Vol 85, No 5 (2013)


Rheumatology in Russia in the early 21st century

Nasonov E.L.


Rheumatoid arthritis (RA) is the most common immune inflammatory rheumatic disease. The paper gives the current data of Russian investigations into the early diagnosis of RA and into innovative approaches to its therapy.
Terapevticheskii arkhiv. 2013;85(5):4-7
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The magnitude of fatigue and its association with depression, pain, and inflammatory activity in rheumatoid arthritis

Lisitsyna T.A., Vel'tishchev D.I., Gerasimov A.N., Seravina O.F., Kovalevskaia O.B., Zeltyn' A.E., Novikov A.A., Aleksandrova E.N., Tallerova A.V., Kovalenko L.P., Durnev A.D., Krasnov V.N., Nasonov E.L.


AIM: To analyze the rate of clinically significant fatigue and to search for its predictors in patients with rheumatoid arthritis (RA)/MATERIAL AND METHODS: The investigation included 95 patients with a valid RA diagnosis. The majority of the patients were women (87.4%); mean age was 46.7±1.2 years; mean disease duration was 135.5±11.6 months. The authors evaluated RA activity by the Disease Activity Score (DAS28), magnitude of fatigue by the Fatigue Severity Scale (FSS), that of pain by the Brief Pain Inventory, and functional status and quality of life by the Health Assessment Questionnaire and EQ-5D. A psychiatrist diagnosed mental disorders in accordance with ICD-10 and using the psychiatric and psychological scales and procedures/RESULTS: 80% of the patients felt clinically significant fatigue (FSS scores of ≥4). Multivariate analysis yielded a prognostic model that made it possible to state that clinically significant fatigue was primarily associated with the magnitude of depression by the Hospital Anxiety and Depression Scale, the presence of a depressive episode, the duration of anxiety and depressive spectrum, the magnitude of pain (Ritchie index), DAS28, and the presence of osteoporosis/CONCLUSION: The presence and magnitude of depression along with the magnitude of pain are an important factor that influences the formation of fatigue in RA, which gives rise to evident functional failure and a low quality of life. Combination therapy for RA may be effective when mental disorders, mainly the anxiety and depressive spectrum, are timely diagnosed.
Terapevticheskii arkhiv. 2013;85(5):8-15
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Genetic factors of angiogenic dysregulation in women with rheumatoid arthritis

Konenkov V.I., Korolev M.A., Shevchenko A.V., Prokof'ev V.F., Ubshaeva I.B., Sokolova O.S., Letiagina E.A., Diubanova G.A.


AIM: To study genotype distribution in the MMP and VEGF genes, angiogenesis regulators, and their combinations with genotypes in other cytokines genes with proangiogenic activity in female patients with rheumatoid arthritis (RA) and healthy individuals/MATERIAL AND METHODS: 509 Europeoid women from the eastern regions of Russia, including 374 healthy women aged 23-68 years and 135 female patients aged 27-66 years with RA, were examined. TNF-α gene promoter single nucleotide polymorphisms (SNP) -863 C⇒A, TNFА -308 G⇒A, TNFА -238 G⇒A; IL1Β -31 С⇒T, IL4 -590 С⇒T, IL6 -174 G⇒C, IL10 -1082 G⇒ A and IL10 -592 А⇒С; VEGF -2578 C⇒A, VEGF +936 C⇒Т; ММР 2 -1306 С⇒Т, ММР 9 -1562 С⇒Т were investigated by the restriction analysis of amplification products/RESULTS: The patients with RA show a preponderance of the combinations of genotypes in vascular endothelial growth factor (VEGF) synthesis inducers, which are related to the high-level production of this factor, and those of genotypes in the degradation of the extracellular matrix of MMP2 and MMP9, which characterize the low baseline elaboration of matrix metalloproteinases (MMP) with a high capability for their induced synthesis, which is specific to the dysregulated states of the angiogenesis control system. Along with MMP and VEGF genotypes, the combinations most commonly contain IL1Β, IL4, IL10, IL6, and TNF-α genotypes/CONCLUSION: The study of the pathogenesis of RA must comprehensively investigate the role of the genes of the factors involved in the regulation of angiogenesis and inflammation, with particular emphasis on molecular genetic mechanisms for monitoring the baseline level of production of these regulatory factors.
Terapevticheskii arkhiv. 2013;85(5):16-23
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Relationship of the clinical efficiency of tocilizumab therapy to the serum level of matrix metalloproteinase-3 in patients with rheumatoid arthritis

