Vestibular migraine (VM) is a common but underdiagnosed form of migraine. The incidence of VM according to various population studies is about 3 %. Like other forms of migraines, VM is more common in women, especially of periand postmenopausal age. Apart from headaches and dizziness being the most frequent complaints to neurologists, according to the latest statistical data VM is also the most common cause of episodic vertigo. Currently, there aren’t any instrumental diagnostic methods that could confirm presence or absence of vestibular migraine. Diagnosis of this disease is based on results of clinical examination and anamnesis of the patient. Diagnostic criteria, jointly developed by the International Headache Society and the Barany Society, make it possible to diagnose probable or definitive vestibular migraine based exclusively on clinical and anamnestic data. Therapy of VM is based on the same principles as other migraines: relief of attacks and preventive therapy aimed at reducing the severity and frequency of the attacks. However, there are not enough studies on the effectiveness of classical antimigraine therapy in vestibular migraine, and currently in the medical community there are no generally accepted guidelines on treatment of this disease. Despite this, due to the accumulated experience of previous years, possibilities of vestibular migraine therapy are quite extensive and can be effectively applied in routine clinical practice of a neurologist.
Chronic heart failure is common among the population. In addition to the necessary drug treatment of this disease, non-drug approaches to management and rehabilitation of patients are also of great importance. One of the main approaches is physical training which can be divided into several types: high-intensity interval training, moderateintensity aerobic training, and resistance training. A search for literature reviews, systematic reviews and meta-analyses from 2023–2024 was performed in the eLibrary, Google Scholar and PubMed databases using relevant keywords. An analysis of the identified sources was performed, the results of which were also compared with the studies published in 2010–2014. All types of physical training had positive effect on the health of the patients. The advantage of high-intensity interval training and resistance training over moderate-intensity aerobic training in the short and intermediate term was shown, which was later smoothed out, probably due to a decrease in patient adherence to non-pharmacological treatment and kinesiophobia. At the same time, the greatest efficacy of the rehabilitation process and positive impact were achieved by combining different types of training, taking into account cognitive, mental and physiological characteristics of the patient, as well as their social, household, and economic capabilities. Telemedicine technologies and personalized selection of treatment tactics taking into account the stages of treatment and rehabilitation the patient was at, as well as a number of measures such as raising awareness and training the patient, improving their communication and interactions with medical personnel, psychological support and treatment of anxiety and depressive disorders helped to improve compliance.
Despite the progress in treatment approaches, infective endocarditis remains a severe life-threatening disease with high mortality rate. Growing antibiotic resistance, as well as the ability of microorganisms to form biofilms, complicate the treatment of this disease. The available guidelines emphasize the need for early initiation of empirical antibiotic therapy immediately after blood sampling for bacteria culture test, followed by correction depending on the sensitivity of microorganisms. Combinations of intravenous broad-spectrum bactericidal antibiotics effective against bacteria in biofilms are used. The issue of switching from intravenous forms of antibiotics to outpatient oral therapy is actively discussed in literature. The key problems in treatment of infective endocarditis at the present stage are the tolerance of microorganisms capable of forming biofilms to ongoing treatment and the growth of antibiotic resistance. Improved microbiological diagnostics, introduction of new therapeutic strategies, and compliance with clinical guidelines are necessary to improve outcomes of infective endocarditis. Individual characteristics of the patient, characteristics of the pathogen, and possible risk factors should be taken into account. The combined effect of antibacterial drugs, both “traditional” and “new”, as well as the use of drugs that do not belong to the antibacterial group, may significantly increase survival and reduce the number of complications in patients with infective endocarditis.
