[Relationship between hypercholesterolemia and osteoarthritis (preliminary results)].

AIM: To evaluate the relationship of hypercholesterolemia (HCE) with clinical, instrumental, and laboratory parameters in osteoarthritis (OA) in a multicenter, cross-sectional study. MATERIALS AND METHODS: The study included 183 patients aged 40-75 years, with a confirmed diagnosis of stage I-III OA (ACR) of the knee joints, who signed an informed consent. The mean age was 55.6±10.7 years (40 to 75), body mass index was 29.3±6.3 kg/m2, and disease duration was 5 [1; 10] years. For each patient, a case record form was filled out, including anthropometric indicators, medical history, clinical examination data, an assessment of knee joint pain according to VAS, WOMAC, KOOS and comorbidities. All patients underwent standard radiography and ultrasound examination of the knee joints and laboratory tests. RESULTS: HCE was detected in 59% of patients. Depending on its presence or absence, patients were divided into two groups. Patients were comparable in body mass index, waist and hip measurement, and disease duration but differed significantly in age. Individuals with elevated total cholesterol levels had higher VAS pain scores, total WOMAC and its components, an overall assessment of the patient's health, a worse KOOS index, and ultrasound findings (reduced cartilage tissue). HCE patients showed high levels of cholesterol, low-density lipoproteins, triglycerides, STX-II, and COMP (p<0.05). However, after stratification by age, many initial intergroup differences became insignificant, and differences in the WOMAC pain score persisted. CONCLUSION: The results of the study confirmed the high prevalence of HCE in OA patients (59%). Patients with OA and increased total cholesterol have more intense pain in the knee joints.

[Efficacy and safety of undenatured type II collagen in patients with knee osteoarthritis: a multicenter, prospective, double-blind, placebo-controlled, randomized trial].

BACKGROUND: Non-pharmacological treatments based on collagen as a dietary supplement are emerging as a new area of interest to support preventive or therapeutic effects in patients with osteoarthritis (OA). AIM: In a multicenter, prospective, double-blind, placebo-controlled, randomized study, to evaluate the effectiveness and safety of the use of the Artneo complex containing undenatured chicken collagen type II in patients with OA of the knee joints. MATERIALS AND METHODS: The study enrolled 212 outpatients from 12 centers in the Russian Federation with knee OA, stages II and III according to the Kellgren-Lawrence classification. The participants included 171 women (80.7%) and 41 men (19.3%), with an average age of 60.2±9.0 years (range: 40 to 75 years). The study population was randomly allocated in equal proportions into two groups using an interactive web response system (IWRS). Group 1 (Artneo) consisted of 106 patients who took one capsule of the drug once daily for 180 days. Group 2 (Placebo) also had 106 patients, with the dosage form and regimen identical to Group 1. During the treatment period, the following outcomes were assessed: WOMAC index, KOOS, pain according to VAS, quality of life using the EQ-5D questionnaire, and the need for NSAIDs. All patients underwent a clinical blood test, general urine analysis, biochemical blood test, and ultrasound examination of the affected knee joint. RESULTS: In a prospective, double-blind, placebo-controlled, randomized study, it was demonstrated that the Artneo combination, containing undenatured chicken collagen type II, has a positive effect on all clinical manifestations of OA: it effectively reduces pain, stiffness, and improves the functional state of joints and quality of life. It has a good safety profile and is superior to placebo in all parameters studied. CONCLUSION: The results of the study confirm the good effectiveness and safety of the Artneo combination in patients with OA of the knee joints.

[Study of the safety and immunogenicity of VLP-based vaccine for the prevention of rotavirus infection in neonatal minipig model].

