Introduction. A cumulative meta-analysis of randomized multicentre placebo-controlled studies of ischemic stroke (IS) therapy confirmed benefit of citicoline treatment in terms of increase of chance for better recovery of functional independence. The effect was observed in cases when citicoline was used at the early stages of IS. To confirm international evidence for the domestic citicoline (Ceresil® Canon), the Research Centre of Neurology analysed its own clinical material on its use in patients with acute ischemic stroke.

Aim. To evaluate the efficacy of citicoline (Ceresil® Canon) in the acute phase of atherothrombotic stroke after systemic thrombolysis.

Materials and methods. The study group included 43 patients (27 men and 16 women, mean age 62 ± 11 years) with primary atherothrombotic stroke after systemic thrombolysis. Patients were randomly assigned to receive citicoline or standard therapy at 24 hours after recanalization. Randomization was conducted using a method with sealed envelopes. Patients (n = 24, mean age 59 ± 12 years; 17 men, 7 women; NIHSS score of 12 (9; 14) after systemic thrombolysis) received citicoline at a dose of 2,000 mg/day (solution for intravenous and intramuscular administration 250 mg/ml) IVFD for 10 days as part of standard therapy regimen, then citicoline at a dose of 1,000 mg/day (oral solution 100 mg/ml) for oral use for 45 days. The comparator group (standard therapy) included 19 patients with ischemic stroke (mean age 63 ± 12 years; 10 men, 9 women; NIHSS score of 11 (8; 13)), who underwent systemic thrombolysis, but did not receive citicoline.

Results. 70.8% of patients with atherothrombotic stroke who received citicoline added to their treatment regimen after systemic thrombolysis achieved a score of ≤2 on the modified Rankin Scale (mRS) (mild disability and functional independence) by day 56 of treatment. Patients who did not receive citicoline after systemic thrombolysis and achieved this score accounted for 36.8%. The differences between the groups were statistically significant (p = 0.034).

Conclusion. Prescription of citicoline to patients with atherothrombotic stroke after systemic thrombolysis at a dose of 2000 mg/day IVFD for 10 days, followed by oral use at a dose of 1000 mg (10 ml of solution) for oral use 45 days as part of standard therapy allows to achieve improvement of functional status.

At the end of the last century, it was realized that not only damage to the gray matter of the brain causes cognitive decline, but also damage to the white matter can lead to a decrease in cognitive abilities of high severity, up to dementia. Modern neuroimaging has played a crucial role in the recognition of white matter pathology and its association with cognitive impairment. There are over 100 disorders (genetic and acquired) in which white matter dysfunction can potentially cause or contribute to dementia. The most common diseases of the white matter which predict cognitive impairment (white matter dementia) are cerebral small vessel disease and multiple sclerosis. At first glance, diseases have various triggering and pathogenetic factors. But modern science finds significant similarities between “purely vascular” and immune-mediated diseases. This paper provides a review of literature from the databases eLibrary.Ru, CyberLeninka, PubMed, Scopus, Embase, Medline, Web of Science, Cochrane and Google Scholar with the key terms “cognitive impairment”, “dementia”, “white matter diseases”, “cerebral small vessel disease”, “multiple sclerosis”. It has now been established that inflammation is an integral factor in the pathogenesis of cerebral small vessel disease, and the vascular factor is a constant participant in the pathogenesis of multiple sclerosis. These diseases may have similarities in clinical manifestation and neuroimaging. The review analyzes the available data on the coincidences and differences in the clinical picture and instrumental diagnosis of these diseases, which will allow for targeted prevention of disease progression and cognitive decline.

Introduction. Identification of the characteristics of patients with chronic migraine (CM) and comorbid chronic insomnia (CI) can improve the quality of management for such patients.

Aim. To compare the socio-demographic and clinical-psychological characteristics of patients with CM combined with and without CI, assess the relationship between insomnia and clinical-psychological characteristics in this category of patients.

Materials and methods. The study included 200 patients with CM combined with and without CI (63 men and 137 women, mean age 33.1 ± 7.1 years), who were divided into Group 1 (96 patients with CM and CI) and Group 2 (104 patients with CM without CI). All patients underwent clinical interviews, testing, neurological and somatic examinations.

Results. There were significantly (p < 0.05) fewer patients who were married, more often divorced and had drug-induced headache and neck pain in Group 1 as compared to Group 2. The frequency of intake and number of doses of pain medications (PM), personal anxiety, depression, rumination, insomnia severity, PM dependence, emotion-focused coping, and pericranial muscle soreness were significantly higher in Group 1 compared to Group 2, whereas adherence to treatment was significantly lower. Insomnia has been shown to correlate significantly positive with the frequency of intake and number of doses of PMs, personal anxiety, depression, rumination, PM dependence, emotion-focused coping, pericranial muscle soreness, and negative correlation with treatment adherence.

Conclusion. In CM, a positive correlation was established between insomnia and the frequency of intake and number of doses of PM, PM dependence, personal anxiety, depression, rumination, emotion-focused coping, pericranial muscle soreness, and a negative correlation between insomnia and treatment adherence, which should be taken into account when managing patients.

Introduction. Post-stoke shoulder pain (PSSP) commonly occurs within the first 2-3 months after stroke, interferes with the recovery of motor function, prolongs hospital stay, is associated with depression, and limits daily activities and proper participation in rehabilitation programs.

Aim. To identify the features of post-stroke shoulder pain before and after the rehabilitation course, taking into account the rehabilitation methods used.

Materials and methods. The study observed 37 patients (average age of 63 years, 17 men and 13 women), of which 32 patients were in the early recovery period after acute cerebrovascular event (ACVE) and 5 patients were in the late recovery period. The study evaluated the type of post-stroke pain syndrome, characteristics of pain syndrome in post-stroke arthropathy and neurological status of patients before and after rehabilitation activities.

Results. Of the 37 patients examined, 30 patients had post-stroke arthropathy (81.1%); 4 patients (10.8%) had central post-stroke pain syndrome and 3 patients (8.1%) had pain syndrome associated with a painful spasm in the spastic muscles of paretic limbs. Stroke patients with severe and pronounced arm paresis more often developed post-stroke shoulder pain. Patients had significantly limited range of motion within the shoulder joint due to pain syndrome. The shoulder’s range of motion in the shoulder joint when measured with a goniometer before rehabilitation activities averaged 1100 with the arm in fixed flexion, and 880 with the arm in passive abduction. At the time of discharge, patients who underwent traditional rehabilitation activities combined with the use of botulinum toxin type A showed better results compared to patients without botulinum therapy.

Conclusions. Early diagnosis of post-stroke shoulder pain and a thorough approach to rehabilitation activities are needed, as specific mechanisms may require personalized therapeutic interventions.

This article presents an analysis of the historical transformation of neurasthenia – from the popular “American disease” in the 19th century to exclusion from modern classifications (DSM, ICD-11). The neurologist J. Bird associated neurasthenia with “exhaustion” due to the transition from a traditional rural lifestyle to a fast-paced urban life. He was the first to describe a wide range of both mental and somatized symptoms. Later, the concept was reinterpreted in European psychiatry through the prism of intrapersonal conflicts, and in the Russian school of I.P. Pavlov’s neurasthenia was considered as an asthenic neurosis, represented by two main clinical forms: hyposthenic (with a predominance of weakness and lethargy) and hyperesthetic (with irritability and increased excitability). In ICD-10, neurasthenia remains as a diagnosis characterized by persistent fatigue from both physical and emotional stress, vegetative disorders and emotional lability, but in recent decades its diagnostic boundaries have significantly narrowed. This is due to the development of diagnostics and conceptualization of depression, anxiety and somatoform disorders, as well as the emergence of the concept of chronic fatigue syndrome, which is especially relevant in the post-covid period. In the framework of the presented study, the authors analyze the modern scientific discourse that examines the question of the clinical validity and diagnostic value of maintaining neurasthenia as an independent nosological unit in modern classifications of mental disorders. This publication also presents three clinical cases, using the example of which it will be possible to trace the main aspects of the clinical picture, differential diagnosis and approaches to the treatment of neurasthenia and related disorders.