Aim. To evaluate the effectiveness of the drug “Polypeptide from the brain of pig embryos” in correction of imperative urinary incontinence after cerebral ischemic stroke.Material and methods. The trial was randomized, controlled, blinded with concealment through envelopes. The trial included 170 patients in the early recovery period after cerebral ischemic stroke who were at the second and third stages of medical rehabilitation. Patients in the main group (n = 89) received the domestic drug “Polypeptide from the brain of pig embryos” 1 ml (0.1 mg) subcutaneously daily for 10 days, while those in the control group (n = 81) received only drugs for secondary prevention of ischemic stroke. The groups were comparable in terms ofsex, age, medical and biological parameters, subtypes of cerebral ischemic stroke, period of ischemic stroke, neurologic deficit, severity of cognitive and emotional disorders, and urological symptoms. Research methods included analysis of complaints and history ofthe patients, clinical somatic and neurologic examinations, evaluation of neuro-urologic symptoms using questionnaires, laboratory diagnostics, ultrasound of the urinary tract, urodynamic examinations, and follow-up for 6 months.Results. During the examination, pollakiuria was diagnosed in 69 (77.5 %) patients in the main group and 64 (79.0 %) in the control group, episodes of imperative urinary incontinence were diagnosed in 43 (48.3 %) patients in the main group and 38 (46.9 %) in the control group, urinary urgency was diagnosed in 41 (46.1 %) patients in the main group and 37 (45.7 %) in the control group; nocturia was diagnosed in 28 (31.5 %) patients in the main group and 25 (30.9 %) in the control group. The intensity of urinary urgency in points was 3.2 in the main group and 3.1 in the control group; the frequency of daytime pollakiuria was 12 ± 0.8 in the main group and 12 ± 0.7 in the control group; episodes of imperative urinary incontinence were 5 ± 0.6 in the main group and 5 ± 0.5 in the control group; cases of night awakenings/trips/night urination in absorbent underwear were 3 ± 0.9 in the main group and 3 ± 0.7 in the control group. Statistically significant differences were obtained in the main group in the form of a decrease in the number of patients with urinary urgencies, daytime pollakiuria, episodes of imperative urinary incontinence compared to the baseline level (p 0.05).Conclusion. The use of “Polypeptide from the brain of pig embryos” demonstrated a decrease in the frequency of imperative urges, pollakiuria, imperative urinary incontinence, nocturia and the severity of the imperative urge in patients with ischemic stroke.
Aim. To identify sensorineural hearing loss and ear noise in patients with chronic cerebral ischemia on an outpatient basis, and to evaluate the experience of using combined neurotropic therapy in this category of patients.Material and methods. The study included 50 patients with chronic cerebral ischemia (CIG), with hearing impairments of varying degrees, ear noise, vestibular, cerebro-asthenic syndrome, and who had an outpatient appointment with a neurologist. All patients underwent a scale assessment of VAS – a visually analog scale of ear noise, VAS-G – a visually analog scale of dizziness, THI – a subjective scale for assessing the severity of ear noise, MFI-20 – a scale of severity of asthenia. All patients in the study group were treated with сellex on the background of complex therapy in the form of two courses of therapy with an interval of 20 days. Before the start of treatment, after the end of the first and second courses of treatment, testing was carried out according to appropriate scales and questionnaires, as well as otoneurological and audiological examinations.Results. In the study group of patients, a varying degree of sensorineural hearing loss was detected, as well as a high comorbid background, with most patients experiencing subjective noise of varying intensity, as well as moderately pronounced vestibular syndrome and cerebral asthenic syndrome. After the complex treatment, there was a statistically significant subjective improvement in hearing and speech intelligibility, as well as a statistically significant decrease in indicators on the scales of subjective assessment of noise and dizziness, a decrease in general, physical and mental asthenia. The most statistically significant difference in positive changes was noted after a second course of therapy.In conclusion, the positive results of this study can be considered a decrease in the severity and severity of symptoms of sensorineural hearing loss, which achieved statistically significant improvement after the second course of therapy, a decrease in the manifestations of ear noise, a decrease in asthenia, a decrease in the feeling of dizziness and instability against the background of neurotropic therapy with сellex. In this situation, preference should be given to drugs with a multimodal mechanism of action, potentially affecting various levels of disorders in vascular pathology of the brain, including the auditory analyzer, as well as contributing to the processes of neuroplasticity of the brain.
Aim. To illustrate a comprehensive approach to management of a patient with long-standing generalized tophaceous gout, taking into account concomitant comorbidities, as well as to analyze the factors influencing adherence to therapy and lifestyle modification.Material and methods. Patient N., 54 years old, with a 16-year history of gout, multiple tophi, hyperuricemia, stage C2 chronic kidney disease (glomerular filtration rate 69.8 ml/min/1.73 m2), dyslipidemia, grade 1 obesity, and nephrolithiasis. A comprehensive clinical, laboratory, and instrumental diagnostic evaluation was performed, and the nature of joint changes and the comorbidity degree were verified. Specialists prescribed uric acid-lowering therapy with febuxostat (80 mg/day), along with preventing therapy for recurrent gouty arthritis using colchicine (0.5 mg/day), rosuvastatin (10 mg/day), and measures for dietary and weight correction.Results. Against the background of the ongoing therapy, a sustained clinical and laboratory effect was achieved over four months: serum uric acid levels decreased to 282 µmol/L, no arthritis recurrences were recorded, and positive dynamics in the volume of tophaceous infiltration were observed. The patient demonstrates a high level of compliance, following the treatment regimen and recommendations on diet and physical activity.Conclusion. Modern management of gout requires a comprehensive approach that includes pharmacotherapy and lifestyle modification. However, in practice, only a few patients achieve target uric acid levels, indicating the need to strengthen prevention, educational programs, and improve adherence to treatment.
