Vol 83, No 5 (2011)

Articles
Perspectives of the treatment of rheumatic diseases in the beginning of the XXI century
Nasonov E.L., Nasonov E.L.
Abstract
Prevalence of immunoinflammatory diseases in general population is about 10%. Rheumatic diseases, first of all rheumatoid arthritis (RA), are among most prevalent immunoinflammatory diseases. In the first decade of the XXI century great progress was achieved in definition of the mechanisms of RA onset and in development of new approaches to its treatment. The article provides information about novel drugs which are effectively used not only in RA but also in other imunoinflammatory diseases.
Terapevticheskii arkhiv. 2011;83(5):5-9
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Methotrexate-induced changes in the concentration of antibodies to modified citrulnated vimentin in blood serum of patients with rheumatoid arthritis
Shilkina N.P., Voronina M.S., Vinogradov A.A., Borisova O.L., Shilkina N.P., Voronina M.S., Vinogradov A.A., Borisova O.L.
Abstract
Aim. To study effects of methotrexate on the titer of antibodies to mutated citrullinated vimentin (anti-MCV) and ascertain possibility of using this marker for control of treatment results and choice of individual effective dose of the drug. Material and methods. A 12-month trial included 76 patients with verified rheumatoid arthritis (RA). Methotrexate per os was given in a dose 7.5-10 mg/week to 44(57.9%) patients, 25 patients received no basic therapy. Anti-MCV (IU/ml) were detected with commercial chemicals made in Germany (ORGENTEC). Results. RA patients given methotrexate doses 7.5 and 10 mg/week and untreated with basic anti-inflammatory drugs showed no significant differences by basic clinical and device parameters, level of anti-MCV at primary examination and 12 months later. Conclusion. Anti-MCV titer cannot be used for control of efficacy of methotrexate treatment in doses 75 and 10 mg/week, choice of individual effective doses.
Terapevticheskii arkhiv. 2011;83(5):10-13
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Ten-year risk of cardiovascular complications in patients with rheumatoid arthritis
Gerasimova E.V., Popkova T.V., Novikova D.S., Aleksandrova E.N., Novikov A.A., Nasonov E.L., Gerasimova E.V., Popkova T.V., Novikova D.S., Alexandrova E.N., Novikov A.A., Nasonov E.L.
Abstract
Aim. To compare 10-year risk of cardiovascular complications (CVC) assessed by Adult Treatment Panel III (ATP III) and Reynolds Risk Score (RRS); to specify contribution of C-reactive protein (CRP) to development of CVC in patients with rheumatoid arthritis (RA). Material and methods. The trial included 116 RA patients (100 females and 16 males) and 85 healthy subjects (63 females and 22 males) under 55 years of age free of clinical symptoms of cardiovascular diseases. RA duration and activity were the same in men and women. The patients and controls were matched by age, incidence of standard risk factors (RF). The 10-year risk of CVC development was estimated by two scales - ATP III and RRS. Total cholesterin, HDLP cholesterin were measured with standard enzyme tests, concentration of CRP was assessed by highly sensitive immune nephelometry. Results. The 10-year risk of CVC was higher in RA patients both by ATP III (1.8 - 1;10%) and RRS (2.6 - 2; 7)% compared to the controls (1 - 1;3)% and (1.2 - 1;4)% (p < 0.05). In male RA patients RRS is higher than in females - 7 (3.5; 12)% and 2 (1;2)%, respectively (p < 0.001). Re-calculation from the scale ATP III to RRS has changed the risk in 17 (17%) females and 7 (44%) males with RA. As a result, the number of RA patients with a low CVC risk decreased, with a moderate risk rose 2 times, with a high risk was the same. RRS dependence on the disease duration, RA activity (DAS28) was not registered. RA patients showed a positive correlation of RRS with thickness of the intima-media complex of the carotid arteries (r = 0.44; p < 0.001). Conclusion. Introduction of a new prognostic scale RRS allows isolation of groups of patients with moderate and high CVC risk and timely medication of such patients.
