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The cross section of atomic electron Compton scattering γ+e→γ′+e′ was measured in the 4.400–5.475 GeV photon beam energy region by the PrimEx collaboration at Jefferson Lab with an accuracy of 2.6% and less. The results are consistent with theoretical predictions that include next-to-leading order radiative corrections. The measurements provide the first high precision test of this elementary QED process at beam energies greater than 0.1 GeV.

The possibility of intensity enhancement of Raman scattering of near infrared light on the photon band gap edge in periodic multilayer structures produced from porous silicon consisting of porous silicon layers sequences with a high and low refractive index was shown theoretically and experimentally. The obtained results show perspectivity of use of these structures as a matrix for enhancement of Raman scattering efficiency.

Introduction. The article discusses the problem of assessing the similarity of the dissolution profiles of two batches of the nebivolol. The use of a generally accepted similarity factor for assessing equivalence is unacceptable in some cases, for example, for drugs with a high variability in the values of the release of the active substance from the formulation. At the same time, at present, there are no generally accepted approaches to comparing the profiles of the dissolution kinetics of drugs, with the exception of the method for assessing the comparability of profiles based on the mathematical calculation of the similarity factor f2, which has certain criteria that limit its application.Aim. To demonstrate alternative methods for assessing the similarity between the dissolution profiles of two drugs using a practical example.Materials and methods. The results of the comparative dissolution test of two series of nebivolol at a dosage of 5 mg. Five model-independent methods for assessing the equivalence of drug dissolution were used. Statistical data processing was performed using Microsoft Excel software.Results and discussion. The paper presents a practical example of using five alternative model-independent methods for assessing the equivalence of the dissolution profile. An example is used to illustrate the proposed equivalence limits and statistical methodology. Also, various approaches to determining the boundaries of equivalence have been proposed to assess the similarity of the dissolution profiles of an active substance.Conclusion. According to the results of the comparative dissolution test of two batches of nebivolol, it was shown that the use of the similarity factor as a criterion for assessing dissolution profiles led to a false positive result. In such cases, the possibility of using alternative methods for assessing the equivalence of dissolution profiles described in the article, or other methods presented in the scientific literature, should be considered, with a justification of their acceptability in each specific case.

The article covers basic scales and tests used in clinical trials and medical practice for the assessment of the effectiveness of treatment of spasticity syndrome with preparations of botulinum toxin type A in children with cerebral palsy. The article gives the information about the recommended methods of assessment, suggests the scales that can be used in evaluation of the effectiveness, as well as carries out an analysis of their informativity and sensitivity.

Regulatory approaches to assessing the safety of homeopathic medicines in the Russian Federation and abroad are formed in accordance with regulatory acts, national and international rules and guidelines. Scientific literature is particularly important for justification of safety of homeopathic medicines. The purpose of this study was to determine the requirements and procedure for presenting justification of homeopathic medicines safety in the registration dossier in accordance with the documents of the Eurasian Economic Union and the European Union. According to the current Russian and foreign regulatory approaches the safety may be justified by scientific literature data on homeopathic use and by substantiation of the dosage in the case of medicines that have long experience of safe use and those that are authorized under a simplified procedure based on a dossier with a product instruction that does not establish indications for use. In both cases, there is no need to provide the results of preclinical or clinical studies of the drug. This approach reflects specific features of homeopathic medicines. An objective criterion of the safety of homeopathic medicines is the assessment of the dosage of active substances, taking into account the «first safe dilution» of homeopathic substances. A formal safety justification using registration data for similar drugs or additional information on the use of these pharmaceutical substances in homeopathy is also possible, but may be insufficient. The completeness and proper documentation of bibliographic data are the main criteria for an appropriate rationale for the safety of homeopathic products.

