Миофасциальная боль является актуальной междисциплинарной медицинской проблемой. Она выявляется более чем у половины пациентов молодого и среднего возраста, точных данных о ее распространенности среди пожилых людей нет. В настоящее время отсутствует систематизированный подход к терминологии и нозологической принадлежности миофасциальной боли. Авторами приводятся и оцениваются значимые факторы возникновения миофасциальной боли и диагностические критерии миофасциального болевого синдрома. В алгоритме лечения делается акцент на общих принципах терапии, механизмах действия и показаниях для обоснованного применения наружных форм НПВП, в частности препарата Вольтарен Эмульгель 12 часов, в качестве как самостоятельного метода лечения при слабой и умеренной боли, так и дополнения к основной терапии, направленной на подавление боли.

Aim. To evaluate a 12-week course of combined alloturinol-lowering therapy with a prophylactic anti-inflammatory dose of movalis for the frequency of exacerbations and the quality of life of patients with gout. Materials and methods. Allopurinol was administered orally, 1 time per day. Every 3 weeks, the dosage of the drug was increased by 50 mg to 300 mg per day under the control of the level of serum uric acid (sUA). The total daily dose of the drug movalis, used in the form of different dosage forms, was 7.515 mg. The clinical effectiveness of the treatment was evaluated after 3, 6, 9 and 12 weeks according to physical examination, the dynamics of joint pain at rest, during movement and palpation, according to the visual analogue scale (VAS) in millimeters, Likert scale, EuroQol-5D-5L questionnaire, care for oneself, habitual daily activities, the presence of anxiety and depression, assessment of satisfaction with treatment (on a scale of 1 to 5, where 1 is the complete absence of improvement or worsening, and 5 is a very good result); took into account the period of remission, as well as the time before the onset of relapse of gouty arthritis. An adverse event (AE) was recorded. Results and discussion. On the background of treatment with movalis 7.5 mg per day more than two-thirds of patients showed no worsening of the articular syndrome with an increase in the dose of allopurinol to 300 mg per day. By the 12th week of observation, a significant difference was found between the severity of gouty arthritis characteristics in the direction of improving mobility, self-care, normal daily activities, reducing soreness, reducing anxiety and depression (p0.05). In addition, the ESR and sUA levels were significantly different initially and at the final observation point (p0.05), which indicates a positive effect on the inflammatory process. A 3-month course of combination therapy was not accompanied by significant increases in blood pressure, changes in creatinine clearance in blood serum. There were no adverse events from the gastrointestinal tract. 90.9% of patients rated the treatment result as very good. AE in the form of a skin allergic rash was observed in one patient; it did not require interruption of treatment and completely stopped without consequences after completion of the course. Conclusion. 12 a week-long combined therapy of the allopurinol-reducing drug with the anti-inflammatory dose movalis prevents the exacerbation of the articular syndrome and improves the quality of life of patients with gout.

One of the main reasons for seeking medical help is myofascial syndrome (MFS), which is manifested by local inflammation with elements of degenerative changes in the affected tissue, pain and muscle spasm due to dysfunctional disorders in the nociceptive system and a decrease in the quality of life. This review discusses etiopathogenesis in detail, taking into account the factors predisposing to the development of MFS, which are divided into anatomical, ergonomic, medical and psychosocial, and also provides diagnostic criteria for pain MFS, including 5 large and 3 small criteria necessary for diagnosis. The second part of the review examines the indications, efficacy, safety, and benefits of topical forms of nonsteroidal anti-inflammatory drugs (NSAIDs), which have a moderate effect on pain, but have a much better safety profile due to reduced systemic absorption. The use of topical drugs allows you to create an effective concentration of the drug directly in the lesion and avoid undesirable systemic effects. Experts strongly recommend prescribing primarily topical, rather than oral, NSAIDs to patients aged 65 years and older who have concomitant cardiovascular and renal pathology, as well as diseases of the gastrointestinal tract. In more detail, the review examines topical forms of diclofenac, which differ in the maximum degree of transdermal penetration compared to other NSAIDs and the effect of slow release of the active substance into the surrounding tissues.

The aim of this study was to compare the haemodynamic effects ofacebutolol, a ~I-selective adrenoceptor blocker with intrinsic sympathomimetic activity, and propranolol, a nonselective ~-adrenoceptor blocker without intrinsic sympathomimetic activity. 44 males aged 35 to 59 (mean 49.7 ± 1.0) years with mild to moderate arterial hypertension (diastolic blood pressure 95 to 114mm Hg) without severe concomitant diseases requiring medication, and without contraindications to ~-adrenoceptor blockade, were included in this double-blind randomised parallel group study. It was shown that during 12 weeks' treatment the magnitude and duration of the antihypertensive effect of acebutolol 400 or 800mg daily did not differ from that of propranolol 80 or l60mg daily. However. there was a trend towards more patients achieving a full or partial antihypertensive effect with acebutolol than propranoloL Moreover, bradycardia was more pronounced with propranoloL The antihypertensive effect of acebutolol was observed after 2 weeks and maintained throughout all 12 weeks of treatment. Unlike propranolol, acebutolol did not cause such unwanted haemodynamic effects as decreased cardiac output and increased total peripheral resistance. Acebutolol was well tolerated. NSNS NS NS NS NS NS NS NS NS NS NS NS NS NS NS

Back pain (dorsopathy) is one of the common syndromes, which is specific to the whole group of diseases with similar clinical presentations. Ankylosing spondylarthritis (Bechterew’s disease) with a distinct clinical course evolving not only spinal and sacroiliac lesion, but also visceral changes is discussed using the example of a clinical case. The authors discuss Nimesulide, a drug from NSAID (non-steroidal anti-inflammatory drugs) group, in the treatment of inflammatory presentations of the disease and evaluate its efficacy.