Репозиторий Университета

© Saint Petersburg Pasteur Institute. All rights reserved. The review is devoted to the analysis of pertussis incidence of children in the age group of 5-7, as well as strategies of DTP immunization with the help of the drugs in foreign countries. Mass vaccination against pertussis began in the middle of the 20th century, which contributed to a reduction in incidence and mortality rate from this infection. However, in the last decade, there has been an opposite tendency of increasing incidence of patients among children under school age, school age and adults. Atypical forms of the disease and complications due to ARVI, respiratory mycoplasmosis and cytomegalovirus infections are described in the review. Various strategies for the use of whole-cell and acellular pertussis vaccines as part of DTP drugs are described, as well as the epidemiological effect of introducing an additional booster dose of vaccine to children under school age. The expediency of revaccination of children aged 6-7 in Russia is argued, which can help to reduce the overall incidence of pertussis. The research materials related to the study of the properties of acellular anti-pertussis vaccine, such as immunogenicity and safety in comparison with whole-cell vaccine, are analyzed. The main drugs and their composition, which are used to vaccinate children against pertussis, are described in the review. It is assumed, that the increase in the incidence among children and teenagers, with the appearance of atypical forms of pertussis, is associated with a number of factors, such as the spread of new genotypes of Bordetella pertussis bacterium, emerged from mutations, as well as short duration of immunity after vaccination with acellular drugs, in comparison with whole-cell, and the use of more modern methods of detecting the pathogen. The mechanisms of the immune response due to different types of pertussis vaccines are also reviewed. It is concluded, that revaccination of children aged 6-7 with an additional fifth dose of an acellular vaccine against pertussis, as part of the DTaP instead of the Td drug, which is regulated in the National Calendar of preventive vaccinations, will have a favorable effect on the epidemic situation with pertussis infection in Russia.

© 2018 The Author(s). Blockchain as technology described to be used in closed Systems to conduct registers of official data in public healthcare. Also this technology had found its use in different other ways, for example it is education of medical staff, control of the contracts for healthcare ServiceS. And the role of Blockchain in CALS / PLM-technologies suggested.

© 2018 The Author(s). The article describes the processes of collecting and adapting the diagnostic information necessary for use in automated analysis of three-dimensional images and surgical navigation. The work is carried out on the basis of the NMRC Obstetrics, Gynecology And Perinatology named after V.I. Kulakov of the Ministry of Health of the Russian Federation with the financial support of the Ministry of Science and Education of the Russian Federation (Agreement dated 03.10.2016 No. 14.607.21.0162, unique identifier RFMEFI60716X0162) The work is devoted to the features of collection, segmentation and description of the results of preoperative radiological diagnostics of newborn patients with congenital urinary malformations such as hydronephrosis (HN), renal duplication with uretherohydronephrosis of the nonfunctional segment (UHN) or multicystic dysplastic kidney (MC). The goal of the work is the development of standards for the collection, classification and segmentation of various diagnostic information of congenital urinary malformations in newborns necessary to use in automated three-dimensional image analysis and surgical navigation. In order to expand the scope of application, it was decided to supplement the data bank with information from the patient's phenotypic chart, compiled by the clinical geneticist when examining the patient. According to the developed and implemented algorithms we collected and segmented 978 series of images belonging to 393 patients with urinary malformations and 452 series of normal urinary System. Available text descriptions of the series are reconstructed to the original developed standard. At present, using this data bank, a subSystem of neural network analysis and reconstruction of diagnostic images of newborn patients is being developed, as well as a surgical navigation System for performing endoscopic surgical manipulations on patients for congenital malformations of the urinal System.

© 2018 The Author(s). Medical drugs interactions and adverse drug reactions are one of the major problems in pharmacotherapy. At the Sechenov University (Russia, Moscow), digital System for drug prescription management is being developed. Artificial intelligence methods to the control of drug therapy will greatly enhance the ability of the automated control System to identify potential problems in drug therapy and provide recommendations for their elimination. Introduction of this System into commercial operation will make it possible to translate the civil circulation of medicines into a single information space and increase the effectiveness of the ongoing pharmacotherapy.