Avdeeva A.S., Aleksandrova E.N., Novikov A.A., Cherkasova M.V., Panasiuk E.I., Nasonov E.L.


AIM: To evaluate the impact of tocilizumab (TCZ) therapy on the level of matrix metalloproteinase-3 (MMP-3) 4, 24, and 48 weeks after treatment initiation in relation to the clinical efficiency of TCZ therapy by the Disease Activity Score (DAS28), the Clinical Disease Activity Index (CDAI), and the Simplified Disease Activity Index (SDAI)/MATERIAL AND METHODS: Forty-two rheumatoid arthritis (RA) patients who had received 6 intravenous infusions of TCZ 8 mg/kg at a 4-week interval during permanent therapy with disease-modifying anti-rheumatic drugs (DMARD) and glucocorticosteroids (GCS) were examined. Then TCZ was discontinued and the patients continued to receive the previous therapy with DMARD and GCS. The European League Against Rheumatism (EULAR) classification criteria, as well as SDAI and CDAI were used to evaluate the efficiency of TCZ therapy. The serum concentration of MMP-3 was measured by enzyme immunoassay using the test systems (Invitrogen, USA)/RESULTS: After 24 weeks of TCZ therapy (at 48 weeks following trial initiation), DAS28 was 4.69 (3.86; 5.44); the SDAI of 17.8 (10.7; 29.5) and the CDAI of 17.1 (7.2; 26.2) corresponded to moderate disease activity. At 48 weeks, DAS28 remission (<2.6 scores) remained in 5 (11.9%) patients; SDAI (≤3.3 scores) and CDAI (≤2.8 scores) remissions did in 3 (7.1%) and 4 (9.5%) patients, respectively. There was a significant reduction in MMP-3 concentrations at 4, 24, and 48 weeks of the therapy, which was 61, 73, and 49.4% of the baseline level. ROC analysis indicated that the normalization of MMP-3 levels in RA patients at 24 weeks of TCZ therapy (a cut-off ≤16.5 ng/ml) was associated with the maintenance of remission/low disease activity from SDAI and CDAI 24 weeks after the drug use (the area under the receiver operating curve was 0.762; 95% confidence interval: 0.548-0.976)/CONCLUSION: Analysis of the results of 48-week TCZ therapy suggests its ability to reduce the levels of markers of bone and cartilage destruction in patients with RA. Serum MMP-3 determination at 24 weeks of therapy may be useful in predicting the maintenance of remission/low activity from SDAI and CDAI after discontinuation of the drug.
Terapevticheskii arkhiv. 2013;85(5):24-29
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Evaluation of the efficacy and tolerance of ibandronic acid in patients with osteoarthrosis in the knee joints concurrent with osteoporosis: A pilot study

Alekseeva L.I., Zaĭtseva E.M., Sharapova E.P., Taskina E.A., Smirnov A.V., Demin N.V., Aleksandrova E.N., Novikov A.A.