Aim. To evaluate the outcomes of using various biologic disease-modifying antirheumatic drugs (bDMARDs) / targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) in patients with difficult-to-treat (DtT) rheumatoid arthritis (RA). Material and methods. A retrospective analysis of medical records of 1145 patients with confirmed RA diagnosis was conducted. Patients with follow-up duration of less than 6 months, those who did not receive basic therapy, and patients with subsequent diagnosis change were excluded. In the selected group (121 patients), DtT patients were identified. These were RA patients who received recommended treatment with conventional disease-modifying antirheumatic drugs (DMARDs) and whose therapy with two classes of bDMARDs / anti-cytokine drugs failed to achieve low disease activity/ remission or was discontinued due to adverse events. A treatment episode with a targeted drug was considered successful if it resulted in at least low disease activity and treatment duration exceeded 6 months. Unsuccessful episodes were defined as those lasting 6 months or less, or those failing to achieve low disease activity or remission. Episodes that could not be classified as successful or unsuccessful were excluded from the analysis. More than 400 quantitative and categorical indicators were analyzed in each subgroup. Results. The analysis included 262 treatment episodes, of which 90 (34.4 %) were classified as successful. The mean duration of successful treatment episodes was 28.5 months (interquartile range 13.0–56.75), while unsuccessful episodes lasted 13,0 months (interquartile range 9.0–25.0). No significant association was found between non-response to various drugs / drug classes and the likelihood of success in subsequent treatment. The highest success rates were observed for: levilimab – 66.7 %, tocilizumab – 54.3 %, abatacept – 44.0 %, tofacitinib – 40.0 %. Patients who received bDMARD therapy within ≤6 months after diagnosis had significantly lower treatment success rates (26.2 % versus 53.2 %; p 0.008 taking into account Bonferroni’s correction). In this group, tocilizumab and levilimab showed the highest success rates (51.6 %). Conclusion. No clear associations were found between the likelihood of success with bDMARD / tsDMARD use and previous unsuccessful use of other drug classes, except for abatacept. In non-responders to abatacept, success was primarily achieved with interleukin 6 inhibitors (except sarilumab) and etanercept (55.6 % and 75.0 %, respectively). The use of TNF inhibitors in DtT patients is relatively less promising after other classes have been used. The exception is etanercept, which proved to be quite effective in non-responders to any drug class. Overweight can be an important factor in inefficacy of some bDMARD / anti-cytokine drugs and can serve as a reason for dose increase in this patient cohort.
Aim. To demonstrate comprehensive approach to management of a patient with chronic pain syndrome and postherpetic neuralgia alongside recurrent herpes virus infection taking into account modern therapeutic capabilities. Material and methods. Female patient A., 47 years, with intense neuropathic pain syndrome on the left in the thoracic spine (up to score 7–8 on the visual analogue scale) and sleep disruption due to pain developed after hypothermia. Had a history of herpes zoster, received a full course of antiviral therapy. Comprehensive clinical, laboratory and instrumental diagnostics were performed, in the Th5–Th7 segments on the left characteristic eruptions, areas of hyperpathia, allodynia and hyperesthesia were verified. The patient took the recommended gabapentin 1500 mg / day with positive but insufficient effect: significant burning and intense itching continued, and laennec (human placenta hydrolysate) was prescribed per the following scheme: 4 mL intramuscularly every other day – N.5; 4 mL intramuscularly 3 times a week – N.10; 4 mL intramuscularly 2 times a week – N.10. Results. Stringent clinical effect of the therapy was achieved after 2 months: shooting pains and intense itching are absent, burning sensation appears rarely and is not bothersome; sleep normalized completely. Conclusion. Modern management of postherpetic neuralgia requires comprehensive approach which should include, apart from symptomatic treatment of neuropathic pain syndrome, medications with immunomodulating and anesthetic effects allowing to not only treat current disease episode but also to prevent its future recurrence.
