PAIN, JOINTS, SPINE http://pjs.zaslavsky.com.ua/ <table id="table1" border="0" width="100%"> <tbody> <tr> <td colspan="2" align="center" valign="top"><strong style="font-family: Verdana; font-size: 13.3333px; font-style: normal; font-variant: normal; letter-spacing: normal; line-height: normal; orphans: auto; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 1; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff;">The journal Pain, joints, spine (Bolʹ, sustavy, pozvonočnik), the official journal of the Ukrainian Association of Osteoporosis, is platinum open-access peer-reviewed periodical for rheumatologists, traumatologists, neurologists, general practitioners, and allied specialists with interest in joint and spine diseases and pain management.</strong></td> </tr> <tr> <td colspan="2" valign="top"><hr noshade="noshade" size="1" /></td> </tr> <tr> <td valign="top" width="25%"><img src="http://pjs.zaslavsky.com.ua/public/journals/343/homeHeaderTitleImage_uk_UA.jpg" /></td> <td valign="top" width="75%"><strong>The founder:</strong> Zaslavsky O.Yu. Published with assistance of the Ukrainian Association of osteoporosis, Ukrainian Association of menopause, andropause and diseases of the musculoskeletal system.<br /><strong>Publisher:</strong> Zaslavsky O.Yu.<br /><strong>Language of edition: </strong>Ukrainian, English, Russian. <p><strong> Registration Certificate:</strong> КВ № 17141-5911 Р. Issued by the Ministry of Justice of Ukraine 21.10.2010.</p> <p><strong>Founded:</strong> March 2011<br /><strong>Publication frequency:</strong> 4 times per year.</p> <p><strong>ISSN</strong> 2224-1507 (print)<br /><strong>ISSN</strong> 2307-1133 (online)</p> <p><strong>DOI: 10.22141/2224-1507</strong></p> </td> </tr> <tr> <td colspan="2" valign="top" width="100%"><hr /></td> </tr> <tr> <td colspan="2" align="center" valign="top" width="100%"><strong> The journal has official endorsement from the</strong> <table border="0" cellspacing="0" cellpadding="0"> <tbody> <tr> <td style="padding: 10px;" valign="top" width="356"> <p><strong><a href="http://zaslavsky.com.ua/images/191031-Vladyslav-Povoroznyuk.jpg" target="_blank" rel="noopener">European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)</a></strong></p> </td> <td style="padding: 10px;" valign="top" width="356"> <p><strong><a href="http://zaslavsky.com.ua/images/bsp_Strafun.jpg" target="_blank" rel="noopener">All-Ukrainian public organization<br />Ukrainian Association of Orthopedists-Traumatologists</a></strong></p> </td> </tr> <tr style="width: 50%;"> <td> <p><a href="http://zaslavsky.com.ua/images/191031-Vladyslav-Povoroznyuk.jpg" target="_blank" rel="noopener"><img src="http://zaslavsky.com.ua/images/191031-Vladyslav-Povoroznyuk.jpg" alt="" width="100" height="141" /></a></p> </td> <td> <p><a href="http://zaslavsky.com.ua/images/bsp_Strafun.jpg" target="_blank" rel="noopener"><img src="http://zaslavsky.com.ua/images/bsp_Strafun.jpg" alt="" width="100" height="141" /></a></p> </td> </tr> <tr style="width: 50%;"> <td> <p><a href="http://www.esceo.org/about_ESCEO" target="_blank" rel="noopener"><img src="http://www.mif-ua.com/media/uploads/index/esceo.jpg" alt="" width="100" height="37" /></a></p> </td> <td> <p><a href="https://uaot.org.ua/" target="_blank" rel="noopener"><img src="http://www.mif-ua.com/media/uploads/index/uaot_logo.jpg" alt="" width="100" height="100" /></a></p> </td> </tr> </tbody> </table> </td> </tr> <tr> <td colspan="2" valign="top" width="100%"><strong>The journal is the official publication of the Ukrainian Association of Osteoporosis.</strong></td> </tr> <tr> <td colspan="2" valign="top" width="100%"><a href="http://osteoporos.com.ua/en/" target="_blank" rel="noopener"> <img src="http://www.mif-ua.com/media/uploads/index/uao.jpg" alt="" width="100" height="37" /></a></td> </tr> <tr> <td colspan="2" valign="top" width="99%"><hr /></td> </tr> </tbody> </table> <table id="table2" border="0" width="100%"> <tbody> <tr> <td align="left" valign="top" width="98%"><strong>The journal in its publication activity is guided by the recommendations of the following editorial associations:</strong><br /><a href="http://www.wame.org/" target="_blank" rel="noopener"> <img src="http://www.mif-ua.com/media/uploads/index/wame.jpg" alt="" width="100" height="37" /></a> <a href="https://publicationethics.org/" target="_blank" rel="noopener"> <img src="http://www.mif-ua.com/media/uploads/index/cope.jpg" alt="" width="100" height="37" /></a> <a href="http://www.icmje.org/journals-following-the-icmje-recommendations/" target="_blank" rel="noopener"><img src="http://www.mif-ua.com/media/uploads/index/icmje.jpg" alt="" width="100" height="37" /></a> <a