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At the meeting of the Expert Council on May 20, the safety of treatment for patients with osteoarthritis (OA), the most common form of joint disease, was discussed. The first step in the treatment of OA should be the administration of symptomatic delayed-acting agents (SYSADOA) and nonsteroidal anti-inflammatory drugs (NSAIDs). However, given the current understanding of the pathogenesis of inflammation, as well as the fact that it is an active process involving multiple proinflammatory and pro-resolving mediators, it is reasonable to limit the cyclooxygenase-2 suppressive treatment and to include medications with multipurpose effects that contribute to the resolution of inflammation, in particular Zeel® T and Traumeel® S. Traumeel® S affects all stages of inflammation, mostly on the pro-resolving mediators synthesis, and Zeel® T affects chondrogenesis, inflammation, metabolic processes in cartilage tissue and prevents angiogenesis.It was found that it is advisable to use Traumeel® S when it is not possible to prescribe systemic NSAIDs for pain relief. The combination of the proven therapeutic efficacy of Zeel® T and Traumeel® S with a minimal number of adverse events and the absence of interactions with other drugs allows them to be used as an independent treatment regimen for OA.

The paper discusses the results and substantiates the effectiveness of pharmacotherapy for osteoarthritis of the knee joints using a dietary supplement Cartilox, which includes five active substances (type II collagen peptide, Boswellia serrata extract, curcuminoids, piperine and hyaluronic acid).

A combination of chondroitin and glucosamine is widely used in clinical practice as both a symptomatic and structure-modifying agent for the treatment of osteoarthritis (OA). The emergence of new drugs based on this combination substantially expands treatment options for OA therapy.Objective: to evaluate the efficacy and safety of Artroflex® that is a combination of chondroitin sulfate 400 mg and glucosamine sulfate 500 mg (CS + GS) to support joint health in patients with knee and/or hip OA.Patients and methods. When implementing an open observational research program, the results of using the CS + GS complex were assessed in 644 OA patients (74.7% women) (mean age, 58.0±14.6 years) who experienced moderate/severe pain and required to continuously take non-steroidal anti-inflammatory drugs (NSAIDs). The CS + GS complex was prescribed in a dose of 2 capsules per day for 3 months. The investigators estimated changes in pain on movement by a 0 to 10 verbal pain scale, general health (GH) by a 0–10 visual analogue scale), the Lequesne index, the need for NSAIDs, and patient satisfaction with treatment and its tolerance.Results and discussion. After 3-month therapy, there were decreases in pain intensity by 49.2±16.8%, GH scores by 45.6±18.1%, the Lequesne index from 9.0 [6.0; 13.0] to 5.0 [3.0; 9.0]; less than half (45.2%) of the patients still needed for NSAIDs. 82.2% of patients were satisfied or completely satisfied with treatment results; 89.6% reported good treatment tolerance.Adverse events (apparently associated with NSAID use) were recorded in 2.2% of cases. There were no serious complications that required CS + GS treatment discontinuation or hospitalization.Conclusion. The findings have indicated that Artroflex® used to support joint health is an effective agent that controls OA symptoms and has a good safety level.

Objective: to investigate the nosological pattern of primary disability due to osteoarthritis (OA) in the Irkutsk Region in 2012–2016, its severity, age- and gender-related features.Material and methods. A continuous method was used to analyze the database on the newly recognized as disabled due to OA in the Irkutsk Region in 2012–2018. The pattern, degree of disability, its age- and gender-related characteristics were studied.Results and discussion. Among those who were the newly recognized as disabled due to OA in 2012–2014, there was the largest proportion of patients with knee OA (46.6 to 52.7%, respectively). There was a preponderance of the disabled due to hip OA in 2015–2016 (55.3% and 65.3%, respectively). Among the OA patients with newly established disability during the analyzed period, there was a preponderance of women, but their proportion in 2016 was smaller than that in 2012 (54.4 and 74.2%, respectively). The decrease was mainly due to women with polyarticular OA (83.5% in 2012; 67.5% in 2016), hip OA (54.3 and 42.0%), or knee OA (87.2 and 80.4%, respectively). Most of the disabled people with OA were pensioners (64.7% for an average of 5 years). Over the past 3 years, the proportion of disabled young people (aged less than 44 years) substantially increased from 7.1% in 2014 to 15.3% in 2016 and that of disabled adult people rose from 21.2% in 2014 to 30.1% in 2016. Among the disabled with hip joint damage, young and adult patients were more and pensioners were fewer than among those with polyarticular OA (16.8 and 3.1%; 31.5 and 23.5%; 51.9 and 73.4% for an average of 5 years, respectively).Knee OA-associated disability was established mainly in pensioners (80.2%), while the proportion of young people was only 2.0%, which was much fewer than in those with hip OA, polyarticular OA, and other variants of the disease (9.2%). The proportion of disabled adult persons was also fewer (18.1% for an average of 5 years). According to the severity of disability due to OA, the largest one was group with class III disability (81.7% in 2012 to 90.9% in 2015). Group with class II disability were much less – from 16.1 to 8.3%, respectively. The minimum number of patients was recognized as having class I disability. The last five years have been marked by an improvement in the pattern of polyarticular OA and osteoarthritis-related primary disability according to its severity, by reducing the proportion of people in the most severe groups with class I and II disability and by increasing the proportion of people having class III disability. The increase in the proportion of people with class II disability due to hip OA to 22.3% in 2016 from 11.4% in 2015 was due to isolated cases of complications after hip replacement.

Objective: to analyze the dynamics of quality of life (QOL) in patients with prior osteoporotic vertebral compression fracture during an 18-month follow-up study. Subjects and methods. The investigation enrolled 219 patients (mean age, 67.6 years) with vertebral fracture from seven centers of the Russian Federation. QOL was assessed four times using the EQ-5D (EuroQoL-5D) and TTO (Time Trade-Off) questionnaires during an 18-month prospective follow-up study. The work was done within the framework of the International Multicenter Study ICUROS (The International Costs and Utilities Related to Osteoporotic Fractures Study) organized by the International Osteoporosis Foundation (www.icuros.org).Results and discussion. The patients with vertebral compression fracture showed a statistically significant decrease in QOL throughout the follow-up period. Immediately after the fracture, there was a dramatic decrease in the total EQ-5D score, followed by its gradual increase. However, the emerging trend in QOL recovery proved to be unstable, and by the end of the 18th month, it was significantly lower than that before the fracture. On the contrary, the TTO questionnaire showed that QOL drastically decreased immediately after fracture, but at month 4 it reached the level that was before the fracture, and remained stable until the end of the follow-up period.Conclusion. The performed investigation enabled us to obtain data on QOL using the EQ-5D (QOL assessment from the social point of view) and TTO (individual QOL assessment) in the population of residents of the Russian Federation, in men and women aged 50 years and older with osteoporotic vertebral compression fracture.

Aim. To analyze the factors of medical choice in the prescription of medicinal drug (MD) for the treatment of cardiovascular diseases. Material and methods. A questionnaire survey of 212 doctors (138 physicians and 42 general practitioners) was performed in Irkutsk region and Republic of Buryatia. Questions were related to the physicians’ choice of the original or generic MD and the factors that influence this choice. Results. The majority of respondents prefer the foreign MD, while they prescribed both original and generic drugs (60.4%). The determining factor in the prescription of MD is its efficacy (91.5-95.3%). The main source of information of MD for physicians is the medical literature (78.3%). Only 23.6% of doctors choose the MD based on the results of clinical trials and information about it in specialized medical literature. A half of the respondents believe that their knowledge of cardiovascular MD is insufficient. Doctors need and are interested in information on the pharmacokinetics and pharmacodynamics of MD, side effects, drug interactions and results of clinical studies. Conclusion. It is necessary to focus on the clinical pharmacology of cardiovascular MD during the training of doctors in specialized courses of continuous medical education.

Objective: to study the rates of primary disability due to musculoskeletal and connective tissue diseases (MSCTD) in the Irkutsk Region in 2013–2015 (in relation to age, gender, and urban or rural residence) and its nosological pattern.Material and methods. A continuous method was used to analyze the database on the newly recognized as disabled due to MSCTD in the Irkutsk Region in 2013–2015. The rates were calculated per 10,000 adult population; the pattern was estimated as a percent.Results and discussion. The rates of primary disability due to MSCTD in the Irkutsk Region were higher than those in the Russian Federation as a whole. Its reduction from 10.4 per 10,000 population in 2013 to 10.3 in 2014 and to 5.9 in 2015 was noted in the adults. Osteoarthritis headed the list of the causes of primary disability in the adults (45.5% in 2015) whereas dorsopathies did in the able-bodied (45.9% in 2015, 47.1% in 2014, and 48.2% in 2013). Osteoarthritis ranked first in the retirement-aged (61.5% in 2015, 75.1% in 2014, and 72% in 2013); it occupied the second place in the able-bodied (31.6% in 2015, 36.3% in 2014, and 38.2% in 2013). Rheumatoid arthritis was third among both the able-bodied and the retirement-aged. Higher disability rates were observed in the urban residents over all the years. The women became disabled more frequently than the men. In 2015, the primary disability rates among the men were 5.2, those among the women were 6.4 per 10,000 population; these were 9.2 and 19.4 and 8.4 and 12.1 in 2014 and 2013, respectively. The lower rates of disability due to MSCTD may be attributable to both the greater availability of high-quality and high-tech medical care for patients and the changes in normative documents on disability criteria.

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for the management of knee osteoarthritis (OA), published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS) (Rottapharm/Meda) and prescription chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk: benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.

Smoking is a significant risk factor of chronic noncommunicable diseases. Smoking prevalence is variable in different populations. A study of the prevalence of this risk factor allows to estimate its contribution to the development of cardiovascular pathology, to plan the necessary amount of medical care for people using tobacco, and to determine the effectiveness of prevention activities in the region. As a result of the study, smoking frequency in population of the Irkutsk region older 18 years of age or over was established as 29.5 %. The number of smokers increased with age, reaching maximum value of 38.6 % in the group 30-39 years. Male smokers made maximum in the age group 30-39 years, women - in the age group of 18-19 years. The average age of smokers was 34 years, the one of nonsmokers - 43 years. The age difference was 9 years, and it was lower in the group of men than in the group of women (5 and 11 years, respectively). The number of the smoking men were 3 times larger, than women: 50.2 % and 13.5 %, respectively. Among persons with arterial hypertension, 22.1 % were smoking with the maximum frequency of smoking in age groups from 20 to 49 years. These figures point to a considerable problem of smoking in the region.

The aim of the study was to examine frequency and risk factors of fractures among adolescents and young adults of Irkutsk aged 14 to 24. The results of the study showed that the frequency of fractures was 23.8 %; and boys have fractures significantly more often than girls (p = 0.01). Risk factors for fractures are: male gender (OR = 1.25); body height (> 174 cm for girls (OR = 3.9), > 177 cm for males (OR = 3.5)); body weight (> 60 kg for girls (OR = 2.5), > 66 kg for boys (OR = 2.1)); tenderness to palpation of spinous processes of vertebra (OR = 3.1 for girls, and OR = 2.4 for boys); dietary calcium intake < 500 mg/day (OR = 1.5 for girls, and OR = 2.3 for boys). In addition, back pain (OR = 1.9) and joint hypermobility syndrome (Or = 1.4) were significantly more often found in girls with fractures. There was no statistically significant connection between fractures in adolescents and young adults and hypodynamia, bone mineral density, social factors (single-parent or multi-child family), and parental history of fractures.

Non-steroidal anti-inflammatory drugs (NSAIDs) are most popular medications for the treatment of pain in common musculoskeletal diseases such as osteoarthritis (OA) and non-specific low back pain (LBP). However, the factors affecting the effectiveness of these drugs have not been determined fully. Aim: to identify factors affecting the effectiveness of NSAIDs in patients with OA and LBP. Materials and methods. An observational study was conducted to evaluate the effectiveness of a 2-week course of NSAIDs in OA and LBP in real clinical practice. The study group consisted of 3604 patients with OA and LBP (60.6% women and 39.4% men, mean age 55.0±13.4 years). According to the study design, aceclofenac (Airtal) and other NSAIDs used in the ratio 1:1. The main criterion of effectiveness was the frequency of complete pain relief after 2 weeks of therapy. In addition, the decrease of pain and general health were determined on a 10-point numerical rating scale (NRS). We compared the frequency of complete pain relief in patients who had and did not have the studied factors. The value of the studied factors was determined using OR (95% CI). Results and discussion. Most patients received aceclofenac (54.9%), as well as diclofenac (2.0%), ketoprofen (1.9%), lornoxicam (2.2%), meloxicam (13.7%), naproxen (2.1%), nimesulide (5.8%), celecoxib (5.9%), ethicoxib (7.1%) and other NSAIDs (4.4%); 56.2% of patients received muscle relaxants, mainly tolperisone (74.7%), vitamin B (10.4%), and proton pump inhibitors (42.8%). Complete pain relief was achieved in 54.8% of patients. The pain decrease and general health improvement were (for NRS) 63.9±13.4% and 61.7±14.8%, respectively. The efficacy of aceclofenac was slightly higher than in the whole group: complete pain relief was in 59.9% of patients. Adverse events in aceclofenac use were observed in 2.3% of patients, other NSAIDs-from 2.4 to 14.1%. The frequency of complete pain relief was higher in men: OR 1,239 (95% CI 1.08-1.418; p=0.002), who had the first episode of pain - OR 3.341 (95% CI 2.873-3.875; p=0.000), a good" response " to NSAIDs in history - OR 1.656 (95% CI 1.385-1.980; p=0.000) and received NSAIDs in combination with muscle relaxants - OR 1.218 (95% CI 1.067-1.390; p=0.004). The effect of therapy is lower in patients 65 years and older-OR 0,378 (95% CI 0.324-0.442; p=0,000), with body mass index >30 kg/m² - OR 0.619 (95% CI 0.529-0.723; p=0.000), with severe pain (≥7 points NRS) - OR 0.662 (95% CI 0.580-0.756; p=0.002), with pain at rest, - OR 0.515 (95% CI 0.450-0,589; p=0.000), pain at night - OR 0.581 (95% CI 0.501-0.672; p=0.000) and the presence of stiffness - OR 0.501 (95% CI 0.438-0,573; p=0.000). Treatment results are significantly worse in the cases of combination of LBP and joint pain, as well as pain in the trochanter major and pes anserinus area (p