Vol 86, No 5 (2014)


Systemic autoimmune rheumatic diseases in 2013: Problems of laboratory diagnosis

Nasonov E.L., