Trauma causes a complex local and systemic reaction of the macroorganism, the consequences of which can be various functional, neurological and psychoemotional disorders. One of the most painful complications of injuries of the musculoskeletal system is chronic post-traumatic pain (CPTP), which occurs, depending on the severity of the damage, in 10–50% of cases. The pathogenesis of this syndrome is multifactorial and includes the development of chronic inflammation, degenerative changes (fibrosis, angiogenesis, heterotopic ossification), pathology of the muscular and nervous systems, neuroplastic changes leading to the development of central sensitization, as well as depression, anxiety and catastrophization. Risk factors for CPTP should be considered the severity of injury, comorbid diseases and conditions (in particular, obesity), stress and serious trauma-related experiences (within the framework of post-traumatic stress disorder), the development of post-traumatic osteoarthritis and chronic tendopathy, genetic predisposition, deficiencies in treatment and rehabilitation in the early period after injury. To date, there is no clear system of prevention and treatment of CPTP. Considering the pathogenesis of this suffering, adequate anesthesia after injury, active anti–inflammatory therapy (including local injections of glucocorticoids), the use of hyaluronic acid, slow-acting symptomatic agents and autologous cellular preparations – platelet-riched plasma, mesenchymal stem cells, etc. are of fundamental importance. However, therapeutic and surgical methods of CPTP control require further study
Arthroscopic interventions are widely used to treat the consequences of the meniscus and anterior cruciate ligament (ACL) injuries. However, the long-term consequences of these surgeries are not always favorable and not in all cases allow to avoid the development of chronic pain and posttraumatic osteoarthritis.Objective: to evaluate the incidence of persistent postoperative pain and the persistence of functional disorders in patients undergoing arthroscopic interventions on the menisci and ACL.Material and methods. The study group consisted of 147 patients (60 women and 87 men, mean age 38.8±12.5 years) who underwent arthroscopic surgery on the knee joint (KJ) in the traumatology and orthopedic department of V.A. Nasonova Research Institute of Rheumatology in 2018– 2021. The condition of patients was assessed by telephone survey and/or online questionnaire. The pain and fatigue levels were assessed on numerical rating scale (NRS, 0–10), as well as the severity of functional disorders on the Lysholm scale (LS).Results and discussion. Moderate or intense knee pain and increased fatigue (≥4 according to NRS) were noted in 11.3% and 14.7% of respondents, respectively. The state of the KJ according to LS in 35.3% of patients was assessed as excellent (95–100 points), in 29.3% – as good (84–94 points), in 21.3% – as satisfactory (65–83 points) and 14.0% – as unsatisfactory (≤64 points).Conclusion. More than 10% of patients after arthroscopic operations on the knee joint experience moderate or severe pain and fatigue, satisfactory and unsatisfactory functional results are observed in 35.4% of cases.
Gastrointestinal disorders are important place among the visceral manifestations of systemic autoimmune and immunoinflammatory rheumatic diseases (RD). Pathology of the esophagus, stomach, small and large intestine can vary from moderate functional disorders to the development of severe chronic inflammation with metaplasia and dysplasia of the mucous membrane, the formation of multiple erosions, hemorrhages and deep ulcers. Complications of gastrointestinal pathology in RD, such as bleeding, perforations and strictures, can cause death. This review examines the main clinical manifestations, possibilities of diagnosis and treatment of gastrointestinal lesions in systemic scleroderma, idiopathic inflammatory myopathies, systemic vasculitis, Sjogren’s syndrome and disease, as well as systemic lupus erythematosus.
Chronic non-specific back pain (CNBP) is the most common pathology of the musculoskeletal system, affecting from 10 to 60% of the adult population in the world, causing severe suffering, disability and a significant deterioration in the quality of life. Osteoarthritis (OA) should be considered as one of the main reasons of the development of CNBP – inflammatory and degenerative changes in the facet and sacroiliac joints, as well as the spinal column itself (in particular, osteitis of the Modic 1 type). Spinal OA is accompanied by biomechanical disturbances, nociplastic (peripheral and central sensitization) and psycho-emotional changes that form a complete picture and various CNBP phenotypes.Recognizing the leading role of OA as the cause of CNBP, it is advisable to use the same therapeutic approaches in this syndrome as in OA of peripheral joints. In particular, it is necessary to consider the use of symptomatic slow acting drugs for osteoarthritis (SYSADOA) in CNBP as the main pathogenetic therapy.Alflutop is one of the most popular parenteral SYSADOA widely used in Russian practice. This drug has a good evidence base: this review presents data from 12 clinical trials of Alflutop in CNBP (n=1479), which confirmed its efficacy and safety.