Terapevticheskii arkhiv. 2011;83(5):14-19
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Cardiovascular risk factors in psoriatic and rheumatoid arthritis
Rebrov A.P., Nikitina N.M., Gaydukova I.Z., Rebrov A.P., Nikitina N.M., Gaidukova I.Z.
Abstract
Aim. To study the role of conventional and new factors of cardiovascular risk in development of atherosclerosis in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PA). Material and methods. Sixty patients with psoriatic arthritis, 414 RA patients and 79 healthy controls entered the trial. All of them had no manifestations of cardiovascular diseases. Screening was made of the leading risk factors of cardiovascular diseases and cardiovascular complications, thickness of the complex intima-media (TIM) of the carotid arteries, vascular wall stiffness were measured, vasoregulatory function of the endothelium, markers of endothelial damage were examined. Results. Patients with psoriatic and rheumatoid arthritis were found to have increased TIM of the carotid arteries, high incidence of atherosclerotic plaques, increased stiffness, damage of the vascular wall, affected endothelial vasoregulation. These alterations were associated with high arthritis activity, systemic manifestations, seropositivity by rheumatoid factor (in RA), presence of entesitis, uveitis and dactilitis (in psoriatic arthritis), dislipidemia, arterial hypertension (AH). Conclusion. To determine cardiovascular risk in patients with arthritis, it is necessary to consider not only standard risk factors (dislipidemia and AH), but also severity of systemic inflammation, arterial stiffness, endothelial damage and ability of the vascular wall to relax reflecting endothelial dysfunction.
Terapevticheskii arkhiv. 2011;83(5):20-24
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Current knowledge about pathogenesis and treatment of arterial hypertension in rheumatoid arthritis
Novikova D.S., Popkova T.V., Nasonov E.L., Novikova D.S., Popkova T.V., Nasonov E.L.
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease with a proved high risk of cardiovascular diseases (CVD). An increase of this risk is mainly due to accumulation of conventional factors of CVD development (arterial hypertension - AH), dislipidemia, et cet). Causes of high prevalence of AH in RA, the role of chronic inflammation, effects of antirheumatic drugs with potentially hypertensive effects are outlined and recommendations on AH prevention and treatment in RA patients are given.
Terapevticheskii arkhiv. 2011;83(5):24-33
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Standardization of methotrexate administration in routine rheumatological practice
Murav'ev Y.V., Muravyev Y.V.
Abstract
The review is devoted to administration of methotrexate - a basic anti-inflammatory drug - in rheumatoid arthritis. Some issues of practical use of this drug are still disputable. Recommendations of international experts and information on standardization for patients are considered.
Terapevticheskii arkhiv. 2011;83(5):33-37
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Arterial stiffness in patients with systemic sclerosis
Karoli N.A., Rebrov A.P., Karoli N.A., Rebrov A.P.
Abstract
Aim. To study arterial stiffness (AS) in patients with systemic sclerosis (SS). Material and methods. A total of 38 SS patients (36 females and 2 males over 40 years of age) entered the study. They met the following criteria: clinical symptoms of coronary heart disease, atherosclerosis of peripheral vessels, other severe chronic diseases in exacerbation. The control group consisted of 28 healthy matched volunteers. AS was measured with Tensioclinic (Tensiomed, Hungary) arteriograph which demonstrated changes in arterial bed in SS patients. Results. Arterial overrigidity and accelerated reflection of the pulse wave have a strong impact on elevation of the central arterial pressure. High blood pressure in the ascending aorta overloads the left ventricle and promotes development of its hypertrophy, deteriorates diastolic relaxation and, finally, damages pump function of the heart. Moreover, chronic elevation of the central arterial pressure is the end component in formation of the vicious circle of a further increase of the cardiovascular risk and the marker of target organ affection. Conclusion. Increased vascular stiffness in SS patients suggests increased cardiovascular risk in these patients. Prospective studies of this risk are needed.
Terapevticheskii arkhiv. 2011;83(5):38-41
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Pleiotropic effects of statins in systemic sclerosis
Alekperov R.T., Korzeneva E.G., Aleksandrova E.N., Novikov A.A., Anan'eva L.P., Alekperov R.T., Korzeneva E.G., Alexandrova E.N., Novikov A.A., Ananyeva L.P.
Abstract
Aim. To study anti-inflammatory and angioprotective properties of statins in patients with systemic sclerosis (SS). Material and methods. Fifty SS patients enrolled in the trial were divided into two groups: the study group included 30 patients who received standard therapy and atorvastatin in a dose 10-40 mg/day, the control group (n = 20) received standard therapy alone. The blood of the patients was studied with enzyme immunoassay for concentrations of highly sensitive C-reactive protein (hs-CRP), IL-6, VCAM-1, E-selectin, WF antigen, VEGF-A, VEGF-R2. The tests were made before the treatment and after 12 months of the treatment. Results. The levels of hs-CRP, IL-6, VCAM-1, E-selectin, WF antigen, VEGF-A and VEGF-R2 were significantly higher in the study group than in healthy donors. The controls also had elevated levels of the above substances except IL-6 and VEGF-A which elevated but not significantly. A 12-month treatment in the study group resulted in a significant lowering of hs-CRP, IL-6, WF antigen, E-selectin, VEGF-A and VEGF-R2, the number of patients with elevated IL-6, WF antigen, VEGF-R2 also reduced while in the controls the parameters did not change. Conclusion. Atorvastatin has anti-inflammatory and angioprotective effects in SS patients.
Terapevticheskii arkhiv. 2011;83(5):41-47
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Systemic lupus erythematosus in men: difficulties of diagnosis and specific features of clinical picture
Klyukvina N.G., Klyukvina N.G.
Abstract
Aim. To characterize specific clinical features of systemic lupus erythematosus (SLE) in male patients. Material and methods. A total of 146 male patients with verified SLE diagnosis were examined in the Research Institute of Rheumatology. Results. Literature and original data on SLE clinical characteristics in men were analysed. Diagnostic search and variants of SLE in male patients are described. Conclusion. To upgrade knowledge on SLE clinical characteristics, further prospective trials should be made.
Terapevticheskii arkhiv. 2011;83(5):47-50
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Some aspects of pathogenesis of ankylosing spondylitis
Erdes S., Erdes S.
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease of the spine (spondylitis) and sacroiliac joints (sacroileitis) associated in many cases with inflammatory affection of the peripheral joints (arthritis), entesises (entesitis), eyes (uveitis), intestine (enteritis) and aortic root (aortitis). AS is considered now as a prototype of diseases from the group of seronegative spondyloarthritis. AS is a hereditary disease. Predisposition to AS (90%) is associated with genetic factors the key gene of which is HLA-B27. As pathogenesis of AS is not still verified, three hypotheses are considered basing on HLA-B27 biology.The role of environmental factors involved in AS development (tension in enteses and infection) are discussed.
Terapevticheskii arkhiv. 2011;83(5):51-56
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Main factors of gender dimorphism of gout (estrogens and diuretics vs alcohol and genetics)
Barskova V.G., Eliseev M.S., Chikalenkova N.A., Barskova V.G., Eliseev M.S., Chikalenkova N.A.
Abstract
The article analyses factors underling gender dimorphism of gout, gender epidemiological differences. Discussion covers the role of estrogens and menopause, alcohol, diuretics, gender-associated genetic characteristics in gout genesis.
Terapevticheskii arkhiv. 2011;83(5):57-61
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Efficacy of combined treatment of patients with severe obstructive sleep apnea and arterial hypertension of the second and third degree
Sukmarova Z.N., Litvin A.Y., Chazova I.E., Rogoza A.N., Sukmarova Z.N., Litvin A.Y., Chazova I.E., Rogoza A.N.
Abstract
Aim. To assess efficacy of two- and three-component antihypertensive treatment (AHT) in patients with severe sleep apnea and arterial hypertension (AH) of the second and third degree in combination with CPAP therapy (continuous positive air pressure) and without it. Material and methods. A total of 58 patients aged 55.5±9.6 years participated in the study. Clinical blood pressure (BP) before treatment was 172.0 (170.7-175.9)/100.0 (98.5-104.2) mm Hg, apnea/ hypopnea index was 26.3 episodes an hour. The patients received amlodipin in combination with walsartan in a dose 5-10/160 mg with addition of 25 mg hydrochlorothiaside if target BP was not achieved. This treatment was followed for 3 weeks by CPAP-therapy. Monitoring was made of clinical BP, central BP, target mean 24-h pressure. Results. Despite a significant reduction of systolic arterial pressure/diastolic arterial pressure (by 30/ 14 mm Hg) as a result of antihypertensive treatment, this reduction was lower than in such patients without obstructive sleep apnea (by data from other investigators). CPAP-therapy reduced the number of resistant patients from 58 to 31%, patients with masked AH - from 19 to 11%, cases of arrhythmia - from 69 to 47%. Conclusion. Multicomponent pathophysiologically sound AHT in hypertensive patients with severe obstructive sleep apnea was effective in less than 42% cases. The maximal effect was achieved in combined treatment with CPAP-therapy.
Terapevticheskii arkhiv. 2011;83(5):61-66
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Transplantation of hemopoietic stem cells in autoimmune diseases
Novik A.A., Novik A.A.
Abstract
Transplantation of stem hemopoietic cells is a new trend in the treatment of some autoimmune diseases.Large international trials made in the last 12 years in the USA, Europe, Russia, China were devoted to evaluation of efficacy of this method. Basing on the results of these trials, experts of the Russian Cooperative Cell Therapy Group and N.I. Pirogov National Medicosurgical Center have developed a conception of high-dose immunosuppressive therapy with transplantation of stem hemopoietic cells in autoimmune diseases. Main positions of the conception and its perspectives are discussed.
Terapevticheskii arkhiv. 2011;83(5):67-70
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Optimization of the control of blood pressure. What contribution can be obtained from use of combinations of fixed doses of ACE inhibitors and calcium channel blockers?
Eliseev O.M., Eliseev O.M.
Abstract
Basing on the results of large trials investigating efficacy of combined use of angiotensin-converting enzyme inhibitors (as a rule, perindopril) and calcium channel blockers (as a rule, amlodipin), the article analyses variety of mechanisms of their combined action, effects on dynamics of blood pressure, heart rate variability. The above combined treatment significantly reduces frequency of cardiovascular complications, improves the course of diabetes mellitus in its combination with arterial hypertension, renal function in patients with chronic renal failure and arterial hypertension. It is important to use fixed doses of the above drugs.
Terapevticheskii arkhiv. 2011;83(5):70-75
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Efficacy of pharmacological inhibition of intestinal saccharases in patients with diabetes mellitus type 2 and/or visceral obesity
Ametov A.S., Kamynina L.L., Ametov A.S., Kamynina L.L.
Abstract
Inhibitors of intestinal enzymes regulate carbohydrate metabolism reducing glycemic index, glycemic load of food and postprandial glycemia which is a prognostic factor of DM2-related cardiovascular complications and death. This class of drugs was proposed for DM2 treatment in 1970s but still holds perspectives. The article gives a detailed description of the mechanism of action, efficacy and safety of inhibitors of alpha-glucosidase and alpha-amilase in experimental and clinical controlled trials.
Terapevticheskii arkhiv. 2011;83(5):76-80
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