INTRODUCTION: In Russia, almost half of the cases of acute intestinal infections of established etiology in 2022 are due to rotavirus infection (RVI). There is no specific treatment for rotavirus gastroenteritis. There is a need to develop modern, effective and safe vaccines to combat rotavirus infection that are not capable of multiplying (replicating) in the body of the vaccinated person. A promising approach is to create vaccines based on virus-like particles (VLPs). OBJECTIVE: Study of the safety and immunogenicity of a vaccine against rotavirus infection based on virus-like particles of human rotavirus A in newborn minipigs with multiple intramuscular administration. MATERIALS AND METHODS: Newborn minipigs were used as an animal model in this study. The safety of the tested vaccine was assessed based on thermometry data, clinical examination, body weight gain, clinical and biochemical blood parameters, as well as necropsy and histological examination. When studying the immunogenic properties of the Gam-VLP-rota vaccine in doses of 30 and 120 µg, the cellular, humoral and secretory immune response was studied. RESULTS: The results of assessing the general condition of animals during the immunization period, data from clinical, laboratory and pathomorphological studies indicate the safety of the vaccine against human rotavirus infection based on VLP (Gam-VLP-rota) when administered three times intramuscularly. Good local tolerance of the tested vaccine was demonstrated. The results of the assessment of humoral immunity indicate the formation of a stable immune response after three-time immunization with Gam-VLP-rota, stimulation of the production of antigen-specific IgG antibodies and their functional activity to neutralize human rotavirus A. It was shown that following the triple immunization with the minimum tested concentration of 30 µg/dose, animals developed a cell-mediated immune response. The results of the IgA titer in blood serum and intestinal lavages indicate the formation of both a systemic immunological response and the formation of specific secretory immunity to human rotavirus A. CONCLUSION: Thus, three-time intramuscular immunization of minipigs with the Gam-VLP-rota vaccine forms stable protective humoral and cellular immunity in experimental animals. Evaluated vaccine is safe and has good local tolerability.

[Xalacom: possibilities and advantages of the drug in the treatment of patients with glaucoma]. / Ksalakom: vozmozhnosti i preimushchestva preparata v terapii glaukomy.

The strategy of glaucoma therapy is aimed at preserving visual functions and ensuring an acceptable quality of life for patients. To achieve this strategic goal, clinicians in their practice use drugs that affect the main factor in the progression of the disease - intraocular pressure (IOP), aiming to reduce it to an individual target level. It is not always possible to achieve optimal IOP values with monotherapy. Many patients require a combination of drugs from different pharmacological groups. Xalacom is a fixed drug with good tolerability and t hypotensive effect. This review focuses on the benefits of this drug for the treatment of glaucoma.

[Pathophysiological mechanisms of the therapeutic action of alternating electromagnetic fields in the treatment of osteoarticular pathology]. / Patofiziologicheskie mekhanizmy terapevticheskogo deistviya peremennykh elektromagnitnykh polei v lechenii kostno-sustavnoi patologii.

Treatment of osteoarticular pathology with an alternating electromagnetic field (AEMF) is used today as a promising, non-invasive and safe strategy of physiotherapy. It has been shown that the action of alternating electromagnetic fields on the musculoskeletal system triggers signaling cascades that effectively contribute to the restoration of bone and articular tissue. The pathophysiological mechanisms underlying the cellular and subcellular effects of stimulation by an alternating electromagnetic field during the restoration of bone and articular tissue are considered. It was pointed out the several key signaling pathways involved in the restoration of bone and articular tissue under the influence of electromagnetic fields with an analysis of the potential for therapeutic application of electromagnetic fields alone or in combination with other available therapies.

[Efficacy of combined use of glycosaminoglycan peptide complex for intramuscular administration and oral diacerein in osteoarthritis: evaluation according to an observational multicenter clinical trial].