© 2018 Russian Photodynamic Association. All rights reserved. Currently, reconstructive-plastic surgery is becoming the standard for surgical and combined treatment of breast cancer (BC) patients. With a one-stage reconstruction of the breast, the use of biological implants that can replace muscle autografts and, consequently, reduce trauma, blood loss and operation time, and also to avoid defects in the donor zones is becoming topical. From 2014 to 2017, 151 reconstructive operations on 121 patients with BC (average age 41.5 years) using synthetic and biological materials were carried out in P.Herzen Moscow Oncology Research Institute. 0 stage of BC TisN0M0 was diagnosed in 11 (9.1%) patients, I stage - in 52 (42.9%), IIA - in 41 (33.9%), IIB - in 9 (7.4%), IIIA - in 4 (3.3%), IIIB - in 2 (1.7%), IIIC - in 2 (1.7%). To strengthen the lower slope, a biological implant - Permacol acellular dermal matrix, was used in 34 cases. Cosmetic result was rated as excellent in 20 (58.9%) cases, good in 11 (32.3%), unsatisfactory in 3 (8,8%). Biological materials are an important addition to various options for breast reconstruction. The criterion for selecting the material for strengthening the lower slope of the breast with subcutaneous or cutaneous mastectomy for cancer with a one-stage reconstruction using a silicone endoprosthesis is the pinch-test value.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: Assessing the dynamics of vulnerability of atherosclerotic plaques in patients with angina pectoris on atorvastatin therapy (40 mg for 10-12 months) based on coronary computed tomography angiography (CCTA) data. Materials and methods: The study prospectively enrolled 74 patients with angina pectoris not medicated with statins. All patients underwent CCTA. 30 patients with vulnerability of atherosclerotic plaques were selected for further observation and atorvastatin was administered to them at dose of 40 mg. Repeated tomography scans were recorded 10-12 months later. Images were analyzed by "Vitrea" workstation in a blind manner. Statistical processing was performed on SPSS version 11.5 software (BioStat). Results: Statistically insignificant decrease in: total plaque volume (from 188.64 ± 35.8 to 184.96 ± 34.45 mm3), low-attenuation plaque (from 60.46 ± 12.87 to 57.06 ± 12.34 mm3), degree of stenosis (from 41.6 ± 3.16 to 40.65 ± 3.26%), spotty calcification (from 86.0 to 90%), remodeling index (from 1.25 [1,0;1,4] to 1.1 [1,0;1,4]), napkin-ring sign (from 69.76 to 60%), irregularity of the contour (from 79.1 to 65%). LDL levels decreased from 3.23 ± 0.33 to 2.76 ± 0.27 mmol/L. Statistically significant decrease of total cholesterol was from 5.75 ± 0.45 to 4.42 ± 0.57 mmol/L. The study also revealed statistically significant positive correlation between decrease of LDL levels and total plaque volume decrease (R=0.51, P=0.002), mainly because of lowattenuation components. Conclusion: We review our experience of using CCTA for noninvasive monitoring of vulnerability of atherosclerotic plaques in dynamics and show that atherosclerotic plaques stabilize on long-term atorvastatin treatment.

© 2018, Media Sphera Publishing Group. All rights reserved. The robotic technologies every day exert an increasingly greater influence on the surgical technique, with the well documented clinical applicability in reconstructive plastic surgery and oncology. At the Department of plastic surgery of I.M. Sechenov First Moscow state medical university, we have gained an extensive experience with the surgical treatment of the patients requiring the major oral robotic intervention. A novel application has recently been documented for the purpose of robotic surgical assistance to the patients presenting with oncological pathology including cancer of the oropharyngeal wall at the early stages of development (T1N0M0). The objective of the present study was to develop and introduce into the clinical practice of the robot-assisted methods for the treatment of malignant neoplasms of the head and neck organs. A hybrid technique was applied, i.e. the combination of the robot-assisted trans-oral surgical intervention and the microsurgical radial flap mobilization to correct the postoperative defect following the extraction of the tumour. The combination of these methods provided the excellent clinical results and positive dynamics of the patients’ condition, with the swell apparent improvement of the quality of life. The early patient activation was due to the application of the minimally invasive transoral surgical technique, with the swallowing ability being reinstated within 14 days after the intervention by virtue of the proper flap function. All the patients successfully underwent the robot-assisted surgical manipulations without complications. The shorter rehabilitation time during the postoperative period in these patients made it possible to quicker initiate chemotherapy and radiotherapy. This significantly improved the patient’s quality of life and prognosis due to the combined approach to the treatment of head and neck oncology. It is concluded that the incorporation of the robotic assistance into the program of surgical treatment significantly increases the effectiveness of the treatment and makes possible the combined approach to the treatment of oncological patients with manageable tumours of the head and neck region.

