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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).

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.

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.

Objective. To assess clinical efficacy and tolerability of "Karmolis" liquid (KL) in pts with osteoarthritis (OA) and rheumatoid arthritis (RA). Material and methods. 230 RA pts and 123 OA pts were included. KL was applied on the most damaged joint surface 10 ml 4-5 times a day with subsequent massage. The course of the treatment continued for three weeks. Joint pain at rest, at movement and at palpation so as joint swelling were used as efficacy measures. Treatment efficacy was assessed at day 1, 7, 14 and 21. Possibility of NSAID dose decrease was also recorded. Results. KL administration provided significant decrease of joint pain at rest, at movement and at palpation already to day 7 as in RA as in OA pts. The improvement then persisted during the rest period of treatment. Joint swelling disappeared to the end of the treatment in 141 from 209 RA pts having such changes at baseline. 74% of RA pts considered KL efficacy very good and good. Synovitis signs disappeared after the treatment with KL in 52 from 65 OA pts. Vfcry good and good results were achieved in 102 (83%) of OA pts. 76 RA pts (33%) and 73 OA pts (53%) could decrease NSAID dose. Adverse events were very seldom and did not require treatment termination. Conclusion. KL in effective in complex treatment of RA and OA. It decrease pain and inflammation and may be recommended for wide administration in the treatment of inflammatory and degenerative joint diseases.

Objective. To investigate the several parameters of femoral neck geometry associated with hip fracture risk in Siberial population. Material anil methods. 51 patients (39 women and 12 men: aged 60-90 years) with hip fractures and 102 persons (78 women, 24 men) without fractures (control group). Bone mineral density (BMD) was measured by dualenergy X-ray absorptiometry (DPX-IQ, Lunar, USA) in lumbar spine and in the hip (femoral neck, trochanter, Ward’s triangle) of the contralateral hip to the fracture. BMD was not significant in both groups. We measured hip axis length (the distance from greater trochanter to inner pelvic brim), the femoral neck axis length (the distance from the trochanter to ihe apex of the femoral head), neck width and the neck/shaft angle on the scan printout. Results. The hip axis length was longer in the women with the hip fractures (56,3±3,9 mm vs.53,7±3,7 mm, p

Preliminary results of interregional program “Social and economic consequences of rheumatic diseases” diagnostic stage are presented.Objective. Clinical examination of persons with joint pathology revealed during screening to determine the diagnosis.Material and methods. A group of persons, who had joint complaints at the examination or during the previous year, was randomly formed according to the results of screening. Thorough uniform clinical examination with participation of a qualified rheumatologist aimed to precise determination of rheumatic pathology character was performed in all cases. During screening 1755 from 2723 persons examined at diagnostic stage positively answered question about presence of joint swelling and 968 complained of pain in knee and hip joints.Results. In 1971 from 2723 persons (72,4%) different rheumatic diseases were diagnosed. Nonrheumatic pathology was revealed in 371 (13,6%), low back pain – in 218 (8%) persons. In 163 (6%) persons no disease was determined. Osteoarthritis (49%) and rheumatoid arthritis (3%) were the most frequent causes of joint complaints. Other RD were revealed in 20%.Conclusion. Preliminary results of program diagnostic stage demonstrated significance of joint pathology problem and allowed to get the first data about structure of RD among adult inhabitants of Russia.

Objective. To reveal in a population sample people with joint pain and swelling. Material and methods. A screening questionnaire for revelation arthritis and arthralgia was filled for each adult resident of 18 years or older. Screening examination was performed in country and city samples. Universal examination was performed among country residents, representative sample was formed for city residents. Results. 23438 residents were screened, mean age was 48,1 ±17,6 years. Women were prevalent - 60%. 8016 were city and 15422 - country residents. Joint pain prevalence was 45%, joint swelling - 27%. These symptoms disappeared with time in 7% and 6% respectively. In other people they became chronic. Population prevalence of joint complaints is connected with sex and depends on age. In people younger than 20 years of age prevalence of joint pain was 9% and swelling - 3%. Conclusion. Preliminary analysis of the screening part of the study showed scale of the joint pathology problem and allowed to get the first data on prevalence of arthralgia and arthritis in Russia.