BACKGROUND: The combined use of intramuscular injection glycosaminoglycan peptide complex (GPC) and oral diacerein can increase the effectiveness of treatment of osteoarthritis (OA). AIM: Compare the effectiveness of combination GPC + diacerein and GPC monotherapy in the treatment of OA in clinical practice. MATERIALS AND METHODS: A retrospective evaluation of the results of a 12-week multicenter observational non-interventional study of the effectiveness of GPC (Rumalon, a course of intramuscular injections 3 times a week, №25) in patients with moderate/severe OA (n=2955) requiring regular administration of nonsteroidal anti-inflammatory drugs (NSAIDs). The analysis identified a group of patients (n=414) who received GPC in combination with diacerein 100 mg/day (Diaflex Rompharm). The therapeutic effect was compared in the groups of GPC monotherapy (n=2541) and the combination of GPC with diacerein. These groups did not differ in average age (61.411.8 and 61.911.3 years), both were dominated by women (76.3 and 70.3%), there was approximately equal intensity of pain during movement and impaired joint function: 6.11.8/6.01.6 and 4.92.1/5.11.8 (according to the numerical rating scale 010). The dynamics of pain intensity, the need for NSAIDs, and the frequency of adverse events (AE) were compared 12 weeks after the start of treatment. RESULTS AND DISCUSSION: In the majority of patients with OA both on the background of GPC monotherapy and combined use of GPC and diacerein, there was a significant improvement. The number of patients with pain reduction 50% was 54.3 and 62.8% (p0.001), NSAID administration was completely stopped in 66.7 and 77.5% (p0.001), respectively. The effectiveness of the combination of GPC and diacerein was significantly higher than that of GPC monotherapy in OA of the knee joint, hip joint, and generalized OA. AE from the gastrointestinal tract was observed in 7.8 and 8.9%, arterial hypertension in 6.3 and 4.6%, allergic reactions in 0.3 and 0.5% of patients (not significant). CONCLUSION: The application of the code of civil procedure is an effective treatment for OA. The combination of GPC and diacerein provides a more significant improvement than GPC monotherapy. GPC and diacerein (including in combination) are well tolerated and rarely cause AE.

[The efficacy and safety of intra-articular application of a combination of sodium hyaluronate and chondroitin sulfate for osteoarthritis of the knee: a multicenter prospective study].

in 3 mL on patients with knee osteoarthritis (OA) in a multicenter prospective study. MATERIALS AND METHODS: 79 outpatients (predominantly females 81.0%) from 5 RF constituent territories with primary tibiofemoral KellgrenLawrence score grade II or III knee OA, 40 mm pain intensity during walking on visual analogue scale (VAS), requiring NSAIDs intake (for at least 30 days during 3 months prior to enrollment) were included into the study after signing the informed consent form. Mean age was 60.38.7 years, mean BMI 29.24.7 kg/m2, disease duration 6 (310) years. Grade II OA was documented in 68.4% of patients, Grade III in 31.6%. The study lasted for 6 months. Efficacy and safety evaluations were made based on VAS pain assessment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [WOMAC pain (0500), WOMAC function (01700), WOMAC stiffness (0200)], VAS patients health status, EQ-5D-based assessment of patients quality of life, global physicians and patients efficacy assessment, and daily NSAIDs requirements. RESULTS: Obtained results demonstrate statistically significant VAS pain reduction during walking already in 1 week after intra-articular injection of the combination [respectively, 62 (5572) and 41 (3251) mm, р0.0001]. Moreover, pain continued to subside during all 3 months of follow up [in 1 month 28 (2042), in 3 month 22 (1437) mm]. A significant pan reduction achieved at Mo 3 persisted until Mo 6 20 (1442) mm, without documented pain increase. Similar trends were observed with total WOMAC score [1125 (8991540) at baseline, and 552 (309837) mm by the end of the study, p0.0001], and all WOMAC sub-scores [268 (189312) baseline WOMAC pain, 91 (48171) mm by the end of the study p0.0001; stiffness 101 (59130) and 40 (2061) mm, p0.0001; function 802 (6471095) and 402 (191638) mm, p0.0001, respectively]. Median time to the onset of therapeutic effect was 7 (518) days. Statistically significant improvement of patients quality of life by EQ-5D and general health status was observed during all follow up period [respectively, 0.52 (-0.020.59) and 0.69 (0.590.80), р0.0001; 48 (3060) and 72 (6080) mm, р0.0001]. One injection of the drug resulted in dose reduction or discontinuation of NSAIDs therapy: at baseline 76 patients (96.2%) were taking NSAIDs, in one week 31 (39.2%) patients discontinued NSAIDs, in 1 month 72.2%, in 3 months 73.4%, and by the end of the study at Mo 6 54.4% were not taking NSAIDs. These data were consistent with physicians and patients global assessment of the efficacy of treatment, who stated significant improvement and improvement in the majority of cases, with only few no effect or worsening cases documented in analyzed population. Adverse events, such as worsening of pain and/or swelling of the joint, were documented in 8 patients (10.1%); they resolved spontaneously or following NSAIDs intake. CONCLUSION: These results suggest that intra-articular injections of hyaluronic acid plus chondroitin sulfate in patients with knee OA are efficient and safe. A single injection of the drug resulted in statistically significant reduction of pain and stiffness, reduction in NSAIDs intake, as well as improvement in patients quality of life and function.