© Ima-Press Publishing House. All rights reserved. Post-stroke cognitive impairment (PSCI) is often characterized by a complex prognosis of neurorehabilitation, insufficient restoration of the functional status of patients, and a high risk of recurrent strokes and disability, which determines considerable health care costs. Objective: to carry out a comparative pharmacoeconomic analysis of the use of actovegin (Takeda Pharmaceuticals, Switzerland) in Russian patients with PSCI. Patients and methods. The investigation was conducted using a modeling method to determine the cost-effectiveness of competing treatment strategies: standard patient management; standard patient management and use of actovegin. Data from the ARTEMIDA clinical trial were used. Results and discussion. The use of actovegin was economically justified, which was expressed in more preferable cost-effectiveness indicators. Also, the use of actovegin in patients significantly reduced the risk of post-stroke dementia and, accordingly, the cost of treatment in future periods. Conclusion. The findings data indicate the clinical and economic feasibility of using actovegin in patients with PSCI.

© 2018 Voprosy Sovremennoi Pediatrii - Current Pediatrics. All rights reserved. The article presents the modern knowledge of the structural and functional peculiarities of the skin in children. Information on the etiopathogenesis of a debut atopic dermatitis has been also given. The results of our own observations with an analysis of the clinical efficacy and safety of cosmetics based on highly purified lanolin and cotton extract in infants have been presented.

© 2011-2018 NSPU Bulletin. All rights reserved. Introduction. The authors investigate the problem of determining the epistemological foundations of pedagogical knowledge. The purpose of the article is to establish epistemological foundations of theoretical standard in pedagogical knowledge. Materials and Methods. The research employed a set of methods, including: a) an analysis of scientific literature on the topic of the article; b) a synthesis of generalized philosophical and scientific ideas, ideas of domain-specific research methodology of natural sciences and their influence on educational research methodology; c) clarifying the content of modern pedagogical knowledge, forms of its presentation to scientific and professional community, and methods of obtaining new pedagogical knowledge. Results. The article proposes an idea about such categories as dbjective subject reality "and Scientific-subject reality"unrepresented in theoretical education studies. The authors clarify the epistemological construct called theoretical standard of pedagogical knowledge" It consists of scientific-problem description of educational reality, fixing the difference between an educational event and a scientific fact, the subject of education and the idealized scientific object ofpedagogics, the correct nomination of problems and hypotheses and their epistemological verification. Conclusions. The authors conclude that the methodological concept of "theoretical standard of pedagogical knowledge" can become a reference point in the process of establishing pedagogics as epistemologically verified humanitarian knowledge.

© 2018, Silicea-Poligraf. All rights reserved. Aim. To evaluate the exact efficacy of the implantable cardioverter-defibrillators (ICD) and combination devices (CRT-D), and to evaluate their influence on the rate of sudden death and overall mortality in patients with the dilation cardiomyopathy syndrome (DCMP), and to clarify the selection criteria for implantation. Material and methods. Totally, 220 DCMP patients investigated: 66 (30%) of them (mean age 48,5±12,8 y. o., 47 males) underwent implantation of ICD (n=37) and CRT-D (n=29), 154 (70%) patients were in comparison group (mean age 47,1±12,4 y. o., 104 males). In 60 patients (93,9%) the devices were implanted for primary prevention of sudden cardiac death (SCD). Follow-up lasted for 16 [6; 37] months. As primary endpoints, the following parameters were used: “death+transplantation”, mortality, SCD, “SCD+shock” and “death+transplantation+proper shocks of the defibrillators”. Results. Mortality in all DCMP patients was 19,1%, “death+transplantation” — 21,4%, SCD — 2,7%. There were no significant differences by these values in patients with both devices (19,7%; 22,7% and 1,5%), ICD (21,6%; 24,3% and 2,7%), CRT-D (17,2%; 20,7; and 0) and patients with no devices (18,8%; 20,8% and 3,2%). Significantly higher rates by “SCD+shocks” (18,2% v 3,2%, p<0,001) and “death+transplantation+shocks” (36,4% vs 20,8%, p<0,05) in patients with the implanted devices witness for real impact of the defibrillators in equality of overall mortality and SCD parameters. Among the patients with implanted devices, the genetic and mixed (genetic and inflammatory) nature of DCMP predominated (62,1 v 35,7%, p<0,001), there was significantly lower EF (26,3±9,2 v 30,7±10,3%, p<0,01), its end value (31,1±11,0 v 39,2±13,5%, p<0,01), significantly higher end diastolic size of the left ventricle (EDS, LV, 6,8±0,8 v 6,5±0,8 cm, p<0,05) and the grade of mitral regurgitation. In patients with the devices, rate of proper shocks was 18,2%. In isolated myocarditis there were no shocks (35,3±9,1% v 26,8±9,3%, p<0,05), EDS significantly lower (6,2±0,6 cm v 6,9±0,9 cm, p<0,01), ECG signs of LV hypertrophy were more rare (16,7% v 56,3%, p<0,05), but more commonly — the low voltage of QRS (33,3% v 10,6%, p=0,53); there were no differences in the rates of cardiotropic drugs prescription. Main predictors of the shocks were genetic origin of DCMP (isolated or with myocarditis, 25/75%, comparing with 20/33% in patients with no shocks, p<0,01, HR 1,58, OR 10,93, sensitivity 94,1%, negative predictive value 99,2%), and sustained (HR 18,0, sensitivity 98,1%) and non-sustained ventricular tachycardia (HR 1,43, sensitivity and negative predictive value 100%), decrease of QRS voltage and absence of the signs of LV hypertrophy on ECG (negative predictive value 92,8% and 95,6%). Conclusion. In DCMP patients, implanting of ICD/CRT-D was performed with acknowledged additional criteria (genetic or mixed DCMP etiology, lower EF and worse response to treatment); due to more effective ICD therapy, the values of mortality, “death+transplantation” and SCD were not higher than in less severe patients with no such devices. Proper shocks developed in patients with significantly higher EF. As an independent SCD risk factor and a criteria for patients selection to defibrillator implantation, genetic origin of DCMP should be used, especially if comorbid with myocarditis. As the predictors for benign outcome — absence of non-sustained ventricular tachycardia, lower QRS voltage, signs of LV hypertrophy on ECG. An algorithm proposed of DCMP patients selection for ICD treatment.

