International Journal of Medical Sciences And Clinical Research

Evolving Paradigms in Axial Spondyloarthritis Management: A Review of Contemporary Treatment Strategies

2025-10-03T12:03:06+00:00

Objective: Axial spondyloarthritis (axSpA), encompassing ankylosing spondylitis and non-radiographic axSpA, is a chronic inflammatory disease that imposes a significant burden on patients through pain, stiffness, and potential long-term structural damage to the spine. This review synthesizes the current, state-of-the-art evidence on the management of axSpA, from foundational therapies to advanced biologic treatments and modern strategic approaches.

Methods: A comprehensive literature review was conducted, focusing on influential publications that shape the contemporary standard of care. Sources included the 2019 ACR/SPARTAN/SLR treatment recommendations, pivotal clinical trials, expert reviews on therapeutic mechanisms and outcomes, and meta-analyses of non-pharmacological interventions.

Results: The management of axSpA is built upon a foundation of non-pharmacological interventions, with strong evidence supporting the efficacy of structured exercise programs in improving physical function [8]. NSAIDs remain the first-line pharmacological treatment for symptom control [1]. For patients with an inadequate response to NSAIDs, biologic therapies, particularly TNF-α inhibitors (anti-TNFs), have revolutionized care by providing substantial and rapid improvements in disease activity and quality of life [2, 4]. However, their ability to definitively halt radiographic progression remains a subject of investigation, with structural damage persisting as a key concern [3]. More recent advances include the approval of drugs with different mechanisms of action, such as IL-17 and JAK inhibitors [7]. Furthermore, there is a paradigm shift towards goal-oriented strategies like Treat-to-Target (T2T), an approach validated by the TICOSPA trial, which demonstrated superior outcomes with a tight-control protocol [5, 6].

Conclusion: The therapeutic landscape for axSpA has evolved dramatically, moving beyond simple symptom relief towards a multi-faceted, goal-directed approach. The integration of non-pharmacological methods, established pharmacotherapies, and strategic management frameworks offers the potential to significantly improve patient outcomes. Preventing long-term structural damage, however, remains the critical unmet need guiding future research.

Effective Control And Correction Of The Main Risk Factors Of Hypertonic Disease In The Conditions Of The Primary Line Of Health Care

2025-10-12T03:26:30+00:00

The past 5-year data from 222 randomly selected outpatient cards of hypertensive patients who were followed up at a family polyclinic (n=54) and in a number of rural ambulances (n=168) of the Republic of Uzbekistan were retrospectively analyzed. The physicians from the Tashkent family polyclinic and rural ambulances of a number of the Republic’s regions, who had taken 10-month retraining courses for general practitioners, were questioned. Two hundred and fifty-six hypertensive patients followed up at the family hospital and rural ambulances were interviewed using questionnaires and examined. Then some of them (a study group) took a course of training at a school for the hypertensive patient and the others (a comparison group) did not participate in the education program. All the patients were followed up for 2 years with a subsequent reexamination and study. Most outpatient cards give recommendations for non-drug treatment incompletely. In a number of cases, the physicians who attach importance to the detection and correction of risk factors have substantially increased after education. The patients who had taken training courses were found to be significantly (р<0,001) more aware of their having hypertension and the major risk factors of hypertensive disease, to be more adherent to treatment, and to know its adequacy.

The Role Of Leptin And Adipokines In The Regulation Of Hemopoiesis

2025-10-10T07:42:01+00:00

The article is devoted to the analysis of the role of leptin and other adipokines in the regulation of hematopoiesis. It is shown that bone marrow adipose tissue is an active component of the hematopoietic niche and affects the maintenance, proliferation and differentiation of stem and progenitor blood cells. Leptin and its receptor provide the production of key factors SCF and CXCL12 by mesenchymal stromal cells. Adiponectin and resistin are involved in modulating hematopoietic recovery after myelosuppression. Impaired adipokine secretion in obesity, aging, and malignant processes leads to niche dysfunction and changes in hematopoiesis efficiency. Understanding the molecular mechanisms of adipokine action opens up opportunities for developing new therapeutic approaches.

The Role Of SGLT-2 Inhibitors In Cardio-Renal Protection And The Management Of Type 2 Diabetes Mellitus

2025-10-10T07:44:06+00:00

In recent years, sodium-glucose cotransporter type 2 (SGLT-2) inhibitors, a class of medications originally developed for managing type 2 diabetes mellitus (T2DM), have demonstrated significant benefits beyond glycemic control. These drugs have shown protective effects on both renal and cardiovascular systems, even in patients without diabetes. Researchers suggests that metabolic reprogramming plays a critical role in the progression of chronic heart failure (CHF) and chronic kidney disease (CKD). This reprogramming is associated with impaired cardiac energy metabolism due to a mismatch between glucose uptake and its oxidation, leading to the accumulation of glucose-6-phosphate (G6P), glycogen deposition, and activation of the pentose phosphate pathway. The consequence is mitochondrial dysfunction, oxidative stress and decreased fatty acid oxidation.

Similar mechanisms occur in the proximal tubules of the kidneys in CKD, resulting in tubular injury, albuminuria, and interstitial fibrosis. By inhibiting glucose and sodium reabsorption in the proximal tubules, SGLT-2 inhibitors increase glucosuria, induce mild osmotic diuresis and promote natriuresis. These processes yield anti-inflammatory effects, reduce oxidative stress and apoptosis, and further stimulate autophagy.

The additional effects include lowered blood pressure, decreased myocardial workload and reduced sympathetic nervous system activity. Additionally, SGLT-2 inhibitors improve tubuloglomerular feedback, reduce glomerular hyperfiltration and enhance erythropoiesis by mimicking systemic hypoxia. These mechanisms form the basis of the cardio- and nephroprotective effects of SGLT-2 inhibitors.