The Clinician最新文献

{"title":"Cardiovascular risk in patients with inflammatory arthritis","authors":"D. A. Anichkov, N. Shostak, V. T. Timofeev","doi":"10.17650/1818-8338-2023-17-4-k702","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-4-k702","url":null,"abstract":"Rheumatoid and other inflammatory arthritis (ankylosing spondylitis and psoriatic arthritis) have a high risk of cardiovascular disease (CVD). It is caused by the accelerated development of atherosclerosis associated with a chronic systemic inflammatory process. Nevertheless, traditional CVD risk factors (hypertension, smoking, dyslipidemia) are also important for patients with inflammatory arthritis. The greatest amount of data has been accumulated regarding the relationship between CVD and rheumatoid arthritis. Due to the difficulties in diagnosing coronary heart disease and other CVD, it is of great importance to identify patients at high and very high risk. The use of scales for assessing the total cardiovascular risk SCORE/SCORE 2 with a coefficient of 1.5 allows to identify patients who need measures to reduce their high risk of CVD. Control of the of the disease activity, lifestyle modification, therapy with statins and antihypertensive drugs in accordance with current guidelines, caution when prescribing non-steroidal anti-inflammatory drugs and minimizing the dose of glucocorticoids are the main components of the strategy for reducing the risk of CVD in patients with inflammatory arthritis.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140413758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Back pain in young people: approaches to diagnosis and treatment","authors":"N. Shostak, N. Pravdyuk, A. Novikova","doi":"10.17650/1818-8338-2023-17-4-k699","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-4-k699","url":null,"abstract":"Back pain in young people (14–35 years old) may have causes rooted in adolescence or even earlier childhood. Diagnosis in this case can present considerable difficulties for a therapist and general practitioner, since “nonspecific back pain” may hide pathological conditions inherent in childhood. The degree of compensation for scoliosis, hereditary abnormalities in the development of the spine, the severity of early degenerative processes, and metabolic diseases of the skeleton that were not identified during school years determine a non-standard scope of diagnostic and therapeutic measures for the doctor. These include collecting a family history and screening the patient for the presence of inflammatory back pain according to the 2009 ASAS criteria, a survey on the hospital anxiety and depression scale, a morphometric assessment of the stigma of dysembryogenesis and an assessment of hypermobility syndrome, advanced laboratory diagnostics with determination of indicators of mineral-calcium metabolism, X-ray diagnostics with functional tests, the use of magnetic resonance imaging or computed tomography of the spine in the absence of radicular symptoms. The patient’s active involvement in non-drug restorative treatment significantly improves his prognosis, and pharmacological support should have a health-saving direction and consider the presence of low-intensity inflammation in the pathogenesis of the disease. The choice of therapy for a reproductively active cohort of patients is made in favor of drugs with the maximum safety profile, which include, among others, selective non-steroidal anti-inflammatory drugs.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140410827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Search for predictors of methotrexate toxicity in rheumatoid arthritis","authors":"I. V. Devald, K. Y. Myslivtsova, E. A. Khodus, G. Ignatova","doi":"10.17650/1818-8338-2023-17-3-k691","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-3-k691","url":null,"abstract":"Aim. To determine prognostic markers of methotrexate (MT) toxicity in rheumatoid arthritis (RA).Materials and methods. The study included 294 patients with RA who were prescribed MT at a dose of 10 to 25 mg per week for the first time as basic anti-inflammatory therapy (BPVT). The following adverse events (AEs) were recorded: hepatotoxicity, toxicity from the gastrointestinal tract, blood system. Qualitative parameters were considered as possible predictors of MT intolerance: gender, obesity, smoking, systemic manifestations, as well as rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (ACCP), intake of glucocorticosteroids (GCS), form of administration of MT; and quantitative: age of RA onset, baseline disease activity according to DAS28 (Disease Activity Score 28) and HAQ (Health Assessment Questionnaire), MT dose. Statistical processing was performed by one-factor methods using Pearson’s χ2 test with Yates correction, Fisher’s exact two-tailed test, Mann–Whitney U-test, and Student’s t-test. Multivariate analysis was carried out by binary logistic regression.Results. In a univariate analysis, significant results