Introduction. The relevance of neuroprotective therapy in patients with cerebral stroke (CS) is due to its high prevalence, as well as the need  for the maximum possible  restoration of damaged  structures and functions  of the central  nervous system (CNS).

Аim. Тo evaluate the  clinical  efficacy  and  nicotinoyl  gamma-aminobutyric  acid  tolerance in  the  complex  rehabilitation of patients in the late recovery and chronic periods  of ischemic stroke (IS) in outpatient stage.

Materials and methods.  110 patients in the  late  recovery period  (LRP) and the  residual  period  of IS, 57 women  and 43 men, average  age 58.0 ± 9.74 years, were observed. The duration  of the stroke was on average  214 ± 28 days in PVP-patients  and 428 ± 47 days for the residual  period. All patients included  in the study received  a standard medical  rehabilitation program. Two main groups included  30 patients in LRP and the residual  period of IS, who treated with nicotinoyl gammaaminobutyric. Two control  groups included  30 patients in LRP and 20 patients in the  residual  period  of IS, who recievedonly  the  standard medical rehabilitation program.

Results. The complex  of rehabilitation with  the  inclusion  of nicotinoyl  gamma-aminobutyric acid  (picamilon)  significantly improved  the  indicators  of neurodynamic  (p < 0.05) and regulatory  functions  (p < 0.05) in the  main subgroups  on the  MoCA scale, emotional status  (p > 0.05 on the Beck scale), general  well-being, activity, mood (WAM scale) and basic functional  activity (the average  Bartel index  at the  end  of the  study was 82.6 ± 3.5 in the  main  groups, p < 0.05). The clinical  effect  was observed  after a month of the therapy and persisted until the end of the study.

Conclusion. The inclusion  of neuroprotective therapy  in the  complex  rehabilitation leads  to earlier  neuropsychological and social adaptation of the patient, regression of fatigue, which is probably associated with an increase  in neuroplastic and regulatory brain processes.

Asthenia is a pathological condition characterized by abnormal, spontaneous fatigue that occurs without exercise, continues for a long time and does not go away after rest. With asthenia, performance decreases, and difficulties arise in maintaining prolonged mental  and physical stress. The presence of these  disorders  is associated with a decrease in quality of life, an increase  in morbidity and mortality  in general. In general,  we can say that  complaints  of weakness,  tiredness and fatigue are the most common  when visiting a primary care doctor. The article  presents various clinical manifestations of asthenia, classification  and features  of these  disorders. In clinical practice, it is important to distinguish  between idiopathic  chronic fatigue  (primary or functional  asthenia)  and  chronic fatigue  syndrome  (CFS). The publication presents modern  diagnostic criteria for this syndrome. It has been  shown that  CFS should be distinguished from nonspecific  chronic fatigue, which can be observed  in various pathological conditions. The article  discusses  the classification,  as well as the features  and criteria for diagnosing of asthenic  disorders  (AD). The close  relationship and  common  pathogenetic mechanisms of the  development  of asthenia and cognitive  impairments (CI) in cerebral  diseases  are reflected. Issues of management of patients with asthenia and  concomitant CI are  discussed,  which  should  be  comprehensive and  include  non-drug  and  drug  treatment methods.  Non-drug  methods,  including  methods of cognitive  stimulation and  cognitive  training,  are  coming  to  the  fore in the treatment of various manifestations of AD. The possibilities  of therapy  with phenylpiracetam for asthenic  syndrome of various origins, including  those  with concomitant anxiety-depressive disorders  and CI, have been  shown.

