New in the pharmacotherapy of common pathologies for a polyclinic therapist
Within the framework of the 17th National Congress of Therapists with International Participation, held in Moscow, dedicated to the 80th anniversary of the birth of of Yu. B. Belousov, a satellite symposium was held on the topic «New in the pharmacotherapy of common pathologies for a polyclinic therapist.» The event discussed two extremely important and most common problems in the practice of a polyclinic therapist - what to do with pain and what to do with heartburn? Modern approaches to pain therapy are considered on the example of chronic osteoarthritis as the most common rheumatic disease. Rheumatologists no longer classify osteoarthritis as a degenerative pathology, but as a disease based on inflammation caused by various factors, including biomechanical stress, such as traumatic exposure. Chronic low-level inflammation is the main mechanism of progressive cartilage cell loss, increasing pain and joint destruction. The molecular mechanisms of maintaining subclinical inflammation in osteoarthritis, which form a vicious circle of mutually reinforcing pathological processes, are already well understood. Attempts are being made to target certain pathogenetic links, the Wnt and NF-kB signaling pathways that trigger a cascade of pathological reactions in osteoarthritis. Modern data on the molecular mechanisms of action of non-steroidal anti-inflammatory drugs (in particular, ibuprofen), which inhibit the cascade of reactions, as a result of which the patient develops nociceptive pain, which eventually turns into neuropathic pain due because of mechanism central sensitization. The latest recommendations from the American College of Gastroenterology suggest that patients with classic symptoms of gastroesophageal reflux disease (heartburn and regurgitation) who do not have alarm symptoms should receive empiric therapy with proton pump inhibitors. However, this approach leads to overdiagnosis of gastroesophageal reflux disease. This problem can be overcome with the help of sodium alginate.Once in the stomach, the drug comes into contact with hydrochloric acid and forms a kind of raft that physically prevents reflux. This is the basis of the alginate test, which serves as an additional criterion for the diagnosis of gastroesophageal reflux disease.