The work presents an analysis of the current literature on the effect of insomnia on cognitive functions. The search was carried out using the databases of RSCI, Russian Medicine, Embase, Medline, Scopus, Web of Science, Google Scholar, using the keywords: insomnia, sleep disorder, cognitive functions, memory, functional MRI, treatment of insomnia, doxylamine. The search depth was 40 years. The consequences of sleep disorders include effects on chromosome telomeres, decreased neuron activation, and impaired brain connectivity. Insufficient sleep alters the activity of cortical neurons in areas responsible for cognitive functions, disrupts the functional connection between brain regions mediating executive functions, memory, and emotion regulation. Glymphatic clearance plays an important role in the pathogenesis of Alzheimer’s disease, as the vast majority of toxic metabolites are eliminated during sleep, and dementia is associated with sleep disorders along with age-related decreased aquaporin-4 function. The accumulation of toxic metabolites (including amyloid-β) begins at a young age and is associated with a shortening of sleep duration. Non-drug sleep improvement measures include behavioral correction: learning sleep habits, optimizing sleep conditions and improving sleep patterns, moderate physical activity during the day, and correcting environmental factors. In case of insomnia, central histamine H1 receptor blockers may be prescribed. Doxylamine is a drug used to treat nausea and vomiting in pregnant women, allergic rhinitis, and insomnia. Valocordin®-Doxylamine is a safe and effective over-the-counter medication that can benefit the patient with minimal side effects if used correctly.

Antidepressants are widely used in psychiatry and general clinical practice and are among the most commonly prescribed medications. First-line antidepressants are selective serotonin reuptake inhibitors (SSRIs), which in recent decades have replaced tricyclic antidepressants (TCAS), which are comparable to SSRIs in efficacy but significantly inferior in tolerability and safety. The main indications for prescribing antidepressants are depression and anxiety disorders. In addition, certain antidepressants are used in the treatment of obsessive-compulsive disorder, post-traumatic stress disorder, insomnia and other disorders. Fluvoxamine occupies a special place among SSRIs, the distinctive features of which are good tolerability, selective effect on the symptoms of obsessive-compulsive disorder, including in children and adolescents, which, combined with high safety, allows it to be prescribed to children from the age of eight, as well as the highest affinity for σ1-receptors among SSRIs, which creates special properties of fluvoxamine, benefits in improving cognitive functions, treating psychotic depression and mental disorders complicated by aggressive behavior. Due to its good tolerability, fluvoxamine is considered the safest antidepressant for elderly patients and patients with cardiovascular diseases. Fluvoxamine’s remarkable ability to reduce neuroinflammation creates special advantages for it in the treatment of major depressive disorder and suggests certain prospects for the prevention and treatment of neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease and Huntington’s disease.

Stress is a psychophysiological response generated by the body due to the undesirable, challenging and difficult circumstances or stressors. The stress effects on the nervous system have been known for quite a long time. Numerous studies confirm the adverse effects of stress on the human brain, on the function of the immune, cardiovascular, digestive, endocrine and other body systems. Acute stress refers to a short-term and adaptive state. In contrast, chronic stress is a long-lasting condition known to be related to maladaptive response, implying harmful effects on the body. There are many systems in the body that regulate the level of stress, the main of them include the hypothalamic-pituitary-adrenal axis (HPA-Axis) and the autonomic nervous system (ANS). The HPA axis reacts to stressors by secreting cortisol, a chemical that prepares the body for fight or flight response and is a significant biomarker for stress. Cortisol is mostly associated with psychological stress. The ANS also contributes to acute and chronic stress generation and regulation. It regulates bodily functions in response to external and internal stimuli (maintenance of body homeostasis including temperature, blood sugar levels, etc.). Adrenaline, noradrenaline, and acetylcholine are the prime neurotransmitters released by the sympathetic and parasympathetic divisions of the ANS. Unlike the transient secretion of stress hormones during acute stress, the long-term elevation of catecholamines and glucocorticoids causes not only mental disorders such as anxiety disorder and depression, but also contributes to the development of many other diseases. Relief of early stress-induced (anxiety, autonomic, cardiac) symptoms, especially in high-risk individuals, is highly important, as timely initiation of therapy will make it possible to achieve a complete and lasting solution to the problem.