Stroke  is one  of the  most  common  causes  of neurological impairment in adults.  Recovery from impairment after  a stroke is  usually  incomplete, and  approximately 50% of  patients are  left  with  disabilities,  making  them  dependent on  others. Functional  deficits after stroke are also associated with huge financial burden  on the patient,  family, and society. Worldwide, stroke  is the  leading  cause  of disability in adults, often  resulting  in impairments such as muscle  weakness,  sensory deficits, spasticity, balance  problems, decreased dexterity, communication difficulties and cognitive impairment. The increased number of stroke  survivors creates  a high  demand  for effective  and  accessible neurorehabilitation  treatments. Rehabilitation after stroke aims to reduce disability by facilitating  recovery of impairment, activity or participation. Different techniques and methods  can  be  used  in rehabilitation management. Stroke  rehabilitation requires  repetitive,  intensive,  goal-oriented therapy. Rehabilitation training  can  effectively  improve  limb functioning  in stroke  patients and  reduce  disability. The effectiveness of most interventions for the upper and lower limbs is driven by repetition and principles  of task- and context-specific motor learning. Among the important directions  of stroke rehabilitation will be to optimize  the prediction  of post-stroke outcomes, identify  more  sensitive  and  specific  recovery  biomarkers,  personalize rehabilitation measures   depending on  the  severity and nature  of the vascular accident, as well as understand and address  socio-economic barriers to the recovery process.

The commonality of cognitive impairment and depression is discussed. Cognitive symptoms are the main symptoms of depressive disorder  and, most often, it is cognitive  impairment that  reduces  the performance and quality of life of depressed patients. The most common  cognitive  disorders  in depressed patients are: attention deficit (both visual and auditory), decrease in the  level of short-term and operative  memory, difficulties in processing  information  of any modality, a decrease in the speed of information processing, as well as difficulties in building an activity program and monitoring her execution. A cognitive symptom that requires further  discussion  is the so-called  cognitive  distortion  – a shift in focus from positive  to negative  stimuli, as well as incorrect reactions  to negative  feedback and decision making. A depressive  episode  develops  against  the background  of dysmetabolic and dysfunctional  cerebral  changes  in the  amygdala,  cingulate  cortex, hippocampus,  orbitofrontal and  mediobasal frontal  cortex. Cognitive impairment in patients who have had depression persists  after recovery from depression;  according  to the figurative expression  adopted in the scientific community of specialists  studying cognitive impairment in depression, each depressive  episode  forms permanent “cognitive scars”. Presumably, cognitive  dysfunction  may be one of the  risk factors  for the  development of a depressive  disorder; depression, in turn, is a risk factor for the development of dementia, including in Alzheimer’s disease and cerebrovascular disease: studies  have shown that the transformation of severe cognitive impairment associated with depression into dementia in elderly patients can reach 70% in five years. The undoubted commonality of depression and cognitive dysfunction is emphasized by the frequency of depression in patients with cognitive impairment.

The article describes  clinical cases of elderly patients with primary headaches and insomnia  managed in neurological practice. The first clinical case provides  details  of the  typical medical  history of a female  patient  with acute  insomnia  and episodic tension-type headache, the  second  one describes  the  typical medical  history of a patient  with chronic insomnia  and chronic migraine. Clinical examples  demonstrate common errors in the management of patients with insomnia  and primary headaches in real-life medical practice. The influence  of psychosocial  (stress, anxiety, negative  misconceptions about the disease,  dysfunctional   behaviour,  symptom  catastrophizing)  and  iatrogenic   (ordering  excessive   additional diagnostic   tests, over-diagnosing of detected structural changes  in the spine, neck vessels, brain, diagnostic  errors, prescribing  of ineffective treatment) factors on the development of insomnia and increase  of headaches in frequency is shown. The features  of the presented  clinical cases  are to demonstrate the relationship between insomnia  and increased frequency of primary headaches. Patients were  treated using  the  interdisciplinary program  comprising  non-drug  treatments and  drug  therapy. It has  been shown that the treatment of insomnia can not only improve the quality of sleep, but also reduce the frequency of headaches.

SonNorm Duo containing melatonin, motherwort extract  and peppermint leaf oil was used as a drug therapy  for acute  and chronic insomnia. Melatonin  and substances of plant  origin have a high level of effectiveness in the treatment of insomnia and are recommended as drugs to be used first to treat  insomnia. The drug therapy of acute  and chronic insomnia  was combined  with highly effective  non-drug  treatments: an educational program  to improve sleep  hygiene, cognitive  behavioural therapy, and relaxation exercises. During treatment, patients reported an improvement in their sleep quality as early as in the first month. A stable  normalization of sleep  and a significant decrease in headache frequency in a patient  with acute  insomnia and episodic  tension-type headache occurred  after  the  fifth week of treatment and in a patient  with chronic insomnia and chronic migraine after the second month of treatment. A 12-month follow-up of patients showed that the positive effect of the treatment was maintained.

