Vol 79, No 5 (2004)


Rheumatoid arthritis as a general medical problem

Nasonov E.L.
Terapevticheskii arkhiv. 2004;79(5):5-7
pages 5-7 views

Features of clinical symptoms and course of systemic sclerosis specific for sex and age of onset

Volkov A.V., Starovoitova M.N., Guseva N.G.


Aim. To define clinical features of systemic sclerosis (SS) in age and sex aspects. Material and methods. The study covered 100 patients aged 15 to 83 years with SS (24 males and 76 females) lasting for 1-15 years (mean 6.2 ± 4.1 years). Groups of females and males, with disease onset age under 50 years (32 years) and over 50 years were compared. Results. Males had a prevalent diffuse clinical form ofSS with advanced skin syndrome, primarily indurative alterations, marked disturbances of microcirculation, abnormal heart rhythm and conduction, interstitial pulmonary fibrosis with development of pulmonary hypertension. The patients with late SS onset are characterized by development of visceral pathology within the first 3 years of the disease. Conclusion. In making SS diagnosis and in the disease treatment it is necessary to consider the patients ' sex and age, peculiarities of the debute, clinical picture, course and prognosis.
Terapevticheskii arkhiv. 2004;79(5):7-11
pages 7-11 views

The level of TNF soluble receptor type 1 in patients with systemic sclerosis

Alekperov R.Т., Timchenko A.V., Samsonov M.Y., Guseva N.G., Nasonov E.L.


Aim. To study content and clinical correlations ofsTNF-RI in patients with systemic sclerosis (SS). Material and methods. Thirty nine SS patients were examined with enzyme immunoassay for serum levels of sTNF-RIand soluble adhesion molecules (sSAM) sVSAM-1, sISAM-1 and sR-selectine using R&D System kits (USA). The control group consisted of 14 healthy subjects (donors). Content of sTNF-RI and sSAM was considered as elevated if it exceeded relevant mean values by 1SD. Results. sTNF-RI content was significantly higher in the patients than in the controls (p = 0.0001) and was similar inpatients with diffuse and limited forms of the disease. A rise in sTNF-RI correlated with a rise in pulmonary artery pressure. In patients with pulmonary hypertension or restrictive pulmonary affection sTNF-RIwas higher than in patients free of pulmonary hypertension or impaired external respiration function. A marked correlation was found between sTNF-RI and sVSAM-1. Patients with high CRP had significantly higher sTNF-RI level than patients with normal CRP. Conclusion. SS is characterized by elevated content ofsTNF-RI. This content may serve a diagnostic marker of the disease progression.
Terapevticheskii arkhiv. 2004;79(5):11-15
pages 11-15 views

Pulmonary hypertension in patients with systemic sclerosis with CREST-syndrome and without it

Karoli N.A., Rebrov A.P., Orlova E.E.


Aim. To study incidence rate and characteristics of pulmonary hypertension development in patients with systemic sclerosis (SS). Material and methods. The study included 31 SS patients (30 females, 1 male, age 33-75 years mean age 47.7+1.7 years). Results. Pulmonary hypertension occurred more frequently in SS patients with CREST-syndrome than in SS patients free of this syndrome. SS patients with CREST-syndrome had also more severe ventricular hypertrophy than ventricular dilation. Conclusion. Echocardiography proved to be a highly informative method for detection of pulmonary hypertension in patients with SS. The necessity of hemodynamical study in SS patients is emphasized.
Terapevticheskii arkhiv. 2004;79(5):15-18
pages 15-18 views

Blood nitrates content in patients with systemic lupus erythematosus and antiphospholipid syndrome

Reshetnyak D.V., Kuznetsova T.V., Kobylyansky A.G., Klyukvina N.G., Reshetnyak T.M., Nasonov E.L.


