N. V. Matveeva

The article presents a clinical and pharmacological review of modern approaches to the diagnosis and treatment of pericarditis, with an emphasis on practical recommendations for selecting anti‑inflammatory therapy. The etiological structure of pericardial diseases and the key clinical manifestations of acute, recurrent, and chronic pericarditis are examined. The regimens for using non‑steroidal anti‑inflammatory drugs, colchicine, and glucocorticosteroids are analyzed in detail, along with a comparative assessment of their efficacy and safety. Special attention is paid to the use of interleukin‑1 inhibitors in patients with idiopathic recurrent pericarditis: the results of the COURSE study, dosing regimens for golimumab, and recommendations from experts of the Russian Society of Cardiology are presented. Issues related to the safety of combination therapy with NSAIDs and oral anticoagulants are considered separately. Algorithms for selecting therapy are proposed, depending on the severity of the disease, the response to standard regimens, and the patient’s comorbid background.

The aim of the article is the gender characteristics study of the adverse drug reactions (ADRs) development based on the data of the notification forms registered in the regional database ARCADe (Adverse Reactions in Crimea, Autonomic Database), for the period from 2009 to 2018.Materials and methods. The objects of the study were 6903 notification forms about adverse drug reactions recorded in the regional database called ARCADe (Adverse Reactions in Crimea, Autonomic Database) for the period from 2009 to 2018. The classification of drugs for separate pharmacological groups was carried out using the codes of the Anatomical Therapeutic Chemical (ATC) classification system of the World Health Organization (WHO) medicinal products, the instructions data of the State Registers of medicinal preparations used in the Russian Federation and Ukraine (for the cases registered before the entry of the Republic of Crimea into the Russian Federation).Results. A general analysis of the number of cases of the adverse drug reactions (ADRs) development in patients of different genders made it possible to determine that 59.9% (4132 notification forms) of ADRs cases were observed in female patients; 37.7% (2602 cases) – in male patients. In 169 cards (2.4%), information about a patient’s gender was missing. The groups with the largest number of the registered cases of ADRs were antimicrobial agents for a systemic use (2864 cases, 41.5% of the total number of the ADRs registered cases), the drugs affecting the cardiovascular (811 cases, 11.7%) and nervous (734 cases, 10.6%) systems. In each of the presented groups, the incidence rate of ADRs in female patients exceeded that in men.Conclusion. The study of the gender characteristics of the pharmacotherapy safety, carried out on the basis of the notification forms of the ADRs data registered in the Republic of Crimea, confirmed a higher likelihood of developing ADRs in female patients. This may be due to the peculiarities of the pharmacokinetics and pharmacodynamics of drugs in the female body, psychological factors, a more frequent use of drugs by this category of people. The implementation of the drug, taking into account specific features of each gender, can lead not only to better treatment outcomes, but also to increased patients’ compliance.

Возможности модификации терапии у пациентов с анкилозирующим спондилитом, достигших частичной ремиссии на фоне лечения адалимумабом: данные реальной практики

The aimof the study was to assess the relationship between the detection of hyperechogenic deposits (HD) in the hyaline cartilage of the knee joints (KJ) at ultrasonography in patients with osteoarthritis (OA), clinical manifestations and structural changes according to KJ ultrasonography and radiography.Material and methods.A prospective analysis of clinical, radiological and ultrasonographic data of 114 patients with knee OA was conducted. The patients were divided into two groups: 32 patients with HD detected in at least one of the KJ, and 82 patients without HD; 32 patients of the 1st group and 34 patients of the 2nd group were observed for 2 years. A comparative assessment of initial clinical manifestations (WOMAC index), x-ray data and ultrasonographic parameters of the subchondral bone, hyaline cartilage and the degree of synovial inflammation in the groups of patients at the beginning of the study and after 2 years was carried out. The exclusion criteria were other joint diseases; paroxysmal course of the inflammatory process in KJ; trauma and history of operations on KJ; ESR >20 mm/h, uric acid level >360 μmol/l and C-reactive protein >5 mg/l.Results and discussion.HD in hyaline cartilage was found in 28.1% of patients with knee OA. After 2 years HD remained in all patients having them at inclusion, and in 5.6% of the patients they were found for the first time. In 13 patients with HD in hyaline cartilage, synovial fluid was studied and in all cases calcium pyrophosphate crystals were identified by phase-contrast microscopy. The presence of HD in the hyaline cartilage of patients with knee OA was accompanied by more pronounced ultrasonographic signs of synovitis and was associated with a higher rate of osteophytes growth in the absence of the changes of the hyaline cartilage thickness according to the ultrasonography and the width of the joint space according to x-ray.Conclusion.The presence of HD in the hyaline cartilage of patients with knee OA according to ultrasound examination may be associated with the deposition of calcium pyrophosphate crystals and is associated with persistent synovitis and accelerated growth of osteophytes.

В последнее время в систему классификационных критериев подагры введен сонографический признак – выявление в гиалиновом хряще линейных гиперэхогенных включений, представляющих собой депозиты мочевой кислоты. В то же время дифференциально-диагностическое значение этого признака на ранней стадии подагрического артрита (ПА) изучено недостаточно. Цель исследования – оценить специфичность и чувствительность факта обнаружения линейных гиперэхогенных включений в дифференциальной диагностике раннего ПА, в сравнении с повышением уровня мочевой кислоты, наличием подкожных тофусов и определением внутрикостных кист при рентгенографии. Материал и методы. Проведен анализ данных обследования 119 больных артритом с длительностью симптомов до 6 мес на этапе дифференциальной диагностики. В дальнейшем были установлены следующие диагнозы: ПА – у 32 больных, остеоартрит (ОА) – у 28, ревматоидный артрит (РА) – у 28, псориатический артрит (ПсА) – у 16. Наряду с клиническим, лабораторным и рентгенологическим обследованиями всем больным проводилась ультразвуковое исследование (УЗИ) воспаленных суставов линейным датчиком (частота – 18 МГц) с целью выявления линейных гиперэхогенных включений в гиалиновом хряще (уратные депозиты). Результаты и обсуждение. Уратные депозиты по данным УЗИ суставов при ПА были выявлены у 28 (87,5%) больных, при ОА – у 3 (10,7%) и при ПсА – у 1 (6,3%). Чувствительность остальных признаков подагры на ранней стадии ПА составила: 21,7% – для рентгенологического определения внутрикостных кист, 25,0% – для подкожных тофусов, 81,3% – для гиперурикемии. Специфичность ультрасонографического выявления уратных депозитов при ПА составила 94,4% и была сопоставима с таковой для остальных признаков подагры (86,1–98,6%). Заключение. Сонографическое выявление депозитов солей мочевой кислоты у больных подагрой характеризуется высокой чувствительностью и специфичностью в диагностике ПА в течение первых 6 мес от появления первых симптомов.