Treatment strategies for migraine  attacks  include the use of nonspecific drugs (simple and combined  analgesics, antiemetics) and specific drugs (triptans, ergotamine derivatives, gepants, ditans), as well as neuromodulation methods. Despite the expansion of the  range  of specific drugs, the  effectiveness of relieving  headache attacks  during migraine  remains  unsatisfactory. The choice of drug for the treatment of migraine attacks is based on their stratification according to the degree  of impairment of the  functional  activity of patients and involves  the  prescription  of specific anti-migraine drugs for moderate and severe disability. The stratified  approach  has a number  of advantages in terms  of the  main parameters of analgesic  effectiveness, is associated with lower treatment costs and carries a lower risk of analgesic  abuse. Migraine attacks are characterized by high polymorphism  and the presence of many clinical manifestations, which largely determine the severity of the patient’s disability and sometimes require  independent treatment. Specific drugs for the treatment of migraine  attacks  (triptans) can relieve not only headaches, but also symptoms of nausea, vomiting, photo- and phonophobia. The choice of drug is based on the individual characteristics of the  patient,  the  profile  of migraine  attacks  and  involves  taking  into  account  the  pharmacological properties of the drug. Features  of migraine  such as a high rate  of increase  in pain during an attack, the presence of rapidly developing nausea, and the need to provide long-term pain relief require the use of fast-acting forms of medications. The benefits of choosing  these  forms are supported by patient  preference studies. Clinical trial data and research  results  from actual clinical practice  allow us to formulate  some approaches to differentiated drug selection.

Introduction. Chronic tension headache and insomnia are a common mutually aggravating pathology. Drugs used to treat these nosologies most often worsen the course of the concomitant disease.

Objective. To evaluate the effect of insomnia correction on the intensity and frequency of headaches

Materials and methods. The study involved 27 patients (25 women, 2 men) with chronic tension-type headache and sleep disorders. The median age was 43 ± 14.8 years. In accordance with the purpose of the study, the clinical group was divided into 2 subgroups. The first group was treated with venlafaxine and doxylamine, the patients of the second group received only venlafaxine treatment. The assessment was carried out before the start of treatment and 8 weeks after, using visual analogue scales for headache, sleep, health status, assessing the severity of insomnia using the Morin scale and the Pittsburgh Sleep Quality Inventory (PSQI), assessing the emotional state using the Sheehan anxiety and Beck depression scales and polysomnography.

Results. In subgroup 1, which received correction of insomnia, there was a significant decrease in the number of days with headache (from 20 to 10, p = 0.002), pain intensity according to VAS (from 7 to 6, p = 0.01) and VAS sleep (from 6 to 4 points, p = 0.003). In the group without correction of insomnia, the number of days with headaches significantly decreased (from 15 to 12, p = 0.01), changes in the severity of headache according to VAS (from 7.5 to 6, p = 0.13) and sleep quality (from 6 to 7.5, p = 0.38) did not have a statistically significant difference. According to the results of polysomnography, patients who received correction of insomnia had an increase in the duration of slow-wave sleep by 12 minutes (p = 0.02), while in patients from the second subgroup by 4 minutes (p = 0.68).

Conclusions. The use of a combination of venlafaxine and doxylamine in the first stages of treatment of patients with chronic tension-type headache and insomnia has an advantage over standard therapy. Combination therapy can reduce the intensity and frequency of headaches and improve sleep quality.

Acute and chronic stress, as well as emotional disturbances as a consequence of stressful situations, are significant risk factors for the development and progression of some of acute and chronic non-communicable diseases, including cardiovascular diseases (CVD), among which the most common are arterial hypertension, chronic heart failure and atherosclerotic CVD. Specific emotional disturbances that arise after exposure to significant traumatic or stressful situations include acute and post-traumatic stress disorder. When a stress factor does not reach high intensity or significance, adjustment disorder may develop. Stress-related emotional disturbances significantly affect other CVD risk factors, reduce patients’ adherence to healthy lifestyle changes and drug therapy, deteriorate quality of life and increase the risk of disability. The urgency of identifying and managing post-stress emotional disturbances in the practice of internists is caused by high frequency of these disturbances in outpatient patients. It is especially important to manage and prevent these disturbances in patients with CVD due to increased number of adverse outcomes resulting from this combination. Treatment of emotional disturbances resulting from stressful situations includes both drug and non-drug methods. Antidepressants and benzo-diazepine anxiolytics are the main classes among the drugs used to treat post-stress emotional disorders. However, the prescription of these drugs requires taking into account a wide range of possible side effects, especially in patients with CVD. The choice of drugs with a favourable safety profile and a rapid onset of sedative and anti-anxiety effects is a key element in the modern effective patient management strategy. Tofisopam and buspirone are the most advanced of this group of drugs in therapeutic and cardiological practice.

Antidepressants (ADs) are a group of drugs whose action primarily consists of stimulating neurotransmitter systems (dopaminergic, serotonergic and noradrenergic systems). Neurologists prescribe them for the treatment of post-stroke and other depression, chronic pain syndromes, neuropathic pain, panic attacks, correction of post-Covid syndrome, for the prevention of migraines, Parkinson’s disease and neurodegenerative diseases, including Alzheimer’s disease. However, even with appropriate therapy, many people with depressive disorder may experience subsyndromal symptoms and complete remission is short-lived, so there is a need to use other therapeutic approaches. Combining two or more antidepressants may target different neurochemical pathways while increasing the risk of side effects and the development of resistance. Therefore, the search for alternative treatments is urgent, and oxidative stress appears to be an interesting therapeutic target. The combined use of AD and antioxidants may provide an effective and safe approach to enhancing antidepressant effects by synergistically enhancing certain antidepressant activities (eg, enhancing monoamine reuptake inhibition) or by additive pharmacological effects, such as adjusting neurotransmitters and reducing the damaging effects of active agents. forms of oxygen. There are a number of clinical studies to prove the effectiveness of the combined use of antioxidants and antioxidants. In the group of patients receiving a combination of antioxidants and antidepressants/anti-anxiety drugs, there was a better regression of symptoms and severity of depression, which probably indicates the usefulness of adjuvant antioxidant therapy with regular psychotropic treatment. The use of combination drugs in complex therapy with blood pressure seems to be a promising direction and requires further study.

Stress defines a cluster of psychophysiological responses aimed at enabling resources to solve difficult situations, as well as restoring and maintaining homeostasis in the body. Stress is a combination of physiological, neuroendocrine, behavioural and emotional responses to new or threatening stimuli and serves as a protective adaptation of the body under physiological conditions. In accordance with the effect on the body, beneficial and negative stress is distinguished. Stress can be divided into “chronic” and “acute”. The intensity of the physiological response to a stressor is highly individual and situationally dependent. Many variables, including personal attributes, coping strategies, social support, and past experiences may modify the physiological stress response in any given situation and can account for the different response of people exposed to the same stressor. Intense and persistent stress can lead to psychological and pathological body injury. Stress has a significant impact on different brain regions, including the hippocampus, hypothalamus, amygdala etc. Depression, anxiety, cognitive deficits, and even stress-induced mental diseases are closely related to functional and structural damage of the related brain regions. Repetitive daily acute stress can be associated with different diseases, first of all cardiovascular diseases, which affect quality of life and can cut short life expectancy. Timely treatment is required to prevent progression of early stress reactions to chronic post-traumatic stress disorder, especially in individuals at high risk. Advanced stress and anxiety management interventions include non-pharmacological and pharmacological treatments.

