[Physiological needs and effective doses of vitamin D for deficiency correction. Current state of the problem].

In addition to classic role of vitamin D in musculoskeletal health over the last decade it was shown that low blood serum concentrations of 25(OH)D are associated with a number of non-skeletal disorders including cancer, high blood pressure, age-related cognitive decline, disorders of the immune and reproductive systems, etc. The prevention of the development of these diseases is reached under considerably higher concentrations of the vitamin in the blood serum, than is necessary to maintain the normal state of the bone tissue, to regulate calcium absorption and homeostasis. To maintain the concentration of the circulating form of vitamin D 25(OH)D in blood serum at a level ensuring optimum course of vitamin D-dependent biochemical processes (greater than 50 nmol/l), a higher intake of vitamin D is necessary. Reduced blood concentration of vitamin D (less than 30 ng/ml) occurs in 50-92% of the adult population of working age in our country, regardless of the season. The causes of vitamin D deficiency are the low efficiency of its endogenous synthesis in the skin due to insufficient sun exposure owing to the geographical position of our country, and inadequate intake of the vitamin from food as a result of rare consumption of the main source of this vitamin - oil-rich sea fishes. In the Russian Federation the current daily norm of physiological need (10 mcg) to some extent allows to maintain skeletal features, but such consumption does not allow to achieve adequate levels of the circulating form of vitamin D in the blood, which provide optimal manifestation of nonskeletal functions of this vitamin. The analysis of the available information and the prevalence of vitamin D deficiency point to the need to increase the physiological needs of vitamin D to 15 micrograms (600 IU/day). Simultaneously it should be recognized that vitamin D daily intake of 25 micrograms (1000 IU/day) is an effective dose to improve vitamin D status and at the same time is safe. Higher vitamin D intake can reliably eliminate the existing deficit of this vitamin in the population and maintain blood concentration of 25(OH)D at an optimum level, which will provide health benefits.

[AGING AND OSTEOARTHRITIS. CHRONIC NONSPECIFIC INFLAMMATION AS A LINK BETWEEN AGING AND OSTEOARTHRITIS (REVIEW)].

This article presents review on the processes underlying aging and the most common age-associated diseases. Special attention is given to the role of chronic nonspecific inflammation. Based on the literature data it was demonstrated that aging and osteoarthritis have the same basic molecular and cellular mechanisms, among which general are cascades intracellular transcription chronic nonspecific inflammation and metabolic disturbances plays an important role. It is concluded that the process of normal aging is not a disease, but makes the human body, and particularly the musculoskeletal system, susceptible to age-associated changes. Number of changes in the human body that accompany the aging process, and play a role in the development and progression of OA, are potentially reversible, regardless of age (eg, chronic non-specific inflammation), and can be considered as a possible entry points for the effective prevention and complex therapy of OA in elderly people.

[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).

[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.