[The сhanges of bone mineral density on the risk of progression of osteoarthritis of the knee].

AIM: To find the relationship between bone mineral density (BMD) and risk of knee OA progression in a 5-year prospective study. MATERIALS AND METHODS: 110 females with knee OA were examined twice with 5-year interval. Examination included filling questionnaires, VAS pain assessment, plain knee radiography and axial skeleton densitometry. I stage knee OA was established in 33 (30%) patients, II stage - in 46 (41.8%), III stage - in 26 (23.6%), and IV - in 5 (4.5%). Normal lumbar vertebrae densitometry BMD values were found in 45 patients (40.9%), osteopenia - corresponding BMD values - in 33 (30.0%), and osteoporosis - in 32 (29.1%). Normal femoral neck BMD values were identified in 60 (54.5%) patients, osteopenia - level BMD - in 48 (43.7%), osteoporosis - in 2 (1.8%). In all premenopausal patients (n=15) axial skeleton BMD values were normal. RESULTS: In 5-year interval radiographic progression was established in 40 patients (Group 2), while in 70 (Group 1) patients no progression occurred. Both groups were comparable in terms of age and disease duration, although, more patients from Group 2 tended to have normal baseline densitometry BMD values - both in lumbar vertebrae and femoral neck: 47.5% vs 37.1%, and 62.5% vs 44.3% as compared to Group 1 patients. Patients from Group 1 more often had BMD values corresponding to osteoporosis and osteopenia: 32.9% vs 22.5%, and 55.7% vs 37.5%, respectively, as compared to Group 2 patients, although not achieving statistical significance. These differences were still identifiable after 5-year interval. Absolute BMD values at the second examination in 5 years were indicative of statistically significant increase in femoral neck and total hip BMD in Group 2 patients with knee OA progression: 0.79±0.11 vs 0.73±0.16, р.

[Therapy for acute/subacute musculoskeletal pain: results of the ATUSA (Analgesic Treatment Using a Systemic Algorithm) observational study]. / Terapiia ostroi/podostroi skeletno-myshechnoi boli: rezul'taty nabliudatel'nogo issledovaniia ALISA (Anal'geticheskoe Lechenie s Ispol'zovaniem Sistemnogo Algoritma).

AIM: To evaluate the efficiency of therapy for acute/subacute musculoskeletal pain (MSP) by applying an individualized pathogenetic approach (an algorithm) elaborated on the basis of Russian experts' recommendations. SUBJECTS AND METHODS: A total of 262 physicians treating patients with rheumatic diseases participated in the ATUSA (Analgesic Treatment Using a Systemic Algorithm) program. The study enrolled 3,304 patients (54.3% women, 45.7% men; mean age, 48.6±14.3 years) with osteoarthritis, nonspecific back pain (NBP), and rheumatic diseases of periarticular soft tissues, who had experienced MSP. Treatment was performed in accordance with the following algorithm: the first prescribed medication was nonsteroidal anti-inflammatory drugs (NSAIDs) (aceclofenac): paracetamol and/or tramadol and a topical NSAID in case of contraindications and muscle relaxants in case of indications. The results of treatment were assessed after 7, 14, and 28 days. The treatment was corrected during each visit; the NSAID was, if necessary, changed; corticosteroids were locally injected; antidepressants or anticonvulsant drugs were used. The investigators assessed dynamic changes in pain using a 0-10 paint intensity numeric rating scale (NRS), the number of patients, in whom MSP was completely relieved, and satisfaction with treatment. RESULTS: The first prescribed medication was oral NSAIDs in 97.5% of the patients and those in combination with a muscle relaxant in 67.6%. By visit 4, MSP decreased from 6.9±1.5 to 2.2±1.3 NRS scores. After 28 days, only 16.2% of patients continued to need analgesics. 88.4% of the patients rated treatment results as good or excellent. NSAID switching was required in 8.1% of cases; local glucocorticosteroid injections were needed in 1.9%; there was a need for the use of an antidepressant or anticonvulsant in 1.5% and for hospitalization in 0.25%. Adverse events were observed in 2.2% of patients. The efficiency of treatment (complete pain relief after 28 days) was influenced by the following factors: NRS diagnosis (OR, 2.24; 95% CI, 1.67 to 3.11), age ≥65 years (OR, 0.72; 95% CI, 0.52 to 0.98), moderate pain (NRS scores of ≤7) at the beginning of the study (OR, 2.63; 95% CI, 1.99 to 3.48), mild/moderate pain (NRS scores of <4) after 7 days of therapy (OR, 2.5; 95% CI, 1.89 to 3.33), and the use of muscle relaxants (OR, 1.77; 95% CI, 1.23 to 2.96) (p<0.05 for all comparisons). CONCLUSION: The comprehensive pathogenetic approach used in analgesic therapy provides an effective and relatively safe relief of MSP in most patients with NBP and osteoarthritis.