Aim. To elucidate clinical implications of nitrates (NOJ concentration as an indicator of nitric oxide (NO) level in blood serum of patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (PAPS). Material and methods. Blood serum concentration of N03 was measured by high-performance liquid chromatography in a total of 41 patients with SLE (n = 17), PAPS (n = 14) and secondary APS (n - 9). Sera from 10 healthy subjects (donors) served as control. N03 concentration > 40 mcmol/l was stated high. SLE activity was assessed by V. A. Nasonova 's scale and SLEDAI index (SLEDAI > 9 indicated SLE exacerbation). Patients with PAPS were divided into two groups depending on clinical symptoms: 7 patients with significant thrombosis or history of more than two thrombotic complications (group 1); 7patients with the history of two or less thromboses (group 2). Results. The mean serum nitrate concentration in the SLE group was 43.59 mcmol/l (range 17.06113.22). The nitrate level of the sAPS + SLE group was 49.81 ± 27.54 and did not significantly differ from APS (33.67 ± 14.70). By univariate standard analyses, serum nitrate concentration was significantly higher in patients with high disease activity (57.31 ± 25.12 vs. 25.62 ± 6.96, Mann-Whitney test, p < 0.01). The Spearman correlation coefficient of nitrate level with SLEDAI was 0.8 (p < 0.001). Conclusion. A nitrate level is increased in patients with active SLE and in APS patients with severe thrombotic complication.
Terapevticheskii arkhiv. 2004;79(5):19-22
pages 19-22 views

Antibodies to proteinase-3 and myeloperoxidase in systemic vasculitis

Baranov A.A., Kirdyanov S.Y., Beketova T.V., Bazhina O.V., Guryeva M.S., Abaitova N.E.


Aim. To investigate occurrence and diagnostic significance of antibodies to proteinase-3 (aPR-3) and myeloperoxidase (aMPO) in systemic vasculitis (SV). Material and methods. A total of 98 patients with different forms of SV were examined: nonspecific aortoarteritis (NAA, n = 18), nodular polyarteritis (NP, n = 18), Wegener granulomatosis (WG, n = 20), obliterating thrombangiitis (ОТ, n - 21), and hemorrhagic vasculitis (HV, n = 21). Eight patients with primary antiphospholipid syndome (PAPS) and 20 donors comprised a control group. aPR-3 and aMPO were detected by solid-phase enzyme immunoassay using kits ORGenTec Diagnostica GmbH. Results. aPR-3 were detected in 1 (5.6%) patient with NP and in 3 (14.3%) patients with HV. aPR3 were detected in 13 (65%) of 20 patients with WG being significantly more frequent not only vs controls (0%) but in some forms of SV and PAPS (p < 0.05). Mean aPR-3 level in 13 WG patients was significantly higher than in 4 patients (1 with NP and 3 with HV) the sera of whom also contained aPR-3. 84.6% patients with WG had higher concentrations of aPR-3, this is significantly more frequently than in the comparison group. In NP and HV these autoantibodies were encountered in the serum only in moderate or low concentrations in patients with high clinicolaboratory activity of the disease. In WG patients there was no correlation between aPR-3 presence, form of the disease and basic clinical manifestations, but mean values of index of clinical activity of vasculitis were significantly higher in patients with aPR-3 than in those free of them. Concentration ofaPR-3 in an active phase of the disease was significantly higher than in patients in remission. Moreover, aPR-3 were detected in 83.3% cases in active vasculitis and in 37.5% patients without it. Detection ofaPR-3 in WG group was associated with mean sensitivity and good specificity. In examination of the patients in an active phase specificity rose but sensitivity fell. Optimal results were obtained in estimation of aPR-3 level. Thus, in moderate or high concentration, aPR-3 have good sensitivity and high specificity for diagnosis of WG, in a high titer (> 15 U/ml) they are highly sensitive and specific for this vasculitis. aMPO were detected in 1 of 18 patients with NP, in 1 of 21 - with ОТ, in 3 of 21 - with HV and in 2 of 21 - w,th NAA. None patients with WG or PAPS had aMPO. aMPO were detected in NP and HV in high activity of inflammation. Part of the patients had affected kidneys. Conclusion. Thus, WG is characterized by the presence and high concentration ofaPR-3. In the latter case aPR-3 have high (100%) sensitivity and specificity for diagnosis of WG. Detection ofaPR-3 can be used as an additional laboratory test for diagnosis of WG and estimation of its activity.
Terapevticheskii arkhiv. 2004;79(5):22-28
pages 22-28 views

