. Disease symptoms were reduced in both groups, as confirmed by better quality of life. In Group 1, there was a reduction in the degree of synovitis; in Group 2 the number of synovitis cases significantly unchanged. The rate of side effects and their magnitude were insignificant and required no treatment discontinuation in Group 1. In 3 patients from Group 2, NSAIDs were discontinued because of the symptoms of gastropathy. This study indicated that Arthrocare®was as effective as NNSAIDs and well tolerated. Arthrocare®treatment decelerated knee OA progression.

The paper presents the data available in the literature on the specific features of systemic lupus erythematosus (SLE) in male patients, analyzes the clinical picture and outcomes of SLE in the men long followed up at the Research Institute of Rheumatology, Russian Academy of Medical Sciences, and gives clinical examples.

Glucocorticoids (GC) are extensively used to treat patients with systemic rheumatic diseases, which can improve their quality of life and substantially increase its span. At the same time their use is associated with the development of serious adverse reactions that cannot be always avoided. One of such complications is osteoporosis (OP) that gives rise to an increased risk for fractures. The paper gives recent clinical guidelines for the treatment and prevention of GC OP and the specific features of management in patients in relation to their age.

The paper deals with a new autoinflammatory disease entity that is proteasomal diseases. The latter include three nosological entities: Nakajo–Nishimura syndrome (NNS), Japanese autoinflammatory syndrome with lipodystrophy; chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE syndrome); joint contractures, muscular atrophy, microcytic anemia, and panniculitisinduced lipodystrophy (JMP syndrome). All the three conditions are caused by mutations in one PSMB8 gene encoding the immunoproteasome subunit β5i. Unlike other autoinflammatory syndromes that are mainly IL-1-dependent, the leading component of the pathogenesis of these diseases is IL-6/γ−interferonі system hyperactivation. These diseases are characterized by childhoodonset, retarded physical development, different skin and muscular lesions, lipodystrophy, joint contractures, and hypochromic anemia, as well as elevated levels of acutephase markers; autoimmune disorders may joint in time.

The paper reviews the literature on the use of methotrexate (MT) in rheumatoid arthritis (RA) and other rheumatic diseases. The efficacy and tolerability of MT are evaluated. The findings permit its consideration as the gold standard treatment for RA. The main adverse reactions of MT, which are given in the literature and have been observed by us for 28 years of its use in patients with RA, are described.

Celecoxib is an effective drug to control chronic pain in rheumatic diseases. It is the only nonsteroidal antiinflammatory drug that has clearly shown the lower frequency of not only upper, but also distal gastrointestinal complications, such as iron-deficiency anemia associated with small bowel pathology. In real clinical practice, the reflection of which is populationbased studies, celecoxib causes cardiovascular events relatively rarely. Its good tolerability and a low risk for gastrointestinal and cardiovascular complications allow its successful use for a long time (if required), without fear of drug-induced complications.

On 23–25 May 2013, the Karolinska Institute (Stockholm, Sweden) with the support of MSD company held a meeting on a Clinical Observational Program for rheumatologists, which was attended by the well-known rheumatologists and leading specialists of the Institute Prof. R. van Vollenhoven, Prof. L. Klareskog, Dr. E. af Klint, and Dr. C. Carlens. The reports and interactive sessions discussed the problems of rheumatoid arthritis (RA), including early RA (pathology, pathogenesis, and treatment), registers of with rheumatic diseases; ultrasound diagnosis of inflammatory locomotor diseases; biological therapy for rheumatic diseases; organization of work in the research immunological laboratory, outpatient/day hospital units of a rheumatology clinic. The Program was also attended by physicians from different European countries (Sweden, Germany, Russia, Spain, Greece, etc.). Below is given an overview of the proceedings of the Clinical Observational Program.

On 23–25 May 2013, the Karolinska Institute (Stockholm, Sweden) with the support of MSD company held a meeting on a Clinical Observational Program for rheumatologists, which was attended by the well-known rheumatologists and leading specialists of the Institute Prof. R. van Vollenhoven, Prof. L. Klareskog, Dr. E. af Klint, and Dr. C. Carlens. The reports and interactive sessions discussed the problems of rheumatoid arthritis (RA), including early RA (pathology, pathogenesis, and treatment), registers of with rheumatic diseases; ultrasound diagnosis of inflammatory locomotor diseases; biological therapy for rheumatic diseases; organization of work in the research immunological laboratory, outpatient/day hospital units of a rheumatology clinic. The Program was also attended by physicians from different European countries (Sweden, Germany, Russia, Spain, Greece, etc.). Below is given an overview of the proceedings of the Clinical Observational Program.

On 23–25 May 2013, the Karolinska Institute (Stockholm, Sweden) with the support of MSD company held a meeting on a Clinical Observational Program for rheumatologists, which was attended by the well-known rheumatologists and leading specialists of the Institute Prof. R. van Vollenhoven, Prof. L. Klareskog, Dr. E. af Klint, and Dr. C. Carlens. The reports and interactive sessions discussed the problems of rheumatoid arthritis (RA), including early RA (pathology, pathogenesis, and treatment), registers of with rheumatic diseases; ultrasound diagnosis of inflammatory locomotor diseases; biological therapy for rheumatic diseases; organization of work in the research immunological laboratory, outpatient/day hospital units of a rheumatology clinic. The Program was also attended by physicians from different European countries (Sweden, Germany, Russia, Spain, Greece, etc.). Below is given an overview of the proceedings of the Clinical Observational Program.

Glucocorticoids (GCs) are used to treat different inflammatory and autoimmune diseases due to their anti-inflammatory and immunoregulatory properties. However, GC may lead to the development of many adverse reactions (ARs): hypertension, diabetes mellitus, lipid metabolic disturbances, sleep apnea, osteoporosis, myopathy, and coagulation and fibrinolysis disorders, which are components of the Itsenko – Cushing syndrome. ARs induced by GCs are known to depend on their composition, route of administration, dose, and duration of treatment. However, the major pathogenic mechanisms of ARs are not clearly defined. There is evidence suggesting a role for imbalance between vasoconstriction
and vasodilation, and its possible association with nitric oxide, prostanoids (prostaglandins, prostacyclin, and thromboxane), angiotensin II, vasopressin, arginine, endothelins, catecholamines, neuropeptides Y, and atrial natriuretic peptide. Enhanced oxidative stress, activated reninangiotensin system, escalating pressor response, metabolic syndrome, and sleep apnea also make their contribution. It could be ideal to discontinue GC treatment; but this is most commonly impossible because of a further disease exacerbation. In addition, it is necessary to carefully plan the choice of the dose, time, and route of administration of GCs and to evaluate each AR. The design of a GC with marked anti-inflammatory activity and insignificant metabolic effects must hold a central position in its researches.

The paper presents data on osteoarthrosis treatment using hyaluronic acid (HA) preparations, on the functions of hyaluronan (HN) in synovial fluid (SF), synovial tissue, and articular cartilage, and on differences in the symptom-modifying effect of HN with varying molecular weight. HN with average molecular weight demonstrates its benefits. The analgesic effect of HA preparations is shown to be determined by not only the improvement of SF elastoviscous properties and by the protection of pain receptors in joint tissues, but by their anti-rheumatic properties.

The paper gives data on differentiated disease-modifying anti-rheumatic therapy for psoriatic arthritis (PsA). When performing the therapy, account must be taken of the presence and magnitude of the major manifestations of this disease: the pattern of arthritis and spondylosis, the number of inflamed entheses, the number of swollen fingers or toes, the pattern of psoriasis in terms of its extent and stage, the presence and magnitude of systemic manifestations and the functional state of involved organs. There are data on the biological activity of leflunomide, its effect on the main manifestations of PsA with an analysis of its efficacy and tolerability, as well as the results of a comparative investigation of disease-modifying anti-rheumatic drugs used for the therapy of this disease.

The paper considers whether a current treatment option for rheumatoid arthritis with genetically engineered biological agents that selectively block the activity of individual proinflammatory mediators and cell surface antigens involved in autoimmune inflammation may be performed in Karelia, which can achieve control of the disease, retard its progression, and improve prognosis.