AIM: To evaluate the efficacy and tolerance of ibandronic acid (bonviva) in patients with osteoporosis (OP) concurrent with osteoarthrosis (OA) in the knee joints (KJ)/MATERIAL AND METHODS: Twenty female outpatients aged 56 to 77 years with postmonopausal OP and primary KJ OA were examined. All the patients took bonviva in a dose of 150 mg monthly during a year/RESULTS: During the treatment, the patients showed a significant reduction in the values of all components of the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) (pain intensity from 51.7±11.6 to 34.6±20.7 mm, stiffness from 96.0±55.6 to 78.5±46.6 mm, and functional failure from 783.6±333.2 to 657.8±360.9 mm according to a visual analogue scale), the Oswestry disability index, as well as in the concentration of markers for bone resorption and cartilage degradation. The need for nonsteroidal anti-inflammatory drugs was stated to decrease/CONCLUSION: Bonviva therapy results in a significant reduction in pain, KJ stiffness, and locomotor functional failure in patients with gonoarthrosis.
Terapevticheskii arkhiv. 2013;85(5):30-36
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Severe adverse events from treatment with genetically engineered biological agents in patients with rheumatic diseases

Moiseev S.V., Novikov P.I., Semenkova E.N., Strizhakov L.A., Guliaev S.V., Ianushkevich T.N., Nikiforova N.V., Meshkov A.D., Panasiuk V.V., Sorokin I.D., Taranova M.V., Parfenova S.A., Dubrovskaia L.V., Zhabina E.S., Kuznetsova E.I., Lopatina I.A., Bulanov N.M., Mukhin N.A.


AIM: To assess the risk of severe adverse events (AEs) within 6 months after treatment with biological agents in patients with rheumatic diseases (RD)/MATERIAL AND METHODS: The 6-month open-label trial included 107 patients with rheumatoid arthritis, antineutrophil cytoplasmic antibody-associated vasculitides, systemic lupus erythematosus, and other RDs who received genetically engineered biological agents (GEBAs), primarily rituximab (n=66) and infliximab (n=31)/RESULTS: The majority of patients were noted to have improvements, including complete and partial remission in 62 (57.9%) and 42 (39.3%), respectively. There were mild or moderate AEs in 22 (20.6%) of the 107 patients, severe AEs in 6 (5.6%): grade IV neutropenia in 2 patients (after the use of rituximab), severe infusion reactions in 2 (after the administration of infliximab and rituximab), and systemic infections in 2 (fatal nocardial sepsis after rituximab treatment and unspecified sepsis after infliximab treatment)/CONCLUSION: The rate of serious AEs, mainly infusion AEs and infections during treatment with infliximab, rituximab, and other GEBAs proved to be relatively low in patients with different RDs. At the same time, the use of biological agents could lower RD activity in the presence of severe visceral injuries refractory to conventional immunosuppressive therapy.
Terapevticheskii arkhiv. 2013;85(5):37-43
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Osteoarthrosis in patients with type 2 diabetes mellitus

Asfandiiarova N.S., Nizov A.A., Nekhaeva T.I., Sakaeva N.A., Filatova T.E., Zhuravleva N.S., Trunina T.P.


AIM: To estimate the frequency of a comorbidity of type 2 diabetes mellitus (DM) and osteoarthrosis (OA) in relation to patient age and to identify risk factors for degenerative and dystrophic changes in the joints/MATERIAL AND METHODS: 160 patients with type 2 diabetes (23 men and 137 women at the age of 44 to 82 years; body mass index 33±5 kg/m2 were examined. A control group consisted of 112 age- and gender-matched subjects without type 2 DM/RESULTS: Degenerative and dystrophic changes in the joints were found in 60% of the patients with type 2 DM, which exceeded the similar values in the control subjects (42.9%; p<0.05). Moreover, OA developed earlier in the patients with DM than in the general population, but the difference became leveled after the age 60 years. The development of OA was found to be associated with lipid metabolic disturbances: the incidence of obesity, hypercholesterolemia, and triglyceridemia was higher in the group of type 2 DM patients with OA (p<0.05)/CONCLUSION: The patients with type 2 DM showed the higher incidence of OA, the age of disease manifestation is less than in the general population. DM and overweight are risk factors for OA.
Terapevticheskii arkhiv. 2013;85(5):44-47
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Behçet's disease: Clinical and demographic associations

Alekberova Z.S., Izmailova F.I., Kudaev M.T.


