[Asthenic disorders correction with Recognan]. / Korrektsiya astenicheskikh sostoyanii preparatom Rekognan.

Asthenia, asthenic syndrome, asthenic condition, asthenic reaction, asthenic disorders are terms that describe the state of «impotence¼. Fatigue that occurs against the background of habitual physical or intellectual stress for a person, and persists after rest, is asthenia. For people of the older age group, the term senile asthenia syndrome is used. Asthenia manifests itself with increased fatigue and exhaustion, mood instability, increased irritability, sleep disorders. Asthenic conditions manifest themselves along with a decrease in physical activity, increased cognitive and mental fatigue. Asthenic syndrome (AS) are considered as an integral part of cardiovascular diseases (CVD), as one of the manifestations of cerebrovascular pathology. Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by an age-associated decrease in the physiological reserve and functions of many body systems, including cognitive functions. One of the drugs that has a positive effect on the severity of AS and improves the state of cognitive functions is the domestic drug Recognan (citicoline). The effectiveness of Recognan in the treatment of AS in patients with CVD, SAS, and post-COVID asthenia has been shown. It is recommended to prescribe Recognan orally at 500 mg / day for 30 days. Recognan has a nootropic and antiasthenic effect.

[Recognan (citicoline) efficacy and safety in cognitive impairment correction of various nosological forms]. / Effektivnost' i bezopasnost' Rekognana (tsitikolin) pri korrektsii kognitivnykh narushenii razlichnoi etiologii.

Insufficiency of a choline derivative (acetylcholine) can lead to the development of cognitive impairment (CI). One of the most well-known and well-studied medical drugs (MD) containing choline and having neuroprotective properties is citicoline (Recognan). A number of studies have demonstrated the effectiveness of Recognan in relation to mild CI, chronic cerebrovascular diseases (CVD), acute vascular disorders (including post-traumatic genesis). Recognan improves memory and other cognitive functions in healthy young people against the background of asthenia due to stress or increased cognitive and emotional stress or infection, and also has a preventive effect on fading cognitive functions in the process of age-related changes. The duration of neuroprotection can reach 6 months or more - up to 12 months, depending on the patient's condition. Therapy regimens include two-stage Recognan prescribing: with CVD intramuscularly (i/m) at 1000 mg /d for 30 days, in the acute period of ischemic stroke, i/m or intravenously (i/v) at 1000 mg every 12 hours from the first day after diagnosis, 3-5 days after the start of therapy, with preservation functions of swallowing, it is possible to switch to per oral (p/o) drug administration.

[Points of undenatured type II collagen application in musculoskeletal pain syndromes treatment]. / Tochki prilozheniya nedenaturirovannogo kollagena II tipa v terapii skeletno-myshechnykh bolevykh sindromov.

The dominant collagen of the cartilaginous matrix in adults is type II collagen. The amount of type II collagen in the intercellular matrix of cartilage is significantly reduced against the background of musculoskeletal system diseases. The basis of articular cartilage is hyaline cartilage tissue consisting of chondrocytes with tissue-specific antigens that induce the production of antibodies in patients with osteoarthritis (OA). Today, new approaches are being considered in the treatment of OA with the use of udenatured type II collagen (UC-II). Such molecular mechanisms of action of UC-II as the formation of a systemic response through oral tolerance are discussed, since the induction of tolerance is the immune pathway, by default, in the intestine. A number of experimental, preclinical (on volunteers) and clinical studies have shown the effectiveness and safety of the use of UC-II in OA. Standardized extracts of UC-II exhibit anti-inflammatory, immunoregulatory, chondroprotective effects, contributing to the reduction of pain symptoms of OA. Against the background of taking UC-II with induced OA, there is a statistically significant decrease in the level of proinflammatory cytokines, such as interleukin (IL-1ß, IL-6), tumor necrosis factor alpha (TNF), C-reactive protein (CRP) in serum and the level of max proteinases (MMP-3), nucleated factor «kappa-bi¼ (NF-κB) in the knee joint. UC-II significantly inhibits the production of prostaglandin E2 (by 20%) and the expression of genes encoding proinflammatory proteins. In experimental models and in OA patients, a decrease in the severity of pain syndrome, an increase in endurance, mobility and an improvement in the functional state of the joints were noted. Clinically, no changes in the structure of the muscle fiber were detected with increased physical exertion. With OA on the background of UC-II (10-40 mg/s), there was a statistically significant decrease in joint pain according to WOMAC. A promising direction of OA therapy is the combination of UC-II with chondroitin sulfate and glucosamine sulfate.

[Hand motor dexterity as one of neurological status assessing indicators]. / Skorost' pis'ma kak odin iz vozmozhnykh pokazatelei v kompleksnoi otsenke nevrologicheskogo statusa.

OBJECTIVE: To assess the degree of hand motor dexterity preservation (on the example of cursive writing) in healthy subjects (HS), depending on age and gender, the severity of cognitive impairment (CI), with damage to hand peripheral nerves (on the example of tunnel hand neuropathy (HN)), of motor hand impaired function with hyperkinesis (on the example of writer's cramp (WC)). MATERIAL AND METHODS: The examined patients and the HS included in the study gave written informed consent to participate in the study. All the subjects were right-handed. Groups of subjects: 1st group- HS (n=140) at the age of 37.7±15.9 years (20-75 years), 2nd group - HN (n=52) at the age of 48.7±10.4 years (20-67 years), 3rd group - CI (n=87) at the age of 64.3±7.0 years (50-75 years), 4th group - WC (n=91) at the age of 39.9±12.9 years (12-66 years). The study followed a single Protocol for performing written tasks: to write a standard passage of text at a moderately fast pace under dictation, the time was recorded using an electronic stopwatch. RESULTS: Writing speed: HS was 26.5±3.9 sec, men write significantly slower with age (p=0.048) than women (27.3±3.4 sec vs 25.8±3.6 sec, respectively); HN - 26.4±3.7 sec; CI (whole group) - 34.4±5.5 sec, with mild CI (MCI) - 32.7±4.3 sec, with non-mild / moderate CI (nMCI) - 39.9±6.1 sec; WC (whole group) - 47.1 ±15.3 sec, WC spastic form - 37.9±14.2 sec, WC tremulous form - 47.6±16.4 sec. HS women, unlike HS men, retain constant cursive writing at different age periods; without central mechanisms involvement of act of writing implementation (as median / ulnar nerves neuropathy), cursive changes are not observed; cursive writing with CI decreases depending on CI degree severity (MCI or nMCI), but regardless of gender; the most pronounced decrease in cursive writing it is observed in WC, to a greater extent in the tremulous form, and in men. With WC, there are violations in the central mechanisms of the motor engram realization, with dystonia formation, there is a gradual destruction of the writing program. CONCLUSIONS: The proposed method of cursive assessment can indirectly help in the differentiation of neurological disorders, become a predictor in the assessment of the development of CI in the elderly or the initial manifestations of dementia in Parkinson's disease. The obtained results of the study require further research in order to study the disintegration of the motor program in neurological diseases and in the process of involution.

[Complex effects of physical exertion with dietary supplements Cartilox in pain syndrome effectiveness and safety evaluation]. / Otsenka effektivnosti i bezopasnosti kompleksnogo vozdeistviya fizicheskikh nagruzok s BAD Kartiloks pri bolevom sindrome.

A promising direction of osteoarthritis (OA) therapy is currently being considered pharmaceutical compositions of Symptomatic Slow Acting Drugs for Osteoarthritis (SYSADOA), which include type II collagen. A clinical observational study was conducted. OBJECTIVE: To Identify the effect of physical activity complex effects with dietary supplements Cartilox (composition: hydrolyzed type II collagen, hyaluronic acid, boswellia, curcumin, piperine) on the severity of pain syndrome in OA knee and hip joint patients, low back pain (LBP); assessment of the need for the appointment of NSAIDs against the background of taking Cartilox. MATERIAL AND METHODS: The study included 60 patients aged 35-65 years, with a confirmed diagnosis of knee and hip OA I-II st., LBP with a slight degree of severity of pain syndrome - 4-5 points on a numerical rating scale (NRS). Patients with comorbid diseases: arterial hypertension (AH), type 2 diabetes mellitus (DM-2), hypothyroidism, diseases of the gastrointestinal tract (gastrointestinal tract). By randomization, the patients were divided into two groups: Main group (n=30; 54.36±8.57 years) received a complex effect of non-drug therapy (physical therapy complex) with dietary supplements Cartilox 1 sachet per day during or immediately after meals for 1 month, in combination with non-medical therapy (physical therapy complex). And Control group (n=30; 53.03±16.18 years) used only non-medical therapy (physical therapy complex). In both groups, topical NSAIDs were used «on demand¼. The patients included in the study had imaging data of the spine and joints. Clinical and neurological examination was used: day 0 (Visit 1), Day 14 (Visit 2), Day 30 (Visit 3) of therapy. The dynamics of the condition was assessed: 10-point NRS of pain assessment (at rest, while walking, palpation), functional status of Oswestry Disability Index (ODI), blood pressure (BP) was measured, the dynamics of biochemical parameters (before and after 30 days) of blood glucose, liver enzymes (AST, ALT), weight indicators, registration of adverse events (AEs). A sub-objective assessment (1 to 5 balls) was given to the patient and the physician. RESULTS: Against the background of taking Cartilox, a statistically significant decrease in the severity of pain syndrome was noted, an improvement on ODI (to a greater extent in the Main group vs the Control group). In no case has a registered AEs. Changes in the level of biochemical blood parameters (glucose, liver enzymes) and blood pressure levels were not observed. The topical NSAIDs use was observed only in the Control group. CONCLUSION: The complex effect of physical exertion with dietary supplements Cartilox can be recommended for patients with unexpressed pain syndrome (4-5 points on the NRS) with LBP and knee and hip OA (I-II st.). The absence of changes in the level of biochemical parameters of blood and blood pressure makes it possible to recommend Cartilox to patients with OA and comorbid diseases.

[SYSADOA place in degenerative-dystrophic joints diseases treatment of neurological practice from the standpoint of evidence-based medicine]. / Mesto preparatov SYSADOA v lechenii degenerativno-distroficheskikh zabolevanii sustavov v nevrologicheskoi praktike s pozitsii dokazatel'noi meditsiny.

Neurologists in their practice often face pain syndrome against the background of degenerative-dystrophic changes in the spine, in the therapy of which drugs of delayed-action symptomatic therapy of osteoarthritis (OA) (Symptomatic Slow Acting Drugs for OsteoArthritis, SYSADOA) are used. SYSADOA includes medicinal drugs (MD) containing chondroitin sulfate (CS), glucosamine, avocado/soy unsaponifiables (ASU), diacerein, intra-articular hyaluronic acid, which can give symptomatic benefit with low toxicity, and with prolonged (up to 6 months) the course of treatment. In Russia, they are guided by the clinical recommendations of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), in which the algorithm for managing patients with knee joint OA with the appointment of CS and glucosamine sulfate (GS) form the basic part of the treatment of OA (Step 1). In order to achieve the expected clinical effects in patients with OA medical drugs (MD) of the SYSADOA class must meet the following criteria: 1) be of pharmaceutical quality and standardization with studied pharmacokinetics; 2) meet the criteria of evidence-based medicine (to have randomized clinical trials (RCTs), to have confirmed the effectiveness of meta-analyses of studies and /or systematic reviews, to have confirmed the safety of use in comorbid patients, to have the conclusions of fundamental and clinical studies of recent years justifying the need for its use); 3) be approved by the regulator - the Ministry of Health of the Russian Federation (be present in the current Clinical Recommendations of the Ministry of Health of the Russian Federation and standards for the treatment of diseases of the musculoskeletal system); 4) be approved and recommended by international and Russian professional communities, associations, experts; 5) have clinical and economic advantages in terms of the outcomes of therapy and the lowest cost-effectiveness coefficient per patient. After analyzing the research materials, it was concluded that the pharmacologically standardized CS (Chondroguard®) satisfies all the above criteria for the reasonable choice of a SYSADOA class MD for the treatment of patients with OA of various localization.