The article considers a clinical case of treatment of one of the variants of nonspecific back pain – sacroiliac joint syndrome.   In this case, we tried to demonstrate the importance of timely and accurate determination of the cause of dorsalgia using currently available tools: medical scales, X-ray and MRI examination, diagnostic drug blockade of the pain zone. A scrupulous analysis of complaints, anamnesis and clinical manifestations of the patient, a differential diagnosis with a number of diseases with a similar clinical picture, as well as the choice of treatment tactics based on federal clinical recommendations for the treatment of patients with nonspecific back pain made it possible to quickly determine the diagnosis and cope with the pain syndrome. Therapy with the inclusion of medications, physiotherapy, manual therapy, post-isometric relaxation, physical therapy, posture correction allowed the patient to stop the pain syndrome and return to an active lifestyle. Dexketoprofen (Dexalgin®) was prescribed to relieve the pain syndrome. Optimization of the method of administration of the drug is a step-by-step scheme for prescribing dexketoprofen: parenteral administration of 2 injections (50 mg) intramuscularly daily for 2 days, then transfer to oral Dexalgin intake – 25 mg 2 times a day for 3 days under the guise of proton pump inhibitors – Esomeprazole 40 mg 1 time a day, the use of a patch with a local anesthetic, vitamins of group B – 12 days, therapeutic and diagnostic drug blockades – contributed to a significant reduction in the intensity of the pain syndrome and allowed to prevent its transformation into a chronic process. As a result of the use of complex, pathogenetically based therapy, a rapid positive therapeutic effect was achieved.

Chronic musculoskeletal pain (CMSP) associated with diseases of the musculoskeletal system is one of the global causes of suffering, disability, and a decrease in the quality of life and its duration for hundreds of millions of people on Earth. Therefore, effective pain control is among the first and most important tasks of the treatment of musculoskeletal diseases. For this purpose, a complex of medications and non-pharmacological approaches (kinesiotherapy, psychological methods, educational programs, etc.) is used. Effective, affordable and convenient nonsteroidal anti-inflammatory drugs (NSAIDs) play a fundamental role among analgesics. They belong to the “first line” drugs for the control of SMB. However, when prescribing them, it is necessary to take into account the presence of comorbid pathology as risk factors for drug complications. At the same time, naproxen is the safest NSAID in terms of cardiovascular risk. The effectiveness of this drug has been proven both in the short-term treatment of acute and long-term therapy of chronic pain. Naproxen is more effective than paracetamol and is not inferior to weak opioids and other NSAIDs, such as ibuprofen and ketorolac. The data of clinical, observational and cohort studies, as well as their meta-analysis, confirm that the risk of cardiovascular complications in the treatment with naproxen is minimal. An urgent problem in the treatment of CMSP is the combination of this pathology with sleep disorders, which determines a significant deterioration in the well-being and quality of life of patients. The use of the combined over-the-counter drug naproxen and diphenhydramine for short-term therapy of insomnia presents new possibilities of pharmacotherapy in this clinical situation.

B-group vitamins are a collection of 8 water-soluble vitamins. They are cofactors for many enzymes, as well as axonal transport, synthesis of neurotransmitters and other metabolic processes. Their function can be divided into catabolic metabolism, leading to energy production, and anabolic metabolism. Some B vitamins are considered neurotrophic and play a particularly important role in both the central and peripheral nervous systems. Neurotropic B-group vitamins (B₁ – thiamine, B₆ – pyridoxine and B₁₂ – cyanocobalamin) play the role of modulators for the treatment of inflammation and pain, they are essential for the proper functioning of the nervous system. B vitamin deficiencies have been considered as etiological factors in the development of various neurological disorders and a broad spectrum of pathological states. The work examines in detail vitamins B₁, B₆ and B₁₂ and their effect on the course of neuropathies, movement disorders, nociceptive and neuropathic pain. The issues of the synergistic action of these vitamins are highlighted. Evidence of neurotropic B vitamin treatment effectiveness of neuropathy symptoms in different groups of patients is presented. The possibility to use vitamin B₁ and B₆ complex in clinical practice under the condition of individual intolerance of vitamin B₁₂ is discussed. Information about Cytipigam® compositum as a drug containing B₁ and B₆ is provided. A clinical case report on the effective use of this drug in clinical practice is described.

Neurodegenerative diseases of the brain pose a serious challenge in diagnosis and treatment. Of particular interest are diseases caused by complex mutations, the clinical picture of which is ambiguous. The article presents a description of a clinical case of a neurodegenerative disease of the brain with symmetrical damage to the cerebellar hemispheres in the projection of the dentate nuclei, in the region of the superior and middle cerebellar peduncles, in the region of the midbrain tegmentum, along the corticospinal tracts, in the subcortical sections of the frontoparietal regions of the brain. It has been shown that these clinical manifestations are caused by the formation of small foci of demyelination in the white matter of the brain. The cause of the disease was revealed to be a deficiency of mitochondrial complex II, nuclear type 4, which is caused by mutations in the NFASC (encoding neurofascin) and SDHB (encoding succinate dehydrogenase) genes. The leading clinical manifestations in this case were motor disorders in the form of persistent bilateral ptosis, external ophthalmoplegia, optic disc atrophy, retinal pigmentary degeneration, subcortical dysarthria, sensorineural hearing loss, and cognitive impairment. However, the clinical picture of this disease developed latently for a long time, which made its diagnosis difficult. The reason for this was a complex genetic defect including mutations in the neurofasciitis and succinate dehydrogenase gene. The paper provides a discussion of currently known effective methods of treating the disease.

Gout is a chronic disease characterized by attacks of arthritis, most often of the lower extremities, which develop under conditions of prolonged hyperuricemia caused by environmental and/or genetic factors. In the last decade, there has been an increase in the prevalence of both hyperuricemia and gout, which causes concern not only among rheumatologists, but also among doctors of related specialties. This is due to the fact that uric acid, deposited not only in joints, but also in other organs and tissues, contributes to the development of cardiovascular and metabolic diseases, as well as chronic kidney disease and osteoarthritis. It has been proven that even asymptomatic hyperuricemia, and not just hyperuricemia as a component of clinical gout, contributes to a more severe course of these comorbid pathologies. Probably, the maintenance of a chronic systemic inflammatory process, oxidative stress and the formation of endothelial dysfunction play a decisive role in the nosogenesis of polypathology. Accumulated scientific evidence suggests that achieving target levels of uric acid (less than 360 μmol/L in the case of atophus gout and less than 300 μmol/L in the case of tophi gout) leads to a reduction in the incidence of cerebral, cardiovascular, and renal events. Prescribing urate-lowering drugs to patients with hyperuricemia and at risk for type 2 diabetes mellitus and osteoarthritis also appears promising. Among the urate-lowering drugs registered in the Russian Federation, febuxostat shows the highest efficiency and safety, and also has a nephroprotective effect, which is especially important in patients with a decrease in glomerular filtration rate.

The article examines in detail the effect of febuxostat on various organs and systems in patients with gout and asymptomatic hyperuricemia.

Introduction. Rheumatoid arthritis (RA) is a systemic autoimmune disease as well as a typical inflammatory process. Chemerin is a fat tissue cytokine, which specific receptors were discovered on the surface of the innate immune cells. It is of interest to study the association of chemerin with the complications and comorbidity in RA.

Aim. To study the association between serum chemerin levels with complications and comorbidity in rheumatoid arthritis.

Materials and methods. 88 women with RA were enrolled in our study. ll patients undergone standard clinical and laboratory examination. Serum chemerin, high-sensitive C-reactive protein (hsCRP), anti-citrullinated protein antibodies, insulin and C-peptide levels were determined using ELISA. X-ray absorptiometry was performed. Statistical analysis was performed using conventional methods with a software package Statistica 10.0.

Results. Median chemerin concentration was  463.5  [366–576.5]  ng/ml.  Chemerin  concentration  correlated  with the age (ρ = 0.232; р = 0.030), weight (ρ = 0.254; р = 0.017) and body mass index (BMI) (ρ = 0.212; р = 0.047), but wasn’t associated with the RA classification criteria. Positive correlation between chemerin concentration and number of painful joints (NPJ) (ρ = 0.213; р = 0.046) and hsCRP (ρ = 0.273; р = 0.010) was observed. Patients with type 2 diabetes mellitus (DM2) had higher chemerin concentration (598.0 ng/ml vs 479.5 ng/ml, Z = -2.68; p = 0.007) and patients with cholecystectomy in anamesis had lower (359.0 ng/ml vs 479.0 ng/ml, Z = 2.02; p = 0.043). Chemerin concentration correlated with systolic and diastolic blood pressure (BP) (ρ = -0.41; р < 0.001 and ρ = -0.27; р = 0.028, respectively).

Conclusions. Chemerin concentration in women with RA correlates with age, weight, BMI, NPJ and hsCRP. Chemerin concentration in patients with comorbid DM2 was higher and in patients comorbid with cholecystectomy in anamnesis was lower. Chemerin concentration correlates negatively with a systolic and diastolic BP.

The article presents the results of a search in the PubMed and Google Scholar databases (meta-analyses, systematic reviews, clinical trials and case studies) evaluating the treatment of PsA with tofacitinib (TOFA). The review contains the most up-to-date information about the efficacy and safety of TOFA, a drug from the group of janus kinase inhibitors (JAKi), a brief description of the mechanism of action of TOFA is given, with mention of blocked signaling intracellular pathways. The spectrum of “key” clinical manifestations of psoriatic arthritis (PsA) is described, in which the therapeutic potential of TOFA (peripheral arthritis, psoriasis, enthesitis and dactylitis) is most fully revealed. The results of the main randomized controlled trials (OPAL Broaden and OPAL Beyond), postmarketing trials, descriptive studies and clinical observations are considered, and the high efficacy of TOFA for the treatment of PsA patients who did not respond to therapy with synthetic disease-modifying drugs and/ or Tumor Necrosis Factor inhibitors (TNFi) is demonstrated. The results (and their interpretation) of studying the safety of long-term use of different doses of TOFA – 5 mg 2 times a day and 10 mg 2 times a day and retention (“survival”) are presented therapy, with an emphasis on adverse events of special interest (“large” cardiological events (MACE), oncologics, infections). The results of treatment with tofacitinib in patients with PsA according to the All-Russian register of patients are presented. The pronounced positive effect of TOFA on the parameters that are defined as “patient-reported outcome – PRO” is particularly emphasized: indicators of fatigue, self-assessment, patient’s assessment of his condition according to VAS, assessment by HAQ-DI (Health Assessment Questionnaire), SF-36 (non-specific questionnaire for quality assessment patient’s life), etc. A clinical observation is presented that demonstrates a vivid therapeutic effect on arthritis, enteritis, dactylitis, clinical signs of spondylitis, sacroiliitis, as well as the skin process in a patient with active PsA.

Osteoarthritis of the hip joints is one of the most common pathology of the musculoskeletal system. The issues of its therapy are discussed in all clinical recommendations and recently more and more attention has been paid to the introduction of hyaluronic acid preparations. In the Russian recommendations for the treatment of coxarthrosis, this recommendation has a high level of credibility and evidence and is based on a significant number of studies confirming the safety and effectiveness of this therapy in the long term. The article provides data from some studies, as well as the conclusions of the European Consensus Group on intra-articular administration of hyaluronic acid, which prescribes indications and contraindications for the introduction of drugs into the hip joints. The issue of choosing a specific drug among a variety of forms is also discussed and a clinical example of the administration of hyaluronic acid to a patient with osteoarthritis of the hip joints under ultrasound control is considered. A detailed technique of drug administration is described. When considering this clinical example, the good tolerability of the drug, the accuracy of the administration of the drug, as well as the long-term results of the safety and effectiveness of therapy in the form of pain reduction and the absence of the need for NSAIDs are demonstrated.

Recent decades have been characterized by high stress levels, which inevitably leads to neuroticism and psychopathization of the population. Emotional stress and the anxiety that follows it can be the cause and provocateur of some pathological processes and diseases. Unlike normal anxiety, intended to adapt the body, protect it and preserve life, pathological anxiety is inadequate to the intensity of the threat, is long-lasting, severe, and disrupts the quality of a person’s life and his activities. Activation of the hypothalamic-pituitary-adrenal axis caused by stress leads to the development of psycho-vegetative syndrome – a complex of somatic, vegetative, and mental symptoms. However, in clinical practice, doctors usually encounter the fact that the patient more often presents various multisystem somatic complaints, ignoring emotional experiences. Undiagnosed anxiety can lead to chronicity or relapse of the disease, the prescription of only symptomatic therapy and aggravation of the course of the missed anxiety disorder. For a doctor to qualitatively assess the clinical picture, it is necessary to understand the structure of autonomic dysfunction in various systems and “recognize” the manifestations of anxiety. Managing such patients, especially comorbid ones, is a complex task, the solution of which will be most effective through joint efforts with psychiatrists and psychotherapists. Psychotherapy, cognitive-behavioral therapy, art therapy, music therapy, medications are an integral part of the therapy for this category of patients. Psychotropic drugs can reduce both anxiety and vegetative symptoms. For subclinical anxiety disorder with somatic manifestations, herbal sedatives or drugs based on them are used in outpatient practice, which have a favorable safety profile with sufficient effectiveness. The drug of choice may be Valocordin, which has sedative, antispasmodic, and hypnotic effects, which corresponds to the goals of treating psychovegetative syndrome.