Although smoking cessation is the most cost-effective approach to prevention and treatment of cardiovascular disease, the number of smokers does not decrease. Currently, the possibility of using new forms of nicotine delivery – electronic cigarettes (ECs) and electronic heated tobacco products (HTPs) – to quit is being discussed. The majority of specialized societies are opposed to the use of ECs and HTPs for this purpose, but a number of studies have demonstrated their effectiveness. Our aim was to provide a descriptive review of the literature on the possibility of using ECs and HTPs as additional tools for smoking cessation. The 2025 Cochrane review found that ECs with nicotine are more effective for smoking cessation than nicotine replacement therapy, nicotine-free ECs, and behavioral therapy. According to the 2022 Cochrane review on the use of HTPs for smoking cessation, there was less exposure to toxins/carcinogens while using HTPs compared to conventional smoking. Finally, the 2023 systematic review of randomized clinical trials of the effects of HTPs on the cardiovascular system demonstrated a significant reduction in biomarkers involved in inflammation, oxidative stress, lipid metabolism, and endothelial dysfunction. The use of ECs may be feasible in patients who are not ready to quit and not interested in pharmacological smoking cessation support, as mentioned in the 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment. The potential for the use of ECs for smoking cessation is also mentioned in the 2023 American Heart Association/American College of Cardiology Guideline for the Management of Patients with Chronic Coronary Disease and in the 2024 European Society of Cardiology Guidelines for the Management of Chronic Coronary Syndromes. At the same time, none of the new forms of nicotine delivery should be considered completely safe and recommended for long-term use, especially in adolescents, young adults, pregnant women, as well as in nonsmoking adults.
Aim. To identify prognostically unfavorable predictors of loss of ability to work in patients with systemic sclerosis. Material and methods. The analysis included 60 patients of working age (mean age 50.18 ± 9.86 years) with confirmed diagnosis of systemic sclerosis established based on the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) criteria (2013). The ratio of men to women was 1:5. Median duration of the disease from the onset of Raynaud’s phenomenon was 7.5 (interquartile range from 3 to 17.5) years, and from the first symptom not related to Raynaud’s phenomenon – 6.5 (interquartile range from 2 to 12.5) years. The severity of clinical, laboratory, and instrumental characteristics of systemic sclerosis, the level of anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS), the degree of reduction of quality of life according to the SF-36 questionnaire, the degree of functional disorders according to the Health Assessment Questionnaire (HAQ) and the Sclerosis Health Assessment Questionnaire (SHAQ) were assessed. The severity of dyspnea was evaluated using the modified Medical Research Council (mMRC) scale. All patients included in the analysis were divided into two groups based on their status: employed or unemployed (due to systemic sclerosis). In this study, ability to work and the status of an employed were considered synonyms. The “unemployed” category included patients who had lost their ability to work due to systemic sclerosis. Patients unemployed for other reasons were excluded from the study. Results. Univariate analysis using binary logistic regression showed that significant predictors of loss of ability to work are functional disorders HAQ ≥0.43 (odds ratio (OR) 17.82; 95 % confidence interval (CI) 3.04–104.61; p 0.001), SHAQ score 0.71 (OR 13.51; 95 % CI 2.53–72.06; p = 0.002), low physical health score per the SF-36 PCS (Physical Component Summary) 36.24 (OR 0.9; 95 % CI 0.84–0.96; p = 0.001), depression per the HADS-Depression scale ≥7 (OR 1.21; 95 % CI 1.03–1.42; p = 0.02), dyspnea per the mMRC ≥2 (OR 3.63; 95 % CI 1.68–7.81; p 0.001), systolic pressure in the pulmonary artery 27.5 mmHg (OR 1.21; 95 % CI 0.07–1.37; p = 0.002), tricuspid regurgitation velocity ≥2.4 m / s (OR 1.04; 95 % CI 1.01–1.07; p = 0.001), decreased distance in the six minute walk test ≤500 m (OR 1.63; 95 % CI 1.16–2.29; p = 0.011), decrease in forced vital capacity ≤90 % from predicted (OR 1.21; 95 % CI 1.03–1.43; p = 0.02), manual labor (OR 16.2; 95 % CI 1.57–167.74; p =0.02). Multivariate analysis using multiple logistic regression with sensitivity 84.6 % and specificity 85.3 % showed that loss of ability to work in systemic sclerosis is affected by dyspnea level per the mMRC ≥2 (OR 33.5; 95 % CI 3.05–367.81; p = 0.004) and tricuspid regurgitation velocity ≥2.4 m / s (OR 69.8; 95 % CI 7.75–625.04; p 0.001). Conclusion. The importance of assessing the severity of dyspnea using the mMRC scale and tricuspid regurgitation velocity as determined by echocardiography in relation to predicting the loss of work ability underscores the necessity of evaluating these parameters in routine rheumatological practice.