Postcovid-19 Asthenic Syndrome.

Objective. To study the characteristics of asthenic syndrome and the potential for treating it in the postcovid period. Materials and methods. A continuous sampling method was used to select 129 patients (mean age 49.8 ± 8.9 years) after COVID-19. Study patients were selected at the clinical out-patient and polyclinic facilities in Samara in the period July-August, 2020. All patients signed informed consent. The envelope method was used to randomize patients into two groups: the study group (n = 64) received ethylmethylhydroxypyridine succinate (Neurox) 1 tablet (125 mg) three times daily for four weeks; medications in the reference group (n = 65) did not include any substances of the pharmacological antihypoxant/antioxidant/nootrope groups. Three visits (V) were made: the first (V1) was before inclusion in the study; the second (V2) was at 14 days; the third (V3) was on day 28 from treatment initiation. The dynamics of overall status (weakness, fatigue, concentration of attention, vertigo, headache, sleep impairment) were evaluated on a visual analog scale (VAS); the subjective perception of the severity of asthenia (tiredness, physical and mental fatigue, decreased motivation and activity) was evaluated using the Multidimensional Fatigue Inventory, MFI-20); cognitive functions were assessed using the Mini Mental State Examination (MMSA); and autonomic tone was assessed using the Kérdö index. Results. At the end of the study (V3), statistically significant changes in measures (VAS, MFI-20) were seen only in patients of the study group; the Kérdö Index showed no statistically significant differences. Analysis of MMSE data revealed a decline in cognitive functions in both groups, which may be linked with pseudocognitive deficit due to asthenia. Conclusions. Our studies yielded evidence of a high incidence of asthenic syndrome after COVID-19. Neurox decreased the severity and extent of the symptoms of asthenia.

[Meloxicam clinical effects]. / Klinicheskie effekty meloksikama.

Pain syndromes, acute and chronic, against the background of inflammatory diseases (such as osteoarthritis (OA)), degenerative-dystrophic changes (involutive process, trauma) or systemic diseases (rheumatoid arthritis, etc.) dictate a steady increase in the intake of nonsteroidal anti-inflammatory drugs (NSAIDs). The choice of the most «safe NSAID¼ is based on the assessment of the toxicity index (the ratio when blocking cyclooxygenase (COX)) and the development of relative risks (the benefit/risk ratio). As well as those adverse events that can be detected with individual sensitivity to a specific NSAIDs, taking into account the anamnesis of previous diseases and intolerance to NSAIDs, existing chronic diseases (gastrointestinal tract, cardiovascular system, type 2 diabetes mellitus), limiting the appointment of NSAIDs. Considering these circumstances, the NSAID meloxicam (Amelotex) can be recommended for the treatment of various genesis pain syndromes. A number of studies have demonstrated the efficacy and safety of meloxicam with different methods of its administration (per oral (p/o), intramuscularly (i/m)) in the treatment of pain syndrome in the lower back, with OA, etc. Recent studies concern intravenous (i/v) meloxicam (30 mg) administration with moderate and severe postoperative pain syndrome. Today, the most commonly pain therapy scheme using meloxicam includes step-by-step administration of injectable and oral forms: meloxicam i/m (1.5 ml) for 3-5 days, followed by a transition to p/o (7.5-15 mg) intake for 14 days, or complex therapy with meloxicam (Amelotex), with muscle relaxant and B vitamins.

[A rare form of secondary orofacial pain: Herzenberg's disease]. / Redkaya forma vtorichnoi litsevoi boli: bolezn' Gertsenberga.

