Objective: to evaluate the efficacy and safety of complex therapy for knee osteoarthritis (OA) using a combination of chondroitin sulfate (CS) and glucosamine (G), as well as intra-articular (IA) administration of a medical device (MD) containing polyacrylamide gel (PAAG).Material and methods. The study included 22 patients aged 40–75 years with definite knee OA, radiographic stage II–III. Median age was 64.5 [59.0; 68.0] years. All patients received comprehensive therapy: a single IA injection of 4.0 ml of the PAAG-containing MD into the target knee in combination with oral CS (800 mg/day) and G (1000 mg/day) for 6 months. Total follow-up duration was 9 months (6 months of treatment and 3 months of follow-up).Results and discussion. During complex therapy, a significant reduction in knee pain intensity on the visual analog scale was observed, along with improvement in all WOMAC components, patient global assessment of health status, the Lequesne index, and quality of life according to EQ-5D (p<0.05 for all). Patients and physicians rated the treatment results highly: improvement and significant improvement were recorded in 90.91% of cases. Therapy was associated with a statistically significant reduction in the need for nonsteroidal anti-inflammatory drugs: 77.27% of patients discontinued their use already 1 month after study initiation. A significant decrease in CRP level was also recorded (p<0.05).Conclusion. The study results confirm the significant efficacy and safety of a complex approach to OA therapy, including the use of a combination of disease-modifying drugs for OA and IA administration of an MD containing PAAG.
Objective: to identify a set of criteria for the differential diagnosis of axial spondyloarthritis (axSpA) and axial psoriatic arthritis (axPsA).Material and methods. A total of 222 patients were examined: 108 with axSpA (Group 1) and 114 with axPsA (Group 2). Group 1 included patients meeting the axSpA criteria; Group 2 included patients with PsA who had axial involvement and met the CASPAR criteria. Axial involvement was diagnosed in the presence of radiographically definite (rd) sacroiliitis (SI), i.e., bilateral SI grade ≥II or unilateral SI grade ≥III, or active SI on magnetic resonance imaging, or ≥1 syndesmophyte in the cervical spine (C-spine) and/or lumbar spine. Inflammatory back pain (IBP) was defined according to the ASAS criteria. Radiographs of the hands and feet were performed. A multivariate analysis method was used (classification tree construction).Results and discussion. Patients with axPsA were characterized by onset of back pain after the age of 45 years, the presence of polyarthritis with a tender joint count >5 and a swollen joint count >3, dactylitis, skin and nail psoriasis, osteolysis, joint ankylosis, extra-articular bone proliferation, and multiple erosions. Distinctive features included syndesmophytes in the cervical spine, asymmetric, non-bridging, bulky syndesmophytes, spinal changes in the absence of SI, and the presence of rdSI that developed without IBP. Patients with axSpA were characterized by a younger age (<40 years) at diagnosis, presence of IBP, spinal involvement without peripheral arthritis, heel enthesitis, uveitis, inflammatory bowel disease, family history of SpA, HLA-B27 positivity, and the presence of rdSI and sacroiliac joint ankylosis.Conclusion. Classification tree construction made it possible to determine that the differential diagnosis is based on features such as the presence or absence of psoriasis in combination with peripheral symptoms (joint swelling, severe arthralgia) and radiographic signs of osteolysis.
Chronic pain is the most burdensome manifestation of rheumatic diseases (RD), a syndrome with a complex multifactorial pathogenesis and a serious threat to the patient’s health and life. It develops when acute pain is insufficiently controlled, against the background of persistent inflammation, degenerative processes, dysfunction of the nociceptive system, and psycho-emotional disturbances. The leading strategy of analgesic therapy in RD is a multimodal approach using drugs and treatment methods targeting the main elements of pain pathogenesis. For pain relief in diseases of the joints and spine, paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids are generally used. One way to increase the effectiveness of analgesic therapy is a rational combination of analgesics. In particular, combined use of NSAIDs and paracetamol increases treatment efficacy by 30–40%. Given that most patients with RD are older individuals with comorbid cardiovascular diseases, the use of naproxen in combination products is of great interest. This NSAID has high analgesic potential and, at the same time, the best cardiovascular safety profile. Therefore, a new drug comprising a combination of naproxen 275 mg and paracetamol 500 mg, which has recently entered Russian medical practice, can be considered one of the most successful tools for controlling musculoskeletal pain in RD.
The pathogenesis of autoimmune rheumatic diseases is a complex multifactorial process based on activation of various components of the immune system. One of the approaches to the treatment of these diseases is extracorporeal therapy technologies, which are techniques aimed at removing from the blood the components involved in pathogenesis and leading to tissue damage. This review discusses various therapeutic apheresis techniques used for the treatment of systemic lupus erythematosus.
Objective: to evaluate the long-term outcomes of cementless total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS).Material and methods. This retrospective study included 30 patients with AS who underwent THA between 1998 and 2018. Complaints, pain intensity assessed by a visual analog scale (VAS), medical history, therapy for the underlying disease, orthopedic status, hip function assessed by the HHS, and operative parameters were evaluated. We also recorded subjective satisfaction with surgery according the SHV questionnaire, as well as complications and revision procedures. Patients were followed up for a mean of 13.7 years.Results and discussion. Mean HHS before surgery was 43.1 points and 86.7 points at long-term follow-up (p=0.001); VAS pain level was 72.3 mm and 20.8 mm, respectively (p=0.001). A good or excellent subjective assessment of surgery was reported by 87% of patients. Periprosthetic femoral fractures were diagnosed in 2 (4.2%) patients and did not require reoperation. Over the follow-up period, two revision THA procedures were performed due to polyethylene liner wear (4.16%).Conclusion. In AS patients with hip involvement, cementless THA provided good long-term functional outcomes. Complications were rare.