AIM: To comparatively study the clinical manifestations, sexual and HLA-B51 associations in patients with Behçet's disease (BD) in two ethnic groups/MATERIAL AND METHODS: The authors examined 143 patients with the valid diagnosis of BD who were divided into 2 groups: 1) 85 patients, the dwellers of Dagestan (a multiethnic cohort), 63 men and 22 women (mean age 29±7.4 years); 2) 58 Russian men and women (mean age 33±11.7 years)/RESULTS: Two major criteria for BD, such as aphthous stomatitis and external genital ulcers, were found with the same frequency. Panuveitis and angiitis of the retina were diagnosed more frequently in the Dagestani population with BD than in the Russians. Out of the minor criteria for BD, the incidence of lower limb deep venous thrombosis was 23% for the Dagestanis versus 3% for the Russians. Arterial thromboses and pulmonary artery aneurysms became causes of death in 4 in 5 men aged 19-23 years from their Dagestani ancestry. HLA B51 (B marker) was found in the dwellers of Dagestan: in 70% of the men and 40% of the women who had BD/CONCLUSION: BD runs a more severe course in male patients and is characterized by severe eye diseases and the systematic pattern of the process at young age. Gender-specific and genetic aspects call for further comparative investigations on large ethnic patient cohorts of other ancestries.
Terapevticheskii arkhiv. 2013;85(5):48-52
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Anti-C1q antibodies in patients with systemic lupus erythematosus treated by rituximab

Tsanian M.É., Torgashina A.V., Aleksandrova E.N., Solov'ev S.K., Nasonov E.L.


AIM: To determine the time course of changes in the blood levels of antibodies (Ab) to complement component C1q (a-C1q) in patients with systemic lupus erythematosus (SLE) during rituximab (RTM) therapy and the association with organ injuries in SLE/MATERIAL AND METHODS: The study involved 41 patients (3 men and 38 women; their median age was 27.5 (range 22-36) years) with definite SLE. Their blood a-C1q levels were determined by enzyme immunoassay. The levels and detection rates of a-C1q were estimated in relation to organ injuries, the time course of RTM therapy-induced changes in a-C1q levels were determined. High-positive (>30 U/ml), low-positive (10-30 U/ml), and negative (≤10 U/ml) a-C1q levels were found/RESULTS: A-C1q was detected in 19 (46.3%) patients with different clinical manifestations of SLE. The patients with renal diseases had high-positive levels of a-C1q statistically significantly more frequently than those without renal involvement (p=0.04). Low-positive and negative a-C1q levels were found in 15 of 16 without nephritis. There was a statistically significant positive correlation of the concentration of a-Clq with Ab to double-stranded DNA (a-dsDNA), Ab to nucleosomes, the SLE Disease Activity Index 2000 (SLEDAI-2K), erythrocyturia, hematuria and a negative correlation between a-C1q and complement components C3 and C4. Just after one month of RTM therapy, the patients with nephritis were observed to have a statistically significant decrease in the levels of a-C1q (p=0.002), which persisted 1 year after the treatment (p=0.006). Nineteen patients with the higher baseline concentrations of a-C1q after RTM treatment showed a statistically significant decrease in the levels of a-C1q at 1-, 3-, 6-, and 12-month follow-up (p=0.016, 0.02, 0.035, and 0.04, respectively) which was accompanied by the decreased SLEDAI-2K (p<0.00004 at 1-, 3-, 6-, and 12-month follow-up)/CONCLUSION: The high levels of a-C1q were found statistically significantly more often in the patients with lupus nephritis than in those with SLE without renal involvement. The level of a-C1q statistically significantly reduced after RTM therapy and remained within the normal range during a year.
Terapevticheskii arkhiv. 2013;85(5):53-59
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Efficacy and safety of sildenafil in patients with systemic scleroderma

Alekperov R.T., Anan'eva L.P., Korzeneva E.G., Cheremukhina E.O.