[Evaluation of the efficacy of pregabalin in the therapy of chronic pain in patients with knee osteoarthritis]. / Otsenka éffektivnosti pregabalina v terapii khronicheskoi boli u patsientov s osteoartrozom kolennykh sustavov.

AIM: To evaluate the efficacy of pregabalin in the therapy of chronic pain in patients with knee osteoarthritis (KOA). SUBJECTS AND METHODS: The study enrolled 60 patients with KOA and neuropathic pain component (NPC) (Douleur Neuropathique en 4 questions (DN4) questionnaire scores, >4) who were randomized into two groups to receive aceclofenac or aceclofenac + pregabalin for 5 weeks. All the patients underwent clinical and neurological examinations, assessment of the functional WOMAC index, pain intensity at rest and during movement, and diagnosis of neuropathic pain (NP) (DN4 and Pain DETECT questionnaires). RESULTS: Both groups were observed to have positive changes in the studied parameters; however, combination therapy using an anticonvulsant drug (pregabalin) showed a more pronounced positive effect against not only NPC, but also the functional activity (WOMAC) and severity of pain (visual analogue scale). CONCLUSION: Combination therapy using pregabalin in KOA patients having the signs of NP is more effective than monotherapy with nonsteroidal anti-inflammatory drugs (aceclofenac).

[Use of ARTRA MSM FORTE in patients with knee osteoarthritis: Results of a randomized open-label comparative study of the efficacy and tolerability of the drug].

AIM: To study the clinical efficacy and safety of the combined medication ARTRA MSM FORTE (400 mg chondroitin sulfate, 500 mg glucosamine hydrochloride, 300 mg methylsulfonylmethane (MSM), and 10 mg sodium hyaluronate calculated with reference to hyaluronic acid) in patients with knee osteoarthritis (OA). SUBJECTS AND METHODS: The study enrolled 100 patients with Kellgren-Lawrence grades 2-3 knee OA with obvious pain syndrome (pain intensity scores on a visual analog scale (VAS)) equal or greater than 40 mm during walking. The patients were examined monthly; changes in WOMAC index scores, Get-Up and Go test results, the efficiency of therapy in the opinion of a physician and a patient, and quality of life according to the EQ-5D questionnaire were estimated. They were randomized into 2 groups: 1) 50 patients took ARTRA MSM as 2 tablets daily for one month, then 1 tablet daily; 2) 50 received ARTRA in accordance with the same scheme. Clinical examination was performed before and at 30, 60, 90 and 120 days of the study. RESULTS: All the 100 patients completed treatment. Analysis of the results showed a significant decrease in pain on VAS in both groups. Reduced pain intensity was observed by the end of the first month of therapy and remained throughout the follow-up. Both medications diminished stiffness just after a month of therapy. They alleviated joint function and reduced total WOMAC scores at Visit 2. Analysis of Get-Up and Go test results indicated significantly less spent time in both groups; however, these differences reached the statistical significance in the ARTRA MSM group just at Visit 2 and in the ARTRA group only at Visit 3. The effect ARTRA MSM occurred more rapidly. This was confirmed by the patient and physician evaluations of the efficiency of treatment, which indicated that its positive effect occurred more rapidly in the ARTRA MSM group (p=0.02). Estimation of EQ-5D scores also showed positive results: there was a significant improvement of these indicators in the two compared groups at Visit 3. Both medications were very well tolerated and caused no adverse reactions; therapy was not discontinued. CONCLUSION: ARTRA MSM is rapider in its effect: a significant improvement in Get-Up and Go test results and patient and physician evaluations of the efficiency of treatment. Additional interviews of the patients taking ARTRA MSM demonstrated that 36 (72%) of them reported a prompter pain relief than the ARTRA-treated patients. ARTRA MSM may be recommended for the treatment of OA in clinical practice.

