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.
The article presents updated guidelines developed by the American College of Rheumatology and the American Association of Hip and Knee Surgeons on the perioperative treatment of patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis and systemic lupus erythematosus undergoing elective total hip or total knee arthroplasty. The perioperative use of anti-rheumatic drug therapy, including traditional disease-modi fying antirheumatic drugs, biologic agents, targeted synthetic small-molecule drugs and glucocorticoids. All recommendations are conditional and based on the results of retrospective clinical studies, which should be taken into account in decisionmaking when choosing perioperative antirheumatic therapy.
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.
One of the main tasks of modern complex therapy of rheumatoid arthritis (RA) is to improve the quality of life of patients. To do this, it is necessary not only to achieve remission or low activity, but also to successfully control the main, most painful, manifestations of the disease. Therefore, when evaluating the results of RA treatment, the dynamics of not only standard indices (DAS28 (Disease Activity Score 28), CDAI (Clinical Disease Activity Index), SDAI (Simplified Disease Activity Index)), but also the so-called “patient reported outcomes” (PRO) – a patient’s global assessment of disease activity (PGA), pain, functional disorders and fatigue.This review examines the effect of one of the main classes of anti–rheumatic drugs - biological disease-modifying antirheumatic drugs (bDMARDs) on the PROs. The results of a series of randomized controlled trials are presented, in which changes in PROs were studied using various tumor necrosis factor α (TNF-α) inhibitors, abatacept T-lymphocyte co-stimulation inhibitor, rituximab CD20 inhibitor and interleukin (IL) 6 inhibitors.The use of bDMARDs in combination with methotrexate (MTX) provides a reduction in PGA and pain by 50-60%, functional disorders according to HAQ (Health Assessment Questionnaire) and fatigue according to FACIT-F (Functional Assessment of Chronic Illness Therapy – Fatigue) – by 15-30%. B DMARDs monotherapy (with the exception of the effect of tocilizumab on HAQ) does not exceed MTX monotherapy in its effect on PROs. Monotherapy with tocilizumab provides more favorable dynamics of PGA and pain than monotherapy with TNF-α inhibitors. An important advantage of IL-6 inhibitors is the rapid achievement of a clinical effect, which is noted already in the first 2 weeks after the first administration of the drug.
In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.
The prescribing of biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (iJAK) during the COVID-19 pandemic requires a balanced approach and tight monitoring of the patients.The aim of the study was to study the effect of bDMARDs and iJAK inhibitors on the condition of patients with rheumatoid arthritis (RA), taking the patients reported outcomes, as well as the incidence of COVID-19 in these patients.Materials and methods. A telephone survey was conducted of 254 patients with RA (average age – 49.8±13.7 years; 64.4% of patients are positive for rheumatoid factor; women – 83.5%; DAS28 score – 5.4±1.6 points), who in the period from January 2020 to June 2021 were prescribed bDMARDs or iJAK for the first time: 148 (58.3%) – rituximab; 57 (22.4%) – tumor necrosis factor α inhibitors; 20 (7.9%) – iJAK; 17 (6.7%) – interleukin 6 inhibitors; 12 (4.7%) – abatacept.Results. At the time of the survey, 204 (80.3%) patients continued taking prescribed medications. The main reason for the interruption of treatment was administrative problems. Synthetic DMARDs (mainly methotrexate and leflunomide) were received by 68.0%, glucocorticoids – 45.3%, nonsteroidal anti-inflammatory drugs – 44.5% of respondents. Among patients treated with bDMARDs or iJAK, 68.1% noted «the state of symptoms acceptable to the patient», the absence of frequent joint pain – 65.3%, the absence of increased fatigue – 14.3%. The incidence of COVID-19 and hospitalization associated with this disease did not differ in individuals who continued and stopped using bDMARDs or iJAK: 41.2% and 44.6%, 13.7% and 14.0%, respectively (p=0.80884). There were no statistically significant differences in the incidence of COVID-19 and hospitalization associated with this disease in patients taking various bDMARDs or iJAK.Conclusion. Despite the COVID-19 pandemic, rituximab remains one of the most popular bDMARDs. About a third of patients receiving bDMARDs or iJAK are not satisfied with their condition. More than 40% of patients who received these drugs suffered COVID-19; 14.0% required hospitalization.
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.
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