Objective of the Review: To describe the problem of chronic musculoskeletal pain associated with a previous SARS-CoV-2 infection. Key Points. COVID-19 is a disease caused by the novel coronavirus infection SARS-CoV-2, characterised by multiple organ damage, systemic immune inflammation, coagulopathy, and serious neuroendocrine and metabolic disorders. The consequences of COVID-19, even with a relatively favourable course of this disease, can be degenerative changes in many organs (primarily, diffuse fibrosis), various functional and mental disorders. Therefore, in some patients (10% to 50%, depending on the severity of the course of COVID-19), various symptoms of the disease persist for a long time after the acute manifestations of the infection subside. This condition has been called “post-COVID syndrome” (PCS), or “long-term COVID-19”. One of the main manifestations of PCS is musculoskeletal pain, weakness and fatigue. COVID-19-induced damage to the musculoskeletal and nervous systems can contribute to the exacerbation of diseases characterised by chronic pain. PCS management should be aimed at correcting functional disorders, pain control, and active rehabilitation of patients. Conclusion. Chronic pain is one of PCS manifestations that requires special attention, timely diagnosis, and comprehensive individual therapy. Keywords: COVID-19, post-COVID syndrome, musculoskeletal pain.
Objective of the Review: To analyse and summarise information on the pathogenesis of psoriatic arthritis (PsA); to discuss therapeutic targets, actual and long-term drug therapy strategies for this disease. Key Points. PsA pathogenesis is still a matter of argument; some of its mechanisms are still studied poorly. It is assumed that, in patients with genetic predisposition, the disease is triggered by the environmental factors, dysbiosis, infections, stress, that can cause and maintain aberrant activation of the innate and adaptive immune system. We found out that increased expression of such cytokines as IL-6, TNF-α and IL-17A causes synovitis; activates neoangiogenesis, bone resorption and erosion; leads to destruction and inflammation of cartilage as a result of induction of several molecular paths in synovial fibroblasts and macrophages, endothelial cells, osteoblasts, osteoclasts, cartilage cells, and immune cells. Taking into account available information on pathogenic mechanisms of PsA and psoriasis, we have developed several drugs targeting cells, cytokines or other mediators, playing a central role in the pathogenesis of the disease. Conclusion. Currently, treatment of psoriasis and PsA involves the use of traditional basic synthetic anti-inflammatory medicines, genetically engineered biological agents, and target oral synthetic medications, particularly phosphodeisterase-4 inhibitors and Janus kinase inhibitors, a majority of which can treat the entire range of skin and bone manifestations of the disease. Taking into account the varying PsA phenotype, comorbidities and a wide range of medicinal products that can be used by medical professionals, a majority of authors are of the opinion that it is necessary to improve the algorithms of individual approaches to the management of each patient. Keywords: psoriatic arthritis; immunopathogenesis; genetically engineered biological agents.
Objective of the Review: To demonstrate new approaches in management of generalized scleroderma (GSD), that gained relevance after publication of drug therapy recommendations in 2017. Key Points. GSD is a progressive immunoinflammatory rheumatic disease, that can cause severe damage of vitals; therefore, it is characterized with poor prognosis. Unfortunately, currently there are no approved drugs to modify the course of GSD. Biological disease-modifying agents are still rarely used in GSD, since none of them have approved indications. The recommendations of the European League Against Rheumatism on GSD drug therapy were last updated about 5 years ago. Scientists have been searching for efficient therapies and undertook clinical trials of various medicinal products. The review presents literature data evidencing expanded range of methods to correct immunoregulatory pathologies; discusses results of latest clinical trials, which can provide the basis for inclusion of such drugs into recommendations on GSD management. Conclusion. New randomised controlled trials and multicentre programs point to some progress in GSD curation and better prognosis. Keywords: generalized scleroderma, autologous haematopoietic stem cell transplantation, Rituximab, Tocilizumab, Abatacept, Nintedanib.
A clinical case of a childhood form of diffuse lipomatosis is considered. The clinical picture and diagnostic methods necessary for the establishment of a clinical diagnosis are reflected. When observing patients with diffuse lipomatosis, it is required to involve specialists of various specialties and conduct thorough diagnostic measures to verify the clinical diagnosis and select the appropriate treatment methods. Key words: congenital malformations of the organ of vision, germ layers, mesenchyme, connective tissue, lipomatosis.
A rare clinical case of nevus of Ota in a 6-year-old child is described. The clinical picture and diagnostic methods used in this case are reflected. On the example of the patients presented in this article, differential diagnosis with alkaptonuria is fully described. Given the risk of transition to skin melanoma and ocular melanoma, patients with nevus of Ota should be observed by Dermatologist and Ophthalmologist annually. Such patients should also strictly avoid exposition to any ultraviolet radiation and exclude possible risk factors traumatizing the nevus. Key words: nevus, Ota nevus, alkaptonuria, skin melanoma, eye melanoma.
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