© 2018 Onkopediatria. All rights reserved. Background. Analysis of statistical data in the federal districts of the Russian Federation provides opportunities to assess the quality of medical care delivery in children with cancer and plan further development with consideration for the point elimination of existing defects. Objective. Our aim was to analyze the main indicators characterizing medical care for children with cancer in the North-West Federal District. Methods. The study analyzed operative reports for 2017 provided by the executive public health authorities of 11 subjects of the Russian Federation affiliated to the North-West Federal District. Results. The pediatric population was 2 537 133 children (0-17 years), the pediatric oncological bed capacity - 174 (0.7 per 10 000 aged 0-17 years), the annual berth average occupancy - 290.7 days. 6 (54.5%) subjects did not provide pediatric population with departments of pediatric oncology, 4 (36.4%) subjects did not have bed capacity. The number of practitioners providing medical care to children with cancer was 38, 27 among them (71%; 0.1 per 10 thousand 0-17 years) had a certificate of pediatric oncologist. 2 (18.2%) subjects did not have pediatric oncologists in the medical stuff. The incidence of malignant tumors in children aged 0-17 was 15.6 (per 100,000), the prevalence was 92.6 (per 100,000), the mortality rate was 2.6 (per 100,000), one-year mortality rate - 4.5% (18/397). The number of patients identified actively was 11 (2.8%). 160 (40.3%) primary patients were sent to Federal medical facilities, 6 (1.5%) - left the territory of the Russian Federation for the further treatment. Conclusion. The incidence and mortality rates are rather low which indicates the defects in patient detection and lack of reliable follow-up data. The percentage of patients referred for treatment to Federal medical facilities is not very high; however, to interpret this indicator according to patient routing, we have to analyze the medical history of all the patients. We can assert that health care delivery service for children with oncological diseases is at an acceptable standard level but needs to be improved.

© 2011-2018 Research Institute of Mechanics of Moscow State University. All rights reserved. Aim. To carry out a comparative analysis of self-rated health, medical activity, and satisfaction with the quality of medical care in public health institutions by residents of rural settlements of the Untsukul district, Republic of Dagestan. Methods. The study was conducted by the method of questioning 2643 respondents, among them 1453 women and 1181 men. Results. According to the results of the survey, the majority of the interviewed residents of Untsukul district (68.2%) are satisfied with their health. Medical activity of the population at the time of the study was 60.6%. As to respondents who applied to the medical institutions of the Untsukul district during this period, 13.5% are not satisfied with the quality of medical care in public health institutions, 23.5% are fully satisfied, 30% are not fully satisfied. Conclusion. A social survey in the form of a questionnaire is one of the most effective methods of obtaining information about the self-rated health of the population. Timely analysis of medical activity of the population, its satisfaction with the quality of medical care will improve the efficiency of the health system.