Osteoarthritis (OA) is one of the most common rheumatic diseases. Knee OA is particularly frequently encountered among all forms of OA, the prevalence of knee OA being about 25% in the general population. Despite multiple guidelines for the management of knee OA, which have been prepared by the European League Against Rheumatism (EULAR), the American College of Rheumatology (ACR), and the Osteoarthritis Research Society International (OARSI), many problems of its treatment policy remain to be solved. The same holds true for not only the symptomatic and disease-modifying effects of chondroprotectors, but also topical therapy options.Objective: to evaluate the clinical efficacy and safety of Carmolis gel in patients with knee OA.Subjects and methods.The trial included 280 patients with knee OA (a study group consisted of 190 patents; a control group comprised 90 patients). The mean age was 58.3±9.3 years in the study group and 59±10.5 years in the control group. The disease duration was 10.3±5.5 and 10.1±4.1 years, respectively. Carmolis gel was applied to the region of the most painful knee joint up to 4–5 times daily, followed by massage of this skin area. The treatment cycle lasted for 2 weeks. No therapy was performed in the control patients. The clinical efficacy was determined by the changes in joint pains at rest or on movement and palpation, according to a visual analogue scale (VAS), WOMAC questionnaire, the synovitis intensity (assessed by ultrasonography), patient and physician global assessments of disease activity (Likert scale), and the possibility of reducing the daily dosage of nonsteroidal anti-inflammatory drugs (NSAIDs). The onset the therapeutic effect of the gel and the duration of its action were recorded.Results and discussion. The topical application of Carmolis gel caused a statistically significant reduction in joint pain at rest and on movement from 57.7±6.8 to 12±1.8 mm (р < 0.01) and from 52±5.3 to 17±2.7 mm, respectively (р

Methotrexate or leflunomide is used as a first-line synthetic disease-modifying anti-rheumatic drug in the therapy of rheumatoid arthritis (RA). In 2011, the Russian Federation registered and since it has been successfully using leflunomide**.Objective: to evaluate the efficacy and tolerability of leflunomide** used to treat RA in routine clinical practice.Subjects and methods.The investigation enrolled patients with varying duration of RA that met the 1987 classification criteria. The patients were followed up in 33 healthcare facilities of Russia from March 2013 to October 2014. A total of 235 patients were randomized; the data of 196 patients were statistically processed. The mean age of the patients was 52.4±11.8 years; the mean duration of the disease was 75.4±69.1 months. The disease activity estimated by DAS28 and CDAI were 5.5±1.2 and 35.1±14.3 scores, respectively. 105 and 57 patients had X-ray Stages II and III disease, respectively. 80.1% of the patients were positive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies. According to the instruction of its use, leflunomide was administered in a dose of 100 mg/day during the first 3 days and then in that of 20 mg/day. When adverse reactions (ARs) occurred, it was recommended that the daily dose of the drug was decreased to 10 mg. The patients were examined before and 1, 3, and 6 months after treatment. The investigators measured the number of tender joints (NTJ) and that of swollen joints (NSJ), and visual analog scale (VAS) pain intensity, performed a laboratory examination involving clinical blood test, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), in patients during their visits to physicians. The disease activity was assessed with DAS28 and CDAI and ARs were recorded.Results. Six-month therapy reduced the mean NSJ from 10.9 to 7.5%, NTJ from 12.3 to 8.9, VAS pain intensity from 64.1 to 39.3 mm, on average, ESR from 37.04 to 23.6 mm/hr, and CRP from 27.8 to 12.35 mg/l. By 6 months of therapy, low and moderate RA activities estimated by DAS28 were noted in 70.9% of cases and those by CDAI in 61.2%. No serious ARs were detected during the study.Conclusion. The findings suggest that leflunomide shows a good clinical efficacy and tolerability.