A clinical analysis of a patient with a rare form of secondary facial pain (Herzenberg's disease) is presented. The conducted research and pharmacological tests made it possible to exclude such diseases as trigeminal neuralgia, stylohyoid syndrome, TMJ pain dysfunction, dental plexalgia, myofascial facial pain syndrome. The patient is consulted by a dental surgeon to exclude pathology of the parotid salivary gland and sialolithiasis. The patient was treated with broad-spectrum antibiotics for 8 days. Also, supportive therapy was prescribed: desensitizing, vitamins, as well as an anxiolytic and an antidepressant in minimum therapeutic doses for a course of 14 days (with subsequent correction of the dosage and duration of administration) to correct the emotional state of the patient. We recommend a gentle diet (alkaline warm drink, soft food), and a diet that does not provoke salivation. Locally it was recommended to rinse with antimicrobial drugs, phonophoresis, electrophoresis, magnetotherapy. On the 6th day of therapy, the therapeutic effect was obtained. By the 14th day of therapy, the pain syndrome was leveled.

[Post-COVID-19 asthenic syndrome]. / Astenicheskii sindrom u patsientov, perenesshikh COVID-19.

OBJECTIVE: To study the features of asthenic syndrome and the possibilities of its therapy in patients in the post-covid period. MATERIAL AND METHODS: The study included 129 patients with an average age of 49.8±8.9 years who had undergone COVID-19 using a continuous sample method. Patients for the study were selected at the clinical bases of outpatient clinics in Samara (Russia) in July-August 2020. All patients signed an informed consent form prior to enrollment. Patients were randomized into two groups: in the main group (n=64), ethylmethylhydroxypyridine succinate (Neurox) was prescribed 1 tablet (125 mg) 3 times a day for 4 weeks; in the comparison group (n=65), medical drugs (MD) did not contain substances from the pharmacological group related to antihypoxants/antioxidants/nootropics. Three visits (V) were conducted: the first (V1) - the period of inclusion, the second (V2) - after 14 days, the third (V3) - on the 28th day from the start of therapy. The dynamics of the general state (weakness, fatigue, concentration, dizziness, headache, sleep disorders) were evaluated on a visual-analog scale (VAS), the assessment of the subjective feeling of severity of asthenia (fatigue, physical and mental fatigue, decreased motivation and activity) - on Multidimensional Fatigue Inventory (MFI-20), cognitive functions - on Mini-Mental State Examination (MMSE), vegetative tone - according to the Kerdo index. RESULTS: At the end of the study (V3), statistically significant changes in indicators (VAS, MFI-20) were obtained only in the main group patients; no statistically significant differences were obtained for the Kerdo index. Analysis of the MMSE data revealed a decrease in cognitive functions in both groups, which may be associated with pseudocognitive deficits due to asthenia. CONCLUSIONS: We have obtained evidence of a high incidence of asthenic syndrome after COVID-19. Against the background of taking Neurox, there was a decrease in the severity and expression of asthenia symptoms.

[Cobalamin in the complex treatment and prevention of cognitive impairment]. / Kobalamin v kompleksnoi terapii i profilaktike kognitivnykh narushenii.

Cognitive impairment (CI) develops not only in structural damage to the central nervous system, but also in encephalopathies of dysmetabolic and deficiency etiology. Recently, special attention is focused on the appearance of CI due to the deficiency of cobalamin (vitamin B12) and folic acid (FA), the change in the level of homocysteine (HC). To detect vitamin B12 deficiency is possible by examining key biomarkers in serum based on a decrease in the levels of vitamin B12 and holotranscobalamin, and levels of methylmalonic acid (MMA) and HC. The article presents an analysis of studies conducted in Norway, Korea, India, and other countries to assess the risks of CI in the presence of reduced levels of vitamin B12 in the elderly, which demonstrated a decrease in brain volume in the elderly (according to MRI data) in combination with altered test parameters that assess cognitive functions. In many studies, female patients with reduced levels of vitamin B12 predominated among the studied patients. Also, some studies have demonstrated the effectiveness of complex CI therapy with the inclusion of vitamin B12 (both for oral and intravenous administration). Oral vitamin B12 therapy at a dose of 1000 µg has been shown to be adequate for the treatment of vitamin B12 deficiency. Also, the administration of vitamin B12 for prophylactic purposes is recommended for patients with subnormal or borderline concentrations of vitamin B12 in the blood serum.

