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Aim to identify outdated terms and make changes to the terminology of spondyloarthritis.At the first stage of the work, the terms divided into two categories: "outdated" definitions and terms that need to be improved or unified. Subsequently, each member of the Expert Group of Spondyloarthritis at the Association of Rheumatologists of Russia (ExSpA) presented by its own definition of the designated term or agreed with the previous term. At the next stage, the existing definitions were put together. After discussion, experts left a term that scored at least 2/3 of the votes. The special opinion of experts was recorded, whose did not coincide with the majority opinion. An open vote was conducted, when defining an "outdated" term with the unanimous decision of all group members, this term was not recommended for further clinical use.The work carried out allowed us to identify a number of terms that are not recommended for use in clinical practice. Number of terms are defined, which should be used when discussing the problem of spondyloarthritis.The Expert Group of Spondyloarthritis at the Association of Rheumatologists of Russia suggests using or, accordingly, not using a number of terms and their definitions in clinical practice.Цель исследования: выявить устаревшие термины и внести изменения в терминологию, используемую при обсуждении проблемы спондилоартритов. Материалы и методы. На первом этапе работы собраны уже употребляемые термины, их разделили на две категории: «устаревшие» определения и термины, требующие доработки или унификации. В дальнейшем каждый член Экспертной группы по изучению спондилоартритов при Ассоциации ревматологов России (ЭкСпА) представлял свое определение обозначенного термина либо соглашался с прежним термином. На следующем этапе имевшиеся определения сводились воедино, после обсуждения оставляли термин, который набрал не менее 2/3 голосов, отдельно фиксировалось особое мнение экспертов, чье мнение не совпадало с мнением большинства. При определении «устаревшего» термина проводили открытое голосование, при единогласном решении всех членов группы этот термин не рекомендовался для дальнейшего клинического использования. Результаты. Проведенная работа позволила выделить ряд терминов, которые не рекомендованы к употреблению в современных условиях, даны определения и расшифровка целого ряда терминов, которые, напротив, целесообразно использовать при обсуждении проблемы спондилоартритов. Заключение. Экспертный совет по спондилоартритам при Ассоциации ревматологов России предлагает использовать или, соответственно, не использовать ряд терминов и их определения в повседневной клинической практике и при описании клинических и иных исследований.

The paper reviews investigations studies that have demonstrated that chronic pain syndrome is mixed in rheumatic diseases. The nervous system is involved in its pathogenesis with different frequency and different mechanisms. Under the influence of afferent pain impulses from damaged joints, there are changes in the excitability of spinal cord neurons, which is called central sensitization (CS). A number of patients have enhanced CS and clinical manifestations as neuropathic sensitive phenomena. The mixed model of the development of chronic pain in joint diseases and its presence along with nociceptive (inflammatory) and neuropathic pain components may explain the discrepancy between joint inflammatory and structural changes and pain intensity, the presence of distant pain and sensitive disorders in the areas outside the joint, and sometimes the efficiency of anti-inflammatory therapy. The presence of the neuropathic pain component serves as a rationale for combined therapy by adding centrally acting drugs, such as anticonvulsants.В статье приводится обзор исследований, которые продемонстрировали, что хронический болевой синдром при ревматических болезнях носит смешанный характер. В его патогенезе с различной частотой и различным механизмом принимает участие нервная система. Под воздействием афферентной болевой импульсации от поврежденных суставов изменяется возбудимость нейронов спинного мозга, что носит название центральной сенситизации (ЦС). У ряда пациентов ЦС имеет усиленный характер и клинические проявления в виде невропатических чувствительных феноменов. Смешанная модель формирования хронической боли при суставной патологии, наличие наряду с ноцицептивным (воспалительным) невропатического компонента боли может объяснить несоответствие воспалительных и структурных изменений в области сустава, интенсивности боли, наличие отдаленной боли и чувствительных нарушений вне сустава, недостаточную в ряде случаев эффективность противовоспалительной терапии. Наличие невропатического компонента служит обоснованием для проведения комбинированной терапии с добавлением препаратов центрального действия, таких как антиконвульсанты.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are extensively used in the treatment of rheumatic diseases to relieve pain and signs of inflammation. However, when treated for ankylosing spondylosis (AS), NSAIDS exert both symptomatic and structure-modifying effects, by slowing down the development of vertebral ankylosis. The effect of these drugs, which underlines the formation of syndesmophytes, may be associated with their anti-inflammatory activity and ability to suppress abnormal bone proliferation. There is convincing evidence to support the capacity of NSAIDs, when long and continuously used, to reduce the rates of X-ray progression of AS. So the continuous use of NSAIDs must be now considered to be a mandatory component of pharmacotherapy for this disease. Their use should be continued even after achieving a marked clinical improvement. At the same time, this situation requires that the development of adverse reactions as structural and functional diseases of the gastrointestinal tract and cardiovascular system be thoroughly controlled in this situation. The danger of these complications determines the need for a physician's attention, obligatory consideration of risk factors, and rational choice of the safest NSAIDs.

To define the prevalence of rheumatoid arthritis (RA) from the data of an epidemiological study.During a questionnaire survey of 37057 adults of Russia, patients with complaints of articular swelling (n = 4975) were selected; of the latter a group (n = 3420) was randomly formed to be clinically examined by rheumatologists in order to detect RA. The 1987 ACR criteria were used for its diagnosis.According to the data of the questionnaire survey, RA was diagnosed in 159 (4.6%) of the 3420 patients with complaints of articular swelling. The prevalence of RA in Russia averaged 0.61%. Among the respondents who complained about articular swelling during the questionnaire survey, 258 (7.5%) respondents considered to have RA before rheumatological examination. While comparing the diagnoses reported by the respondents during the survey and the final diagnosis established by a specialist, RA was confirmed only in 61 (24%) patients. Out of all the identified patients with RA (n = 159), only 61 (38%) were aware of their diagnosis. In RA patients with less than one-year articular complaints (n = 24), 17% were familiar with their diagnosis; the diagnosis was first made in the others (n = 20). Among the patients with long-term articular complaints (n = 135), 42% were aware of their diagnosis.The epidemiological survey indicated that the number of patients with RA were twice higher than those given in the official statistics of the Russian Federation (671,000 versus 300,000, respectively). In outpatient practice, RA is correctly diagnosed only in 38% of cases. There is a significant hyperdiagnosis of this disease. The duration of articular complaints affects the establishment of the diagnosis of RA.

The analysis of rheumatic disease morbidity in the Russian Federation in early XXI century is presented.

To characterize prevalence and features of low back pain (LBP) in Moscow outpatients.The questionnaire designed in the Rheumatology Institute of Russian Medical Academy was used in the trial performed for a month with participation of 1300 Moscow outpatients aged 18 to 50 years.LBP is a frequent cause of consulting a physician in an outpatient practice. Most of the outpatients complained of acute and subacute moderate or severe LBP. This pain often caused disability. Of diagnostic tools most frequent was x-ray investigation of the spine.Spinal osteochondrosis is the most frequent diagnosis made in LBP outpatients. Detectability of threat marks in LBP patients is not more than 10%.

To design Markov's model of decision making to study the role of order in the use of most usable basic antirheumatic drugs (methotrexate-MT, parenteral gold--PG and sulfasalasine--SS) in terms of the course duration and cost.The model was based on metaanalysis made in 2000. The program TreeAge 3.0 was used. The prices for the drugs were taken as mean about Moscow for 2002 and prices presented by ACR for 2002.The sequence MT-PG-SS had the advantage over the other sequences in that less number of patients stopped treatment after 5 and 10 years of therapy. Mean cost of the drugs per patient is the lowest (for five years) if MT is prescribed first. In longer treatment SS-MT-PG is more cost-effective.It is feasible to design Markov's models for making decision on optimal therapy of rheumatoid arthritis both in terms of cost and clinical response.