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Patients with rheumatic diseases infected with hepatitis B virus (HBV) are difficult to manage not only due to the presence of risk factors for the development and rapid progression of liver cirrhosis, but also due to the likelihood of reactivation of this infection. Despite the successes achieved in the fight against HBV, the virus cannot be completely defeated due to the presence of hidden forms of the disease, escaping the field of vision of a rheumatologist and an infectionist. Based on the results of the analysis of current publications, the paper presents the rationale for a complete immunological screening of patients with rheumatic diseases when prescribing antirheumatic therapy. The issues of the role of COVID-19 in the exacerbation of chronic viral hepatitis B, antiviral prevention and monitoring are discussed, the classification of antirheumatic drugs according to the risk of HBV reactivation is presented.

Despite great advances in the diagnosis and treatment of immunoinflammatory rheumatic diseases, which have led to a significant improvement in the prognosis in many patients, the fundamental medical problems of this pathology the restoration of the quality of life and the reduction of mortality to the population level are far from being resolved. This served as a stimulus for the study of new approaches to the pharmacotherapy of IVRD, one of which is associated with the use of low molecular weight chemically synthesized drugs that inhibit intracellular "signaling" molecules Janus kinase. Modern advances regarding the use of Janus kinase inhibitors in the treatment of immunoinflammatory rheumatic diseases and COVID -19 are considered.

Background: Currently, observations are accumulating indicating the negative effect of therapy with a number of biologic disease-modifying anti-rheumatic drugs (bDMARDs) drugs on the course of COVID-19. These facts determine the relevance of studying the factors of severe course and unfavorable outcome in immuno-inflammatory rheumatic diseases (IIRD) patients treated with bDMARDs in order to develop tactics for managing this category of patients in a pandemic., Aim: To evaluate the influence of clinical and demographic factors on the risk of development, severity of the course and clinical outcomes of a new coronavirus infection in patients suffering from IIRD and receiving therapy with genetically engineered biological drugs., Materials and Methods: A retrospective analysis of the database of the register of patients with IIRD receiving bDMARDs in the Novosibirsk region was performed, which included 318 patients, 94 of whom had indications of having suffered viral infection/pneumonia for the period from 01.04.2020 to 31.12.2020., Results: According to the data obtained, at the time of the analysis, 94 people out of 318 patients with IIRD had a new coronavirus infection. Most (53%) of the patients had a mild infection. At the same time, the nosological form, the use of anti-rheumatic drugs and glucocorticoids did not increase the risks of severe coronavirus infection. When using bDMARDs, only anti-B-cell therapy (rituximab) associated with statistically significant increase in the risk of severe/extremely severe COVID-19. The mortality rate according to the analysis of the register was 6,38%., Conclusion: Patients with IIRD have a high risk of severe coronavirus infection, while the severity of the disease is associated with the type of therapy performed.

This review is devoted to the potential application of genetically engineered biological drugs of different classes in the treatment of main forms of uveitis and other types of non-infectious ocular inflammation in immunoinflammatory rheumatic diseases. The article presents the results of studies demonstrating the influence of interleukin-17 inhibitor secukinumab on the course of uveitis in spondylarthritis, shows the possibilities of treating uveitis in juvenile idiopathic arthritis with inhibitors of interleukin-6, co-stimulation of T-lymphocytes. Inhibition of interleukin-1 is considered an effective method of influencing the ocular inflammation in monogenic autoinflammatory syndromes and Behcet's disease. Rituximab is considered as an option for immunosuppressive therapy of non-infectious uveitis and scleritis.

Deciphering immunopathogenesis, expanding the scope of diagnostics and developing new methods for treating human autoimmune diseases are among the priority areas of XXI century medicine. Particularly widely autoimmune pathology is presented in immunoinflammatory rheumatic diseases (IIRD), such as rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, systemic vasculitis associated with the synthesis of antineutrophilic cytoplasmic antibodies, Sjogren's syndrome, idiopathic inflammatory myopathies and other other types of others. Deciphering the pathogenesis mechanisms of IIRD created the prerequisites for improving pharmacotherapy, which in the future should lead to a dramatic improvement in the prognosis for these diseases. The review discusses new approaches to IIRD pharmacotherapy associated with the inhibition of tumor necrosis factor-α, interleukin-6 (IL-6), IL-1β, IL-17, IL-23, and the prospects for using Janus kinase inhibitors, depending on the prevailing pathogenesis mechanisms - autoimmunity or autoinflammation.

Pregnancy in the presence of rheumatic diseases (RD) and adequate therapy before planned conception, during gestation, and after delivery during lactation is challenging. Advances in the treatment of RD are largely due to the clinical introduction of a new class of biological agents (BAs). There are less than two decades of experience in using BAs in rheumatology and to date there are no unified standards and accepted rules governing their use during pregnancy. According to the current requirements, information on a medicine should be given in three sections: 1) pregnancy; 2) lactation, and 3) use in men and women who are planning concept (the latter section has appeared for the first time). The present article summarizes data on the possible use of BAs in patients with RD during pregnancy planning, pregnancy, and breastfeeding.

The representatives of immunoinflammatory diseases are rheumatic ones, such as primarily rheumatoid arthritis, juvenile idiopathic arthritis, spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, and other systemic connective diseases, which are characterized by a high risk for untimely death. The high risk of untimely death in these diseases has been found to be associated with the severity of an immunoinflammatory process that gives rise to severe irreversible damage to vital organs and systems and with the development of a wide spectrum of comorbidities (infections, interstitial lung disease, malignant tumors, osteoporotic fractures, etc.). Among them, diseases of the cardiovascular system, which are most commonly caused by the early development and.accelerated progression of atherosclerotic coronary lesions, hold a central.position. The paper gives the data available in the recent literature on the impact.of antirheumatic therapy (disease-modifying antirheumatic drugs and biological agents) on' the cardiovascular system.

Aim: To assess the risk of severe adverse events (AEs) within 6 months after treatment with biological agents in patients with rheumatic diseases (RD)., Subjects and Methods: The 6-month open-label trial included 107 patients with rheumatoid arthritis, antineutrophil cytoplasmic antibody-associated vasculitides, systemic lupus erythematosus, and other RDs who received genetically engineered biological agents (GEBAs), primarily rituximab (n = 66) and infliximab (n = 31)., Results: The majority of patients were noted to have improvements, including complete and partial remission in 62 (57.9%) and 42 (39.3%), respectively. There were mild or moderate AEs in 22 (20.6%) of the 107 patients, severe AEs in 6 (5.6%): grade IV neutropenia in 2 patients (after the use of rituximab), severe infusion reactions in 2 (after the administration of infliximab and rituximab), and systemic infections in 2 (fatal nocardial sepsis after rituximab treatment and unspecified sepsis after infliximab treatment)., Conclusion: The rate of serious AEs, mainly infusion AEs and infections during treatment with infliximab, rituximab, and other GEBAs proved to be relatively low in patients with different RDs. At the same time, the use of biological agents could lower RD activity in the presence of severe visceral injuries refractory to conventional immunosuppressive therapy.

With the growth of rheumatic morbidity the spectrum of medicines for its management needs to be extended. Selected aspects of etiology and clinical course of rheumatic diseases are discussed with reference to prospects of their application for etiopathogenetic therapy.

Aim: To investigate incidence and recurrence rate of endoscopic ulcers in patients with rheumatic diseases (RD) taking NSAID in respect to factors of NSAID gastropathy risk., Material and Methods: Endoscopic findings in the gastrointestinal tract were analysed for 6103 patients (age 50.1 +/- 14.6 years, 83.1% females) with RD taking NSAID regularly, 1642 of them took also glucocorticoids (GC). Control RD patients (n = 504) matched by age and sex took no NSAID, GC and low dose aspirin a month and more before the trial., Results: Gastric or duodenal ulcers were detected in 763 (12.5%) RD patients treated with NSAID, in 20 (4.0%) in the control group, p < 0.0001. Ulcers were more frequent in older patients (65 years of age and older) with ulcer history treated with nonselective NSAID in combination with low aspirin doses (15.1 and 12.0, p < 0.05; 27.3 and 9.7%, p < 0.001; 13.1 and 9.8%, p < 0.001; 19.1 and 12.2%, p < 0.001; respectively). No significant difference in ulcer occurrence was observed in patients given NSAID+GC and NSAID only (11.3 and 12.9%, respectively; p = 0.041). The recurrence rate was assessed in 407 patients with NSAID-induced ulcer 12 months later. Control consisted of 1640 patients having no ulcer, multiple erosions after 12 months of regular intake of NSAID. Ulcer recurrence rose in 163 of 407 patients (40%) while only in 107 f 1640 controls (6.5%, p < 0.0001). Old age and GC administration had no impact on the recurrence rate. Recurrences were less frequent in patients taking nonselective NSAID than those taking nonselective ones (23.4 and 46.5%, respectively; p < 0.001) and in patients treated with NSAID in combination with proton pump inhibitors (24.6 and 42.6%, respectively; p < 0.001). Prophylactic intake of H-2 blockers did not reduce recurrence rate., Conclusion: Old age, ulcer history and intake of nonselective NSAID increased the risk of endoscopic GI ulcer. Combined use of NSAID and GC did not increase the risk of ulcer development or recurrence. In a year or later of NSAID continuation recurerences arose in 40% patients with NSAID-induced ulcers. Recurrence risk was reduced by selective NSAID and proton pump inhibitors.