[Chondroitin sulfate role in the complex rehabilitation of elderly people with chronic pain syndrome]. / Rol' khondroitina sul'fata v kompleksnoi reabilitatsii lits pozhilogo vozrasta s khronicheskim bolevym sindromom.

The article presents the data of the latest domestic and foreign original studies, the results of a number of meta-analyses, conclusions of randomized clinical trials (RCTs), and other scientific studies that prove the effectiveness and necessity of mandatory inclusion in the treatment of chronic pain syndrome of the stage of non-invasive non-pharmacological therapy. One of the promising areas of pharmacotherapy for degenerative-dystrophic joint lesions is the use of chondroprotectors (CP), in particular chondroitin sulfate (CS). According to new Clinical Recommendations of Ministry Health (MH) of the Russian Federation (RF) «Chronic pain in patients of elderly and senile age¼ (2020), according to which the purpose of CS is recommended for patients older than 60 years with joint pain and contraindications to non-steroidal anti-inflammatory drugs (NSAIDs) or senile asthenia for the purpose of pain relief and the prevention of exacerbations of pain. A high level of reliability and persuasiveness of the recommendations was noted (1A) of CS use. Most of the CS is available in the form of forms for oral use, the bioavailability of which, according to clinical studies, is 13-38% due to the destruction of the CS molecules in the gastrointestinal tract. Intramuscular (i/m) administration of the drug can increase the bioavailability of CS, which can not only increase the effectiveness of therapy, but also lead to a more rapid development of the symptomatic effect. In Russia available parenteral forms of CS (Chondroguard) pharmaceutical quality, efficacy has been proven in randomized clinical trial (RCT) MH RF. To relieve pain in the joints, it is recommended to use parenteral forms of CS (Chondroguard) at a dose of 100-200 mg per day, every other day, the total duration of the course of treatment is 25-30 injections.

[Chondroitin sulfate in therapy osteoarthritis chronic pain patients according to actual clinical recommendations].

Of undoubted interest is the search for new drugs comparable in effectiveness to nonsteroidal anti-inflammatory drugs (NSAIDs), but with a safer application profile. NSAIDs are characterized by a good analgesic effect due to the modulation of prostaglandin metabolism by inhibition of cyclooxygenase-2. One of the promising directions of pharmacotherapy of degenerative-dystrophic joint lesions is the use of symptom-modifying drugs of delayed action, which include chondroitin sulfate (CS). CS has antiresorptive activity, anti-inflammatory and anti-inflamaging effects. In addition to the direct effect on pain syndrome severity, he also have a modulating level effect of systemic inflammation of cartilage tissue. According to experts of international and Russian societies, pharmaceutical prescription-quality CS is a basic part of the treatment of osteoarthritis. One of the advantages of CS over NSAIDs is the preservation of the effect for 24 months after the treatment. Against the background of the use of CS, it is possible to reduce the dose or completely cancel NSAIDs, which helps to reduce the frequency of adverse events associated with their intake. CS has a favorable safety profile, which is important for elderly patients and those with comorbid diseases (cardioprotective effects). CS drugs can be administered per orally, intramuscularly, intra-articularly and in combination with different administration methods. Several clinical trials of CS (Chondrogard), including randomized, were conducted in Russia. The Russia Health Ministry approved the appointment of parenteral CS in clinical guidelines: Chronic pain in elderly and senile patients (2020), Falls in elderly and senile patients(2020), "Knee osteoarthritis" (2021), "Hip osteoarthritis" (2021).

[The assessment of efficacy and tolerability of the complex therapy of low back pain]. / Otsenka effektivnosti i perenosimosti kompleksnoi terapii nespetsificheskoi poyasnichnoi boli.