Currently, comprehensive medical care for combat veterans on the part of primary care doctors is an important problem. To improve the unified teaching strategy in medical universities for preparation of highly qualified specialists, the main questions of the training process of students studying the general medicine specialty are discussed. The article presents points of view of psychiatrists, psychologists, internal medicine doctors, ophthalmologists, dermatologists, and proposals on optimization of continuity of teaching how to manage patients with post-traumatic stress disorder and how to improve communication skills of future doctors during caring for patients with this acute emotional disorder. To improve preparedness of medical students to apply knowledge in clinical practice, the experts focus on the classical manifestations of post-traumatic stress disorder and psychosomatic disorders, teaching systemic approach to patients’ needs with focus on communication during outpatient appointments, discussion of combat stress target organs. During comprehensive discussion, the experts concluded that it is necessary to strengthen interactions between clinical and scientific departments of medical universities to study the role of stress in stepwise development of long-term consequences of stress-induced somatic pathology, to increase attention to details in communication between doctors and patients with post-traumatic stress disorder, to introduce problems of outpatient observation of combat veterans into the summer working practice of 5th year students training in general medicine. Regular updates of the training materials will help to better understand the problem of post-traumatic stress disorder and prepare graduates for performing qualified and rounded medical services to combat veterans.
Background. The 6-minute walk test (6MWT) is used to assess physical performance (PP) in cardiac rehabilitation. PP in the 6MWT in patients with rheumatoid arthritis (RA) is poorly studied. Aim. To assess results of comprehensive rehabilitation including aerobic activity in patients with RA using 6MWT, to determine PP factors and dynamics affecting 6MWT parameters. Material and methods. 6MWT was performed in 127 patients with RA, out of exacerbation, aged 33–81 years, before and 2 weeks after comphehensive rehabilitation with moderate aerobic exercise on Kardiomed 700 cardio-machines. 79.5 % of patients had arterial hypertension, 74 % had overweight or obesity. The dynamics of RA activity according to the Disease Activity Score 28 (DAS-28), rheumatoid factor in blood serum, pain intensity according to the visual analogue scale, vital signs index per the Health Assessment Questionnaire – Disability Index (HAQ-DI), hand compression strength, and daily blood pressure monitoring were studied. ROC analysis was used to determine factors that allow prediction of the results of 6MWT. Results. The median distance in 6MWT initially was 400 m (IQR (interquartile range) 340–480 m), after 2 weeks of rehabilitation it increased to 430 m (IQR 386–510 m; p 0.01) but remained below the required value 473.9 m (IQR 431.5–529.9 m; p 0.01). The distance in the 6MWT positively correlated with the strength of the left arm (p = 0.02) and negatively with age (p = 0.02), HAQ-DI (p = 0.01), mean pulse (p = 0.01) and systolic blood pressure at night (p = 0.02), overall health (p = 0.02) and pain intensity (p = 0.01). An increase in the distance after rehabilitation was accompanied by a decrease in the tender and swollen joint counts, improvement of overall health per the DAS-28 assessment, decrease in pain, increase in the compression force of the hands, increase in HAQ-DI, and decrease in systolic and diastolic blood pressure during the daytime. According to ROC analysis, 6MWT before and after rehabilitation depended on age (less than or more than 61 years), body mass index (less than or more than 27 kg / m2), and duration of RA less than or more than 1 year). Conclusion. The PP in patients with RA out of exacerbation and in the absence of serious comorbid diseases is moderately reduced and increases after 2 weeks of rehabilitation with moderate-intensity aerobic exercises, accompanied by improvement in joint syndrome indicators, increased vital activity, and decreased blood pressure. The 6MWT is an additional tool for assessing the functional state of patients with RA. The 6MWT distance varies depending on age, body mass index, and the duration of RA, which should be taken into account when predicting the results of rehabilitation and evaluating its effectiveness.
Osteoarthritis (OA) is one of the most common chronic diseases and is frequently associated with comorbid conditions, primarily cardiovascular diseases, metabolic disorders, and other musculoskeletal diseases. Patients with OA have a moderately increased risk of cardiovascular events (myocardial infarction, stroke, thromboembolic complications) which is related both to traditional risk factors and comorbidity clustering, as well as to specific features of the therapy used, primarily the administration of nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs remain a key tool for pain control in OA, but their use is associated with a risk of gastrointestinal, cardiovascular, renal, and hepatotoxic complications, as well as a number of other adverse events, which is of particular importance in elderly and comorbid patients. Current clinical guidelines emphasize the need for individualized risk stratification, selection of a drug based on its safety profile, possible use of gastroprotection, and administration of the lowest effective dose for the shortest possible duration of therapy. Nimesulide, a moderately selective cyclooxygenase-2 inhibitor, has demonstrated analgesic efficacy and a favorable benefit – risk profile in OA patients with moderate risk of gastrointestinal complications and low to moderate cardiovascular risk. Thus, successful management of comorbid patients with OA is based on comprehensive risk assessment, personalized therapy selection, and careful monitoring for potential adverse effects.
Systemic connective tissue diseases may be associated with various forms of pulmonary hypertension (PH). The prevalence of PH varies among different systemic connective tissue diseases, with systemic scleroderma (SSc) having the highest rate, ranging from 8 to 12 %. With SSc, PH is one of the severe and life-threatening manifestations, which necessitates the study of this problem. The pathogenesis of PH in SSc varies and depends on the predominant organ damage. PH can be represented by pulmonary arterial hypertension (PAH) (group 1) with isolated damage to the pulmonary vessels, or with more rare conditions such as veno-occlusive disease, portopulmonary hypertension, or drug toxicity. Venous PH can also develop due to damage to the left chambers of the heart, such as myocardial fibrosis, diastolic dysfunction of the left ventricle, or valve pathology (group 2). PH associated with lung damage may develop due to interstitial lung Systemic connective tissue diseases may be associated with various forms of pulmonary hypertension (PH). The prevalence of PH varies among different systemic connective tissue diseases, with systemic scleroderma (SSc) having the highest rate, ranging from 8 to 12 %. With SSc, PH is one of the severe and life-threatening manifestations, which necessitates the study of this problem. The pathogenesis of PH in SSc varies and depends on the predominant organ damage. PH can be represented by pulmonary arterial hypertension (PAH) (group 1) with isolated damage to the pulmonary vessels, or with more rare conditions such as veno-occlusive disease, portopulmonary hypertension, or drug toxicity. Venous PH can also develop due to damage to the left chambers of the heart, such as myocardial fibrosis, diastolic dysfunction of the left ventricle, or valve pathology (group 2). PH associated with lung damage may develop due to interstitial lung diseases, such as nonspecific and usual interstitial pneumonia (group 3). Patients with SSc are more susceptible to thrombosis and pulmonary embolism due to formation of antiphospholipid antibodies, which can lead to the development of chronic thromboembolic PH (group 4). A characteristic feature of SSc is that one patient may have several reasons for PH development. The variety of pathogenetic variants of PH in SSc requires personalized and comprehensive diagnostic approaches to each patient. Management of the patient and determination of indications for appointment of PAH-specific therapy depend on the variant and pathogenesis of PH.
Osteoarthritis (OA) is increasingly recognized as a complex degenerative joint disease that develops under the influence of mechanical, biochemical and genetic factors. The pathogenesis of OA includes a complex of interactions at both cellular and molecular levels, leading to progressive damage to joint tissues – cartilage degeneration, synovial inflammation, remodeling of the subchondral bone, and periarticular changes. In the last decade, the term “early osteoarthritis” has been increasingly mentioned in the scientific literature. The concept of early OA was largely determined by the experience of rheumatoid arthritis treatment. Given the heterogeneity of OA, pathological processes at the cellular and molecular levels, reflecting the early stage of the disease, are diverse and depend on the factors that induce the disease. Symptoms of early OA of the knee joint can be suspected with the appearance of intermittent pain or discomfort in the joint, short-term “initial” stiffness and functional limitations. Clinical examination in most cases reveals pain on palpation of the joint, crepitation or moderate articular effusion. X-ray data are of limited importance at an early stage of the disease, since one of the typical signs of OA – narrowing of the articular gap – may not appear for many years. Quantitative, contrast-enhanced magnetic resonance imaging methods, as well as hybrid methods are used to visualize OA at an early stage. The final goals of developing classification criteria for early OA and early diagnosis of the disease in real clinical practice differ. Early OA represents a “window of opportunity” to prevent disease progression before OA becomes clinically apparent. It is necessary to continue research on the definition and classification of early OA of other localizations. Pharmacological innovations, regenerative methods, and gene therapy represent the future of OA treatment, including at an early stage of the disease. One of the modern drugs that modify the course of OA is Elmosa, a unique combination of glucosamine sulfate, boswellic acids combined with acetyl-L-carnitine and B vitamins.