[Association between bone mineral density and erosive and destructive changes in patients with rheumatoid arthritis: preliminary results].

AIM: To obtain information on and to study an association between the erosive and destructive changes in the hand and foot joints, bone mineral density (BMD) in different parts of the skeleton and the X-ray alterations in the thoracic and lumbar vertebrae of patients with rheumatoid arthritis (RA). SUBJECTS AND METHODS: The investigation enrolled 66 women with a valid RA diagnosis, whose mean age was 51.6 +/- 9.6 years and the disease duration was 13.2 +/- 9.1 years. All the patients underwent clinical, laboratory, and X-ray studies assessing the progression of joint changes by the Sharp/van der Heijde method and estimating the vertebral body deformity index by the Genant technique, and BMD in 3 skeletal regions by dual-energy X-ray absorptiometry employing a Holovic Discovery A device. RESULTS: With X-ray higher-stage RA and higher Sharp total scores, regardless of age, there was a decrease in BMD in all skeletal areas and an increase in the number of patients with deformities of vertebrae and osteoporosis (OP) in at least one of the analyzed skeletal part. Thus, OP was found in 29% of the patients with Stages I and II RA and in 65% of those with Stages IV; deformities of vertebrae were in 12 and 22%, respectively. Comparative analysis of BMD and erosive and destructive changes in the patient groups different in age at onset of the disease has established that its young onset (from 16 to 30 years) and long duration have a negative effect on bone status. Femoral neck BMD in these patients is significantly lower than that in patients who were ill at older age (31-50 or over 50 years) (0.661 +/- 0.080, 0.739 +/- 0.111, and 0.713 +/- 0.120 g/cm2, respectively) and the Sharp total score was higher (181.1 +/- 91.3, 100.5 +/- 71.5 and 103.9 +/- 74.5, respectively). The patients' mean age in these groups at the study inclusion was 46.7 +/- 12.1, 51.9 +/- 6.7, and 60.3 +/- 3.3 years, respectively. CONCLUSION: With the longer disease duration, regardless of the age of patients with RA, there are increases in both Sharp total scores, X-ray RA stage, and the number of patients with OP, deformities of thoracic and lumbar vertebrae (however, there is no evidence of significant differences), BMD decrease in all skeletal parts.

[Evaluation of the efficacy and tolerance of ibandronic acid in patients with osteoarthrosis in the knee joints concurrent with osteoporosis: a pilot study].

AIM: To evaluate the efficacy and tolerance of ibandronic acid (bonviva) in patients with osteoporosis (OP) concurrent with osteoarthrosis (OA) in the knee joints (KJ). SUBJECTS AND METHODS: Twenty female outpatients aged 56 to 77 years with postmonopausal OP and primary KJ OA were examined. All the patients took bonviva in a dose of 150 mg monthly during a year. RESULTS: During the treatment, the patients showed a significant reduction in the values of all components of the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) (pain intensity from 51.7 +/- 11.6 to 34.6 +/- 20.7 mm, stiffness from 96.0 +/- 55.6 to 78.5 +/- 46.6 mm, and functional failure from 783.6 +/- 333.2 to 657.8 +/- 360.9 mm according to a visual analogue scale), the Oswestry disability index, as well as in the concentration of markers for bone resorption and cartilage degradation. The need for nonsteroidal anti-inflammatory drugs was stated to decrease. CONCLUSION: Bonviva therapy results in a significant reduction in pain, KJ stiffness, and locomotor functional failure in patients with gonoarthrosis.

[Neurogenic mechanisms of chronic joint pain].