Changes in inflammatory activity of rheumatoid arthritis at early stages of basic therapy with leflunomide

Balabanova R.M., Makolkin V.I., Shostak N.A., Chichasova N.V., Olyunin Y.A., Goryachev D.V., Loginova Т.К., Ryabkova A.A., Petukhova N.V., Menshikova I.V., Igolkina E.V., Chizhova K.A., Nasonov E.L.


Aim. To assess leflunomide efficacy and tolerance in patients with rheumatoid arthritis (RA) during the first four months of the treatment. Material and methods. The study included 200 RA patients treated in four Moscow clinical centers. Leflunomide was given in a dose of 100 mg/day for 3 days, then 20 mg/day for 16 weeks. The activity of the disease according to the criterion DAS 28 was assessed before the treatmend and 4, 8, 12 and 16 weeks after the treatment start. Results. RA activity diminished considerably after one month of leflunomide treatment. Later, the articular syndrome continued to improve. A significant improvement by DAS 28 was observed after 16 weeks of the treatment in 65% (129 of 200) patients, high RA activity persisted only in 17 of 90 patients. Conclusion. Leflunomide reduces articular inflammation and raises RA patients' quality of life at early stages of the treatment. This reduction continued for 4 months of the study. Therefore, adequate assessment of leflunomide efficacy should be made only after 4-6 months of therapy.
Terapevticheskii arkhiv. 2004;79(5):28-32
pages 28-32 views

Persistence of various infective agents in blood mononuclear leukocytes in debute of rheumatoid arthritis

Petrov A.V., Dudar L.V., Maly K.D.


Aim. To study persistence in blood mononuclear leukocytes (ML) of Herpesviridae viruses (cytomegalovirus-CMV, herpes virus of type I and II, Epstein-Barr virus-EBV, hepatitis В and С viruses, Mycoplasma arthritidis-Ma, , Mycoplasma fermentans-Mf, Ureaplasma urealiticum-U, Chlamidia trachomatis-Ct). Material and methods. 56 patients with debute of rheumatoid arthritis (RA) and 30 healthy persons were examined using methods of direct and indirect immunofluorescence, polymerase chain reaction and enzyme immunoassay. Results. In patients with early RA persistence of infective agents in blood ML was found high (67.9%). Persistance of the viruses was studied for 1.5-2 years. Features of the clinical course of the disease were specified for various infective agents: seronegativeness in persistence of Ma, Mf and U, high activity and frequent development of systemic manifestations of RA in persistence of Herpesviridae viruses, rapid progression of bone destruction in persistence of Ct. Conclusion. Carriage of Herpesviridae was associated with high activity of inflammatory process, of Chlamidia - with rapid bone destruction, of mycoplsma and ureaplasma - with unchanged rate of progression. Eradication of Herpes viruses, CMV, EBV and CT is indicated.
Terapevticheskii arkhiv. 2004;79(5):32-35
pages 32-35 views

Markov's model of decision making on basic therapy of rheumatoid arthritis: monotherapy and its cost

Goryachev D.V., Erdes S.F.


