SHOULDER AND NECK PAIN: INTERDISCIPLINARY ASPECTS OF TREATMENT

Shoulder and neck pain syndrome is a widespread and socially significant problem. In this article the authors make an attempt to combine and classify the main causes of the onset of pain and impairment of function in the cervico-brachial region, and present the tactics of a differentiated approach to the treatment of patients with cervico-brachial syndrome

Disorders of bone mineral density associated with pregnancy and lactation (a literature review)

Traditionally, the problem of osteoporosis (OP) and osteopenia (OPe) in women is associated with the period of menopause. Increased bone fragility and osteoporotic fractures in pregnant, postpartum and breast-feeding women is less expected but the socio-economic burden can be significant. Neither the existing classification of OP nor the International Classification of Diseases separate OP associated with pregnancy, childbirth and lactation [1]

Substantiation of strategic therapy of gonartrosis by chondroitin-containing drugs in diabetes mellitus patients

Introduction. Currently, there is a high prevalence of type 2 diabetes mellitus (DM2) and osteoarthritis (OA). DM2 worsens the prognosis of the results of arthroplasty for OA, and also becomes an additional insecurity factor in the administration of traditionally often used non-steroidal anti-inflammatory drugs (NSAIDs) and in local injections of glucocorticosteroids. It is considered safer to prescribe chondroitin sulfate.Objective. Identification of clinical, radiological and arthrosonographic features of the manifestations of gonarthrosis with concomitant DM2 and related differences in the strategic conservative therapy.Methods. The study included 386 women with OA of knee joints (mean age 61,3 + 7,8 years). Patients were divided into groups of euglycemic status (group “OA”, n = 224) and comorbid according to DM2 (group “OA + DM2”, n = 162). The amplitude of an active mobility of the knee joints (KJ), the severity of gonarthrosis using the Lequesnealgo-functional index (AFI_Lequesne) and the WOMAC questionnaire were assessed. Radiography and arthrosonography of the KJ were performed.Results. In patients in group “OA + DM2” AFI_Lequesne were less by 18,2% (p = 0,0001), the total WOMAC index were less by 15,6% (p = 0,0001) compared with the “OA” group. In the group “OA + DM2”, the first x-ray stage was 2,6 times less common, and the third was 2 times more likely than the group “OA” (χ2 = 25,5; p = 0,001). The arthrosonography in the group “OA + DM2” detected a more pronounced thinning of the articular cartilage and more severe osteophytosis. The masking effect of DM2 on the symptoms of OA led to a rarer use of slowly acting symptom-modifying agents containing chondroitin in patients with “OA + DM2” in 1,7 times as compared with “OA” patients.Conclusions. In patients with gonarthrosis, concomitant DM2 minimizes symptoms, but accelerates the degeneration of the knee joints tissues. There is no information on the deterioration of the carbohydrate metabolism with a prolonged use of chondroitin sulfate, which suggests the safety of such therapy for patients with OA and concomitant diabetes mellitus type 2

Local anti-inflammatory therapy for osteoarthritis with high comorbidity

Osteoarthritis (OA) is a widespread disease, the leading symptom of which is pain in the load-bearing joints, and the incidence increases with age. Many patients with OA have several comorbidities, such as arterial hypertension, coronary heart disease, diabetes mellitus, gastric and duodenal ulcers. Currently, there are different approaches to the treatment of OA with and without comorbidity. In particular, oral non-steroidal anti-inflammatory drugs (NSAIDs) are not recommended for OA with high comorbidity. The literature review discusses the prospects and popularity of the use of local forms of NSAIDs associated with their equal analgesic efficacy relative to oral drugs, but with a smaller number of adverse events. Data on transcutaneous forms of diclofenac are analyzed, which can provide at least oral equivalent analgesia, improved physical function and reduced stiffness in  osteoarthritis of  the  hands and knee joints, while showing fewer systemic adverse events. This feature of  topical NSAIDs allows them to be considered as an effective first-line treatment option, especially in elderly patients and those with severe comorbidity. Topical medications containing diclofenac as the main active ingredient are popular among both patients and doctors, and their use has an extensive evidence base. Diclofenac ethylenediamine salt has advantages over sodium salt in its penetrating properties, and the form of an emulsion gel containing a hydrophobic phase that slows down the drying of the substance applied to the skin provides ease of use and improves the consumer properties of agents for local antiinflammatory therapy of osteoarthritis