To study pathogenetic features of chronic joint pain, we examined 183 patients with rheumatoid arthritis (RA) and 80 patients with osteoarthrosis (OA). The presence of mixed pain syndrome was found. A neuropathic component of pain (NCP) was observed in some patients with nociceptive pain (43 and 30% with RA and OA, respectively). Patients with RA had tunnel syndromes (14%), polyneuropathies (55%), mononeuropathies (19%) and sensitive specific disorders, characteristic of NCP, which were localized in anatomic zones corresponding to affected nerves. No signs of the damage of the somatosensory nervous system were found in patients with OA. Neuropathic pain was concomitant to secondary hyperalgesia which covered the zones localized far from the affected joint that allowed to suggest the involvement of dysfunctional mechanisms in the pathogenesis of chronic pain in OA. The study opens new possibilities for pharmacotherapy.

[Osteoarthritis and cardiovascular diseases in elderly patients: clinical and pathogenetic interrelationship].

Osteoarthritis (OA) is one of the most common medical conditions in elderly people. This article presents the survey data on a problem of poly-morbidities (co-morbidities) at osteoarthritis. Special attention is paid to a combination of osteoarthritis with cardiovascular pathology, and also the data testifying the association between osteoarthritis and the increased death rate from cardiovascular pathology. On the basis of the literature data analysis a hypothesis about an etiopathogenic interrelation between osteoarthritis and cardiovascular pathology is presented. According to the authors, potential pathogenetic links include a chronic nonspecific inflammation and metabolic infringements. There are also evidences that vascular pathology may initiate and/or worsen the disease progression. The important factors aggravating a current cardiovascular disease in patients with osteoarthritis are: the restriction of physical activities and irrational pharmacotherapy of osteoarthritis clinical symptoms (increased risk of cardiovascular accidents is considered as a class-specific side-effect for all NSAIDs). The authors present the own data on rational pharmacotherapy of patients with osteoarthritis and somatic pathology by means of SYSADOA influencing the disease symptoms and being able to modify structural changes (glucosamine, chondroitine sulphate - ARTRA).

[Comparative evaluation of the safety and efficacy of etoricoxib and diclofenac on the upper gastrointestinal tract in patients with osteoarthrosis and rheumatoid arthritis (the multinational etoricoxib and diclofenac arthritis long-term (MEDAL) study program)].

The review gives and analyzes the data of a number of studies evaluating the safety and efficacy of nonsteroidal anti-inflammatory drugs on the upper gastrointestinal tract. Particular emphasis is laid on the results of the multinational etoricoxib and diclofenac arthritis long-term (MEDAL) study program. The randomized MEDAL study has shown that etoricoxib has more benefits than diclofenac.

[The morphological characteristics of osteoarthrosis].

Osteoarthrosis (OA) is a group of overlapping diseases that have various etiologies, but equal biological, morphological, and clinical outcomes. OA is characterized by degenerative and destructive changes in the articular hyaline cartilage, subchondral bone, spongiosis, synovium, capsule, and articular ligamentous apparatus. The clinical symptoms of OA are closely associated with morphological changes in articular tissue elements, primarily in the articular hyaline cartilage. Six stages that reflect the magnitude of changes in the hyaline cartilage and 4 degrees of the extent of the process along the articular surface are identified.

[Combined medication ARTRA in the treatment of osteoarthrosis].