By taking into account the fact that there are a few alternative biological agents for the treatment of rheumatoid arthritis (RA), the cost of an annual therapy cycle using the agents is greater than that of high-technology surgical interventions, and a pharmacoeconomic study substantiating the optimal choice of a specific drug has been conducted. The pharmacoeconomic analysis has indicated the use of the biological agents etanercept (ETC) can decrease the cost of an annual therapy cycle for each patient with RA by an average of 84,764–481,622 rubles and considerably increase the number of patients receiving the current therapy without allocating additional resources. Switching 100 patents with RA to a treatment regimen including ETC enables 14–78% of the patient with this condition to be additionally treated within the framework of the same budget. The given results with regard to the data that there are significant differences in the efficacy and safety of biological agents usedto treat RA (National and EULAR guidelines for the treatment of RA, a number of meta-analyses of randomized controlled clinical trials) may conclude that the treatment regimen incorporating ETC is most preferential. The cost-effectiveness analysis based on the single meta-analysis proposed by G.J. Bergman et al., which had demonstrated differences in the efficacy of biological agents, also yielded the similar results. In this case, the administration of ETC is also more preferential because it can minimize expenditures of the health care system to achieve ACR20 and ACR50 responses. This advantage of ETC will cause the highest reduction in the number of hospital admissions, social benefits, and other expenses associated with the management of patients with RA. The authors are aware of the disadvantages of the performed trial, which cannot fully interpret uniquely the findings: the results of meta-analyses have limitations due to its low sensitivity in assessing the differences between the drugs; the virtually complete absence of published data on the direct comparison of the drugs, by employing sufficient patient samples, makes it necessary to use the data of the meta-analyses and to state that biological agents have similar efficacy and safety within the clinically permissible limit to recognize their equivalence; the trial has considered only an annual perspective to use the agents without regard for their therapy discontinuation rate and remission rate that requires that treatment should not be continued.

Objective. To study the association between the clinical manifestations and work ability in patients with rheumatoid arthritis (RA) and to elaborate mathematical methods for predicting work productivity indicators according to the evaluation of the functional status of patients and disease activity.Material and Methods. A total of 185 RA patients were examined; 105 of them were employed. The mean age was 48.2±11.3 years; RA duration was 77.9±70.7 months; DAS28 4.68±1.53; visual analogue scale (VAS) score was 40.6±22.2; HAQ was 1.3±0.7. The employed patients in the test group had a longer duration but weaker activity of RA according to DAS28 as compared to those in the control group (p

Objective: to study the impact of the clinical characteristics of rheumatoid arthritis (RA) on work efficiency. Subjects and methods. One hundred and thirty-seven patients (116 women and 21 men) with RA were examined. Their mean age was 52.03+13.17 years; mean age at disease onset was 42.12+14.43 years. Median RA duration was 84 (range 24-174) months. DAS 28 for RA was moderate. The HAQ score was 1.42+0.82. Results. Fifty-nine (43%) of the 137 patients were in work. Absenteeism was 28.2%. It was equal to 0 in 28 of the 59 working subjects. The mean presenteeism was 42.3±27.9%. The reduction of overall work efficiency was 54.8±34.4%. The day-to-day activity determined in all the patients was reduced by 53.6±25.7%. Absenteeism turned out to be negatively related to RA duration (R = 0.26). DAS 28 scores were directly related to all WPAI indicators: absenteeism (R = 0.28), presenteeism (R = 0.63), lower overall work efficiency (R = 0.47), day-to-day activity (R = 0.64). The WPAI indicators (R >0.5), exclusive of absenteeism, were noted to have the strongest correlation with VAS pain intensity. The HAQ score was unassociated with absenteeism, but its association with presenteeism, lower overall work efficiency, and day-to-day activity proved to be high (R = 0.65; R = 0.43; R = 0.75, respectively). The correlation of the WPAI components with the transformed index of a patient's physical state (SF-36 PCS) was much higher than that with mental one (MCS). Conclusion. RA activity had a major influence on work efficiency. Presenteeism was much stronger related to the clinical characteristics of RA than with absenteeism. All WPAI scores were associated with activity, degree of functional defect, quality-of-life values, and fatigability. At the same time, absenteeism was least related to the clinical characteristics of RA.

Objective: to analyze disease activity, functional state, quality of life (QL), and the frequency of infectious complications in methotrexate (MT) – or leflunomide (LF)-treated patients with rheumatoid arthritis (RA) who had undergone endoprosthetic replacement of the large joints of the lower limbs. Subjects and methods. One hundred and fourteen patients with RA who had undergone endoprosthetic replacement of the knee and hip joints were divided into 3 groups: 1) 36 patients who continuously received MT or LF in the perioperative period; 2) 42 patients who dis- continued MT or LF 2 and 4 weeks, respectively, prior to surgery; 3) 36 patients who took no disease-modifying anti-rheumatic drugs (DMARDs) within 12 months before surgery. Disease activity was estimated by the DAS28 index. QL was determined using the EQ-5D questionnaire and functional capacity was estimated by the HAQ index. Results and discussion. In all the groups, there was a preponderance of patients with moderate RA activity (more than 60%). In Groups 1 and 2, the mean dose of MT was about 10 mg weekly and that of LF was 20 mg daily. The use duration of glucocorticoids (GC) and their doses were comparable in all the groups. Twelve months after surgery, DAS28 significantly reduced from 4.22±1.08 to 3.58±1.07 months in Group 1 (p = 0.01); in Group 2, the decrease was insignificant: from 4.17±1.17 to 3.80±1.15 (p > 005); in Group 3, RA activity remained as before. All the groups achieved 50% functional improvement; better results were obtained in the group of patients who continued to use DMARDs in the perioperative period (∆HAQ=-0.67). The difference in the Eq-5D index corresponded to a moderate QL improvement: ∆EQ-5D = 0.28, 0.29, and 0.31 in Groups 1, 2, and 3, respectively (p < 0.05). There were no significant group differences. Deep infection in the endoprosthetic replacement area was detected in 2.8, 2.4, and 8.3% of cases, respectively (p > 005). Conclusion. Continuous use of MT and LF leads to a reduction in total disease activity and to functional improvement in patients with RA after endoprosthetic joint replacement, without increasing the frequency of infectious complications.

Objective. To evaluate the functional state of rheumatoid arthritis (RA) patients receiving Infliximab therapy (IF) in real clinical practice and its efficiency. Subjects and methods. The analysis covered 225 patients receiving IF therapy, the follow-up duration in whom was 54 weeks. Disease activity was estimated by the DAS 28 index; functional status was assessed according to the Health Assessment Questionnaire (HAQ). The authors made an analysis of a Per-Protocol (PP) population (n = 154) at 54 weeks of treatment and an analysis that could consider the results of treatment (by the ACR and EULAR criteria) in patients who had been withdrawn before the control time - a LOCF (Last Observation Carried Forward analysis) population. Results. The mean age of the patients was 47.6±11.4 years; the duration of the disease was 7.8±6.4 years; DAS 28 activity scores were 6.6±1.1; the majority of patients had significant functional impairments (HAQ scores of 2.0±0.7), 86.7% of the patients had extraarticular manifestations; 79.6% were found to have rheumatoid factor (RF); the patients received an average of > 2 disease-modifying antirheumatic drugs (DMARDs). After 2 week-therapy, there was a reduction in RA activity by DAS 28 index in both the PP (from 6.7±1.1 to 4.0±1.4) and LOCF (6.6±1.1 and 4.2±1.4; p < 106) populations. Drug-induced remission (DAS 28 < 2.6) at 54 weeks was observed in 16.9 and 15.1% of the patients, respectively. Functional improvement was noted in the PP population: HAQ decreased from 2.0±0.7 to 1.7±0.7 scores by week 2; its reduction continued until week 14 (p < 0.05), by remaining stable later on. HAQ dropped from 2.0±0.7 to 1.2±0.7 scores in the LOCF population. At 54 weeks, normal population values of functional activity were achieved in 16.4%. Log regression analysis in the LOCF population indicated that the previous use of DMARDs and a short history of the disease were predictors of an ACR70 response to IF therapy [OR=1.61 (1.13-2.30), p = 0.008 and OR = 0.91 (0.84-0.98), p = 0.018, respectively]. RF seronegativity was a predictor for achievement of low RA activity [OR = 0.44 (0.23-0.84)]. The previous use of glucocorticoids failed to increase the probability of a good response to IF therapy and achievement of clinical remission [OR = 0.26 (0.11-0.60), p = 0.001]. Conclusion. Therapy with IF in combination with methotrexate or other DMARDs reduces RA activity and improves the functional capacities of patients with RA in real clinical practice.

Objective: To evaluate the functional status of patients with rheumatoid arthritis (RA) receiving two courses of rituximab (RTМ) therapy and its efficiency from the Russian registrys data. Subjects and methods. The analysis covered 269 patients receiving 1 or 2 courses of RT therapy, their clinical follow-up schedules and quality of life (QL) questionnaires were filled in before drug administration and at 8, 16, and 24 weeks of a follow-up: 220 and 49 patients received 1 and 2 courses of RT therapy, respectively. The DAS28 index was used to evaluate disease activity; the patients functional status was assessed according to the Health Assessment Questionnaire (HAQ). Results. The patients' mean age was 46.5311.79 years; the disease duration was 9.806.87 years; disease activity scale (DAS28) scores were 6.501.06; the majority of patients had significant functional disorders estimated at 1.90 [1.37-2.38] scores according to the HAQ; 78% patients had extra-articular manifestations; rheumatoid factor was detected in 82.9%; the patients received more than 2 basic antiinflammatory drugs on average; 33.5% took TNF-р inhibitors. After the first course of therapy at 24 weeks of the follow-up, there was a gradual decline in DAS28 from 6.491.05 to 4.091.32 scores (p < 0.000001, ANOVA). A significant reduction in serum C-reactive protein was achieved during the first course of therapy just at 2 weeks of the follow-up. A decrease in DAS28 to і1.2 was seen in 79.9 of the patients after the first course at 24 weeks of the follow-up and in 85.7% after the second course. 13% of patients achieved drug-induced remission (DAS28

Objective. To evaluate the functional status of patients with rheumatoid arthritis (RA) in Russia, to compare the distribution and associations between functional insufficiency (FI) and functional class (FC), as well as disability groups (DG), and to consider their impact of a number of the patients' demographic, social, and clinic characteristics. Methods. Rheumatologists from 27 cities and towns of Russia (a total of 30 centers) participated in the cross-sectional epidemiological study. The study included all patients with valid rheumatoid arthritis, who had consecutively turned to a polyclinic rheumatologist or who had been treated at hospital for 3 months. The demographic and social characteristics of a patient, his/her occupation, the onset and duration of RA, DG and a reason for its receiving, and the patient's clinicofunctional status at the study were recorded. Results. A total of 1504 patients, including 1271 women, were examined; their mean age was 53 years; the mean duration of the disease was 10.5 years; 80.4% were seropositive for rheumatoid factor; 94.3% patients had erosive arthritis (X-ray stages II-IV RA). High disease activity scores (DAS) were found; the mean DAS [Mean (SD)] was 5.44±1.18. Severe extraarticular manifestations were identified in 10% of cases. 63% of the RA patients were in FC III and IV; 67% had grades 2 and 3 FI, and 44.5% had DGs I and II. An association was found between FC and FI (r = 0.43; p < 0.0001), DG (r = -0.396; p

Objective: To study the severity of rheumatoid arthritis in a Russian patient population on the basis of the data of rheumatological care. Methods. Polyclinic and hospital rheumatologists from 27 cities and towns of Russia (a total of 30 centers) participated in the cross-sectional epidemiological study. The study included all patients with valid rheumatoid arthritis, who had consecutively turned to a polyclinic rheumatologist or who had been treated at hospital during the established 3-month period. The demographic and social characteristics of a patient, his/her occupation, comorbidity, the onset and duration of rheumatoid arthritis, clinicofunctional status at the study and antirheumatic therapy were recorded. Results. A total of 1504 patients, including 1271 women, were enrolled; their mean age at the study was 53 years; the mean duration of the disease (after the onset of its first symptoms) was 10.5 years. Most (66%) patients had a family. More than half of the examinees were professionals and specialists. More than 64% of patients were unemployed at the study. Mean disease activity scores were high: morning stiffness [Ме, range 25-75%] for mean 60.0 (30.0-180) min; number of tender (mean [SD] - 26.1±15.8), and swollen (13.4±11.4) joints; ESR, 29.45±15.5 mm/hr; pain, 58.1±22.6 mm (VAS); general health status, 57.4±20.6 mm (VAS). The mean DAS28 score (mean [SD]) was 5.44±1.18. The absolute majority (94%) of patients had erosive arthritis (Steinbrocker stages II-IV). Severe extraarticular manifestations were identified in 10%. The distribution of the patients by the ACR functional classes was as follows: Class I, 8%; Class II, 29%; Class III, 52%, and Class IV, 11%. Comorbidity was as high as 75%, there was a preponderance of cardiovascular diseases, diabetes mellitus, and chronic lung disease. The mean HAQ score in the examined patient cohort was 1.81±0.8. At the study, 89 and 43% of the patients received nonsteroidal anti-inflammatory drugs and systemic glucocorticoids, respectively. Methotrexate (62%) headed the list of basic anti-inflammatory drugs, sulfasalazine (8%), leflunomide (7%), and aminoquinolines (6%) were much less frequently used. Biologicals were given to 9% of the patients. Conclusion. The examined cohort of Russian patients with rheumatoid arthritis, which reflects experience in real clinical practice, is generally characterized by the severe course of the disease in both clinical and functional parameters.

Lethality of pts with rheumatoid arthritis (RA) exceeds mortality values in general population. Possibility of disease modifying anti-rheumatic drugs (DMARD) influence on RA pts lethality has been widely discussed lately in scientific works. Objective. To determine possible lethality diminishment in Russian population of RA pts with one of biological drugs TNFα antagonist adalimumab. Material and methods. Model construction is based on the fact of lethality dependence on pt functional state assessed by HAQ. Model simulating progression of functional disability in pts with RA visiting medical institutions of Russia was made (RAISER study). 3 model variants for imitation of consecutive change of DMARDs including adalimumab were done. First consecution assessed DMARD change in the next chain: adalimumab-methotrexate-sulfasalazine-leflunomide-azathioprine-cyclosporine-palliative therapy. Second consecution: adalimumab administration after failure of first 3 DMARDs. Third consecution considered only change of synthetic DMARDs without adalimumab inclusion. Model imitated participation of 3000 pts in every consecution. Prognosis horizon was 12 years. Age of pts and initial HAQ distribution were get from results of epidemiological RAISER study. Calculation was done on the base of elevation of standardized lethality level (SLL) in population of RA pts in average from 135% to 300%. SLL values from 80 to 320% were used depending on functional disability degree with converting to Russian values of age-specific lethality coefficient for 1999. Results. Lethality in treatment consecutions including adalimumab was significantly lower. To the end of 12th year in group not using adalimumab, using it at once and using it after 376 DMARDs respectively 65,1%, 71,6% and 71,1% of pts were still alive. Conclusion. Significant decrease of lethality with adalimumab inclusion in consecution of DMARD change during treatment of RA pts was demonstrated with imitation modeling method.