© ABC-press Publishing House. All rights reserved. Today it is noted that the most cases of the hypospadias, cryptorchidism, testicular microlithiasis, as well as problems of semen quality and testicular germ cell tumours can be a clinical manifestation of testicular dysgenesis syndrome caused by abnormal development of reproductive organs. In the last decade, technological progress in the molecular genetics has made possible to carry out a directed search for genetic factors associated with reproductive disorders in men. In the review we attempted to analyze available literature data on the testicular dysgenesis syndrome and its constituent condition and also to consider the risk factors associated with its development. We give particular attention to the consideration of genetic factors that determine the manifestation of testicular microlithiasis, cryptorchidism and testicular germ cell tumors, both individual clinical conditions and in the syndrome of testicular dysgenesis. Knowledge of the genetic aspects of reproductive damage will allow us to characterize the complex interconnection of the human genome with the clinical phenotype, clarify the role of unfavorable factors of the environment and the lifestyle of the individual, and suggest new approaches to treatment.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective — to investigate the growth mechanisms of large uterine leiomyoma (LULM) on the basis of a clinical morphology examination, by providing immunohistochemical (IHC) characteristics of the expression of growth factors (transforming growth factor-beta (TGFβ) and platelet-derived endothelial cell growth factor (PD-ECGF)) and markers of stemness (CD117/c-kit, Connexin 43, Nestin) and proliferation (Ki-67). Subject and methods. The investigators examined surgical specimens from 38 women diagnosed with simple uterine leiomyoma (ULM), who had been divided into two groups: 1) 21 patients with LULM (>6 cm in diameter) (a study group); 2) 17 patients with small ULM (<4 cm in diameter) (a comparison group). Each group was also divided into two age subgroups (younger (<45 years) and older (≥45 years) subgroups (1a (n=12), 1b (n=9), 2a (n=8) and 2b (n=9), respectively. Histological specimens were used to make IHC examination with antibodies against TGFβ, PD-ECGF, CD117/ckit, Connexin 43, Nestin, and Ki-67. Results. The growth mechanisms of LULM of simple histological structure were found to be associated with the larger number of growth zones in the tumors, with their enhanced cellular proliferative activity, and with the appearance of cells with signs of stemness, which is combined with the preserved subsequent maturation of tumor cells and determines the benign nature of LULM. Conclusion. There were differences in the molecular profile of LULM and small ULM, as well as LULM in perimenopausal and young women by the expression levels of Ki-67, TGFβ, PD-ECGF, CD117, and Connexin 43, which can be used for diagnosis, prediction, and development of targeted therapies.

© 2018, Media Sphera Publishing Group. All rights reserved. The paper describes a case of essential cryoglobulinemia unassociated with hepatitis B and C viruses. The morphological substrate of the disease was exclusively proliferative endothrombovasculitis without destructive changes in the walls of affected vessels. In addition, in the late stage of the disease, there was its unusual manifestation associated with inflammation of the mesentery arteriolar walls and with the formation of occlusive blood clots in their lumens, which led to severe abdominal diseases. The female patient showed a mosaic involvement of the loops of the bowel in the necrotic process as its separate segments, which was associated with damage to a large number of small vessels. The feature of the case is a set of 4 risk factors for a fatal disease outcome, such as age over 65 years, pulmonary, renal, and intestinal lesions.

© 2018, Media Sphera Publishing Group. All rights reserved. Urothelial carcinoma is one of the most frequently diagnosed malignant tumors of the bladder and upper urinary tract, which ranks seventh in the pattern of cancer. Urothelial carcinoma of the renal pelvis is less common; but has a more aggressive clinical course and a worse prognosis than that of the bladder. This is due to the clinical and morphological features of this form of cancer, which, unlike bladder cancer, have not been studied enough. Objective — to comparatively analyze the morphological and immunophenotypic parameters of urothelial carcinomas of the renal pelvis and bladder. Subject and methods. Surgical specimens from 196 patients diagnosed with urothelial carcinoma of the renal pelvis and bladder were investigated. Paraffin sections were immunohistochemically examined using the standard protocol. Antibodies against CK5/6, CD138, CDX2 (≪Dako≫), CK7, CK14, CK20, CEA, CD10, CD117, EMA, E-Cadherin, HMWCK, p63, Uroplakin III, Vimentin (≪Novocastra≫), CD44, GATA-3, MUC1, MUC2, and MUC-5AC (≪Cell Marque≫) were used. Results. Most tumors (n=147 (75%)) were invasive. Of them, 65 (33%) cases had a histological structure of conventional urothelial cancer; and 3 (1.5%) had paradoxical differentiation. Divergent tumor zones were verified in 66 (34%) neoplasms; 4 (2%) cases showed an inverted growth pattern. Pseudosarcomatous stroma reaction in the invasion zones was verified in 9 (5%) cases. The tumor stage corresponded to pT2—pT4 in 128 (65%) tumors. Conclusion. Urothelial carcinomas of the renal pelvis and bladder show a broad spectrum of histological variants. The findings support that, unlike urothelial carcinomas of the bladder, the majority of primary urothelial carcinomas of the renal pelvis are high-grade and highly invasive.