Parkinson’s disease is one of the most common neurodegenerative pathologies manifested by progressive motor and cognitiveaffective disorders. In the context of global population aging, the prevalence of pathology continues to grow steadily, which creates a significant medical and social burden on health care systems and determines the relevance of the search for new therapeutic approaches. As an additional method of Parkinson’s disease treatment transcranial direct current stimulation (tDCS) is used to reduce motor and non-motor manifestations. Randomized controlled trials, meta-analyses, and systematic reviews have been conducted to evaluate the efficacy of tDCS in Parkinson’s disease. Clinical studies demonstrate the significant potential of tDCS for the correction of motor impairments, with a focus on symptoms of hypokinesia, postural instability, gait disturbances, and cognitive impairment, with the most pronounced positive changes in executive function and working memory. Additionally, there is a positive effect on the affective sphere, manifested in a reliable reduction of depressive symptomatology according to standardized assessment scales. In addition, there is strong evidence of a normalizing effect on sleep architecture, including improvements in sleep duration and quality, which is of particular importance in patients with comorbid sleep disorders. Overall, tDCS represents a promising direction in the complex therapy of Parkinson’s disease, demonstrating a good safety profile and a wide range of therapeutic effects. The greatest clinical efficacy is achieved when optimized stimulation protocols are used in combination with other rehabilitation methods. Future research should focus on developing personalized approaches and more thorough investigation of long-term effects.

Diabetes mellitus remains a global medical and social problem due to its prevalence, presence of severe complications, and high disability and mortality rates among the population. One of the most common chronic complications of diabetes mellitus is the diabetic distal neuropathy, the main risk factors for the development of which are chronic hyperglycemia, arterial hypertension, obesity, smoking, age, and genetic predisposition of the patient. Diabetic distal neuropathy stems from a complex interaction of metabolic processes, immune system, and genetic predisposition, which result in morphological changes in the form of demyelination and thickening of axons, a decrease in the number of Schwann cells, as well as disruption of the structure of the Ranvier nodes. Sensory and motor disorders are manifested by a decrease in all types of sensitivity, weakening of reflexes. Asymptomatic course is observed in 50% of patients with diabetic distal neuropathy. Ideal methods for early diagnosis and therapy of patients with diabetic distal neuropathy do not exist. Controversial issues of diabetic distal neuropathy treatment mainly concern the use of В vitamins and alpha-lipoic acid preparations. Some studies of the alpha-lipoic acid have determined its anti-inflammatory, antioxidant properties, as well as its possible effect on carbohydrate metabolism in patients with diabetic distal neuropathy. B vitamins have long been used as an additional therapy for patients with diabetic distal neuropathy. Clinical experience in treating patients with diabetic distal neuropathy shows that the best result is achieved by using a combination of alpha-lipoic acid and B1, B6, B12 vitamins which is due to their synergistic effect. This review examines the issues of complex pathogenetic therapy of diabetic distal neuropathy in patients with diabetes mellitus.

Entrapment neuropathies are a common group of peripheral nervous system disorders that develop due to compression of nerve trunks as they pass through anatomically narrow canals. The article discusses the main types of compression neuropathies of the arm nerves, clinical symptoms, diagnostic tests and therapeutic approaches. Clinical manifestations of entrapment neuropathies fluctuate based on the level of compression and the degree of nerve injury. Diagnostic tools include electroneuromyography and visualization methods such as ultrasound and MRI, which are particularly valuable for differential diagnosis and detection of structural changes in the nerve itself and its surrounding soft tissues. Treatment of entrapment neuropathies depends on the stage of the disease. Initial treatment is conservative and may include orthotics, local administration of corticosteroids and modification of physical activities. If conservative therapy is ineffective and patients show movement disorders, persistent neuropathic pain, surgical treatment aimed at decompressing the nerve trunk is recommended. It is advisable to include highdose B vitamins in the complex therapy of entrapment neuropathies at any stage of the disease, as they have neurometabolic effects and promote the regeneration of injured nerves. The prognosis of the disease is based on timely diagnosis and adequate therapy. Early treatment allows complete nerve function recovery, while prolonged compression can lead to irreversible changes, including persistent motor impairments and muscle atrophy.

