Management of patients after ischemic stroke is based on the prevention of the repeated ischemic stroke and other cardiovascular diseases.  It’s  necessary to use drugs (antiplatelet  drugs or anticoagulants, statins, antihypertensive drugs), non-drug methods (smoking cessation, alcohol abstinence, rational diet, increase of physical activity), surgical therapy is indicated for a share of patients (carotid endarterectomy). In motor disturbances the remedial gymnastics targeted at training of movements in paretic extremities and prevention of contractures plays the leading role. Currently the effectiveness  of drugs to improve restoration of the motor functions is not proved. Possibilities  of cerebrolysin and results of the recently published study ECOMPASS are discussed, in which effectiveness of cerebrolysin was studied on 70 patients (30 ml intravenously for 7–28 days of IS) versus placebo. Improvement of restoration of the motor functions in a subgroup of patients with pronounced motor disturbances has been observed as well as improvement of neuroplasticity processes by results of the diffuse and tensor and functional magnetic and resonance tomography in use of cerebrolysin (versus placebo). Use of all effective methods in management of patients after ischemic stroke allows reducing the risk of development of repeated stroke, improving the restoration and quality of life of patients.

Recommendations for treatment of somatoform disorders with use of the drug sulpiride (Eglonyl) are provided. The analysis of possibility of use of sulpiride in the treatment of somatoform disorders has shown that a wide range of action of the drug, including antianxiety, growth and catalytic effects, provides a good therapeutic response in all types of somatoform disorders. A high level of safety of sulpiride not only promotes more effective relief of symptoms within the borderline mental pathology, but also makes possible its use in general medical practice for correction of concomitant somatic diseases  of alarming and functional disorders.

The term “vegetovascular dystonia” (VSD) is commonly used in the domestic medical practice. However, the VSD is neither included in the International Classification of Diseases, 10th Edition, nor has any generally accepted diagnostic criteria. This disorder is usually diagnosed in young and mature patients, who do not have any clear organic pathology and present various somatic complaints such as dizziness, headache, sleep disturbances, palpitations, shortbreathing, etc.

But under the guise of the VSD, physicians often discover anxiety disorders. The article deals with the advanced principles of diagnosis and treatment of the anxiety disorders. Non-drug therapy includes educational conversations, psychotherapeutic and psychological methods. Pharmacotherapy of anxiety disorders comprises the administration of antidepressants, in some cases combined with tranquilizers.  If antidepressants are contraindicated, but used, side effects may occur, or if the patient refuses to take them, Tenoten may be prescribed. The article presents clinical studies data confirming the efficacy and safety of Tenoten in the treatment of anxiety disorders.

Social losses and expenses of healthcare resources related to chronic back pain continue remaining a high burden for the society. The mechanism of the central sensitization partially accounts for the formation of the chronic back pain, but these etiologic mechanisms of CNS dysfunction in this category of patients remain understudied. Of late more and more studies show that chronic neuroinflammation and aberrant activation of neuroglia are involved in formation and/or maintenance of the central sensitization. The work is focused on the analysis of the contribution of the inflammatory reactions in peripheral and central mechanisms of pain chronization in the back. General principles of chronic back pain are discussed, special attention is given to the possibility of target effect of etoricoxib on peripheral and central sensitization.

The term «dorsopathy» now refers to pain syndromes in the back of of neurovisceral etiology related to degenerative spinal diseases.

The most important type of dorsopathies is the back pain, which, according to WHO experts, at the end of the XX century  became a non-communicable epidemic as it affects about 80 per cent of the population during life.

Dorsalgia (DA) is an exceptionally common skeletal pain syndrome in the population. For the treatment of patients nonsteroid antiinflammatory drugs (NSAIDs) with express pain and anti-inflammatory effects are widely used. Their indication is often associated with the risk of side effects, which are increasing in older patients with polymorbidity requiring simultaneous administration of several drugs at the same time. An alternative to systemic use of NSAIDs may in some cases be the local use of transdermal forms of drugs. Consideration is being given to the use of Deep Relief and Deep Hit in patients with DA depending on the characteristics of the clinical pattern of the disease. Research findings on the bioavailability, efficiency and tolerability of drugs are presented.

Shoulder and neck pain syndrome is a widespread and socially significant problem. In this article the authors make an attempt to combine and classify the main causes of the onset of pain and impairment of function in the cervico-brachial region, and present the tactics of a differentiated approach to the treatment of patients with cervico-brachial syndrome.

The article is devoted to the topical problem of post-stroke pain syndromes, which are a frequent complication after a stroke. Pain after a stroke is associated with psychoemotional disorders, cognitive dysfunction, dysfunction, impaired quality of life and limited opportunities for medical rehabilitation. The review of clinical aspects, risk factors of development of post-stroke pain, features of therapy and rehabilitation measures of the most common pain syndromes after a stroke is presented. The data of own observation of 1317 patients who have suffered a stroke are given. The effectiveness of lornoxicam in the complex program of medical rehabilitation of stroke patients with myofascial pain syndrome of lumbar localization and pain in the shoulder was demonstrated.

Conclusions: In order to improve the effectiveness of the rehabilitation process, optimize the quality of life and function after a stroke, it must be taken into account that the pain is a frequent complication after a stroke and identify patients at high risk of its development. Timely and adequate therapy of PBS with the inclusion of effective and safe NSAIDs in rehabilitation programs contributes to the improvement of functional outcomes after a cerebral stroke.

In summary, this review provides complex presentation of the most contemporary concepts of pathogenesis, clinical presentation and therapy of diabetic polyneuropathies. The article also provides data on the epidemiology of the condition, classification of diabetic polyneuropathies; considers issues of symptomatology, morphological changes in this pathology. The problems of etiopathogenetic and symptomatic therapy of polyneuropathies are discussed using the results of multicentre clinical trials.

Post-stroke spasticity is one of the most frequent motor disturbances. Therapy of spasticity can improve motor performance of the upper and lower limb. The article provides results of the study of effectiveness  of type A botulinic toxin at an early restorative period in 27 patients with spastic lower limb. The major group (n = 18) as part of complex rehabilitation received botulotoxin injections. Dynamics of the muscular tonus, muscular strength, walking speed, values of functioning by Rivermid and Bartel scales  were assessed.  The statistical data proving considerable advantages in the major group of patients on reductional of the muscular tonus, pain, increase of the walking speed, increase of patient independence in daily life were obtained. A necessity to include the botulinic toxin in rehabilitation programs of patients with post-stroke spasticity of the upper and lower limb starting from the second stage of the rehabilitation is discussed.

The lecture presents the new EULAR clinical guidelines on the treatment of rheumatoid arthritis (RA) published this year. The new version of the recommendations is fully international, because for its creation, the largest group of experts in the history of the development of the EULAR recommendations was collected, including not only the representatives of the EU countries, but also Russia, Asia, North and South America. The main changes compared to the previous (2013)  version are: approval of achieving sustainable  remission as treatment goal; the possibility of changing the treatment schedule  during the first 3 months, the feasibility of short-term use  of medium and high doses  of glucocorticoids; the possibility of using targeted synthetic (ts-) DMARDs (tofacitinib) as second-line drugs; the advantage of the combination of biologics and ts-DMARDs with synthetic (s-) DMARDs over monotherapy; the advantage of tocilizumab and ts-DMARDs over other drugs if necessary using in monotherapy.

The article on a specific clinical example illustrates difficulties in the selection of symptomatic therapy of acute attack of gout arising in connection with the common combination of diseases  with metabolic disorders and cardiovascular diseases. The peculiarities of the use of certain drugs in this pathology are set forth. Possible options for effective therapy, minimization of adverse events are considered, the efficacy of nimesulide in the treatment of acute pain in patients with gouty arthritis attack is shown.

