The article reviews a clinical case of Alzheimer’s disease (AD) with early onset. This case study shows current approaches to the diagnosis of this form of AD and the management of this group of patients. It is reasonable to use Acathinol memantin in patients with early onset of AD. The drug is characterized by a minimal number of side effects and a limited spectrum of contraindications.

The article presents data from various studies on the incidence of chronic diseases and conditions among adults, which is a serious public health problem today. The problem of comorbidity in the conditions of demographic aging of the population is highlighted. The results of recent studies on the frequency of side effects depending on the number of drugs taken are presented. It is shown that in old age another problem is the development of cognitive impairment. The results of detection of cognitive disorders among patients of general hospitals are described. Data on the efficacy of the drug application from the standardized extract of ginkgo biloba leaves EGb 761® for prophylaxis and treatment of cognitive disorders are presented. The question of the effect of EGb 761® preparation on blood coagulation properties in comorbid patients taking antiagregants and anticoagulants was considered.

The article discusses the principles of neuroprotective therapy as a pathogenetically justified direction in chronic cerebrovascular diseases (CVD). The results of numerous clinical trials demonstrated efficacy, safety, a wide range of pharmacological effects and good tolerability of the powerful antioxidant Idebenone (Neyromet), as well as domestic cytoprotector, Choline alphosceratus of (Cerepro®), affecting the basic pathophysiological processes of the ischemic cascade at CVD. The role of rational multimodal pharmacotherapy of CVD, which provides the necessary energy for the processes of neuroprotection and neuroplasticity of brain cells, is emphasized.

Frequency is considered as a key sign of the course of some forms of primary headaches (PH). One of the most prominent representatives is the hypnical and cluster headache, which predetermined their name. Clinical observations demonstrate a clear circadian rhythm and seasonal pattern of cluster headache (CH) and migraine (M) attacks. In accordance with modern concepts, the phenomenon of the periodicity of painful episodes of a number of forms of primary headaches is associated with dysfunction of the suprachiasmatic nucleus of the hypothalamus, the main pacemaker of biological rhythms. The connection of PH with chronopathology is confirmed by revealing the disturbances of melatonin secretion in CH and M. Melatonin has proven to be effective in treatment of these PH.

Chronic lumbar pain (CLP) is one of the most common causes of temporary disability. Both the elimination of specific causes of pain and the assessment of social and psychological factors of pain management are of great importance in the examination of patients. A comprehensive multidisciplinary approach is effective in managing patients with chronic nonspecific LP, which includes rationalization of drug therapy, therapeutic gymnastics, correction (if necessary) of the workplace and motor activity, psychological methods and educational program. Non-steroidal anti-inflammatory drugs (NSAIDs) are the drugs most commonly used during the integrated treatment period. The use of slow release ibuprofen as a NSAID in chronic non-specific LP is discussed.

Non-steroidal anti-inflammatory drugs (NSAIDs) – means of treatment of acute and chronic pain associated primarily with inflammatory changes, so this group of drugs is widely used in neurology, rheumatology, traumatology, etc. The mechanism of action of the drugs is associated with the effect on cyclooxygenase-2 (COG-2) and blockade of proinflammatory prostaglandins (PG) synthesis, as well as the effect on COG-1 and suppression of cytoprotective PG synthesis, which determines the possibility of side effects from the gastrointestinal tract (GIT). Now application of NPVP is focused not so much on increase of efficiency, as on their big safety. Creation of COG-2-selective inhibitors (meloxicam) and COG-2-high selective inhibitors (coxybes) allowed to reduce significantly the risk of complications from gastrointestinal tract while maintaining high efficiency. Thus, the safety profile of meloxicam, mainly inhibiting COG-2, is estimated in a whole series of studies. In particular, two large prospective controlled trials - MELISSA and SELECT - proved that meloxicam is less toxic to gastrointestinal tract than traditional NSAIDs. Thus, a reasonable conclusion can be made about the high efficacy of meloxicam, which is not inferior to that of non-selective NSAIDs, with good tolerability and safety of the drug against gastrointestinal tract.

Cardiac autonomic neuropathy (CAN) is a common and insufficiently diagnosed complication of diabetes mellitus. This is usually due to the fact that the disease runs asymptomatically until the very late stages. The impact of CAN on patients with diabetes can be devastating, because CAN is associated with increased mortality, cardiovascular disease, chronic kidney disease. CAN prevalence: 17-66% in patients with type 1 diabetes and 31–73% in patients with type 2 diabetes. Hyperglycemia, autoimmune reaction, genetic factors, obstructive sleep apnea, and inflammation are the key points in the pathogenesis of neuropathies in diabetes, in particular, CAN. Clinical manifestations of CAN and risk factors of CAN development in patients with diabetes are considered. Early diagnosis of CAN is of vital importance for the success of therapy, as there is an assumption that denervation of cardiovascular system may be reversible if diagnosed soon after its beginning. Antioxidant, vasoactive and vitamin therapy is used in the treatment of CAN. Emphasis is placed on the use of the injection form of Neuromultivitis.

The article is devoted to the analysis of the pathogenetic mechanisms of the formation of alcoholic lesions of the peripheral nervous system. Various clinical forms of alcoholic polyneuropathy are considered, ways to diagnose using modern instrumental and laboratory methods are proposed. The authors analyze the main ways of forming a therapeutic strategy, consider groups of drugs used to treat alcoholic polyneuropathy. The data of own clinical experience of using the preparation of thioctic acid are given.

The article presents the data of international and domestic controlled studies, in which the effectiveness of topacitinib in the period of 6-24 months is evaluated in respect of clinical and laboratory manifestations of RA activity, progression of destructive arthritis and functional ability of rheumatoid arthritis patients. Also the data of efficiency and safety of tofacitinib in long terms - up to 96 months - are given. According to the results of short- and long-term studies, tofacitinib is a highly effective drug for the treatment of patients with active RA who have not responded to standard therapy with UCVD and GIBP. Tofacitinib is also highly effective in monotherapy. Tolerability of the drug is comparable with other variants of RA treatment.

Gout is a chronic systemic inflammatory tophus disease with recurrent arthritis of the peripheral joints in patients with hyperuricemia and the deposition of monosodium urate crystals in various tissues. Only 50% or less of patients receive therapy lowering serum uric acid levels to the target level. The lowering therapy is started with a low dose and subsequent titration in all patients with high UA serum levels in the presence of renal pathology, and in such comorbid diseases as hypertension, heart failure, coronary artery disease.

Osteoarthritis (OA) is a degenerative joint disease. Modern theories consider various structural (cartilage destruction) and biophysical disorders (matrix loss of glycosaminoglycans) as the basis of acute and chronic pain syndrome. The main aim of OA therapy is pain relief and functional improvement. To manage pain syndrome in OA it is reasonable to use complex bioregulatory drugs (CBD) (Traumeel S, Zeel T, Discus compositum) both in monotherapy and in combined treatment. The effectiveness of CBD is comparable to that of NSAIDs and CS.

Numerous non-surgical and surgical procedures have been proposed to treat injuries and diseases of the large joints. Any small bone and cartilage defect can progress quite quickly and cause osteoarthritis to develop in many joints without proper treatment. Surgical procedures include tunnelization, microfracturing, mosaic autochondroplasty, etc. The joint condition can be improved by using exogenous growth factors. Platelet-rich plasma (PRP) is one of the remedies that contain regeneration-stimulating factors. The article discusses the positive effects of PRP not only on chondrogenesis in the area of hyaline cartilage defects, but also on osteoarthritis. There is a need to further clarify the mechanism of action of plasma and the exact concentration of the preparation.