Постковидный синдром (ПКС) представляет собой актуальную проблему современной медицины ввиду его высокой встречаемости и недостаточной изученности. Вовлечение костно-мышечной системы является одним из самых распространенных симптомов ПКС. Поражение опорно-двигательного аппарата характеризуется достаточной гетерогенностью с диапазоном клинических проявлений от неспецифической боли вследствие малоподвижности и набора веса до развития системного аутоиммунного процесса с вовлечением суставов и/или мышц. В данной статье нами предпринята попытка обобщить полученные к настоящему времени сведения по проблеме ПКС, а также обсудить доступные терапевтические возможности. Postcovid syndrome (PCS) is an urgent problem of modern medicine due to its high incidence and insufficient knowledge. Involvement of the musculoskeletal system is one of the most common symptoms of PCS. The musculoskeletal system involvement is characterized by heterogeneity, with a range of clinical manifestations from non-specific pain due to inactivity and weight gain to the development of a systemic autoimmune process involving joints and/or muscles. In this article, we have attempted to summarize the knowledge gained so far on the problem of PCS, as well as to discuss the available therapeutic options.

Волкова, М. В. Клиническая гетерогенность ревматоидного артрита = Clinical heterogeneity of rheumatoid arthritis / М. В. Волкова, Е. В. Кундер // БГМУ в авангарде медицинской науки и практики: сб. рецензир. науч. работ / М-во здравоохранения Респ. Беларусь, Бел. гос. мед. ун-т; редкол.: А. В. Сикорский, О. К. Доронина. — Минск, 2017. — Вып. 7. — С. 48-54.

Abstract. A group of 266 patients with spondyloarthritidis and 69 healthy persons were included in our study. IgG preparations were isolated from blood sera by a combined rivanol/affine chromatography technique. Homogeneity of IgGs was tested by means of SDS-PAGE. Serum samples from patients and healthy persons, and IgG subclasses 1, 2 and 4 were tested for DNAse activity. A method of DNAse activity measurement was based on rivanol capacity to form a clot with DNA. We have found highly significant differences between the levels of DNAse activity associated with IgG preparations and in blood sera from patients with spondyloarthritidis, and healthy donors (p < 0,0001). DNAse activity of IgG and sera in patients with psoriatic arthritis was higher than in patients with reactive arthritis and ankylosing spondylitis (p < 0,0001). Multiple correlations were revealed between DNAse activity of IgG, blood serum, clinical signs of psoriatic arthritis, reactive arthritis, ankylosing spondylitis, and laboratory findings. We have developed novel tests for differential diagnosis between various disorders, e.g., spondyloarthritidis, based on IgG and serum-associated DNAse activity, corresponding to the criteris of useful and very useful diagnostic tests in rheumatology.

Abstract. Polyclonal immunoglobulins G (subclasses 1, 2, 4) from sera of 255 patients and 69 healthy persons were studied by a combined approach using rivanol treatment and affinity chromatography. Enzymatic reactions were carried out according to the methods that we have previously developed and validated for evaluation of abzyme activity in the patients with different disorders. The levels of DNase, proteolytic BAPNA-amidase (benzoylarginine-p-nitroanilide amidase), and superoxyde dismutase abzyme activity in spondyloarthropathies proved to be significantly higher (p = 0.001), as compared with a control group. Catalase activity of immunoglobulines in the disorders studied was compatible to control levels (p > 0.05). Analysis of relations between abzyme activity and clinical and laboratory signs of the diseases has revealed some significant correlations. Prevalence of abzyme DNAse activity is found in the patients with psoriatic arthritis, as compared to reactive arthritis and ankylosing spondilitis (p < 0.001).

Summary. Osteoarthritis is currently being mined to a problem that is related to its enormous prevalence, as well as a large number of elderly patients and persons with obesity. Inflammation plays an important role in the implementation of pathogenetic processes in osteoarthritis, so the use of anti-inflammatory drugs is warranted. The article is a literature review of rational choice of anti-inflammatory therapy of osteoarthritis and specifically relates to the using of the aceclofenac. The modern views of efficiency and safety of aceclofenac in osteoarthritis are presented. The chondroprotective properties of aceclofenac are substantiated. Keywords: osteoarthritis, chondroprotection, aceclofenac. О стеоартроз (остеоартрит, ОА) – гетерогенная группа забо-леваний различной этиологии, в основе которых лежит хроническое заболевание суставов с поражением всех компонентов (хряща, субхон-дральной кости, синовиальной обо-лочки, связочного аппарата, капсулы сустава, мышц). Термин ОА введен в клиническую практику вследствие накопления данных, подтверждаю-щих роль воспаления в формирова-нии заболевания. На сегодняшний день ОА являет-ся доминирующей проблемой в рев-матологии, что связано с его огром-ной распространенностью (болеют около 20% населения), а также с большим количеством пожилых па-циентов (после 75 лет клинические признаки ОА выявляются у каждого второго жителя, а рентгенологиче-ские – у 80% населения) и лиц с по-вышенной массой тела. По данным эпидемиологического исследова-ния, в России ОА с преимуществен-

The study analyzed serum hyaluronidase and deoxyribonuclease activity in patients with early arthritis--early rheumatoid arthritis and acute reactive arthritis. The criteria of their differential diagnostics were developed on the basis of data obtained. The genuine methods were applied to analyze hyaluronidase and deoxyribonuclease activity of blood serum based on formation of clot of etacridine acetate (rivanol) with hyaluronic acid and DNA inversely proportionally to their polymerization under the impact of enzymes. The increased serum hyaluronidase and deoxyribonuclease activity was established in patients with early arthritis as compared with control group (p < 0.001). The prevalence of mentioned types of activity under early rheumatoid arthritis as compared with acute reactive arthritis was detected too. The rests for differentiate diagnostics of early rheumatoid arthritis and acute reactive arthritis were developed conformed to criteria of the most useful diagnostic tests in rheumatology.

The study analyzed serum hyaluronidase and deoxyribonuclease activity in patients with early arthritis early rheumatoid arthritis and acute reactive arthritis. The criteria of their differential diagnostics were developed on the basis of data obtained. The genuine methods were applied to analyze hyaluronidase and deoxyribonuclease activity of blood serum based onformation of clot of etacridine acetate (rivanol) with hyaluronic acid and DNA inversely proportionally to their polymerization under the impact of enzymes. The increased serum hyaluronidase and deoxyribonuclease activity was established in patients with early arthritis as compared with control group (p<0.00l). The prevalence of mentioned types of activity under early rheumatoid arthritis as compared with acute reactive arthritis was detected too. The tests for differentiate diagnostics of early rheumatoid arthritis and acute reactive arthritis were developed conformed to criteria of the most useful diagnostic tests in rheumatology.

Rheumatoid arthritis and osteoarthritis are severe chronic diseases, which decrease the quality of life, disturb the physiologic and social status of the patients. Thus the including of psychotherapy in complex system of rehabilitation measures of the patients with rheumatic diseases is a very urgent problem. The aim of the study was to assess the types of attitude towards the disease in patients with rheumatoid arthritis and osteoarthritis. The specific personal features of these patients were described. In patients with rheumatoid arthritis the disturbance of social adaptation is marked to a greater extent than that in patients with osteoarthritis. The predominant type of attitude towards the disease in patients with rheumatoid arthritis is ergopathic. In patients with osteoarthritis the harmonic type prevails. The results obtained enable us to conclude that the majority of patients with rheumatoid arthritis and osteoarthritis need qualified psychological aid for more successful treatment.

The study was undertaken to evaluate serum hyaluronidase activity in patients with spondyloarthropatgies and to develop criteria for their differential diagnosis. The author's methods for evaluating serum hyaluronidase activity, which were based on that the formation of a clot of ethacridine lactate (rivanol) with hyaluronic acid is in inverse proportion to its depolymerization under the action of hyaluronidase, were used. Enhanced serum hyaluronidase activity was seen in patients with spondyloarthropathies as compared with the control group (p < 0.0010, which was most evident in psoriatic arthritis. With the diagnostic level of hyaluronidase activity of 4 scores or more, the diagnostic sensitivity of the method in the differential diagnosis of psoriatic arthritis and other spondyloarthropathies was 92% and its diagnostic specificity was 86%.