OBJECTIVE: To assess the efficacy of the complex therapy of nonspecific low back pain (LBP) with amelotex, calmirex, kompligamB in comparison with the monotherapy with amelotex. MATERIAL AND METHODS: This observational study included sixty patients, aged 53.73±11.84 53 years, with nonspecific LBP. Patients were divided into 2 groups: the basic group (n=30) received calmirex (150mg 2 times a day during 10 days), amelotex (7.5 mg 2 times a day, 7 days) and kompligamB (1 ml once a day, 10 days). The control group (n=30) received only amelotex (7.5 mg 2 times a day, 7 days). The dynamics of the condition was assessed on a 10-point numerical rating scale (at rest, walking, palpation), the Oswestry functional status questionnaire (Oswestry Disability Index; ODI), as well as indicators of laboratory markers reflecting the severity of the inflammatory process (erythrocyte sedimentation rate, C-reactive protein (CRP)). RESULTS: The severity of pain syndrome significantly decreased in both groups, to a greater extent in the basic group, and ODI indicators also significantly improved in the basic group. CRP indicators showed more pronounced changes in the basic group. CONCLUSION: The complex therapy that affects all links in the formation of pain syndrome should be recommended to patients with LBP.

[Chronic pain syndrome in diseases of periarticular tissues]. / Khronicheskii bolevoi sindrom pri zabolevaniyakh periartikulyarnykh tkanei.

The search for an effective method of treating diseases of the musculoskeletal system is a rather actual problem for a practicing physician nowadays in connection with the modern lifestyle of most people. A prolonged stay in the same position, as a rule, leads to overstrain of the capsule-joint complexes, and, as a consequence, to the development of degenerative changes in the joints and periarticular tissues. These changes can manifest themselves clinically in the form of a chronic or acute pain syndrome. One of the common diseases characterized by degenerative periarticular changes with a variety of clinical manifestations are periarthropathies. Periarthropathy or periarthrosis is still the subject of discussion by doctors of related specialties: neurologists, orthopedists, rheumatologists, etc. Pain in this case can be caused by the primary degenerative process in muscles and tendons in combination with their chronic microtraumatization, ischemia, and reactive inflammation. Periarthropathy can be considered as a «train¼ of any arthropathy, because pain always causes muscle spasm, a change in the motor stereotype, a limitation of motor activity in the joint, etc. In the absence of joint pathology, it should be considered as a primary disease. There is still no common understanding of this nosological unit, including pathogenesis, classification, diagnostic algorithms and therapy. Treatment is based on general recommendations: limiting the load on the damaged joint, massage (according to indications), exercise therapy, manual therapy, physiotherapy. Drug therapy includes intramuscular or intraarticular administration of glucocorticosteroids (GCS), non-steroidal anti-inflammatory drugs (NSAIDs) but these drugs have certain side-effects and contraindications. Treatment of peritropathy with chondroprotectors (chondrogard) is rapidly gaining momentum, as well as GCS and NSAIDs, they reduce pain and increase the functionality of the joints, but, unlike the latter, their safety profile is much higher. The authors summarize current findings on this issue.

[Antiresorptive activity of pharmacological chondroitin sulfate in the older age group].

The prevalence of osteoarthritis (OA) increases in proportion to age, so in the population of people over 65 years of age. The pathogenesis of OA is based on inflammation of the cartilage tissue of the joint, which leads to damage to the cartilage, activation of signaling pathways and increased levels of cytokines. AIM: To study the literature data on bone and cartilage remodeling with the development of resorptive processes and discuss possible algorithms and recommendations for the management of patients with OA on the background of chondroprotective therapy. MATERIALS AND METHODS: A comprehensive analysis of data presented in open sources, published and available on such resources as PubMed, EMBASE, Cochrane, and Library. RESULTS: According to the available recommendations and the opinion of experts, among the methods of OA therapy, drugs containing pharmaceutical chondroitin sulfate are currently being discussed, which in a number of studies has demonstrated high antiresorptive effectiveness. CONCLUSION: The use of drugs based on pharmaceutical chondroitin sulfate (Chondroguard) contributes not only to the reduction of pain in OA, but also has a positive effect on the processes of inflammation, including those associated with age-related changes in the body.