Start therapy of pain at gonarthrosis in patients with diabetes mellitus

Introduction. Among phenotypic variants of osteoarthritis (OA), a special place is occupied by OA with a comorbidity. A therapy of a pain in OA patients with the comorbid for diabetes mellitus type 2 (DM2) should be carried out with account for its effectiveness and safety.Objective. Perform comparative analysis of the clinical and laboratory characteristics of gonarthrosis and their therapeutic dynamics in moderate comorbid risk groups.Methods. The clinical and laboratory characteristics of gonarthrosis were studied in 386 women (mean age 61.3 ± 7.8 years), of which 162 ones had DM2. We evaluated several characteristics of the pain, which were summarized in the rating of pain (R_P). The level of C-reactive protein (CRP) in the blood serum was determined. An analysis of 75 samples of a synovial fluid (SF) obtained by a puncture of knee joints (KJ) in patients with severe synovitis was performed. An open-label controlled short-term trial of the analgesic and anti-inflammatory activity of diclofenac sodium in gonarthrosis was performed in 30 people in the euglycemic group and in the comorbid one according to DM2.Results. R_P for concomitant DM2 was 22.2% (p = 0.0001) lower than for isolated gonarthrosis, but the concentration of CRP in serum and SF did not differ between groups. The glucose level in the SF with concomitant DM2 was 46.6% (p = 0.0001) higher. NSAIDs were used according to the needs of more than 75% of patients, but women with concomitant diabetes mellitus type 2 used non-selective drugs 1.9 times (p = 0.008) more often. The efficacy and safety of the drug containing diclofenac sodium was comparable in the euglycemic group and in the concomitant diabetes mellitus type 2 group, but patients with comorbid DM2 achieved an effect of 23% less quantity NSAIDs.Conclusions. The use of drugs containing diclofenac sodium in 87% of patients provides an analgesic and anti-inflammatory effect with the satisfactory tolerance and the low drug demand, including in patients comorbid for type 2 diabetes

Glucocorticoid-induced osteoporosis: pathogenesis and prevention

Osteoporosis (OP) along with myocardial infarction, oncological diseases and expected death takes the lead in the general morbidity and mortality profile of population. The indicators of primary and general incidence of OP are markedly different in the regions of Russia according to the Healthcare Monitoring, Analysis and Strategic Development Department of the Central Research Institute of Organization and Informatization of Healthcare of the Ministry of Health of Russia and according to the data of epidemiological studies. Osteoporosis is classified as primary, if it develops in postmenopausal women or in older men in the absence of any underlying predisposing disease, and as secondary if there is a pathogenetic relationship with the disease or drug intake. The glucocorticoidinduced osteoporosis, which is distinguished in the International Classification System of Diseases and Death Causes (X revision) under code M 81.4 - drug-induced osteoporosis is the most common form of secondary osteoporosis. The topic of glucocorticoidinduced OP affects the professional fields of a significant number of medical specialties in connection with the common use of glucocorticosteroids in medicine. This article presents the issues of epidemiology, pathogenesis, complications of glucocorticoid-induced OP. Particular attention is paid to the prevention of this disease, including such non-pharmacological methods as a balanced diet, body weight gain to the recommended values, smoking cessation, regular exercise against weightlifting and resistance, protection against falls. Drug prophylaxis of glucocorticoid-induced OP is focused on the rational treatment to target of the underlying disease and the use of complex drugs containing vitamin D, calcium and synergistic osteotropic micronutrients

Metabolic risks of hyperuricemia

Hyperuricemia (HU), traditionally considered as an important risk factor and therapeutic target for patients with gout, currently draws attention of many researchers from the perspective of its contribution to the pathogenesis of metabolic syndrome and metabolic syndrome-associated diseases. The study aimed to determine the frequency of detection of HU and its conjugation with burden of metabolic comorbidities in outpatients. HU was detected in 253 (27.1%) of 933 people referred to the determination of the uric acid (UA) level. The investigators took into account the presence of established diagnosis of gout, cardiovascular system diseases associated with metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease (CKD) and urolithiasis, and nonalcoholic fatty liver disease. The study showed that patients with HU had four times higher metabolic comorbidity level than individuals with normal UA levels. Not only gout (6.25 times), but also urolithiasis with CKD (2.2 times) and cardiovascular disease (CVD) (1.9 times) were more common in people with elevated UA levels. Among patients with HU, women were 2.2 times more likely to have type 2 diabetes than men. Patients with type 2 diabetes and CVD, especially women, need to correct HU to reduce the risk of progression of metabolic disorders. The article presents a brief overview of modern drugs for the management of GU

Significance of inflammation in the development of vascular wall stiffness

This review deals with arterial wall stiffness in rheumatic diseases. It shows a role of inflammation in the pathogenesis of increased vascular stiffness, considers its mechanisms at the level of altered cell components, the clinical signs of an inflammation-arterial stiffness association and the possibilities of its reduction, and a search for novel therapeutic strategies to diminish the stiffness of arterial vessels with antirheumatic drugs