AIM: To retrospectively analyze the efficacy and safety of sildenafil (Sf) in patients with systemic sclerosis (SS). Subjects an/RESULTS: Sf was used in 16 patients (including 14 women) aged 20-66 years (mean 48.6±14.6 years; median 51.5 years) with SS of a duration of 2 months to 27 years (mean 8.8±7.3 years; median 6.5 years). The indications for Sf treatment were significant Raynaud's phenomenon (RP) in 3 patients, digital ulcers (DU) and/or necroses (N) in 9, pulmonary hypertension (PH) in 5 (2 patients had PH concurrent with DU/N), and critical ischemia of the left fingers in 1 patient. RP was seen in all the patients and so the effect of Sf on the course of RP was evaluated in the whole patient group/RESULTS: There was a significant decrease in the frequency and intensity of Raynaud's attacks in 11 (73%) of the 15 patients treated with Sf. This effect was obvious just in the first days of Sf treatment and remained stable throughout the treatment. No RP changes were seen in 3 patients. All 7 patients with DUs showed a decrease in their sizes just within the first two weeks of treatment. Complete DU healing was observed within 4-12 weeks of treatment. During a month, the necrotic area reduced and the signs of reparation appeared in 4 of the 6 patients. Pain ceased just within the first 5-7 days of treatment. Sf resulted in a rapid reduction in systolic pulmonary artery pressure (sPAP); in one case the latter diminished from 60 to 40 mm Hg just 90 min after the first intake of Sf 50 mg and remained unchanged during all 6 months during which the female patient was taking the drug. Doppler echocardiography showed that sPAP decreased from 103 to 85 mm Hg in another female taking Sf 100 mg for a month. The two cases showed clinical improvement as alleviated dyspnea and increased physical activity. In another case, Sf was discontinued because of dizziness after its first intake in a dose of 12.5 mg. The initial drug intake of the drug was not followed by adverse reactions in 12 (75%) of the 16 patients. Four patients had Sf-induced complaints, including headache (1), dizziness (2), and more severe angina pectoris (1). In different periods after treatment initiation, four more patients developed complications, such as fatal myocardial infarction after 6-week treatment, atrial fibrillation at 8 weeks, more severe angina at 6 months, and congestive heart failure after 5-year treatment. These complications were observed in patients with severe ECG changes, such as myocardial focal fibrosis or blood supply impairment/CONCLUSION: Sf is an effective drug to treat the manifestations of scleroderma vasculopathy, such as RP, DU/N, and PH. Sf is well tolerated in most cases. The SS patients with pronounced ECG changes have an increased risk of severe cardiac events and they need careful ECG monitoring.
Terapevticheskii arkhiv. 2013;85(5):60-67
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Comparative evaluation of the impact of four-week therapy with amlodipine and atenolol on quality of life and blood lipid composition in patients with coronary heart disease associated with metabolic syndrome

Kaliuzhin V.V., Tepliakov A.T., Pushnikova E.I., Bespalova I.D., Kaliuzhina E.V., Kolesnikov R.N.


AIM: To comparatively estimate the time course of changes in key metabolic parameters and quality of life (QL) in patients with coronary heart disease during 4-week therapy with atenolol and amlodipine/MATERIAL AND METHODS: The 4-week randomized open-label trial included 60 patients with functional classes II-III stable angina pectoris on exertion associated with metabolic syndrome (all male patients aged 29 to 62 years (mean age 48.1±0.9 years)). Along with the traditional studies accepted in specialized cardiology practice, QL was assessed using the EORTC QLO CORE 30 questionnaire prior to treatment and on the last day of the trial/RESULTS: Four-week therapy with the individually adjusted dosages of atenolol (68.7±4.17 mg/day) or amlodipine (5.5±0.34 mg/day) ensured comparable positive changes in the subjective assessment of QL/CONCLUSION: The positive changes in exercise tolerance that was considered to be an objective indicator for physical improvement in the treatment with amlodipine were more pronounced than those in that with atenolol. Therapy with amlodipine caused no change in blood lipid parameters while that with atenolol was associated with a 9.7% increase in blood triglyceride concentrations.
Terapevticheskii arkhiv. 2013;85(5):68-72
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Epidemiological parameters in the evaluation of endemic goiter in the Republic of North Ossetia-Alania