Pregnancy rates are rapidly increasing among women of reproductive age diagnosed with multiple sclerosis (MS). Over the past decades, several studies have proven that MS does not affect the course of pregnancy, and pregnancy does not negatively affect the long-term course of the disease. The results of numerous studies have shown that the frequency of exacerbations in MS patients decreases during pregnancy, but increases after childbirth. According to the summary of product characteristics (SmPC) of disease modifying drugs (DMD) most of them are contraindicated during pregnancy. To prevent possible neonatal risks, it is necessary to use contraception before pregnancy planning for a certain period of time after their last use. Medical data of MS pregnancy registries of patients receiving DMD before, during pregnancy and postpartum provide important information for the formation of further therapeutic approaches. The most valuable are the data from prospective studies with clearly selected points for analysis, including both pregnancy outcomes and newborns health. In the group of anti-CD20 drugs, ocrelizumab has the largest database of use during pregnancy. In February 2025, an expert Advisory Council (AC) was held to review and analyze data on the use of anti-CD20 therapy in family planning. According to AC expert’s opinion the use of ocrelizumab 4.5 months before the planned pregnancy does not have an increased risk of adverse neonatal outcomes and allows effectively to control disease activity during pregnancy and in the postpartum period.

Introduction. Over the past 30 years, there has been a dramatic change in approaches to the treatment of multiple sclerosis (MS), due to the development of a large number of drugs with different mechanisms of action for the disease-modifying treatment (DMT) of MS.

Aim. To form, based on the analysis of the obtained data, an optimal algorithm for the management of patients with MS receiving cladribine tablets in the conditions of real clinical practice.

Materials and methods. A retrospective analysis of the data obtained on the background of therapy with cladribine in MS patients at the end of 2024 was conducted on the basis of the Moscow inter-district departments of MS. The data from outpatient records of MS patients treated with cladribine from 2021 to 2023 were used as research material. Data collection was carried out on the initial clinical and demographic characteristics of patients, as well as indicators of the effectiveness of therapy (average annual frequency of exacerbations, activity according to MRI data and progression according to the EDSS scale) and the presence of adverse reactions against the background of therapy with cladribine.

Results. This publication presents the experience of using the drug cladribine in real clinical practice in 267 MS patients in Moscow in the period from 2021 to 2023. Patients who underwent two full annual courses of therapy showed a significant reduction in the mean annual frequency of exacerbations and brain MRI activity after the first year of therapy. There was also no significant increase in neurological deficits according to the EDSS scale. During the safety analysis, good tolerability of the drug was noted. The spectrum of adverse events and their frequency were comparable to the data of the instructions for medical use. Conclusion. Effective treatment of MS patients requires optimizing therapy, balancing benefits and risks, and long-term treatment planning from the moment of diagnosis. All these principles can be met with an understanding of the mechanism of action of the drugs and clear adherence to recommendations for monitoring the duration of washout periods when switching from one MS-modifying drug to another.

Introduction. The study was driven by the prevalence of secondary progressive multiple sclerosis (SPMS) in Russia and the lack of data on siponimod in the real clinical practice (RCP).

Aim. To collect and analyze data on the administration of siponimod in SPMS patients within Russia’s RCP as part of the EMBOSSES study (rEtrospective Multicenter oBservatiOnal Study Siponimod rEal-world Spms).

Materials and methods. The study encompassed data of 606 SPMS patients from 11 centers who received siponimod for at least 6 months. The analysed data included demographic and clinical characteristics of patients, changes in the Expanded Disability Status Scale (EDSS) scores over time, percentage of patients with 6-month confirmed disability progression (6mCDP), annualized relapse rate (ARR) for MS, radiological signs of the disease activity and adverse events (AEs).

Results. Among the study patients, women predominated (64.9%), while men accounted for 35.1%. The median age of patients was 49.5 (±8.9) years. 143 (23.6%) patients reported relapses during 2 years, whereas relapse-free SPMS was observed in 463 (76.4%) patients. The average EDSS scores remained stable, demonstrating minimal changes from 5.44 (±0.998) to 5.58 (±1.028) scores during the 2-year therapy. The percentage of patients free from 6mCDP was 85.5%. The KaplanMeier analysis revealed that 25% of patients achieved 6mCDP by Month 27 of therapy. The average ARR decreased from 0.14 to 0.032 at 12 months and remained low (0.062) after 2 years of treatment. The MRI showed a decrease in the percentage of patients with Gd+ T1 lesions to their complete absence over 2 years of therapy. Main AEs: lymphopenia, bradycardia, and elevated liver enzymes; serious AEs were observed in 3.3% of all cases.

Conclusions. Siponimod demonstrated efficacy in controlling disability progression and inflammatory activity, as well as a favourable safety profile in patients with SPMS in the RCP setting. The results confirm the feasibility of using siponimod in patients with SPMS.

Traumatic brain injury (TBI) is a major public health concern with an estimated not less than 3 million children worldwide affected annually. It can result in death or disability, especially in patients with moderate or severe TBI. According to the Federal State Statistics Service (Rosstat), in Russia 1,014.3 thousand cases of head injury were registered in children aged 0 to 17 years (3,353.5 per 100,000 children) in 2023, which is second only to wrist/hand injuries and ankle/foot injuries in terms of figures. Children who had TBIs may suffer not only from movement disorders associated with brain injury, but also have a combination of cognitive, behavioural, and emotional impairments that may persist for a long period of time after the injury. Children with moderate to severe TBIs develop deficits that persist into adulthood, affecting education and employments outcomes, psychosocial functioning, and quality of life. Post-concussion syndrome, the most common complication of mild TBI, can develop in all age groups. Dysexecutive syndrome has been shown to be present during the acute period of recovery from TBI and may persist over the long-term horizon. Executive functions are crucial for a child's academic performance and overall development. Blood biomarkers have been explored for their potential to provide objective measures in the assessment of injury severity and to help identify children at risk for delayed recovery of CNS functions. Medical treatment for children with TBI should include a multidisciplinary approach and creation of individual trajectories of recovery programs with due account for identified disorders. Choline alfoscerate is a promising effective drug to correct neurodevelopmental disorders and recover cognitive functions in children after TBI.

Introduction. Assessment of serum uricemia is currently becoming an available laboratory marker of metabolic distress associated with an increased risk of a wide range of comorbid conditions and diseases, from gout and urate nephrolithiasis to cardiovascular pathology and type 2 diabetes mellitus.

Aim. To analyze the interrelationships of hyperuricemia and gout with impaired renal function and nephrolithiasis in dynamic follow-up over three years in real outpatient practice.

Materials and methods. The retrospective observational study included 324 patients (121 men and 203 women) who sought medical help in 2021–2024. The presence of concomitant pathology, the dynamics of UA levels, creatinine, and estimated (CKD EPI) glomerular filtration rate were analyzed in subgroups of men and women with UA levels < 360 μmol/l (normouricemia) and ≥ 360 μmol/l (GU).

Results. An increase in the prevalence of hyperuricemia by 15% among men and 10% among women over three years is determined. The increase in the number of gout patients over the same period was 7% and 3%, respectively. A statistically significant relationship between the presence of hyperuricemia (uric acid ≥ 360 μmol/l) and impaired renal function was determined only in women (χ2 = 15.4; p = 0.00046). In the presence of GU, there were no patients with normal glomerular filtration rate, either initially or during dynamic follow-up, and CKD of advanced stages (3b-5) was observed in them 6.8 times more frequently initially and 4 times more frequently after 3 years of follow-up.

Conclusion. A significant inverse correlation (-0.25; p < 0.05) was found between an increase in serum uricemia and a decrease in glomerular filtration rate, regardless of gender differences. The use of urate-lowering therapy with the achievement of a target uric acid level of less than 300 mmol/l demonstrated the possibility of stabilization of renal function and resorption of tophi in a patient with gout.

Introduction. For successful planning and implementation of measures for the prevention and treatment of osteoporosis (OP), data on the prevalence of clinical risk factors (FR) of the disease and the frequency of high risk of osteoporotic fractures (OP-fractures) in a particular population are needed.

Aim. To establish the prevalence of high risk of OP-fractures using the FRAX® instrument based on an assessment of the incidence of clinical RF for OP among the urban population of the Central Federal Region of the Russian Federation.

Materials and methods. The study included 7,320 residents (5,613 women and 1,707 men) aged 50 years and older from 9 cities with a population of more than 100,000 people. A questionnaire was conducted on the main RF of OP, daily calcium intake and physical activity during the month preceding the survey were assessed.

Results. The most common clinical RF of OP were the presence of a low-energy fracture after the age of 40 (29.3%), the causes of secondary OP (23.2%), and smoking (10.8%). 39.9% of the surveyed individuals had three or more RF, including 41.4% of women and 35.1% of men (p < 0.05). The daily calcium intake ≥ 1000 mg was detected only in 9% of women and 5% of men. Low physical activity was recorded in 24.9% of the surveyed individuals, while significantly less among men (20.4%) than among women (26.3%), p < 0.05. 32% of women and 3.6% of men had a high 10-year probability of major OP fractures (p < 0.05).

Conclusions. The most common RF of OP were insufficient intake of dietary calcium, low physical activity, previous low-energy fracture after the age of 40, smoking and the causes of secondary OP in residents aged ≥ 50 years. About 1/3 of women and 3.6% of men in this region had a risk of major OP-fractures according to the FRAX® above the threshold of therapeutic intervention and they need to be prescribed a course of anti-osteoporotic therapy.

Rheumatoid arthritis (RA) is a chronic autoimmune disease with a multifactorial pathogenetic basis, characterized by progressive development preceding clinical manifestation. This review examines the natural history of the disease, including stages from genetic predisposition and exposure to external provoking factors to the formation of preclinical autoimmunity and subsequent inflammatory joint damage. The central role in pathogenesis is played by the interaction of key genetic determinants, such as HLA-DRB1 alleles, with exogenous triggers, including smoking and infectious agents, leading to the production of specific autoantibodies – anticitrullinated protein antibodies and rheumatoid factor. These serological markers can be recorded years before the onset of joint symptoms, indicating a long preclinical period of the disease. Prodromal stages of RA, accompanied by systemic inflammation and immune dysregulation, are considered as critical “windows of opportunity” for preventive measures aimed at preventing the disease from progressing to a clinically expressed phase. Of particular importance are studies aimed at restoring immunological tolerance and modulating microbiomes, which opens up prospects for the development of innovative therapeutic approaches. These strategies should be aimed at preventing disease at the earliest stages of its pathogenesis, long before clinical manifestation. In addition, the development of methods for visualizing subclinical changes and refining risk stratification criteria will be critical for identifying individuals in need of targeted measures. Current strategies of primary and secondary prevention include risk factor modification (smoking cessation, microbiome and diet correction). These approaches offer prospects for reducing the incidence of RA among individuals with a genetic predisposition or the presence of immunological markers in the preclinical stage of the disease.

Osteoarthritis (OA) is one of the most common rheumatic diseases that leads to degeneration of hyaline cartilage, synovial inflammation, and structural changes in joints. The main risk factors for developing OA are obesity, age, genetic predisposition, injury, and mechanical overload. Diagnosis of OA is based on clinical symptoms, examination data, and X-ray signs, but the early stages of the disease often remain unrecognized. A clinical case of a 52-year-old patient with primary OA of the knee joints, interphalangeal joints of the hands and feet is presented. A combination of burdened heredity, morbid obesity, menopause, prolonged wearing of high-heeled shoes, changes in the arches of the foot (flat feet), irrational intense sports activity led to the manifestation of OA. Comprehensive treatment included long-term administration of chondroitin sulphate at a dose of 1 000 mg/day, individually tailored therapeutic exercises, foot orthotics, and the development of a healthy diet, which led to a reduction in fat mass and an increase in muscle mass. After 1.5 years of therapy, improvement was achieved: a 23 kg reduction in body weight, complete relief of joint pain syndrome, normalisation of the initially elevated level of oligomeric matrix protein in the cartilage, and no radiographic progression of OA. It was this comprehensive personalised therapy at the stage of OA manifestation that made it possible to achieve good results in managing the disease at an early stage and prevent its further progression.

Introduction. Changes in the qualitative and quantitative parameters of bone tissue, the structure and density of the vertebrae, and intervertebral discs affect the severity of pain in the lumbar spine (LS). Pain in the LS in RA is less common than in the population and is associated with low functional activity and higher pain rates in general.

Aim. To study changes in bone tissue parameters and pain index in the pelvic floor in patients with RA during long-term prospective observation.

Materials and methods. The prospective multi-year cohort study included 151 women with RA aged 53.9 ± 9.2 years, with a follow-up period of 9.7 ± 1.7 years, with recurrence of pain in the pelvic area from 53.6 ± 12.2 years, which was assessed using the VAS scale (mm). All patients underwent clinical, laboratory and radiological examination of the pelvic area at baseline and over time.

Results. Δ BMD in L1-L4 was -0.75%, in the SB – -8.6%, in the total hip – -5.3%. X-ray morphometry revealed the appearance or increase of the initial deformation (fractures) of the vertebrae in the POP without an increase in BMD in L1–L4 in 4 (2.6%) people. Degenerative changes increased in all analyzed segments of the POP. The number of patients with pain in the POP increased from 77 (51%) to 101 (67%) people, the pain intensity was 47 ± 21 points, became 51 ± 19 points.

Conclusions. Long-term observation revealed stabilization of BMD in L1–L4; in patients younger than 55 years, a decrease was noted, and in patients older than 55 years, an increase in BMD. A relationship was established between the increase in BMD in L1–L4 and degenerative changes in the PP. Severe pain in the PP correlated with age, daily dose of glucocorticoids, RA activity according to DAS-28, health status assessment, and degenerative changes in the dynamics of the L2–L3, L3–L4, L4–L5 segments.

Introduction. Diagnosis and treatment of chronic migraine (CM) has not been sufficiently investigated in the Russian neurological practice, which formed the basis for conducting this study.

Aim. To evaluate the quality of diagnosis and treatment of CM and comorbid disorders in real-life neurological practice. Materials and methods. The study included 200 patients with CM (63 men and 137 women, mean age 33.1 ± 7,1 years) who sought advice from A.Ya. Kozhevnikov Clinic of Neurologic Diseases (CND) of Sechenov University with complaints of headache (HA). Prior to the study, the patients visited neurologists in other healthcare facilities to receive advice and treatment. Each patient underwent a clinical interview, analysis of previous management, and testing.

Results. Prior to contacting CND only 6% of patients had a diagnosis of CM. All patients had previously undergone additional examinations, mainly neuroimaging of the cervical spine and brain, ultrasound examination of the neck vessels, even if there were no "red flags". Over 90% of patients were diagnosed with drug-induced headache (DIHA) and/or comorbid disorders (increased anxiety, depressive symptoms, insomnia and/or musculoskeletal pain) in the CND settings, and only 8% of patients were diagnosed in other healthcare facilities. All patients had their own experience of treatment with drugs and non-drug methods that are not consistent with the clinical guidelines for the management of migraine. Only 8.5% of patients with DIHA had previously received treatment aimed at resolving that condition. None of those who sought advice from the CND had previously received any cognitive behavioural therapy or treatment using a comprehensive personalized approach with due account for their comorbid disorders.

Conclusion. In real-life neurological practice, CM and comorbid neurological disorders are inadequately diagnosed, additional examinations are assigned in the absence of "red flags" and treatment methods that are not consistent with the clinical guidelines for the management of migraine are used. The comprehensive personalized approach involving effective drug and nondrug methods of treatment taking into account comorbid disorders is not applied.