Gout is a fairly common rheumatic disease, the significance of which becomes an increasingly important interdisciplinary problem. It is known that about 2.5% of men over the age of 30 and women over the age of 50 suffer from gout. By the age of 80 y.o. the disease is registered already in 9% of men and 6% women. The increased incidence, high comorbidity, and low compliance of patients with gout put new questions when the adequate complex therapy is sought.

Despite the fact that the treatment of this disease is well known and widely discussed in the literature, it’s possible to achieve remission of gout only in very rare cases. In the literature, there is evidence that less than ½ of patients with gout get ordinary therapy, while often drugs are prescribed in doses not sufficient to obtain the effect [1].

Febuxostat, a selective  inhibitor of isoforms xantinoxydoreductase, it is an alternative to a limited number of medications to reduce urates levels  applied in recent decades. Inhibition of xantinoxydoreductase by febuxostat more is more powder and effective  than by allopurinol, as evidenced  by more frequent achievement  of target urate level  in the blood serum, especially  in patients  with high urates concentration. Unlike allopurinol pharmacokinetic properties febuxostat  do not depend  to a large extent  on renal clearance, which is important for patients  with chronic renal disease.  A few studies conducted further evaluation of the febuxostat  safety for the cardiovascular system and its potential positive impact on renal function. It is also important that elderly patients didn’t require correction doses of the drug.

Currently, nonsteroidal anti-inflammatory drugs (NSAIDs) are a major component of pharmacotherapy of chronic rheumatic pain and are the most commonly prescribed drugs. The cyclooxygenase (COX) – a key enzyme in the synthesis of prostaglandins (PG) mediating the inflammation development – is the target for NSAIDs. The use of NSAIDs is associated with risk of mucosal damage of the gastrointestinal tract (GIT). Its protection is carried out with the participation of PG, the synthesis of which is controlled primarily by COX1, to a lesser extent – by COX2, inducing an inflammatory process. Therefore, one of the most effective measures to prevent disorders of the gastrointestinal tract, was the development of drugs that selectively inhibit the activity of COX2. Such drugs include, in particular, nimesulide (NM Nimesin, Shreya Life Senses). In addition to synthesis of PG-mediated COX2, NM inhibits a number of other mechanisms involved in the development of the inflammatory process. The ability of the NM to act simultaneously on many parts of the inflammatory process allows successfully using it in various inflammation-associated disease. NM was covered in over 200 clinical trials that included more than 90 thousand patients with acute and chronic diseases accompanied by pain syndrome. These authors demonstrated that NM can significantly reduce pain, being not inferior by effectiveness than any of the NSAIDs both: selective and non-selective. At the same the sparing effect of NM on COX1 allows maintaining sufficient concentration of prostanoids, providing physiological protection of the mucosa and reducing the frequency of adverse reactions from the GIT.

The article concentrates on the possibilities of using modern non-steroidal anti-inflammatory drugs to treat diseases of the musculoskeletal system. It presents the review of studies of clinical efficacy and safety of meloxicam in patients with rheumatologic profile.

The article discusses experimental data that demonstrated the ability of Aflutop to stimulate proliferation and regeneration of chondrocytes, to inhibate in vitro extracellular release of IL-6 cytokine and IL-8 chemokine compared to control cells, to inhibit VEGF, a proangiogenic factor, a biochemical proactive factor in destructive processes of OA, as well as the proven existence of the antioxidant activity of Alflutop. The data of numerous clinical studies (including the double blind placebo-controlled) show that it has an expressed analgesic effect, developing in the first weeks after administration in osteoarthritis patients, including with periarthrites, osteochondrosis, with back pain of different genesis, and the existence of the anti-inflammatory effect and a positive impact on the quality of life of osteoarthritis patients. At a high evidentiary level, the structural modifying effect of Alflutop and its safety is confirmed.

The article reviews the etiological  factors and pathophysiological mechanisms by which the cerebral vascular insufficiency develops and advances. It presents the main directions in the treatment of such patients including the combined use of polymodal drugs with neuroprotective, metabolic and vascular effects.