Tsabolova Z.T., Zangieva O.D., Basieva O.O.


AIM: To study the incidence of endemic goiter among urban and rural schoolchildren in the Republic of North Ossetia-Alania (RNO-Alania)/MATERIAL AND METHODS: 1198 urban (637 girls and 561 boys) and 227 rural (137 girls and 90 boys) adolescents aged 13-16 years were examined. All the adolescents underwent thyroid palpation. Thyroid ultrasound study (USS) was performed using an ALOKA SSD-500 scanner (Japan) with a 7.5-mHz transducer. Ioduria levels were measured by the cerium-arsenite method. Thyroid function was evaluated from the content of circulating hormones, such as total triiodothyronine (T3), free thyroxin (free T4), and thyrotrophic hormone (TTH), by using the Alkor-Bio enzyme immunoassay kits/RESULTS: Varying degrees of iodine deficiency were found in the RNO-Alania. Median urban and rural ioduria was 52.1 and 60.7 µg/l, respectively; which corresponded to mild iodine deficiency. Analysis of the gender-specific findings revealed that moderate ioduria was identified in a larger number of girls and mild iodine excretion was detected in most boys. The rate of increased thyroid dimensions was also higher in the boys than in the girls in both the urban and rural areas. Examining the hormone profile revealed a euthyroid state in virtually all schoolchildren. The levels of TTH, free T4, and T3 did not exceed the normal range. The families consuming iodized salt were 46.2 and 47.7% in the urban and rural areas, respectively/CONCLUSION: The findings allow one to give an additional insight into the specific features of formation of a goitrous endemic in the RNO-Alania and may serve as the basis for further investigations and development of pathogenetically sound approaches to treating and preventing iodine deficiency states.
Terapevticheskii arkhiv. 2013;85(5):73-77
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Effect of a fixed-dose perindopril and amlodipine combination on intrarenal hemodynamic and kidney functional parameters in patients with essential hypertension

Iskenderov B.G., Budagovskaia Z.M., Sisina O.N.


AIM: To evaluate the effect of prestans on intrarenal hemodynamic and kidney functional parameters and to study their correlations during 24-week therapy in patients with grade I-II essential hypertension (EH)/MATERIAL AND METHODS: Eighty-two patients (44 men and 38 women) with EH were examined and allocated to 3 groups according to glomerular filtration rate (GFR): 1) 31 patients with a GFR of >90 ml/min/1.73 m2; 2) 28 with a GFR of 60-89 ml/min/1.73 m2; 3) 23 with a GFR of 59-30 ml/min/1.73 m2/RESULTS: Group 3 patients were found to show a preponderance of metabolic disturbances, such as dyslipidemia, obesity, as well as intrarenal arterial lesions and diminished kidney function. In addition, the most pronounced therapy-induced changes in the parameters under study were also observed in Group 3. In particular, resistive index, pulsatility index of interlobar arteries of the kidneys, and serum creatinine levels increased, the frequency of microalbuminuria episodes reduced, and GFR, endothelium-dependent dilation of the brachial artery, and systolic index rose statistically significantly. Group 3 also displayed statistically significant correlations of the resistive index of the interlobar arteries with GFR, urinary albumin excretion, endothelium-dependent vasodilation, and cardiac index/CONCLUSION: The fixed-dose perindopril and amlodipine combination in patients with EH and hypertensive nephropathy improves intrarenal hemodynamics and exerts marked nephroprotective and antihypertensive effects.
Terapevticheskii arkhiv. 2013;85(5):78-83
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Diagnosis and problems in therapy of interstitial lung disease associated with rheumatoid arthritis

Bestaev D.V., Karateev D.E., Nasonov E.L.


