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The paper considers problems in the treatment of acute and chronic pain in patients with rheumatic diseases and shows the role of inflammation and muscle spasm in the pathogenesis of acute and chronic pain. It gives the results of clinical trials and the clinical use of nimesulide (Nise ®) and tizanidine (Sirdalud ®) in the treatment of acute and chronic pain.

Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow The paper gives data on the prevalence, pathogenesis, clinical manifestations, and treatment of fibromyalgia (FM) syndrome. It is stated that the ratio of all clinical symptoms of FM syndrome should be borne in mind when treating patients with this disease. Various specialists should be attracted to the treatment of these patients. Psychotropic medications that are prescribed by a psychiatrist are indicated where there is a preponderance of psychological disorders; the duration of this therapy is variable, but not more than 2—3 months. Most patients need proper analgesia, improved sleep quality and duration, and diminished fatigability that frequently leads to lower (none) working capacity. Pregabalin (lyrica) promptly suppresses the major manifestations of FM; the onset of its action is seen just after one week of treatment; the use of the drug may be continued as long as it is effective and safe.

I.M. Sechenov First Moscow State Medical University The given data available in the literature offer new possibilities for the use of leflunomide in rheumatology. The conducted trials enable leflunomide to be considered as a promising agent in the treatment of inflammatory diseases of the joint and vertebral column. The encouraging results of preliminary studies of the efficacy of leflunomide in Crohn's disease, Wegener's granulomatosis, and systemic lupus erythematosus need to be confirmed in large-scale randomized controlled studies.

The paper depicts the aspects of symptomatic therapy for chronic inflammatory diseases of joints and the mechanisms of action of nonsteroidal anti-inflammatory drugs. It gives the data available in the literature on the efficacy of Voltaren (diclofenac sodium) and pharmacodynamic differences of original Voltaren and its generics.

The paper presents the long-term outcomes of rheumatoid arthritis (RA) according to the data of a 15-year prospective follow-up and treatment in 240 patients with the disease. Disease activity resistance (stable remission of more than 2 years, a recurring course with druginduced remissions of 6-18 months, or no remissions), the degree of joint destruction progression, the functional state of patients and their survival were assessed in relation to the time of use of basic anti-inflammatory drugs (BAIDs). In groups 1, 2, and 3, BAID therapy was initiated within the first 5 months of RA, 6-11 and 12-36 months after its onset, respectively. The treatment was monitored, by estimating clinical and X-ray parameters, the functional state of the locomotor apparatus and by correcting the therapy at its stages in the absence of reliable suppression of RA activity and/or with the continuing emergence of new erosions in small joints. The early use of BAIDs under meticulous control of the degree of RA activity suppression and RA progression were shown to frequently achieve clinical and laboratory remissions and to improve functional and life prognosis in the patients.

Objective. To study the functional outcomes of rheumatoid arthritis (RA) 1, 3, 5, and 8 years after use of various procedures of anti-inflammatory therapy. Subjects and methods. One hundred patients with valid RA were examined. The patients were divided into 3 groups: 1) 38 patients received basic anti-inflammatory drugs (BAIDs) only; 2) 37 patients took BAIDs in combination with glucocorticoids (GCs); 3) 25 patients had synchronous programmed intensive therapy. Results. The early use of therapy with BAIDs without GCs in controlled therapy allows functional outcome improvement in patients in RA to greater extent. No therapy control leads to functional outcome worsening in RA. During a long follow-up, there is a reduction in the correlation of the Health Assessment Questionnaire (HAQ) scores with the parameters reflecting disease activity and an increase in the correlation of the HAQ with those reflecting the progression of RA. The development of the structural and anatomic changes in hand periarticular tissues with the formation of irreversible deformities does not correlate with the HAQ score in patients with RA.