Introduction. Studying clinical manifistations and prognostic factors for the development of post-covid syndrome (PCS) remains an actual task for doctors of various specialties.

Aim. To study the clinical manifestations and probable predictors of the formation of PCS in neurological practice.

Materials and methods. The study included 34 patients aged 18 to 65 years undergoing treatment at the A.Ya. Kozhevnikov Clinic of Nervous Diseases for the underlying disease: tension headaches (GBN), migraine (M), musculoskeletal pain (SMB), who had a documented coronavirus infection (CI) COVID-19. The main group (OG) consisted of 21 patients (average age 47.95 ± 12.21 years), in addition to the manifestations of the underlying disease, complaining of memory impairment, decreased concentration and performance, fatigue, anxiety and internal tension, low mood background and unwillingness to do anything, headache that occurred for the first time during, immediately after the end or within 2 months after the transferred CI, which met the criteria of the PCC. The comparison group (GS) included 13 patients (average age 38 ± 12 years) who complained only about their underlying diseases and did not note any peculiarities in their course due to the transferred CI. In addition to the main research methods, questionnaires were used: fatigue (MFI-20 scale), anxiety (Spielberger – Khanin scale), depression (Beck scale), cognitive impairment (MOCA test), impaired concentration (Munsterberg test), symptoms of central sensitization (CSI), quality of life (SF-36).

Results. Clinical manifestations of PKS consisted in mild or subjective cognitive impairment (CN) without a change in concentration and asthenic symptom complex. OG patients were older, had moderate and severe acute period of CI and risks of cardiovascular pathology, statistically significantly differed from HS with higher scores on the scales: Beck depression, Spielberger – Khanin, CSI, MFI-20 and a lower score on the MOCA scale.

Conclusions. Possible predictors of the formation of PKS can be: age over 40 years, moderate and severe course of CI, the presence of risks of cardiovascular pathology, depression and increased personal anxiety, higher rates of central sensitization.

Affective spectrum disorders, such as depression and anxiety disorders, are important psychoemotional risk factors for the development and complicated course of many common chronic non-communicable diseases, including cardiovascular ones: arterial hypertension, coronary heart disease, chronic heart failure, atrial fibrillation, acute coronary syndrome, etc. A feature of this comorbidity is the significant impact of psychoemotional factors on the motivation and adherence of patients to a healthy lifestyle, as well as various drug treatment options, which involves an increased risk of complications and, as a consequence, increased healthcare costs. The topicality of the issues of screening and management of psychoemotional disorders in the internist practice arises from a variety of reasons. On the one hand, it is a high incidence of these disorders in patients with cardiovascular diseases, including young and middle-aged ones, which is associated with a deterioration in the quality of life and an increased risk of complications and adverse outcomes in the future. On the other hand, it is caused by insufficient level of awareness among doctors about new possibilities for the management of the psychoemotional state of such patients. This review presents data on the effectiveness and safety of therapy of psychoemotional disorders in patients with various CVDs with a drug containing D,L-hopanthenic acid (rat-hopanthenic acid) as an active substance of the nootranquilizer class, which has a wide range of clinical effects, including a beneficial effect not only on psychoemotional sphere, but also on cognitive functions. The prospects for prescribing a D,L-hopantenic acid drug to young and middle-aged patients with CVD, which reduces the drug burden on the patient and provides high quality of life for patients both in hospital and at subsequent stages of treatment, are discussed. The key point is availability of an option for prolonged use of D,L-hopanthenic acid drug without any risk of addiction, withdrawal syndrome or hyperstimulation, which is an important clinical aspect of drug therapy for patients with CVD, especially in young and middle age.