href="https://www.councilscienceeditors.org/resource-library/editorial-policies/white-paper-on-publication-ethics/" target="_blank" rel="noopener"> <img src="http://www.mif-ua.com/media/uploads/index/cse.jpg" alt="" width="100" height="37" /></a></td> </tr> <tr> <td align="left" valign="top" width="98%"><hr /></td> </tr> <tr> <td align="left" valign="top" width="98%"><strong>We endorse the following declarations:</strong></td> </tr> <tr> <td align="left" valign="top" width="98%"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5209927/pdf/CroatMedJ_57_0527.pdf" target="_blank" rel="noopener"> <img src="http://www.mif-ua.com/media/uploads/index/sarajevo.jpg" alt="" width="100" height="37" /></a> <a href="https://sfdora.org/" target="_blank" rel="noopener"> <img src="http://www.mif-ua.com/media/uploads/index/dora.jpg" alt="" width="100" height="37" /></a></td> </tr> <tr> <td align="left" valign="top" width="98%"><hr /></td> </tr> <tr> <td align="left" valign="top" width="98%"><strong>The journal is indexed/listed by the following databases and platforms:</strong></td> </tr> <tr> <td align="center" valign="top" width="98%"><a href="http://www.irbis-nbuv.gov.ua/cgi-bin/irbis_nbuv/cgiirbis_64.exe?C21COM=S&amp;I21DBN=JRN&amp;P21DBN=JRN&amp;S21FMT=Jwu_B&amp;S21ALL=(&lt;.&gt;T=Біль. 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for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.</li><li>The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.</li><li>The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.</li><li>The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.</li><li>The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.</li></ol> Acknowledgement to Reviewers http://pjs.zaslavsky.com.ua/article/view/227974 <p>No abstract</p> No authors Copyright (c) 2021 http://creativecommons.org/licenses/by/4.0 2021-04-02 2021-04-02 11 1 50 50 10.22141/2224-1507.11.1.2021.227974 A clinical case of the retroperitoneal fibrosis (Ormond's disease) in rheumatology practice http://pjs.zaslavsky.com.ua/article/view/226909 <p>Retroperitoneal fibrosis (RPF) is a rare disease cha­racterized by the proliferation of inflammatory and fibrous tissue in the retroperitoneum. These masses are commonly loca­lized around the infrarenal part of the abdominal aorta and iliac arteries, often covering the ureters or other organs of the abdominal cavity; idiopathic diseases accounting for 70 % of cases. RPF may be associated with immunoglobulin G4 (IgG4), which accounts for two-thirds of idiopathic RPF cases. Secondary RPF may develop due to infections, malignant neoplasms, medication, retroperitoneal bleeding, or various other diseases. A cli­nical case of idiopathic RPF, probably associated with IgG4, was described in a patient who had undergone a symptomatic surgical treatment in an urological clinic and continued being trea­ted by a rheumatologist, given pathogenetic therapy (methylpredni­solone and mycophenolate mofetil) with a significant improvement. For rheumatologists, this pathology is of an undoubted clinical interest, since these changes are based on processes si­milar to those occurring in systemic diseases of the connective tissue, and the RPF is extremely rare, ranging from 0.1 to 1.3 cases per 100,000 patients per year. However, more often than not, such patients are referred to the doctors of ancillary specialties (urologists, nephrologists, surgeons, vascular surgeons). All of the abovementioned facts emphasize the importance of analyzing such a clinical case.</p> S.А. Trypilka Ye.D. Yehudina Copyright (c) 2021 http://creativecommons.org/licenses/by/4.0 2021-04-02 2021-04-02 11 1 42 49 10.22141/2224-1507.11.1.2021.226909 Efficacy and safety of Ketoprofen Gel treatment in patients with low back pain http://pjs.zaslavsky.com.ua/article/view/226906 <p><em><strong>Background.</strong> </em>The purpose was to study the effectiveness and safety of Ketoprofen gel (Fastum gel) therapy in patients with low back pain (LBP) caused by degenerative-dystrophic changes of the spine. <em><strong>Materials and methods.</strong> </em>24 males and females aged 50-69 years with LBP lasting over 14 days were examined, with a further division into two groups. Group I – 12 patients received thin ketoprofen applications on the lumbar region 2 times a day for 10 days. Group II – 12 patients who received thin applications of Vaseline on the same area 2 times a day for 10 days. Patients used the study drugs as a monotherapy. Examination was performed before the treatment initiation, after 10 and 20 days of treatment. <em><strong>Results.</strong></em> Patients receiving ketoprofen applications had a significantly reduced pain intensity registered by all four components of VAS and the Roland-Morris questionnaire. At the same time, the functional capacity by Schober (t = 3.54, p = 0.005) and Tomayer (t = 3.08, p = 0.01) tests was significantly improved. The quality of life according to the EuroQul-5D scale in patients who used the topical ketoprofen significantly increased by 45 % (t = 4.19, p = 0.002), and life expectancy according to the Oswestry questionnaire by 39.3 % after 10 days of treatment (t = 3.9, p = 0.002). 75 % of patients from the main group and 33.3 % from the compa­rison group assessed the effectiveness of treatment as high according to the Likert index. Neither group reported localized nor systemic side effects. <strong><em>Conclusions.</em></strong> Monotherapy of ketoprofen gel significantly reduced the intensity of pain and improved the functional capacity of patients with LBP. The absence of side effects during treatment indicates its high safety profile for patients.</p> V.V. Povoroznyuk A.S. Musiienko N.V. Zaverukha A.A. Tkachuk Copyright (c) 2021 http://creativecommons.org/licenses/by/4.0 2021-04-02 2021-04-02 11 1 28 34 10.22141/2224-1507.11.1.2021.226906 Economic justification of blood pressure lowering costs in the complex therapy of arterial hypertension with Cholecalciferol supplementation http://pjs.zaslavsky.com.ua/article/view/226907 <p><em><strong>Background.</strong> </em>The purpose of the study was to calculate the cost of lowering blood pressure (BP) in the complex antihypertensive therapy of arterial hypertension (AH) with and without Cholecalciferol. <em><strong>Materials and methods.</strong></em> 154 patients with grade II AH were divided into the AH(+)CH group recei­ving combined antihypertensive therapy plus Cholecalciferol in a dose of 2000 IU / day and into the comparison group — <br />AH(–)CH. Office BP and total Vitamin D levels were measured. The costs of medication were calculated. <em><strong>Results.</strong></em> Du­ring the follow-up examination, the blood level of Vtamin D increased; in the AH(+)CH group getting higher (p = 0.0000001) than in the AH(–)CH group. The per capita cost of medication in the AH(+)CH group was higher than in the AH(–)CH group ($ 106.8 and $91.5, respectively); however, the cost of SBP reduction by 1 mmHg in the AH(+)CH group was $ 3.9 lower than in the AH(–)CH group. The Cholecalciferol dose of 2000 IU/day for 3 months results in an optimum level of Vitamin D for 83 % cases, irrespective of antihypertensive therapy. The Cholecalciferol dose of 2000 IU/day from 6.5 to 12 months results in an optimum level of Vitamin D for 100 % cases. The greatest dynamics of increase in the level of 25(OH)D achieved in response to taking cholecalciferol occurs when its initial le­vel is &lt; 20 ng/ml. <em><strong>Conclusions.</strong></em> The economic costs of reducing SBP, with a more frequent achievement of its target values, were the lowest in combination therapy with Cholecalciferol, especially in combination with a diuretic. In addition, with complex therapy, we received not only a correction of blood pressure, but also of the Vitamin D status.</p> L.V. Yakubova V.A. Snezhitskiy V.P. Vdovichenko Copyright (c) 2021 http://creativecommons.org/licenses/by/4.0 2021-04-02 2021-04-02 11 1 35 41 10.22141/2224-1507.11.1.2021.226907 Polymyalgia rheumatica in the 2018–2020 guidelines. Part II: diagnosis of vasculitis http://pjs.zaslavsky.com.ua/article/view/226904 <p>The issue of improved diagnosis of both rheumatic diseases of the elderly and aortic diseases does not lose its relevance. In terms of aortic aneurysms, dissection and ruptures and their attended pathogenesis, both inflammation and structural wall damages may be detected with imaging methods whose role is vital. A number of international guidelines deal with the ma­nagement of polymyalgia rheumatica, giant cell arteritis, or aortic aneurysms. Aortitis is associated with up to 40 % of polymyalgia rheumatica’s cases. The clinical suspicion of aortitis is based on the detection of blood pressure and pulse asymmetry, aortic regurgitation murmur, vascular bruits, as well as persistent polymyalgia rheumatica or inflammatory dorsalgia, pelvis or leg pain. In 2020, the positron emission tomography/computed tomography’s use is approved by the Italian Society for Rheumatology for the diagnosis of vasculitis attended by polymyalgia rheumatica at the secon­dary healthcare level and by the European Headache Federation for the diagnosis of large vessel giant cell arteritis in the neurological practice. A review of the guideline by the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the American Society of Nuclear Cardiology (2018) was performed in terms of po­sitron emission tomography with fluorodesoxyglucose combined with computed tomography (angiography) imaging in large vessel vasculitis and polymyalgia rheumatica. It is further compared with the clinical guidelines, other guidelines by the societies of nuclear medicine and new scientific data. Both procedure and patient’s preparation for examination are decribed. The criteria for assessing vasculitis proposed for either clinical practice or cli­nical studies are consi­dered, as well as the factors influencing the test results and their interpretation (such as atherosclerosis, diabetes, age, body mass index, glucemia’s and acute phase markers’ levels). The guideline substantiates the benefit of both positron emission tomography’s use and its combination with computed tomography to detect extracranial vasculitis, as well as the va­lue of performing computed tomography-angiography at different stages of the disease. There is a need to strengthen evidence on both standard time of fluorodesoxyglucose exposure and the benefit of combining positron emission tomography with computed tomography-angiography, in particular for detection of vasculitis relapses. Finding a consensus for early test’s performing is nee­ded, as well as its score standardization, ensuring reimbursement and implementation of new imaging techniques for the cranial vessels. In the future, the evidence-based approach to managing vasculitis will be supplemented by teranostics.</p> О.H. Puzanova А.А. Lyzikov Copyright (c) 2021 http://creativecommons.org/licenses/by/4.0 2021-04-02 2021-04-02 11 1 1 16 10.22141/2224-1507.11.1.2021.226904 Clinical significance of spondyloarthritis-attended enthesites: from pathophysiology to treatment (review) http://pjs.zaslavsky.com.ua/article/view/226905 <p>The article presents the latest views on enthesites’ anatomy and pathogenesis, clinical features, diagnostic and thera­peutic options. The enthesis lesions are considered an outstan­ding pathologic and clinical manifestation of spondyloarthritis group; this symptom is included into the classification criteria by the Assessment of SpondyloArthritis International Society for the peripheral and axial forms. The typical spondyloarthritis-atten­ded enthesites’ localizations are: the site of Achilles tendon and plantar aponeurosis’ attachment to the calcaneus, the lateral condyle of the humerus, the medial condyle of the femur, the upper edge of the patella, the upper edge of the iliac bones, trochanters of the femoral bones, spinous processes of the vertebrae. The structures focused in the entheses’ sites have anatomical, functional and physiological interactions and constitute a single synovial-entheseal complex. Unlike the rheumatoid arthritis with a key pathological process occurring in the synovial lining, the spondyloarthritis is mainly provoking the morphological modifications, namely enthesites, while the developing arthritis (synovitis) appears secondary to enthesites. The enthesitis is detected in 30–50 % of spondyloarthritis patients and associated with a higher activity, higher pain indices and a compromised life qua­lity. The presence of enthesites in the psoriatic arthritis patients is associated with axial and peripheral joint lesions, a high chance of ankylosation, a high disease activity, pronounced pains, a compromised life quality and functional state, sleeping disorders. Furthermore, the enthesitis is considered a precursor of the negative disease outcome, and may forecast a lower probability of remission and a low activity. The entheseal inflammation occurs as a result of mechanical and/or infection-originating stress, resulting in the prostaglandin E2 and interleukin-23 activation with a further vasodilatation, and T-cell and Group 3 innate lymphoid cell (ILC3) activation. The innate immunity-generated inflammation is characterized by a release of tumor necrosis factor and interleukin-17, resulting in the immune cell influx, namely the polymorphonuclear neutrophils. Under the influence of interleukin-17 and interleukin-22, the mesenchymal proliferation is characte­rized by an activation and proliferation of resident mesenchymal stem cells in the periosteum. The enthesitis treatment strategies remain undefined; however, the ones most commonly used are the nonsteroidal anti-inflammatory drugs (NSAIDs), localized glucocorticoid injections, Apremilast, as well as targeted medications, namely the tumor necrosis factor, interleukin-17 and interleukin-23 inhibitors.</p> I.Yu. Golovach Copyright (c) 2021 http://creativecommons.org/licenses/by/4.0 2021-04-02 2021-04-02 11 1 17 27 10.22141/2224-1507.11.1.2021.226905