The review describes the molecular architecture and physiology of the blood-brain barrier (BBB), modern methods for assessing the condition of the BBB, the role of its dysfunction in some neurodegenerative diseases, and the contribution of vascular pathology. The pathogenetic mechanisms by which violation of BBB leads to neurodegeneration are discussed. Early diagnosis in these nosologies is crucial for adequate therapy and a favorable prognosis. In this regard, the possibility of identifying neuroimaging patterns indicating violations of BBB permeability is being considered, and the pathoanatomical characteristics of BBB dysfunction are also being studied.
Aim. To identify the phenotypes of patients with asymptomatic hyperuricemia (HU) in the Russian Federation by analyzing demographic and clinical and laboratory parameters in outpatient practice.Material and methods. The data obtained in the framework of the non-interventional multicenter program “Assessment of epidemiological data on the detection of serum uric acid levels in patients with arterial hypertension, combined with metabolic syndrome, diabetes mellitus, and joint pain”, conducted in the Russian Federation, are presented. All study participants were examined according to the same single protocol.Results. Asymptomatic HU was detected in every 10th patient, predominantly in women, every 2nd person worked, 1/3 of the persons had a higher education, the majority had a family. Among comorbidities, the most common were arterial hypertension (AH), coronary heart disease, osteoarthritis. In HU, the risk of AH was elevated more than 2-fold, atrial fibrillation (AF) – 3-fold, osteoarthritis – 2-fold. A direct correlation of HU with age (p = 0.004; r = 0.17), female sex (p = 0.001; r = 0.76), retired status (p = 0.002; r = 0.19), AH (p = 0.018; r = 0.18), AF (p = 0.007; r = 0.16), osteoarthritis (p = 0.032; r = 0.13) was determined. Association of HU with age (odds ratio (OR) 1.04; 95 % confidence interval (CI) 1.02–1.07; p = 0.002), retired status (OR 2.59; 95 % CI 1.35–3.77; p = 0.002), AH (OR 2.27; 95 % CI 1.13–4.53; p = 0.021), AF (OR 3.07; 95 % CI 1.31–7.20; p = 0.010), osteoarthritis (OR 1.90; 95 % CI 1.05–3.43; p = 0.033) was confirmed.Conclusion. The phenotypes of patients with asymptomatic HU living in the Russian Federation were determined. An association of HU with a number of socio-demographic indicators, concomitant cardiovascular diseases, and osteoarthritis has been established.
Aim. To present a clinical case and describe the features of dermatomyositis (DM) with myositis-specific anti-Mi2 antibodies (MSAs).Material and methods. Clinical manifestations, abnormalities of laboratory and immunologic tests, strategy and efficacy of pharmacotherapy in a patient with DM are described.Results. A clinical case of DM is presented in a patient born in 1992. The disease manifested through lesions in the skin (periorbital edema with heliotropic rash, Gottron papules, diffuse alopecia, cheilitis, digital ulcers), mucous membranes (enanthem), muscles (myalgia), joints (polyarthritis), peripheral nervous system (polyneuropathy), and constitutional symptoms (weight loss, general weakness, subfebrile temperature). Laboratory examination showed increased erythrocyte sedimentation rate of 40 mm/h and lactate dehydrogenase level of 672 U/L, antinuclear factor was measured at 1:320, and anti-Mi2 antibodies were detected by MSAs panel. Combination immunosuppressive therapy with methylprednisolone at an initial dose of 1 mg/kg/day and subcutaneous methotrexate at a dose of 15 mg/week was initiated, followed by correction depending on the clinical and laboratory dynamics. This case demonstrates benign course of anti-Mi2 antibody-positive DM. Classic skin symptoms (periorbital edema with heliotrope rash, Gottron papules) and muscle damage completely regressed after 21 months of combination pharmacotherapy with methylprednisolone and methotrexate. Stable immunological seroconversion of MSAs and drug-free clinical remission were achieved. Low risk of malignant neoplasms with this DM serotype is emphasized. Atypical symptoms of polyneuropathy and myalgia are considered.Conclusion. The presented clinical case demonstrates the characteristic features of the DM subtype with anti-Mi2 antibodies: a combination of classic skin symptoms with muscle damage, benign course during two-year combination pharmacotherapy with a glucocorticoid and a cytostatic, persistent immunological seroconversion of MSAs, drug-free clinical remission. Presumably, determination of DM serotype can be useful in clinical practice for predicting the course of the disease, response to pharmacotherapy, and the risk of developing neoplasia.