AIM: To study clinical effectiveness, safety and duration of the effect of combined medication ARTRA (500 mg glucosamine hydrochloride+500 mg chondroitine sulphate) in osteoarthrosis. MATERIAL AND METHODS: Ninety women aged 40-75 suffering from knee OA and satisfying diagnostic criteria for OA of American Rheumatological Committee having x-ray II-III stages according to Kellgren-Lawrence; with distinct pain syndrome (pain intensity at walking 40 mm and more by the analogue visual scale); taking NSAIDS regularly during 30 days within 3 months before the study were enrolled in the study. The patients were randomly divided into 2 groups: 45 patients of the study group taking 1 tablet ARTRA 2 times a day within the first month, than 1 tablet a day within the following 5 months and diclofenac sodium 50 mg 2 times a day with gradual decrease of the dosage as the pain was decreasing; 45 patients of the control group taking only diclofenac sodium 50 mg twice a day during 6 months. Clinical examination of the patients was done before the treatment, 30, 120 and 180 days after the study. Long-term effects of ARTRA was evaluated 3 months after the study. The treatment efficacy was assessed by WOMAC index, daily need in NSAIDS intake, evaluation of the efficacy by the patient and the doctor. RESULTS: The true WOMAC index decreased in 4 and 6 months of therapy in the study group (p < 0.03). 3 months after the treatment the study group patients experienced continuous reduction of the functional index and pain intensity unlike of the control patients experiencing a pain increase and worsening of joints functional ability. When analysing pain syndrome according to VAS, after 4 months of the treatment pain was relieved more in the study group (p = 0.008). The differences were stable for 6 months. On aftertreatment month 3 pain syndrome tended to attenuation in the study group but to intensification in the controls. While taking ARTRA, the patients decreased their need in NSAIDS intake (diclofenac). After 1 month of therapy 4.5% patients gave up taking diclofenac; after 4--20%, after 6--40%. Objective and subjective effects did not differ much (94 and 90%, respectively). ARTRA tolerability was very good. None of the patients of the study group discontinued therapy because of side effects, in the control group 14 patients gave up diclofenac because of the adverse effects. CONCLUSION: Combined ARTRA medication decreases pain, improves joint function. Regular intake of ARTRA helps decrease NSAIDS dosage or discontinue intake in many cases. ARTRA is very well tolerated and is safe. ARTRA has an evident long lasting effect.

[Ecdysone 20-monooxygenase activity of cytochrome P450 in plants and cell culture of Ajuga reptans L]. / Ekdizon-20-monooksigenaznaia aktivnost' tsitochroma P450 v rasteniiakh i kul'ture kletok Ajuga reptans L.

The concentration of cytochrome P450 and ecdysone 20-monooxygenase activity in plants and callus cell culture of the bugleweed Ajuga reptans L. were determined. The maximal ecdysone 20-monooxygenase activity of cytochrome P450 was found in vegetative rosettes of intact plants. During the stage of flowering, the ecdysone 20-monooxygenase activity of cytochrome P450 in plant leaves was higher than in other organs. It was demonstrated that the content of ecdysteroids in callus cell culture is higher than in the intact plant with concurrent retention of a high ecdysone-20-monooxygenase activity.

[Long-term effects of structum administration (according to data from multicenter trial)]. / Otdalennye rezul'taty primeneniia struktuma (po materialam mnogotsentrovogo issledovaniia).

AIM: To evaluate duration of a clinical response to the drug structum in patients with osteoarthrosis (OA) of the knee and hip joints as well as structum effects on OA course and that of concomitant diseases. MATERIAL AND METHODS: The duration of a clinical response to structum after the end of the treatment and its effect on OA and concominant diseases course were studied for 12 months in 9 centers participating in the study of the drug efficacy and tolerance in patients with gon- and coxarthrosis in an open multicenter randomized controlled 6-month trial. Out of 555 patients with OA of the knee and hip joints enrolled in the first study, the examination covered 373 patients: 159 patients of the test group treated for 6 months with structum and 214 controls. By basic clinical parameters the groups were similar. Clinical examination was made after structum treatment and 12 months later and included assessment of the number of exacerbations, hospitalizations, outpatient consultations, days of temporary disability for OA, pain in the joints while walking and at rest by the visual scale, Leken's functional index, x-ray pictures of the joints, administration of nonsteroidal anti-inflammatory drugs (NSAID), exacerbations of concomitant diseases (gastrointestinal diseases, arterial hypertension, ischemic heart disease). RESULTS: An overall functional Leken's index in patients with gon- and coxarthrosis given structum 12 months after the treatment did not reach the initial values as well as pain and daily need in NSAID. Structum effect in patients with knee joint OA persisted for 4.6 months, in hip joint OA--4.1 months; in patients with stage I-II the effect lasted longer than in stage III (5.2 and 4.6 months vs 4.17 and 3.24 months, respectively. Even short-term therapy with structum reduced the number of further exacerbations, hospitalizations and visits to their doctor. 12 months after structum therapy the effect persisted in 40% patients. Frequency of exacerbations of the concomitant diseases was less than in patients on continuous NSAID. CONCLUSION: Structum is a highly effective drug against OA as it acts long, reduces frequency of exacerbations, hospitalizations, visits to the doctor, duration of disability, NSAID requirement and improves the course of some concomitant diseases.