were obtained for hepatotoxicity: a direct correlation with the use of corticosteroids at the onset (odds ratio (OR) 2.0; 95 % confidence interval (CI) 1.1–3.8, p = 0.03), inversely correlated with MT tablet intake (OR 0.5, 95 % CI 0.2–0.95, p = 0.03). According to the results of multivariate analysis, hepatotoxicity was recorded more often when taking GCS in the debut 2.01 times (95 % CI 1.02–3.96, p = 0.043), and in the presence of ACCP – 3.16 times (95 % CI 1.06–9.45, p = 0.039); and less frequently when taking tableted MT by 2.62 times (95 % CI 0.17–0.84, p = 0.017). Gastrointestinal toxicity tends to be associated with a younger age of RA onset (p = 0.06) and greater RA HAQ activity at onset (p = 0.07).Conclusions. Hepatotoxicity is more expected in patients seropositive for ACCP and GCS treatment in the onset of RA, but is less common when taking MT tablets. AEs from the gastrointestinal tract are associated with a younger age of onset of the disease and a greater degree of activity according to the HAQ index.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"64 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139613491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of vascular cognitive disorders","authors":"V. V. Zakharov","doi":"10.17650/1818-8338-2023-17-3-k694","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-3-k694","url":null,"abstract":"Cognitive impairment (CI) usually is the earliest and most prevalent manifestation of cerebral vascular disease. Post stroke CI may have different clinical presentation depending on location of vascular lesion, so appropriate temporal association of CI onset with the event of stroke is of most important diagnostic value. Non-stroke (subcortical) variant of cerebral vascular disease usually is associated with small vessel disease. CI in subcortical variant is characterized with attention and executive functions deficit, frequently in combination with emotional disorders, postural instability and gait disturbances of frontal origin. Presence of vascular CI means essential need of thorough vascular risk factor (arterial hypertension, dyslipidemia, diabetes etc.) control. Vasotropic agents are prescribed with pathogenic purposes. The article presents clinical experience of nicergoline treatment of patients with vascular CI of different severity.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139612037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TAFRO syndrome associated with C3 nephropathy (an analysis of clinical experience)","authors":"I. V. Pozharov, A. O. Grigorevskaya, G. R. Setdikova, E. S. Stolyarevich","doi":"10.17650/1818-8338-2023-17-3-k697","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-3-k697","url":null,"abstract":"Aim. To present a clinical case of TAFRO syndrome – a recently described subtype of idiopathic multicentric Castleman disease of unknown etiology, characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis of the bone marrow and / or renal dysfunction, organomegaly associated with an increase in serum IL-6 secretion.Materials and methods. Herein, we report a young patient diagnosed with TAFRO combined with C3 nephropathy. The patient was treated with glucocorticoids (methylprednisolone), colchicine, sarilumab, rivaroxaban, and symptomatic treatment.Results. Key aspects of diagnosis, treatment and course of the syndrome were discussed. The possibility of the combined course of two rare pathologies – a subtype of idiopathic multicentric Castleman disease and C3 nephropathy is still unclear.Conclusion. The diagnosis of TAFRO syndrome can be considered after the exclusion of a number of infectious, paraneoplastic, systemic connective tissue diseases, POEMS syndrome, liver cirrhosis against the background of autoimmune hepatitis, autoimmune thrombocytopenic purpura, as well as hemolytic-uremic syndrome. Kidney damage in this category of patients, in most of the described clinical cases, is morphologically represented by thrombotic microangiopathy or mesangioproliferative glomerulonephritis. C3 nephropathy in that clinical case seems to be concomitant. Glucocorticoids in high and ultrahigh doses, cyclosporine, IL-6 type inhibitors, as well as anti-CD20 antibodies are used as therapy.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"100 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139612357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interstitial lung disease in patients with systemic scleroderma: approaches to predicting lesion volume","authors":"D. V. Khorolsky, A. Klimenko, E. Pershina, N. Babadaeva, A. Kondrashov, N. Shostak, E. P. Mikheeva, M. P. Mezenova, E. Zhilyaev","doi":"10.17650/1818-8338-2023-17-3-k684","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-3-k684","url":null,"abstract":"Aim. To determine the factors that contribute to the prediction of the volume of pulmonary lesion in patients with systemic scleroderma (SSc).Materials and methods. The analysis included patients with SSc observed in the Registry of Myositis, systemic sclerosis and mixed connective tissue disease (REMISSIS), who underwent high-resolution computed tomography (HRCT) of the lungs. For the immunological characteristic, all patients were tested for anti-topoisomerase (anti-Scl-70), and anti-centromeric (anti-CENP-B) antibodies, and anticentromere antibodies (anti-Pm-Scl).Results. The study included 79 patients with SSc. There was 94.9 % women. Average age – 64.4 ± 11.5 years. Signs of interstitial lung disease (ILD), according to HRCT were detected in 50 patients. The largest extent of lung injury was noted in patients with SSc sine scleroderma (32.7 ± 29.3 %), a smaller extent in patients with diffuse form SSc (16.9 ± 17.1 %) and the lowest in patients with limited SSc (8.5 ± 14.2 %). In addition to the type of disease, the extent of lung injury in patients with SSc-ILD was statistically significantly higher in patients with arthralgia, dyspnea and the presence of antibodies to topoisomerase I and combined autoantibodies. Also, a statistically significant feedback was established with all indicators of the test with a 6-minute walk and forced vital capacity and a direct relationship with indicators of pulmonary artery systolic pressure. When evaluating the correlation between the extent of lung injury and the degree of dyspnea according to Borg, it was found that in patients who assessed dyspnea less than 3 points, the extent of lung injury was less than 25 %. Due to the high degree of correlation, a regression formula was created for the dependence of the extent of lung injury on the distance in the test with a 6-minute walk: extent of lung injury = (52.7–0.1) × distance 6MWT. A multivariate model was also obtained for predicting the extent of lung injury in SSc, in which the patient’s immunotype, distance in the 6-minute walk test, saturation after the 6-minute walk test, and the presence of dyspnea became the most effective.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"97 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139612387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern possibilities of therapy of nonspecific pain in the lower back","authors":"D. Khaibullina, Y. N. Maksimov","doi":"10.17650/1818-8338-2023-17-3-k692","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-3-k692","url":null,"abstract":"Aim. To evaluate the effectiveness of combination therapy for low back pain (LBP) associated with spinal osteoarthritis (OA) using the Symptomatic Slow Acting Drugs for OsteoArthritis (SYSADOA) group drug Ambene® Bio.Materials and methods. The study included 30 patients with LBP aged 40 to 65 years. Various scales and questionnaires were used to assess the patients’ condition. All patients received Ambene® Bio 2.0 ml intramuscularly every other day for a total course of 10 injections. Some patients with severe pain continued to receive previously prescribed non-steroidal anti-inflammatory drugs (NSAIDs). After completing the course of treatment with Ambene® Bio, the overall effect of the therapy, changes in individual need for NSAIDs and the presence of adverse events were assessed.Results. All patients sought medical care due to exacerbation of chronic LBP. X-ray examination of the lumbosacral spine revealed degenerative-dystrophic changes in the vertebral-motor segments of the lumbar spine in all patients and in some patients – in the sacroiliac joints. The treatment showed positive dynamics in 27 (90 %) patients in the form of pain reduction not only in the lower back but also in peripheral joints. Of the 13 patients initially receiving NSAIDs, 7 (53.8 %) reduced the daily dose of the drug, and 3 (23.1 %) were able to stop taking NSAIDs. In 3 (23.1 %) cases, the initial NSAID dosage remained unchanged. Monotherapy with Ambene® Bio was received by 17 (56.7 %) patients. All patients expressed satisfaction with the treatment, of which 18 (60 %) rated the result as “excellent”, 7 (23.4 %) as “good” and 5 (16.6 %) as “satisfactory”.Conclusion. In all patients, therapy with Ambene® Bio, both in mono mode and in in combination with NSAIDs, had a positive effect, which was expressed in the reduction of the intensity of LBP on visual analog scale, improvement of peripheral joint function. In 7 (23.3 %) patients pain reduction was observed after the second injection of the drug (“the effect of the first dose”). In other cases the pain regressed later, but also within the course of treatment. All patients showed high adherence to therapy, which was explained by the rapid onset of the effect. The results of the study allow us to recommend Ambene® Bio for the treatment of LBP associated with spinal OA and within generalized OA, including patients with comorbid conditions.