[Experience of using the chondroprotector Sustagard Artro (sashe) in the treatment of lower back pain]. / Opyt primeneniia khondroprotektora Sustagard Artro (poroshok) pri boliakh v nizhnei chasti spiny.

AIM: To compare the efficacy of oral administration of the chondroprotector (CP) Sustagard Artro and nonsteroidal anti-inflammatory drugs (NSAIDs) in reducing lower back pain and to assess the level of blood glucose in patients taking CP. MATERIAL AND METHODS: Sixty patients with spondylarthrosis (SA) were studied. Patients were randomized into the CP group (n=30), which received Sustagard Artro (1 sachet once a day for 6 weeks), and the NSAIDs group (n=30) treated with injectable forms of different groups of NSAIDs for 3-7 days. Pain intensity was evaluated by the numerical rating scale (NRS) and the Oswestry disability index (ODI). RESULTS: The reduction in the severity of pain on NRS was similar in both groups: 5.73±1.74 before treatment and 1.43±0.33 after treatment in the CP group; 6.03±0.93 and 1.17±0.97 in the NSAIDs group, respectively. No significant difference in the efficacy was observed between two groups on ODI: 34.66% at baseline and 1.86% after 6 weeks in the CP group; 37.47% and 2.27% in the NSAIDs group, respectively. Changes in the level of glucose were within the upper limit of normal in the CP group. CONCLUSION: Oral administration of CP (Sustagard Artro, sashe) reduces pain syndrome as effectively as NSAIDs.

[Chondroitin sulfate injection in neurological practice]. / In''ektsionnaia forma khondroitina sul'fata v nevrologicheskoi praktike.

Chondroprotectors (CP) are biological agents that contribute to the regeneration of the cartilage surfaces, joint capsule, participating in the metabolism of the articular cartilage. Progressive loss of hyaline cartilage and a decrease in chondroitin sulfate (CS) is observed in osteoarthritis (OA) including low back pain. OA therapy is aimed at slowing disease progression, relief of pain symptoms, reduction of functional disorders. With this purpose, orally or injectable CP (chondroguard) are used. The optimal dosing regimen for the parenteral forms of CP is recommended: 3 injections of 1 ml (100mg) of chondroguard introduction for 1 week, 2 ml (200mg) from the 4-th injection, 25-30 injections at 200 mg in a day, with a second 6 month course.

[Burning mouth syndrome]. / Sindrom 'pylaiushchego rta'.

A case-report of burning mouth syndrome is presented. A 27-year-old man complained of burning pain in the tongue and oral mucosa, taste disorder, and sensory impairment. All symptoms appeared after suffering a cold and had a wave-like course during self-medication with antibiotics. The pain has continued for 8 months. Diagnoses of atypical facial pain, glossodynia or secondary facial pain (craniomandibular dysfunction) were made. The effect of treatment in the hospital (carbamazepine, amitriptyline, haloperidol, phenozepam) was not achieved. A microbial test showed a higher number of pathogenic microbes. The final diagnosis was secondary facial pain (burning mouth syndrome) with concomitant lesions of the oral mucosa (Staphylococcus aureus, Candida sp.). The patient received a combined therapy with the pronounced positive effect.

[The clinical status and treatment options for osteoarthritis in patients with frailty].

Aging is an independent risk factor for the development of many diseases and geriatric syndromes. Osteoarthritis (OA), as the most common joint disease in the elderly, can be attributed to age - associated conditions. And the most significant geriatric syndrome, which dramatically affects the management and prognosis of an elderly, is frailty. The review provides current information on the prevalence of OA and frailty, their clinical and prognostic significance, and also shows the mutually aggravating role of these two conditions. The difference between non - and medication management of patients with OA and frailty is emphasized.