Во всем мире продолжается разработка эффективных средств для диагностики и лечения ревматических заболеваний. В последнее десятилетие сделано большое количество открытий, созданы принципиально новые технологии, основанные на использовании достижений молекулярной биологии, которые позволяют значительно улучшить качество жизни (КЖ) больных тяжелыми воспалительными заболеваниями суставов.Все большее значение приобретает оценка экономической эффективности терапии больных ревматоидным артритом (РА). Это обусловлено быстрыми темпами роста стоимости лечения, особенно вследствие все более широкого применения новых генно-инженерных биологических препаратов, при выборе которых приходится учитывать не только их клиническую эффективность, но и стоимость, а также тенденцией к общему удорожанию медицинских услуг. Ни одно государство не располагает достаточными средствами для того, чтобы полностью покрыть потребности национального здравоохранения, а для рационального их распределения необходимо проведение тщательного экономического анализа [1].

Severity of hands and feet joint destruction is the most objective marker of rheumatoid arthritis (RA) progression determining functional disability. The main aim of RA treatment is suppression of joint destruction. Objective. To study dependence of joint erosions forming speed on disease modifying anti-rhcumatic drugs (DMARD) administration and RA activity. Material and methods. Retrospective analysis of 451 cases of RA treatment was performed. Erosions were counted according to modified Sharp method. Erosions forming speed was counted as ratio of erosion number increase to a year’s time space. Averaged disease activity was calculated as arithmetic mean for all DAS28 values obtained during disease course. Considering close relationship between disease activity and DMARD administration two-factor analysis was used. DMARD administration (>3 months) and mean activity of RA were considered as factors. Results. Variance analysis (ANOVA) with covariant showed that mean RA activity is a significant factor influencing erosions forming speed (F=12,5; p=4xl0 4). Character of DMARD, fact of its administration and disease duration did not significantly influence erosions forming speed considering disease activity covariant. Regression model with inclusion disease duration factor mean disease activity and DMARD administration at the moment of assessment allowed to explain 42% of dispersion (determination coefficient). Conclusion. Activity of RA is the main factor influencing erosions forming speed. Therapy not decreasing activity of RA does not change erosions forming speed

To standardize general quality of life (QL) questionnaire SF-36 scales and calculate population scale measures depending on respondents sex and age. Material and methods. Standardized QL measures of all SF-36 questionnaire scales were calculated in 3400 respondents of 5 centers of Russian Federation stratified according to sex and age. Results. Male population had better QL measures than female (p

Aim. To design Markov's model of decision making to study the role of order in the use of most usable basic antirheumatic drugs (methotrexate-MT, parenteral gold -PG and sulfasalasine - SS) in terms of the course duration and cost. Material and methods. The model was based on metaanalysis made in 2000. The program TreeAge 3.0 was used. The prices for the drugs were taken as mean about Moscow for 2002 and prices presented by ACR for 2002. Results. The sequence MT-PG-SS had the advantage over the other sequences in that less number of patients stopped treatment after 5 and 10 years of therapy. Mean cost of the drugs per patient is the lowest (for five years) if MT is prescribed first. In longer treatment SS-MT-PG is more cost-effective. Conclusion. It is feasible to design Markov's models for making decision on optimal therapy of rheumatoid arthritis both in terms of cost and clinical response.

Objective: to evaluate the efficacy and safety of immard in rheumatoid arthritis (RA) in outpatient practice. Subjects and methods. The open-labeled uncontrolled trial enrolled 30 patients with the reliable and valid diagnosis of RA of varying duration. Immard was used in patients with early RA or as an additive agent when a disease-modifying anti-rheumatic drug (mainly methotrexate) was ineffective. The effect of immard was evaluated 3 months of its intake of 400 mg from the number of swollen and tender joints, patients' and physicians' total ratings of disease activity on a visual analogue scale, from ESR values, C-reactive protein (CRP) levels, and DAS28 scores. Results. There was a significant decrease in the number of swollen joints and DAS28 scores in the patients receiving a combination of methotrexate and immard. No significant reduction in ERS and CRP levels was revealed during the follow-up period.