Aim. To design Markov's model of decision making to study the role of order in the use of most usable basic antirheumatic drugs (methotrexate-MT, parenteral gold -PG and sulfasalasine - SS) in terms of the course duration and cost. Material and methods. The model was based on metaanalysis made in 2000. The program TreeAge 3.0 was used. The prices for the drugs were taken as mean about Moscow for 2002 and prices presented by ACR for 2002. Results. The sequence MT-PG-SS had the advantage over the other sequences in that less number of patients stopped treatment after 5 and 10 years of therapy. Mean cost of the drugs per patient is the lowest (for five years) if MT is prescribed first. In longer treatment SS-MT-PG is more cost-effective. Conclusion. It is feasible to design Markov's models for making decision on optimal therapy of rheumatoid arthritis both in terms of cost and clinical response.
Terapevticheskii arkhiv. 2004;79(5):35-39
pages 35-39 views

Statistic-mapping modeling of rheumatic diseases prevalence among population of different regions of Russia

Erdes S., Folomeeva О.М., Dubinina T.V., Zhukova О.V.


Aim. To assess feasibility of the method of mapping modeling for spacial featuring of rheumatic diseases (RD) morbidity statistics for population of Russia. Material and methods. Population morbidity statistics for 78 administrative units of the Russian Federation (1993-2000) were processed. Statistic-mapping modeling employed weighted mean interpolation i.e. mathematic prediction of the sign value depending on its magnitude in basic points. Results. Mapped images of RD prevalence, prevalence/primary morbidity values and number of documented cases/number of rheumatologists demonstrate special distribution of the signs studied about the RF territory. The estimation of mean, minimal, maximal values and dispersion of each sign established dynamic trends in the markers for the period under study(increased area with RD prevalence above 95/1000 from 15.9 to 44.5%; increased mean ratio prevalence/morbidity from 2.8 to 3.2 and decreased ratio of patients/rheumatologists from 10882 to 9031). Regions with minimal and maximal values are shown. Conclusion. Statistic-mapping modeling demonstrates spacial distribution of the markers, reveals the relations between them.
Terapevticheskii arkhiv. 2004;79(5):40-45
pages 40-45 views

Pharmacotherapy of acute tonsillopharyngitis in outpatient setting: results of a multicenter pharmacoepidemiological study

Kozlov S.N., Strachunsky L.S., Rachina S.A., Dmitrenok O.V., Ilyuschenko L.A., Kuzin V.В., Ortenberg E.A., Palyutin S.K., Sosonnaya N.A.


Aim. To analyse current practice of pharmacotherapy (PT) in outpatient treatment of acute tonsillopharyngitis (ATP) in different regions of Russia. Material and methods. Case repords for 1333 outpatients (493 male and 840 female, age 16-76 years) with ATP from 7 cities of Russia have been studied. Each ATP case was documented on a special chart to contain the following information: demographic data, history of the disease, bacteriological findings, FT regimens, complications, treatment outcomes. Results. FT of ATP was made primarily with antibiotics. Most frequent of them was ampicillin (about half the cases). Further antibiotics by frequency of use were: erythromycin, ciprofloxacin, doxicyclin, amoxicillin, midecamycin, ampicillin/oxacillin. Among other drugs, wide use was registered of antihistamine drugs, throat disease drugs, analgetic and antipiretic drugs, vitamins. Bacteriological examinations were conducted rarely. Conclusion. The problems ofFTofATP patients consist in overuse of systemic antibiotics as a result of adequate differential diagnosis of this infection and choice of antibiotics without consideration of current recommendations on the treatment of streptococcal ATP.
Terapevticheskii arkhiv. 2004;79(5):45-51
pages 45-51 views

Immunoresistance syndrome in gout patients and its influence on formation of clinical features of the disease

Barskova V.G., Eliseev M.S., Nasonov E.L., Yakunina I.A., Zilov A.V., Ilyinykh E.V.