Ревматоидный артрит (РА) – системное воспалительное заболевание с преимущественным поражением суставов, обычно полиартикулярное. Заболевание может дебютировать с постепенно- го нарастания активности воспаления или остро, может иметь неуклонно прогрессирующее течение или протекать с периодическими обострениями, следующими за улучшением. Хронический характер течения РА обусловливает нарушение функциональных способностей больного, что в тяжелых случаях может привести пациента к необходимости передвижения на коляске или даже к невозможности покинуть постель. Несмотря на успехи терапии, в целом прогноз РА остается серьезным. В первую очередь это касается функциональной недостаточности (ФН) больных и снижению (утрате) их трудоспособности. По заключению T. Pincus и L.F Callahan [1] через 10 лет от начала болезни инвалидизируется 60% пациентов. В Швеции, по данным E.Fex и соавт.[2], через 8 лет от начала болезни не могли работать 37% больных. В Москве, по материалам О.М. Фоломеевой и соавт. [3], в 1999 г. стойкая нетрудоспособность при РА наступала в среднем через 8 лет от начала болезни, средний возраст выхода на инвалидность составил 48,5 года. РА ассоциируется также с повышением летальности, чаще всего по причине кардиоваскулярных заболеваний как следствия хронического воспаления, повышения риска развития лимфом, коррелирующим с тяжестью заболевания, а не с видом проводимой терапии, кроме того, осложнения терапии также могут влиять на продолжительность жизни больных. В настоящее время стало очевидным, что рано начатое лечение базисными противовоспалительными препаратами (БПВП) способно существенно улучшить функциональный и жизненный прогноз при РА. Однако проблема ранней диагностики РА до сих пор не решена, поскольку диагностические критерии РА не соответствуют цели как можно более ранней дифференциации раннего РА от других форм артритов [4] (рис.1). Это приводит к задержке с назначением БПВП и ухудшает функциональный прогноз при РА.

Aim. To assess leflunomide efficacy and tolerance in patients with rheumatoid arthritis (RA) during the first four months of the treatment. Material and methods. The study included 200 RA patients treated in four Moscow clinical centers. Leflunomide was given in a dose of 100 mg/day for 3 days, then 20 mg/day for 16 weeks. The activity of the disease according to the criterion DAS 28 was assessed before the treatmend and 4, 8, 12 and 16 weeks after the treatment start. Results. RA activity diminished considerably after one month of leflunomide treatment. Later, the articular syndrome continued to improve. A significant improvement by DAS 28 was observed after 16 weeks of the treatment in 65% (129 of 200) patients, high RA activity persisted only in 17 of 90 patients. Conclusion. Leflunomide reduces articular inflammation and raises RA patients' quality of life at early stages of the treatment. This reduction continued for 4 months of the study. Therefore, adequate assessment of leflunomide efficacy should be made only after 4-6 months of therapy.

According to modern ideas, pain is a multidisciplinary problem with serious medical and socio-economic importance. The most common pain occurs in various structures of the musculoskeletal system. It is noted that the universal mechanism of acute and chronic pain is inflammation, which requires therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Data on the effectiveness and good tolerability of local NSAIDs are presented. The latest recommendations of the international Committee ESCEO 2019 on the management of patients with osteoarthritis (OA), which confirms the effectiveness and safety of local forms of NSAIDs, in connection with which, ESCEO recommends their use in elderly patients, in patients with comorbid conditions and at high risk of adverse reactions. It is also envisaged to use these drugs for the treatment of OA before the appointment of systemic NSAIDs. The results of randomized clinical trials (RCTS) and meta-analyses confirming clinical efficacy and safety in the treatment of acute and chronic pain by one of the representatives of local NSAIDs-diclofenac sodium gel are presented. Diclofenac sodium gel has been shown to be more effective than placebo in the treatment of acute and chronic pain. Good tolerability of the drug was observed in patients in different age groups, including patients older than 65 years, and in patients with comorbid conditions. The results obtained indicate the effectiveness and good tolerability of diclofenac sodium gel, including long-term, and allow the drug to be widely used as symptomatic therapy for the treatment of acute and chronic pain, including in elderly patients and patients with comorbid conditions.

Treatment of diseases of the musculoskeletal system to date remains not only a serious medical, but also socio-economic problem. Chronic diseases of the joints and spine are one of the most common causes of disability in patients. The main clinical manifestations of most diseases of the musculoskeletal system are pain and inflammation, which requires adequate antiinflammatory therapy. The data on various mechanisms of action of non-steroidal anti-inflammatory drug (NSAID) diclofenac (Voltaren), as well as the results of clinical studies and meta-analyses confirming its effectiveness and good tolerability are presented. The data of experimental and clinical studies of the efficacy and safety of local forms of diclofenac-Voltaren Emulgel (diclofenac-diethylamine) –are presented. Provides information about the form of the Voltaren Emulgel 2% for 12 hours. It is shown that a wide range of analgesic and anti-inflammatory effects of diclofenac (Voltaren), and good tolerance can be used as symptomatic therapy in the treatment of diseases of the musculoskeletal system.