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Objective: to investigate in a multicenter study relationship between type 2 diabetes mellitus (DM) and clinical manifestations of osteoarthritis (OA). Material and methods. The study involved 767 patients aged 40–75 years with a confirmed diagnosis of stage I–III knee OA who had signed an informed consent form. The mean age of patients was 57.9±9.6 years, body mass index (BMI) was 30.8±6.4 kg/m2 and median duration of disease was 5 [2; 11] years. An individual record card was filled out for each patient, it contained anthropometric parameters, medical history and clinical examination data, knee pain assessment using a visual analogue scale (VAS), WOMAC, parameters of KOOS questionnaire and patient's global assessment of health. Results and discussion. DM was detected in 17.2% of cases. Patients were categorized into two groups according to the presence or absence of DM. In the presence of DM, more severe clinical manifestations of OA were noted. However, patients with DM were older, had higher BMI values, longer disease duration and were more frequently diagnosed with radiological stage III OA. After stratification by age and disease duration, individuals with DM retained worse pain scores according to VAS compared to patients without DM (median 51.5 [41.5; 70] mm versus 36 [25; 50] mm, p=0.049), total WOMAC index (1047.5 [792; 1260] mm versus 823 [536; 1145] mm; p=0.005) and its components (pain – 200 [160; 254] mm versus 155 [108; 230] mm, p=0.002; stiffness – 90 [50; 115] mm versus 60.5 [35; 100] mm, p=0.03; functional impairment – 765 [550; 918] mm versus 595 [350; 820] mm, p=0.009). Conclusion. Type 2 DM is common in patients with OA (in 17.2% of cases) and is associated with more severe clinical manifestations: greater pain intensity according to VAS and higher WOMAC scores (total index and its components).

Objective: to investigate the efficacy of Alflutop therapy in patients with knee osteoarthritis (OA) with or without concomitant diseases. Material and methods. The large-scale, multicenter prospective, open-label, observational, non-interventional ISKRA study (Study: Prescribing the drug Alflutop, solution for injection, for OA in real world clinical practice) included 22,525 patients, 10,616 of whom had knee OA. The mean age of patients with knee OA was 60.1±11.7 years, body mass index (BMI) was 28±4.6 kg/m2 , and median disease duration was 60 [24; 120] months. All patients had significant comorbidities: arterial hypertension in 90% of cases, and ischemic heart disease, diabetes mellitus and obesity in one in three cases. Alflutop was administered daily 1 ml intramuscularly (IM), No. 20, or every second day 2 ml IM, No. 10. The efficacy of the treatment was assessed by the dynamics of pain intensity using a visual analogue scale (VAS), patient's general health assessment (PHA) using VAS and quality of life using EQ-5D, and the need for non-steroidal anti-inflammatory drugs (NSAIDs). Results and discussion. After one course of treatment, median pain intensity decreased from 60 [40; 70] to 20 [10; 40] mm, quality of life improved – median EQ-5D increased from 0.59 [0.36; 0.69] to 0.85 [0.73; 1]) and PHA from 50 [37; 70] to 80 [60; 90] mm, and the need for NSAIDs decreased. Female gender, older age, high BMI, severe pain, radiological stages III and IV, poorer quality of life, presence of concomitant diseases and lower adherence to treatment were associated with a less significant response to therapy. Conclusion. The results of the use of Alflutop in knee OA suggest that widespread use in real-life clinical practice is possible. The inclusion of additional therapeutic targets in the OA treatment strategy, as well as the identification and correction of factors associated with a less pronounced analgesic effect of the drug, will potentially improve treatment efficacy.

Objective: to investigate the efficacy and safety of olokizumab (OKZ) in patients with knee osteoarthritis (OA) with synovitis, persistent pain and ineffectiveness of previous conservative therapy. Material and methods. The study included 15 patients with stage II–III knee OA who fulfilled the ACR criteria and had pain ≥50 mm on a visual analogue scale (VAS), synovitis and treatment failure. The age of patients ranged from 54 to 75 years; the duration of the disease was from 1 to 23 years. The duration of the study was 12 weeks, during which the patients received 3 subcutaneous injections of OKZ at a dose of 64 mg. The effectiveness of the treatment was assessed by the dynamics of pain intensity according to VAS, WOMAC and KOOS indices, the values of the DN4 questionnaire and the quality of life according to EQ-5D. In addition, the general assessment of the patient's health (GHA) according to VAS, the assessment of treatment efficacy by doctor and patient and the need for non-steroidal anti-inflammatory drugs (NSAIDs) were considered. All patients underwent laboratory testing. Results and discussion. During treatment, there was a significant decrease in pain intensity according to VAS, a statistically significant improvement in the KOOS and WOMAC indices (p

The use of slow-acting disease-modifying symptomatic drugs, such as bioactive concentrate from small marine fish (BCSMF, Alflutop), is considered a potential element of complex therapy for chronic non-specific back pain (CNBP).Objective: to evaluate the efficacy of the BCSMF in patients with CNBP in real-life clinical practice.Material and methods. An open observational study included 10,047 patients with CNBP (age – 58.3±14.9 years, 58.4% women) with moderate or severe pain – 60 [50; 70] mm on the visual analogue scale (VAS). All patients received a course of BCSMF medication: 1 ml intramuscular (IM) daily No. 20 or 2 ml IM every other day No. 10. 68.8 % of patients also took non-steroidal anti-inflammatory drugs. Treatment outcomes were assessed 10 days after completion of BCSMF therapy (30 days after initiation of treatment).Results and discussion. As a treatment result, the pain intensity according to the VAS decreased from 60 [50; 70] to 20 [10; 30] mm (p< 0.0001). A good response to treatment (pain reduction >50%) was observed in 73% of patients. On average, an improvement was observed on the 8th [5; 10] day of BCSMF therapy. There were no serious adverse effects associated with the use of the drug. Older age, overweight, initially more severe pain, and the presence of comorbid conditions were slightly more frequently associated with a less pronounced response to therapy.Conclusion. The use of BCSMF rapidly and effectively reduces the severity of pain and other symptoms associated with CNBP.

Osteoarthritis (OA) is one of the most important medical and social problems due to the steady increase in morbidity and disability. Prevention, management of risk factors, and early treatment of OA are critical.Objective of the ISKRA study was to evaluate the efficacy of Alflutop in patients with OA of different locations and/or low back pain (LBP) with or without concomitant diseases.Material and methods. We selected 11,136 patients with OA of specific localizations aged 50 to 72 years. The duration of the study ranged from 20 to 31 days, and the number of visits was 2 (B1 and B2). Alflutop was prescribed 1 ml intramuscularly (IM) daily No. 20 or 2 ml IM every other day No. 10.The efficacy of therapy was determined by the time of onset of clinical effect (pain reduction, as assessed by the patient), the dynamics of pain intensity in the studied joint during movement and/or LBP according to the visual analogue scale (VAS), the assessment of quality of life according to the EQ-5D questionnaire and the patient's general health status (PGH) according to VAS. We assessed treatment adherence, need for nonsteroidal anti-inflammatory drugs (NSAIDs), satisfaction with treatment (based on VAS). The presence of comorbidities was also considered.Results and discussion. In hand OA (n=2776), a positive effect of therapy was observed in 98.6% of cases, according to patients' assessment. During the course of therapy, there was a significant decrease in pain on movement in the hands (according to VAS), improvement in PGH and quality of life (according to EQ-5D). Rapid development of the analgesic effect was seen on average at day 9.In hip OA (n=6666), a decrease in pain was noted in 83.3% of cases (

The review considers the full spectrum of currently known autoantigens in osteoarthritis (OA) and discusses their role in the development and/or persistence of synovitis and the initiation of subsequent destruction of articular cartilage with the development of an autoimmune response and auto-inflammation. Of great interest are methods of drug prevention of OA considering autoimmunity responses and associated auto-inflammation, including the use of pharmaconutraceuticals.Preclinical and clinical studies of the safety and efficacy of pharmaconutraceuticals containing native type II collagen are presented. A clear relationship between the composition/chemical structure of the collagen components and its mechanism of action and efficacy is discussed. Taking into account the autoimmune pathogenesis of OA, new combined pharmaconutraceuticals aimed at reducing the manifestations of autoinflammation (chondroitin sulfate, glucosamine sulfate) are developed. They have an optimal ratio of active ingredients with a sufficient level of evidence, which allows enhancing their beneficial pharmacological effects.

Local injection therapy (LIT) is an important component of the complex treatment of musculoskeletal disorders (MSD), which is widely used in real clinical practice. Glucocorticoids, hyaluronic acid drugs (HA), autologous cell drugs, botulinum toxin type A, radioactive isotopes, etc. are used for LIT. LIT makes it possible to achieve a pronounced symptomatic effect, while in some cases, for example, repeated HA treatments in patients with osteoarthritis, the possibility of slowing the progression of the disease and reducing the need for surgical treatment is discussed.The performance of LIT requires special skills and abilities of the physician, careful compliance with the rules of asepsis and antisepsis, and instrumental visualization. LIT can be associated with serious complications and therefore must be performed according to strict indications.The Expert Council was devoted to defining the basic principles of LIT. The indications for the use of certain types of this therapies, the evidence base for its efficacy and safety, the order of application of different drugs, and the need to combine LIT with other drug and non-drug treatments of MSD were reviewed.

Local forms of non-steroidal anti-inflammatory drugs (NSAIDs) are characterized by a high safety profile due to low systemic absorption. They do not increase the risk of developing class-specific gastrointestinal, cardiovascular and kidney adverse events (AEs), which makes it possible to prescribe them even in severe comorbid pathology, which is typical for patients with osteoarthritis (OA).Objective: to evaluate the efficacy and safety of Artoxan gel (tenoxicam) 1% in comparison with Diclofenac gel 1% in patients with knee OA in a prospective comparative randomized trial.Material and methods. The study included 60 patients with Kellgren–Lawrence stages II–III knee OA, aged 41 to 78 years. The patients were randomly divided into two groups: the 1st group received Artoxan gel 1%, 5 cm 2 times a day for 14 days; 2nd – Diclofenac gel 1% according to the same scheme. During therapy, we assessed pain using a visual analog scale, the WOMAC index, quality of life using the EQ-5D questionnaire, satisfaction with therapy, and time to effect.Results and discussion. It has been demonstrated that local forms of NSAIDs have a positive effect on all clinical manifestations of OA: effectively reduce pain, stiffness, improve the functional state of the joints and quality of life. They also have a good safety profile and a fast symptomatic response. Comparison of the two groups showed that in patients receiving the local form of tenoxicam, there was a tendency to a more rapid and pronounced analgesic effect.Conclusion. The results of the study confirm the good efficacy and safety of local forms of NSAIDs.

In recent decades, there has been an increase in the prevalence and medical and social burden of osteoarthritis (OA) and nonspecific back pain in all countries of the world. The First Multidisciplinary Bilateral Russia-Uzbekistan Expert Council presented innovations in the prognosing, personalized prevention and adjuvant therapy of degenerative-dystrophic diseases of the joints and spine, the evidence base for the effectiveness and safety of the use of drugs that modify the course of OA (Disease-modifying osteoarthritis drugs, DMOADs): chondroitin sulfate, glucosamine sulfate, undenatured type II collagen for adjuvant pharmaconutraceutical support – prevention and adjuvant therapy (treatment) of OA and nonspecific lumbosacral pain. The expert counsil resolution presents an optimized algorithm for the management, prevention and adjuvant therapy of OA and non-specific back pain, maintaining the function of healthy joints after intense physical activity with the inclusion of the drug Chondroguard solution for intra-articular and intramuscular administration (INN – chondroitin sulfate) and a new pharmaconutraceutical from the DMOADs group – TRIO trademark Chondroguard® (Chondroguard®TRIO).

Evaluation of the effect of new drugs should be carried out in randomized controlled trials (RCTs), and observational studies (OSs) are carried out to confirm and refine the results obtained in RCTs, for example, to study the effectiveness of drugs in large groups of patients who were not included in RCTs or had comorbidities or older age.Objective: to evaluate the effectiveness of Alflutop (AF) via OS of patients with osteoarthritis (OA) of the knee and/or hip joints and/or low back pain (LBP) with or without comorbid diseases.Material and methods. A multicenter prospective cohort OS was conducted in 163 clinical centers in 58 cities of the Russian Federation and included 22,525 patients with OA and LBP who received AF as a part of a planned treatment prescribed by a doctor, or self-prescribed and purchased in a pharmacy. Pain, satisfaction with therapy, health assessment, need for non-steroidal anti-inflammatory drugs (NSAIDs), and quality of life were recorded using the EQ-5D questionnaire.Results and discussion. After one treatment course with AF, improvement was detected in 98% of cases, there was a rapid positive trend with a significant decrease in pain, the median time to clinical effect was 8 [5; 10] days. Assessment of general health status and satisfaction with therapy improved significantly. In 94.5% of patients, the daily requirement for NSAIDs decreased.Conclusion. The first results from the OS confirm the symptomatic effect of AF.

Osteoarthritis (OA) is the most common joint disease due to the increasing life expectancy of the world's population. Every 2nd patient over the age of 50 suffers from knee or hip OA, and this is directly related to the increased burden on healthcare. Accumulated data on the comorbid profile of patients with OA dictate the need to identify disease phenotypes in order to provide personalized care. Individual clinical manifestations of OA also require a differential approach: the pain treatment requires consideration of the patient's psycho-emotional profile and the possibility of involving nociceptive pathways in the process. However, due to the ambiguity of existing clinical guidelines, most experts note a number of difficulties in prescribing treatment for patients with OA.The resolution presents an agreed opinion of experts on the algorithms for managing patients with OA, starting from the primary level, with the gradual involvement of related specialists. Some issues of a personalized approach are considered depending on the presence of comorbid pathology and the severity of individual symptoms of the disease. The prospects of the combined use of pharmacological and non-drug methods of treatment are noted; emphasis was placed on the importance of rehabilitation measures at the first level of medical care, provided to patients with OA, long before the development of structural changes.The proposed algorithms for managing patients can be considered as the basis for future recommendations for managing patients with this pathology.

This review is focused on the issue of terminology in patients with multiple coexisting diseases in modern clinical practice. We articulate that multimorbidity is one of the leading problems in the field of public healthcare and that the treatment of these patients demands an integral approach derived from the combined nature of the pathology . It was shown that multiple coexisting diseases have a negative effect both on the course of osteoarthritis (OA) and its concomitant ailments, including higher risk of polypharmacy and death. Extra attention is paid to slow-acting symptomatic drugs, which often have positive pleiotropic effects towards both the OA and the concomitant diseases. In particular, there is more and more research showing evidence of the beneficial effects of chondroitin sulfate both on the OA treatment effectiveness as well as on the terms of cardiometabolic prognosis, mitigation of glucose metabolism deficiency and mortality.

About 10–40% of patients with osteoarthritis (OA) are not satisfied with the results of total arthroplasty (TA) of large joints. At the same time, the most common complication associated with the ineffectiveness of TA is postoperative pain (PP).Objective: to identify genes whose expression in the peripheral blood before TA is associated with an increased risk of PP developing. Patients and methods. Before TA, the blood of 50 patients with late-stage knee OA was examined; the control group consisted of 26 healthy individuals. The level of pain was assessed using the visual analog scale (VAS), the BPI short questionnaire, and the WOMAC index; the presence of neuropathic pain was assessed using the DN4 and PainDETECT questionnaires. The development of PP was determined 3 and 6 months after TA. The levels of matrix metalloproteinase protein (MMP) 9 and tissue inhibitor of metalloproteinase (TIMP) 1 were quantified by ELISA. Total RNA isolated from blood was used to determine the expression of caspase 3, MMP9, TIMP1, cathepsins K and S, tumor necrosis factor (TNF) α, interleukin (IL) 1β, and cyclooxygenase 2 genes using a quantitative real-time reverse transcriptase polymerase chain reaction.Results and discussion. PP according to VAS ≥30 mm was noted in 17 patients. Before TA, these patients had significantly increased expression of cathepsins K and S, caspase 3, TIMP1, IL1β, and TNFα genes compared to other patients with OA. ROC analysis revealed a statistically significant relationship between the expression of these genes and the likelihood of developing pain after TA.Conclusion. High expression of genes associated with degradation of the extracellular matrix (catepsins S and K, TIMP1), inflammation (IL1β, TNFα), and apoptosis (caspase 3) can serve as an important biomarker for the development of PP in patients with knee OA. To confirm the value of preoperative gene expression testing in predicting the onset of PP, further studies involving large cohorts of patients are needed.

The review systematizes modern data indicating effective pain control and a significant improvement in the functional activity of patients suffering from osteoarthritis (OA) using pharmaceutical substances of chondroitin sulfate (CS) and glucosamine (GA). The effect of a combination of CS and GA on subclinical inflammation (low-grade inflammation) in the joints, slowing down the progression of OA, reducing cardiovascular risk, metabolic disorders, etc. are discussed. There are promising reports of a possible decrease in overall mortality and mortality from cardiovascular diseases during long-term therapy with symptomatic delayed-acting drugs (SYSADOA). A wide range of pleiotropic effects of CS and HA allows us to classify these drugs as geroprotectors and recommend their use not only in OA, but also in various comorbid conditions.

We present the review of clinical and experimental studies on the pathogenesis of neurorheumatological complications (NRC) in COVID-19. The influence of systemic hyperinflammation caused by impaired innate immunity on the functioning of the neurovascular endothelium and the bloodbrain barrier, activation of signaling pathways of innate immunity and parainfectious autoimmunity in the central nervous system were analyzed.Hyperinflammation has been shown to contribute to the development of NRC in COVID-19. The potential therapeutic efficacy of drugs, including those based on chondroitin sulfate, which can be used for the prevention and treatment of NRC in COVID-19, is considered.

The prevalence rate of dry eye syndrome varies from 6.5 to 95 %. Diagnostic criteria are based on different methods and/or their combinations and are characterized by heterogeneity.The aim of the study. To identify the risk factors for the development of dry eye syndrome in order to create a technology for early diagnosis of the degree of the disease in young people without concomitant ocular and general somatic pathology.Materials and methods. Fifty patients aged 24 [22; 27] years were examined. We carried out an ophthalmological examination, including autorefractometry, visometry, biomicroscopy, the Norn test, a survey using the author’s questionnaire, and an assessment of the degree of dry eye syndrome using the Ocular Surface Disease Index (OSDI). Three study groups were formed: control group (OSDI = 0–13 points); group 1 – patients with OSDI = 14–22 points; group 2 – patients with OSDI > 22 points.Results. When examining presented independent variables, screen time had the highest normalized importance (100 %), followed by tear film breakup time (58.4 %), smoking (24.3 %), night shifts (22.5 %) and using soft contact lenses (11.1 %). The technology for early diagnosis of the degree of dry eye syndrome is implemented on the basis of a multilayer perceptron, the percentage of incorrect predictions during its training process was 8.0 %. The structure of the trained neural network included 8 input neurons (the value of screen time and tear film breakup time, the presence or absence of smoking, night shifts and/or the use of soft contact lenses), two hidden layers containing 3 and 2 units, respectively, and 3 output neurons.Conclusion. The proposed neural network has no difficulties in assessing the early diagnosis of the severity of dry eye syndrome and can be used in clinical practice.