Rheumatoid arthritis (RA) is an inflammatory rheumatic disease of unknown etiology, which is characterized by symmetric, chronic, and erosive arthritis (synovitis) of the peripheral joints and systemic inflammatory involvement of the viscera. Lung pathology, including interstitial lung disease (ILD), is one of the common extra-articular manifestations in RA. ILD is considered to be present in almost 25% of the RA patients. To study a prognosis in RA patients with ILD was the objective of some investigations in the past decade, the majority of which concluded that the mean survival after the diagnosis was about 3 years. These indicators may reflect the predominance of usual interstitial pneumonia (UIP) in patients in specific trials as this type of lung disease is associated with a poorer prognosis. In addition, there are discrepant results on survival differences between RA patients with ILD and those with idiopathic ILD. However, the data were limited by a small number of cases in both medical centers and daily clinical practice. ILD is the only extra-articular manifestation of RA, the rate of which is increasing. ILD is considered to be a cause of death in nearly 6% of all the patients with RA. The pattern of ILD may be determined by high-resolution computed tomography and may be a major prognostic marker; the development of UIP is worst. The material is dedicated to the successes recently achieved in the diagnosis and therapy of RA-associated ILD. The state-of-the-art of investigations in this area is discussed.
Terapevticheskii arkhiv. 2013;85(5):84-91
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Strategy for the use of chondroprotectors in osteoarthrosis

Noskov S.M., Lavrukhina A.A., Shirokova K.I., Prianichnikova A.A.


Symptomatic slow-acting drugs (chondroprotectors) as different dosage forms have widespread application in the treatment of osteoarthrosis (OA) at different locations. The literature review considers their possible effect on carbohydrate metabolism, which is particularly important due to the high prevalence of diabetes mellitus in patients with OA. Current clinical recommendations for the use of chondroprotectors in the therapy of OA are given.
Terapevticheskii arkhiv. 2013;85(5):92-94
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Aspirin resistance candidate genes and their association with the risk of fatal cardiovascular events

Grinshteĭn I.I., Kosinova A.A., Grinshteĭn I.I.


The review presents the current data available in the world literature on the most likely gene polymorphisms, such as cyclooxygenase, glycoproteins (GP) Ib/IIIa, GP Ibα, GP VI, adenosine diphosphate receptor P2Y1 and P2Y12 polymorphisms that may lead to aspirin resistance. The frequency of these polymorphisms in laboratory aspirin resistance and their association with the development of adverse cardiovascular events from the use of aspirin are considered.
Terapevticheskii arkhiv. 2013;85(5):95-100
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Problem of a comorbidity of arterial hypertension and acid-dependent diseases

Khlynova O.V., Tuev A.V., Beresneva L.N., Agafonov A.V.


The paper presents a concise literature review on the concomitant course of the most common nosological entities in the population, such as arterial hypertension (AH) and acid-dependent diseases (ADD). Data on the prevalence, commonness of etiological and pathogenetic factors, the specific features of a clinical course, and diagnostic difficulties are analyzed in persons with AH associated with ulcerative and gastrointestinal reflux diseases. The causes and consequences of these nosological entities are shown; their clinical, morphological, and hemodynamic features are covered. The results of investigations characterizing the specific features of autonomic regulation, diurnal blood pressure variations, and the central hemodynamics in the comorbidity of the diseases in question are given. The rational antihypertensive therapy of AH concurrent with ADD is presented in terms of their impact on gastrointestinal tract disease.
Terapevticheskii arkhiv. 2013;85(5):101-106
pages 101-106 views

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