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"19 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139613622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and diagnostic markers for acute coronary syndrome in chronic kidney disease","authors":"L. Kamyshnikova, D. S. Pisankina, K. S. Gorbachevskaya, G. V. Biryukov, M. S. Sviridova, I. V. Kalashnikova","doi":"10.17650/1818-8338-2023-17-1-k675","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-1-k675","url":null,"abstract":"Introduction. Acute coronary artery disease is the leading cause of death in patients with chronic kidney disease (CKD). In addition, CKD itself is the initiator of acute coronary syndrome (ACS), the prevalence of which is greater, the more pronounced the impairment of kidney function and the more concomitant risk factors in the patient.Aim. To study the predictive value of various laboratory and instrumental markers in identifying the risk of developing ACS in patients with CKD.Materials and methods. A search was made for articles for the last 10 years in the databases: PubMed, Medline, Google Scholar and eLIBRARY by keywords in Russian and English, the articles were selected in accordance with the purpose of the study.Results. ACS manifests itself in CKD patients with an atypical picture, and in 3 % of cases it is generally asymptomatic. The risk of death from cardiovascular complications increases in proportion to the deterioration of the glomerular  filtration rate (GFR). This progression also increases the risk of coronary artery calcification. At the same time, it was found that cystatin C is a more universal marker of a decrease in GFR than creatinine. Other laboratory markers that indicate the risk of ACS are inflammatory markers, albuminuria, troponins, natriuretic peptide.Conclusion. So far as ACS is atypical or asymptomatic, in addition to troponins and traditional instrumental diagnostic methods, markers such as GFR, albuminuria, an increase in serum cystatin C, phosphate, fibroblast growth factor-23, interleukin-6, tumor necrosis factor-alpha, total parathyroid hormone, fibrinogen, natriuretic peptide can help in its prediction.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49265073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The problem of choice of therapy for a patient with dorsalgia","authors":"P. Kamchatnov, R. Cheremin, L. Skipetrova, A. V. Chugunov","doi":"10.17650/1818-8338-2023-17-1-k679","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-1-k679","url":null,"abstract":"Musculoskeletal pain syndromes are one of the most common causes of temporary disability, they are often associated with a significant decrease in the quality of life of patients. Due to the peculiarities of biomechanics (significant phy­sical exertion experienced throughout life, a large volume of movements in various directions), the lumbar spine is especially vulnerable, the lesion of which is often associated with the development of lumbar pain (PB). The mechanisms of formation of PB are diverse, however, as a rule, inflammation is the basis of the pain syndrome. The results of modern studies have convincingly demonstrated the presence of imaging and biochemical markers of the inflammatory process in the area of altered spinal structures, in particular, in intervertebral discs and arch-process joints. There are reasons to believe that it is the focus of inflammation that can be the source of pain, although in the future the role of the active inflammatory process may become less important, and other mechanisms are involved in maintaining pain and other clinical manifestations. In this regard, drugs should be chosen for the treatment of patients with PB, depending on the predominant action - analgesic or anti-inflammatory. In the article, along with the main mechanisms of the occurrence and persistence of PB, modern approaches to the treatment of such patients are considered. The undoubted validity of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of patients with PB is noted. Their most significant clinical effects are noted, which may be useful in the treatment of patients with PB. The features of side effects associated with the use of NSAIDs, including those from the gastrointestinal tract and the cardiovascu­lar system, are considered. Information is provided on the results of studies devoted to the study of the efficacy and safety of dexketoprofen (Dexonal®, Binnopharm Group) in the treatment of patients with PB. The undoubted positive properties of the drug are noted (rapid development of action with a powerful analgesic effect and a favorable safety profile) Dexonal®.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43024980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An integrated approach to the implementation of the stage of pulmonary rehabilitation of patients with chronic obstructive pulmonary disease: the importance of lifestyle modification","authors":"T. V. Tayutina","doi":"10.17650/1818-8338-2023-17-1-k689","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-1-k689","url":null,"abstract":"","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42594404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}