Aim. To evaluate the occurrence of immunoresistance (IR) syndrome in gout and its correlation with a gout course. Material and methods. Anthropometric parameters, blood lipid spectrum, levels of glucose, uric acid (UA), immunoreactive insulin, HOMA index were studied in 55 male patients with gout (mean age 50.1 ± 7.9 years, mean duration of the disease 7.5 ± 7.2 years). Statistic processing was made with computer program Statistica 6.0. Results. IR was revealed in 49% patients. Immunoresistant patients had visceral obesity, arterial hypertension, abnormal lipid profde, high UA concentrations, longer disease, chronic articular syndrome, high occurrence of diabetes mellitus and vascular events significantly more frequently. Conclusion. IR in gout patients is the risk factor of cardiovascular diseases; combination of IR and hyperinsulinemia is characterized by marked hyperuricemia and a trend to chronic course of the articular syndrome. Longer duration of gout, especially treated inadequately, raises the risk of IR. IR deteriorates prognosis in relation to cardiovascular diseases, diabetes mellitus type 2, course of gout itself.
Terapevticheskii arkhiv. 2004;79(5):51-56
pages 51-56 views

Affection of the heart in patients with psoriatic arthritis

Badokin V.V., Kotelnikova G.P.


Aim. To examine the rate and features of heart damage in psoriatic arthritis (PA) patients and find out whether some parameters of PA are associated with cardiac involvement. Material and methods. The study enrolled 370 PA patients aged 15 to 72 years with the disease history 1 to 44 years having different variants of the articular and skin syndromes. The patients have undergone various tests including chest x-ray, ECG, echocardiography. Results. Myocarditis, adhesive pericarditis, valvular defects (mitral, aortic and combined mitral-aortic were diagnosed in 15.9, 18.2 and 5.7% of PA patients, respectively). Aortitis was detected in 51.3% patients with advanced sacroileitis and alky/osing spondylarthritis. Alterations in the heart were associated with spinal lesions, other systemic manifestations, activity of the disease and, in a lesser degree, with carriage of HLA-B27. Conclusion. Cardiac syndrome in PA is characterized by marked heterogeneity and is one of basic systemic manifestations of this disease. Latent PA aortatis can be detected at echocardiography.
Terapevticheskii arkhiv. 2004;79(5):56-61
pages 56-61 views

Allele polymorphism of alkaline, acid soluble phosphatase genes and vitamin D-binding protein in postmenopausal osteoporosis

Krylov M.Y., Korotkova T.A., Myakotkin V.A., Benevolenskaya L.I.


Aim. To study polymorphism of genes involved in mechanisms regulating metabolism of bone tissue: alkaline (ALPL) and acid (ACPI) phosphatases, vitamin D-bindingprotein (GC); to ascertain associations of their genotypes and alleles with osteoporosis (OP) and mineral density of spinal and femoral bone tissue (BTMD). Material and methods. Relevant genetic examination was made in 70 females with OP diagnosed by the WHO criteria (1994) aged 60-79years (mean age 71.0 ± 6.2years) and 51 ОP-free females in the same age interval (mean age 69.0 ± 5.6 years). Polymorphic sites of the genes were examined by polymerase chain reaction. Trinucleotide repeat, ARG105GLN polymorphism of restrictive fragment length (PRFL), [GC, TRH420LYS] PRFL were studied for ALPL gene, ACPI gene and GС gene, respectively. Results. Association was found between frequencies of genotypes SS, 2F and FS, F allele of GC gene with OP as well as between PRFL of the spine, femur and some GC genotypes in OP women. Genes ALPL and ACPI were not associated with OP. Conclusion. It is suggested that genotypes SS, 2F and FS have marked functional differences in fixation and transport of vitamin D active metabolites involved in metabolism of bone tissue in OP.
Terapevticheskii arkhiv. 2004;79(5):61-65
pages 61-65 views

Immune system in patients with metabolic syndrome

Zabelina V.D., Zemskov V.M., Mkrtumyan A.M., Balabolkin M.I., Antonova O.A.