The problem of infectious pathology is quite actual for state-of-the-art rheumatology. Various infectious agents take part in the development of rheumatic diseases (RD), playing a trigger role and launching immune mechanisms of inflammation. Besides, comorbid infection often complicates the RD course due to the immune status disorders connected with a background disease and the use of immunosuppressive drugs. Treatment of such pathology is an important task. The main data on frequency and localization of infections in RD are represented. The authors also proved necessity of clinical researches with the aim of development of optimal antimicrobial therapy and prophylaxis of infections in RD patients.

Study of presence of antibodies against pertussis in 72 rheumatic patients (with uvenile rheumatoid arthritis, systemic lupus erythematosus, etc.) aged 1-18 year old without history of pertussis was performed. Mean age of the patients was 10.6 +/- 0.48 year old, duration of illness--51.2 +/- 4.42 months. Immunosupressive therapy at the time of the study was conducted in 68 (94.4%) children. Using ELISA method, IgG to pertussis toxin (PT) and to antigens of acellular pertussis vaccine (aPV) were detected in 98.6% and 100% of children. High titers of antibodies were detected more frequently in 7-18 year old age group, which can indicate recent pertussis disease or infection. Vaccination history was studied in 131 children with rheumatic diseases. Incidence of pertussis in 43 unvaccinated children was 116.3 per 1000, and in 16 children with incomplete vaccination--62.5 per 1000. Out of 75 patients, who received vaccination series and revaccination, clinically distinct pertussis was not diagnosed.

The aim of the study was to evaluate the prevalence and character of non-steroid antiinflammatory drug (NSAID)-associated pathology in patients with rheumatic diseases (RD) in the Russian population. The study included questioning of 2537 RD patients (81% women and 19% men, mean age 55.8 +/- 14.2 years) who were taking NSAID, in 6 regions of Russia, between the October of 2003 and April of 2004. The results were analyzed using chi2 criterion, Fisher exact test, and Student t-criterion. 7.6% of the questioned and 14.7% of their relatives had ulcerous background [corrected] history (ulcers diagnosted prior to the beginning of treatment with NSAID). Most patients (70.1%) were taking non-selective NSAID (NSNSAID), chiefly diclophenac (50.9%). The most often used non-selective cyclooxygenasa-2 (COG-2) inhibitor was nimesulid, taken by 23.5% of the patients. 20.2% of patients were not aware of the influence of NSAID on the gastric and intestinal mucosa. 33.7% of the patients underwent esophagogastroduodenoscopy (EGDS) while taking NSAID. In 8.8% of the examined gastric or duodenal ulcers were found while they were taking NSAID; 1.5% of the examined developed gastro-duodenal hemorrhage or ulcer perforation. 53.1% of the questioned had gastroduodenal complaints; in most cases it was heartburn (37.3%), "heaviness" in the epigastral area (37.4%), and meteorism (37.4%). 51.3% of the patients associated gastroesopagial reflux and dyspepsia symptoms with intake of NSAID. 26.9% of the questioned associated stool disturbances and meteorism with NSAID intake. 32% of the patients took medications to eliminate gastrointestinal disorder symptoms. Patients taking selective COG-2 inhibitors had complaints less frequently than those who were taking NSNSAID (p = 0). Most frequently complaints were associated with intake of glucocorticoids (p = 0), low doses of aspirin (p = 0), smoking (p = 0), and elderly age (p = 0.007). Appearance of complaints was not associated with the dose of NSAID (diclophenac) (p = 0.257). 8.8% of the patients with ulcerous background were not aware of the effects of NSAID on the alimentory tract; 34.1% of the patients din not undergo EGDS withing the period of treatment with NSAID. Only 40.3% of patients were taking selective COG-2 inhibitors; 54.7% of patients were taking gastroprotective preparations. Alimentary tract pathology is a prevalent complication of therapy with NSAID in the Russian population. The most frequent gastrointestinal symptoms are subjective; they affect life quality substantially. Their risk factors are: elderly age, ulcer background, and glucocorticoid intake. Russian doctors do not take sufficient measures to prevent serious NSAID intake complications.