© 2018, Media Sphera Publishing Group. All rights reserved. This article presents a review of Russian and foreign literature about the impact of arterial hypertension (AH) on the risk of cognitive impairment and dementia. Large studies have demonstrated the effect of blood pressure (BP) on the risk of vascular dementia and Alzheimer’s disease (AD) in elderly and oldest old people as well as a role of antihypertensive therapy. There is evidence of a negative effect of hypertension in middle age on cognitive functions in late-life. Observational studies as a whole have shown the positive effect of antihypertensive therapy on the prevention of cognitive function and dementia. However, there are a number of limitations that dictate the need for further research on this issue. The importance of the interdisciplinary approach to treatment of cognitive impairment by cardiologists and/or therapists, together with neurologists, as well as complex treatment regimens, including correction of risk factors and neuroprotective therapy, is highlighted.

© 2018, Media Sphera Publishing Group. All rights reserved. Solid pseudopapillary tumor is a low-grade malignant neoplasm of the pancreas. The clinical manifestations are variable, ranging from an asymptomatic course to cases with severe symptoms that dramatically impair the patients’ status. The paper describes the rare case of a solid pseudopapillary tumor in a 34-year-old woman, which was accompanied by difficulties in the interpretation of clinical data and morphological patterns.

© 2018 Ima-Press Publishing House. All right reserved. In accordance with international and Russian guidelines for the management of patients with rheumatoid arthritis (RA), after its diagnosis, a synthetic disease-modifying antirheumatic drug is prescribed, among these drugs, methotrexate is anchor and, when the latter is impossible to use, leflunomide is commonly administered. Objective: to evaluate the efficacy and safety of a leflunomide generic (Elafra) during a multicenter follow-up. Subjects and methods. The investigation enrolled 347 patients aged over 18 years who met the 2010 ACR/EULAR criteria for RA, had its duration of less and more than 2 years, signed informed consent, and followed up in 29 centers of Russia. Elafra was prescribed at a saturating dose of 100 mg for the first 3 days, then 20 mg/day. There might be a temporary two-fold reduction in the dose when adverse events (AE) occurred. The patients were examined before and 4, 12 and 24 weeks after beginning leflunomide treatment. The treatment efficiency was evaluated with DAS28 and CDAI and by the physician global assessment. Results and discussion. The patients were divided into two groups: 1) 125 patients with RA of less than 2 years' duration and 2) 222 patients with RA of more than 2 years' duration. The mean age of patients in Group 1 was 48.7±12.9 years; that in Group 2 was 52.5±11.95 years; the mean disease duration was 11.9±7.8 and 90.99±54.28 months, respectively. During 24-week treatment, there was a highly significant decrease in all assessed clinical, laboratory parameters and indices of RA activity in both groups. At 4 weeks of treatment, the effect was observed in 91.8% of the patients in Group 1 and in 84.6% in Group 2, whereas at 12 weeks the effect was noted in almost all patients (99.1% and 96.9% in Groups 1 and 2, respectively). The highest rate of AE during Elafra therapy was recorded in the early periods: at 4 weeks, AE were noted in 6.5% of the patients in Group 1 and in 9.9% in Group 2, without needing to discontinue the drug. Treatment continuation decreased the rate of AE. Because of its intolerance, Elafra was discontinued due to in one case in Group 1 (diarrhea at 24 weeks of treatment) and in 6 cases in Group 2 (at 12 and 24 weeks of treatment). Conclusion. Treatment with leflunomide (Elafra) leads to the rapid development of its effect in early and late RA in most patients and is characterized by a good tolerability.