Osteoarthritis (OA) is the most common joint disease due to the increasing life expectancy of the world's population. Every 2nd patient over the age of 50 suffers from knee or hip OA, and this is directly related to the increased burden on healthcare. Accumulated data on the comorbid profile of patients with OA dictate the need to identify disease phenotypes in order to provide personalized care. Individual clinical manifestations of OA also require a differential approach: the pain treatment requires consideration of the patient's psycho-emotional profile and the possibility of involving nociceptive pathways in the process. However, due to the ambiguity of existing clinical guidelines, most experts note a number of difficulties in prescribing treatment for patients with OA.The resolution presents an agreed opinion of experts on the algorithms for managing patients with OA, starting from the primary level, with the gradual involvement of related specialists. Some issues of a personalized approach are considered depending on the presence of comorbid pathology and the severity of individual symptoms of the disease. The prospects of the combined use of pharmacological and non-drug methods of treatment are noted; emphasis was placed on the importance of rehabilitation measures at the first level of medical care, provided to patients with OA, long before the development of structural changes.The proposed algorithms for managing patients can be considered as the basis for future recommendations for managing patients with this pathology.
The control of musculoskeletal pain (MSP) is an important part of the complex treatment of rheumatic diseases (RD). Analgesic therapy still plays the leading role in osteoarthritis (OA) and chronic nonspecific back pain (most cases of this syndrome are associated with spinal OA) treatment. Despite the use of modern basic anti-inflammatory drugs (including biological and JAK inhibitors), the problem of MSP control remains relevant in immuno-inflammatory diseases, such as rheumatoid arthritis and spondyloarthritis. The pathogenesis of MSP is complex and closely related to the processes of damage, inflammation and degeneration. A fundamental role here belongs to local and systemic inflammatory response occurrence, which largely determines such elements of the pathogenesis of chronic MSP as peripheral and central sensitization. Depending on the prevailing pathogenesis mechanisms, MSP can manifest itself in several phenotypes: «inflammatory», «mechanical», «enthesopathic», associated with central sensitization. A combination with such symptoms as stiffness, fatigue, muscle tension, sleep disturbance, depression and anxiety is characteristic for MSP. The control should be comprehensive and must include the use of both drug and drug-free preparations. Nonsteroidal anti-inflammatory drugs, opioids, muscle relaxants, antidepressants and anticonvulsants, local injection therapy (glucocorticoids, hyaluronic acid, platelet-rich plasma), as well as methods of physiotherapy and rehabilitation are used in pain treatment.
According to experimental studies, nonsteroidal anti-inflammatory drugs (NSAIDs) can affect the healing of bone tissue after fractures. The significance of this effect of NSAIDs for real clinical practice is the subject of discussion. We analyzed publications on the problem of nonunion or development of fractures against the background of taking NSAIDs presented in the PubMed and MEDLINE system. From 1976 to 2021, 75 papers on this topic were published, of which 19 were observational, cohort and randomized controlled trials, as well as case-control studies, 4 meta-analyses. According to meta-analyses, which included from 6 to 16 studies, there was an association between taking NSAIDs and nonunion of bones after fractures or postoperative trauma: the odds ratio ranged from 2.07 (95% CI: 1.19–3.61) to 5.27 (95% CI: 2.34–11.88). A number of large studies confirm an increased risk of nonunion of fractures and the development of “marching” fractures in patients treated with NSAIDs. The risk of nonunion was increased when using NSAIDs for more than 2 weeks and in high doses. With short-term use of NSAIDs (less than 2 weeks) and the use of these drugs in pediatric practice, the frequency of bone tissue repair disorders did not increase.
Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used type of drugs in the world and are prescribed for a wide range of indications, including osteoarthritis, rheumatoid arthritis, other diseases of the musculoskeletal system and soft tissues, as well as for the relief of postoperative pain. It is well known that the use of NSAIDs is associated with the risk of gastrointestinal (GIT), cardiovascular (CVS) and kidneys complications. Lornoxicam belongs to the NSAIDs of the oxicam class and is a balanced inhibitor of both cyclooxygenase (COX) isoforms – COX1 and COX2 – and differs from other oxicams in its rapid onset of action, high elimination rate. The drug is characterized by a pronounced analgesic effect and a favorable safety profile both in relation to the gastrointestinal tract and cardiovascular system, does not require dose adjustment in patients over 65 years of age.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.