Aim: To evaluate rate of erosions and ulcers of the upper gastroduodenal tract (UGDT) in patients treated with selective cyclooxigenase inhibitors (C-NAID)., Material and Methods: A retrospective analysis of esophagogastroduodenoscopies made in the Institute of Rheumatology in 2002-2004 was made for two groups. The study group received C-NAID (nimesulid, n = 330; meloxicam, n = 371; celecoxib, n = 66), the control group--diclofenak (n = 1935). The groups were matched by age, gender and concomitant therapy. Incidence of ulcers in the past was significantly higher in the study group., Results: Occurrence of erosions and ulcers in the study and control groups was comparable: 22.4, 24.5, 21.2 and 27.6%, respectively. Multiple erosions (ME, n > 10) and ulcers significantly less frequently occurred in the study group: 8.8, 10.5, 10.6 and 14.6%, respectively (p < 0.05). Significant difference in occurrence of erosions and ulcers in UGDT for different C-NAID was not found. ME and ulcers in patients with ulcer anamnesis were recorded less frequently in intake of C-NAID than diclofenak (22.5 and 46.2%, resopectively, p < 0.001)., Conclusion: Selective inhibitors of COG-2 are not safe enough in relation to gastrointestinal pathology, especially in patients with ulcer anamnesis. Nimesulid, meloxicam and celecoxibe were comparable in respect to detectability of gastrointestinal erosions and ulcers.

Aim: To specify causes of discontinuation of the disease-modifying antirheumatic drugs (DMAD) used in rheumatoid arthritis (RA) by the results of special questionnaire survey., Material and Methods: The study included 298 RA patients treated in the Institute of Rheumatology (34 males and 264 females aged 18-82, mean age 54.6%, duration of the disease 1 to 38 years, mean 10.7 years) who responded to questioning., Results: The following DMAD were used: metotrexate (n = 137), sulfasalasine (n = 49), aminoquinoline drugs (n = 33), chlorbutin (n = 19), azathioprin (n = 13), tauredon (n = 11), cyclophosphamide (n = 5). The drugs were discontinued due to unwanted effects in 50, 10, 46, 9, 4, 3, 3 (methotrexate, sulfasalasin, aminoquinolines, chlorbutin, azathioprin, Ag salts, cyclophosphamide, respectively). Cyclophosphamide and chlorbutin appeared most toxic, while sulfasalasine and aminoquinolines were found least effective., Conclusion: DMAD discontinuation rate ranges from 12.1% (aminoquinolines) to 60% (cyclophosphamide), mean 31.1%.

The purpose of the study was to examine the clinical features of the course of coronary heart disease (CHD) in patients with rheumatoid arthritis (RA) and to evaluate the effects of the selective cyclooxygenase-2 (COG-2) inhibitor movalis (meloxicam) in two dosage forms (as injections and tablets) on the course of CHD in this group of patients. The developed questionnaire was used to make a comparative screening survey of 304 patients with RA and 152 patients with osteoarthrosis (OA), who were aged above 40 years. A comprehensive examination of the cardiovascular system was performed in 52 patients with RA concurrent with CHD and 25 patients with OA concurrent with CHD. Angina pectoris on exertion was detected in 37% of the patients with PA and in 35% of the patients with OA. Most (52%) patients with RA and CHD reported rare anginal attacks (once a month) whereas 24-day ECG monitoring revealed myocardial ischemia in 71% of the patients with RA concurrent with CHD; only silent ischemic episodes were recorded in 70% of them. The incidence of silent myocardial ischemia was higher in patients with RA concurrent with CHD than that in those with OA concurrent with CHD (p < 0.03). Examination of the incidence of anginal attacks showed that there was a tendency of the incidence of pains to decrease in patients with RA concurrent with CHD who took selective COG-2 inhibitors. Patients with RA concurrent with CHD who received movalis had atendency of arrhythmia to occur more rarely and of the duration of myocardial ischemia to reduce as compared with those who took nonselective COG-2 inhibitors.

Aim: To estimate frequency of ulcers and erosions associated with administration of nonsteroid anti-inflammatory drugs (NSAID) in patients with rheumatic diseases., Material and Methods: The analysis of the clinic endoscopic data base allowed division of the patients into three groups: group 1--207 patients examined with esophagogastroduodenoscopy (EGDS) which detected ulcers or multiple erosions of the stomach and/or duodenum in the course of treatment with NSAID; group 2--157 patients with a few erosions of the stomach or duodenum; group 3--404 controls who had neither erosions nor ulcers in the course of NSAID treatment., Results: Frequency of detection of ulcers and multiple erosions for groups 1, 2 and 3 was 40.1, 12.1 and 7.4%, respectively. Recurrences did not correlate with age, sex, dose of glucoorticosteroids, NSAID dose, cytostatics, preventive use of antiulcer drugs. Few gastric erosions were detected more frequently in patients of group 2 than group 3 (22.9 and 9.2%, respectively, p < 0.05)., Conclusion: NSAID-induced ulcers in patients with rheumatic diseases are recurrent. Preventive intake of H2-blockers did not lower the risk of ulcer recurrence. Erosions tend to recurrence but their presence do not raise the risk of ulcer development.

The aim was to evaluate antihelicobacter therapy in the treatment and prophylaxis of NSAID-induced gastropathy recurrences in patients with rheumatic diseases (RD). 66 patients with RD (58 females and 8 males, mean age 53.6 +/- 12.6 years) participated in the study. They met the following criteria: the presence of ulcers or multiple (more than 10) erosions of gastric or duodenal erosions, administration of nonsteroid anti-inflammatory drugs, Helicobacter pylori (HP) in gastric mucosa biopsies. The patients were randomized into two groups matched by sex, features of RD, antirheumatic therapy, history of ulcer, GIT disease. All the patients received omeprazol in a dose 40 mg/day. Patients of group 1 took also amoxicillin (1 g/day) and klarythromycin (0.5 g/day) for 10 days. Group 2 was control. EGDS was conducted 2, 4 weeks and 6 months after the treatment. HP eradication and dynamics of morphological changes were examined in biopsies of the antral gastric mucosa and mucosa of gastric body. The efficacy of 4-week treatment (ulcer scarring and epithelization of erosions), rate of ulcer recurrences and erosions 6 months after treatment were compared. The efficacy of the treatment was 88 and 95% in group 1 and 2, respectively. HP eradication was achieved in 88% of patients of group 1. In 6 months, recurrences arose in 50 and 48.3% of patients of groups 1 and 2, HP was detected in 22% of patients of group 1. Morphological changes in group 1 patients was characterized by alleviation of chronic active gastritis. HP eradication does not raise the efficacy of the treatment and does not lower the risk of recurrences in patients with NSAID-induced gastropathies. Active chronic gastritis is not the background for recurrences of NSAID-induced gastropathy.

A comparative evaluation was done of frequency and severity of upper gastrointestinal mucosal lesions in patients taking nonsteroid antiinflammatory drugs (NSAID) and glucocorticosteroids (GCS). A total of 65 rheumatic patients examined endoscopically entered the study. The patients were divided into three groups. Group I comprised 12 patients placed on GCS only, group II was 35 patients on NSAID, group III was 18 patients who received NSAID plus GCS. Gastropathies were diagnosed in 25%, 45.7%, 44.4% of patients in groups I, II, and III respectively. Group II patients had a higher incidence of serious afflictions. As far as the gastrointestinal mucosa is concerned, GCS have been shown to be superior to NSAID. A combined use of NSAID + GCS, unlike NSAID alone, has not been found to increase the risk of development of gastropathy.

Aim: To compare occurrence of upper gastrointestinal tract (UGT) cancer in rheumatic patients taking long courses of nonsteroid antiinflammatory drugs (NSAD) and in non-rheumatic patients who have not received NSAD., Material and Methods: The study group of 1271 rheumatic patients on NSAD for at least 12 months. Control group of 654 patients free of rheumatic diseases and having no history of regular NSAD intake. The groups did not differ by the mean age, erosion and ulcer incidence., Results: Esophagogastroduodenoscopy detected and histology confirmed adenocarcinoma in 2 patients of the study and 10 patients of the control group (0.16 and 1.5%, respectively, p < 0.001)., Conclusion: Long-term treatment with NSAD lowers the risk of UGT tumors.

Comparative randomized opened pharmacokinetic evaluation of benzathine benzylpenicillin in three dosage forms was performed. Benzathine benzylpenicillin was used as extencilline (2.4 million U or 1.2 million U, "Rhône-Poulenc Rorer", France) and as bicillin-5 (1.5 million U, "Synthesis" Russia). 33 patients were included in investigation (23 women and 10 men aged 16-60 years). 25 persons had verified rheumatism without blood circulation failure signs, 4--had chronic tonsillitis and 4 were healthy volunteers. Benzylpenicillin concentration was estimated by microbiology test in blood samples taken at 1, 3, 24 hours and 7, 14 and 21 days after intramuscular drug injection. After 2.4 million U extencilline injection (12 patients) its concentration, was at the inhibition level for beta-hemolytic streptococcus group A (25 ng/ml) for 3 weeks-period in 83.3 per cent of patients. After 1.2 million U extencilline injection (10 patients) or 1.5 million U bicillin-5 injection (12 patients) the above mentioned concentration was achieved on the 21st day in 30 and 0 per cent of patients respectively. Thus the treatment with benzathine benzylpenicillin at the 1.2 million U dose in the form of extencilline or bicillin-5 doesn't provide adequate antistreptococcal concentration in blood in prolonged period and is not suitable for correct rheumatism prophylaxis in adult patients.

Aim: A comparative evaluation of the frequency and severity of upper gastrointestinal mucosal lesions in patients taking nonsteroid anti-inflammatory drugs (NSAID) and glucocorticosteroids (GCS)., Materials and Methods: The trial entered 1086 rheumatic patients examined endoscopically. To compare the effects of their medicines, the patients were divided into 3 groups: 726 patients on NSAID alone (group 1); 238 patients on NSAID and GCS (group 2); 122 patients on GCS only (group 3)., Results: Gastropathies were diagnosed in 38.2, 32.4, 12.5% of group 1, 2 and 3 patients, respectively (the difference is significant). More serious diseases prevailed in group 1: multiple erosions and gastroduodenal ulcers. Group 2 and 3 patients had erosions only., Conclusion: GCS are safer for gastrointestinal mucosa than NSAID. Combination of NSAID with GCS does not increase the risk of gastropathy onset compared to NSAID alone.

The paper deals with the achievements of the Institute of Rheumatology in antirheumatic therapy, among them there are methods of objective assessment of antirheumatic drugs, the first use of antimalarials in the treatment of chronic rheumatic fever, discovery of immunodepressive properties of these drugs, specification of the mechanism of action of several NSAIDs. Antilymphocytic globulin, salazopyridazine and the alkylating drug dopan were used for the first time in therapy of rheumatic diseases. Administration of the most potent NSAIDs diclofenac or indomethacin to patients with acute rheumatic fever proved to be as effective as prednizolone. Special attention is paid to the combination treatment of rheumatoid arthritis with NSAIDs. The concurrent administration of aurannofin and methotrexate was shown to cause a more rapid development of clinical improvement than monotherapy with either drug. A combination of gold aurothiomalate and hydroxychloroquine and that of low doses of D-penicillamine and cyclophosphamide had no advantages over monotherapy. Revealing the therapeutical potential of antibodies to interferon-gamma in the treatment of rheumatic arthritis and psoriatic arthritis was the most important achievement of recent years. These studies open new vistas for anticytokine treatment of rheumatic diseases.

The efficacy and tolerance of 3 fluoroquinolones (ciprofloxacin, pefloxacin, lomefloxacin) were studied in 157 patients with rheumatic diseases concurrent with infection-induced abnormalities. Infection cure was achieved in 123 (78.6%) patients, as evidenced by clinical, microbiological, and serological studies. The tolerance of fluoroquinolones was regarded as good, satisfactory, and poor in 114 (72.6%), 37 (23.6%), and 6 (3.8%) patients, respectively. All representative drugs of the fluoroquinolones series produced typical adverse reactions. The authors consider it expedient to make further clinical studies to test the optimal treatment regimens and to expand indications for the use of fluoroquinolones in this group of patients.

A clinical trial of arthrotek (Searle) in 60 RA patients aged 16-77 years demonstrated its high anti-inflammatory activity in 47 of them. These patients have received a complete treatment course, 10 patients were not included in the overall estimations because of side affects (gastric pains and nausea) causing them to withdraw early in the treatment course, 3 patients were nonresponders. The responders experienced attenuation of joint pain, morning stiffness. Inflammation in some joints declined, the articular index decreased.

The review of the modern literature about a role of essential dietary antioxidants and first of all of vitamins E, C, P, A and carotenoids in protection of cell components against of damage by excessive strengthening of free radical oxidation is submitted. Expediency of inclusion of antioxidant vitamins in complex therapy of rheumatic diseases is discussed taking into account the failure in an antioxidant system and excessive strengthening of free radical oxidation as important symptoms in development of rheumatic diseases.