Aim. To investigate the effectiveness and safety of Cellex® drug (active substance is polypeptides from the brain of pig embryos) in nontraumatic intracranial hemorrhage.Material and methods. The study included 116 patients with hypertensive intracranial hemorrhage aged between 30 and 80 years. Patients of the treatment group (n = 61) in addition to the basic therapy were administered 0.1 mg (1 mL) of Cellex® once a day for 10 days while patients of the control group (n = 55) only received basic therapy in accordance with the clinical guidelines on management of patients with hypertensive intracranial hemorrhage. For 30 days, dynamics per the Glasgow Coma Scale, stroke severity per the National Institute of Health Stroke Scale (NIHSS), patient disability per the Modified Rankin Scale (mRаnkin), Barthel and Rivermead scales, speech disorders per the Speech Questionnaire, cognitive functions per the Montreal Cognitive Assessment and a number of other characteristics were evaluated.Results. Percentage of survived patients (96.7 %) was higher in the Cellex® group compared to the control group (p = 0.0237). In the Cellex ® group, speech function per the Speech Questionnaire improved from 17.0 (14.0–22.0) to 24.0 (21.0–27.0) (p = 0.009) while in the control group no significant improvement in speech function was observed. A trend toward more significant decrease in stroke severity per NIHSS, patient disability per the mRаnkin, Barthel and Rivermead scales in the Cellex® group compared to the control group was observed. Cognitive functions per the Montreal Cognitive Assessment improved in the Cellex® group from 14.0 (12.0–22.5) to 20.0 (14.5–25.0) points. No adverse events were observed in the patient group receiving Cellex®.Conclusion. High efficacy and safety of Cellex® drug in patients with hypertensive intracranial hemorrhage were confirmed.
Aim. To investigate predictors of achieving low disease activity (LDA) in patients with difficult-to-treat (DtT) rheumatoid arthritis (RA) and to assess the role of interleukin 6 (IL-6) inhibitors in reaching the target disease activity in this patient population.Material and methods. Analysis of medical records of 1145 patients with a confirmed diagnosis of RA was conducted. Patients with a follow-up duration of less than 6 months, those who had not undergone conventional disease-modifying antirheumatic drug (DMARD) therapy, and patients later reclassified with a different diagnosis were excluded. In the selected group (n = 966) DtT patients were identified as those with RA who received recommended treatment with conventional DMARD but failed to achieve LDA or remission after therapy with two classes of biologic disease-modifying antirheumatic drugs (bDMARDs) or janus kinase inhibitors (JAKi)/bDMARDs, or had their treatment discontinued due to adverse events. In the DtT group, two subgroups were distinguished: those who achieved LDA after being classified as DtT due to a change in JAKi/bDMARDs and those who did not achieve LDA.Results. Median duration of the disease in the DtT cohort was 186 months (interquartile range 104–278), and median duration of DtT status at the time of the last observation was 27.8 months (interquartile range 10.2–56.0 months). A total of 484 treatment episodes involving JAKi/bDMARDs among DtP patients were analyzed. Comparison of the group that achieved LDA (LDA+, n = 172; 35.5 %) with the group that did not achieve LDA (LDA–, n = 312; 64.5 %) revealed that the LDA+ was characterized by younger age of RA onset (p = 0.005), later initiation of DMARD (p = 0.005) and JAKi/bDMARDs (p = 0.034) therapies from the onset of RA, and more frequent presentation with stage IV radiological findings per Steinbroker (p = 0.007). Additionally, glucocorticoids were used less frequently at the last visit in the LDA+ group (p = 0.042). Comparison of the frequency of LDA or remission within the DtP cohort revealed no significant differences among classes or individual medications. In the highest percentage of cases, abatacept and IL-6 inhibitors achieved target disease activity (40.5 % and 40.4 % respectively). Among the IL-6 inhibitors, the highest success rates were observed with levilimab (48.0 %) and tocilizumab (41.3 %).Conclusion. Patients with late-stage RA and pronounced radiological changes show potential for achieving LDA. The administration of abatacept and IL-6 inhibitors as first-line therapies may reduce the likelihood of developing DtT status, and in cases with this status occurs, target disease activity can be achieved in 40.5 % and 40.4 % of cases, respectively.