Aim. To characterize features of immune status in patients with metabolic syndrome (MS). Material and methods. 41 MS patients entered the study (mean age 55.9 + 9. 7 years). Blood free triiodthyronine (TJ), thyroxine (TJ), TTH, antibodies to thyroglobulin (abTG), thyroid peroxidase (AbTP) were studied with enzyme immunoassay; levels of CD3+, CD4+, CD8+, CD 16+, CD72+ were studied with monoclonal antibodies; IgG, IgA, IgM were measured by radial immunodiffusion in gel by Manchini. The size and the structure of the thyroid were investigated with ultrasound. Results. Thyroid pathology was in 48.8% patients with MS, chronic infectious diseases (CID) - in 51.2%. MS patients free of thyroid pathology and CID had elevated blood levels of IgG, IgA, dysimmunoglobulinemia and low relative number of CD3+ lymphocytes, close correlations of Tfree with the levels ofCD3+, CD4+, CD8+, Tfree with CD72+ (r = -0.97 to +0.92), TJree with IgA, IgG (r - -0.96, r = -0.90), TTH and IgA (r = -0.89), weak negative correlations of uric acid with the levels of CD3+, CD4+, CD72+and positive with CD8+, CD 16+, immunoglobulins. Combination of MS with thyroid pathology and/or CID was characterized with aggravated defects in T- and B-cell immunity, fall in IgG, IgA and changed direction of correlations of thyroid and immune statuses. Conclusion. Immune status in MS patients was characterized by stimulation of humoral immunity, dysimmunoglobulinemia, T-cell immunity deficiency. This may be related to chronic hyperinsulinemia, dyslipidemia, antigenic stimulation with modified lipoproteins. Thyroid hormones levels positively correlate with concentrations of immunocytes and negatively - with immunoglobulins.
Terapevticheskii arkhiv. 2004;79(5):66-72
pages 66-72 views

Comparative characteristics of stress tests (bicycle exercise and psychoemotional test) in patients with ischemic heart disease

Smakotina S.A., Bernes S.A., Mineeva E.V., Barbarash O.L.


Aim. To compare efficacy bicycle exercise (BE) and psychoemotional tests (PET) in provoking myocardial ischemia and arrhythmia in patients with acute and chronic forms of ischemic heart disease (IHD). Material and methods. BE and PET (mathematical count test) were performed in 108 IHD patients. 30 patients had stable effort angina (FCII-III), 48 patients had progressing effort angina and 30 patients were at the subacute stage of myocardial infarction. Results. PET was less efficient in detection of myocardial ischemia but is more adequate in detecting episodes of painless ischemia and ventricular rhythm disorders compared to BE. The greatest differences in efficiency of the tests occurred in patients with acute forms of IHD. Conclusion. Application of different stress tests in IHD patients raises efficacy of detecting episodes of painful, painless myocardial ischemia and rhythm disorders, specifies mechanisms of coronary failure development.
Terapevticheskii arkhiv. 2004;79(5):72-75
pages 72-75 views

Therapy of acute radicular syndrome with application of glucocorticoids in a pain relief department practice

Gnezdilov A.V., Zagorulko О.I., Syrovegin A.V., Medvedeva L.A.
Terapevticheskii arkhiv. 2004;79(5):75-77
pages 75-77 views

Current therapy of osteoarthrosis: pathogenetic grounds

Tsvetkova E.S.
Terapevticheskii arkhiv. 2004;79(5):77-79
pages 77-79 views

Grounds for development of endothelial dysfunction in rheumatoid arthritis

Rebrov A.P., Inamova О.V.
Terapevticheskii arkhiv. 2004;79(5):79-85
pages 79-85 views
pages 86-90 views

Nikolai Romanovich Paleev (the 75th anniversary of birth)

- -.
Terapevticheskii arkhiv. 2004;79(5):90-92
pages 90-92 views

2004 calendar of jubilees in the history of therapy

- -.
Terapevticheskii arkhiv. 2004;79(5):92-95
pages 92-95 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies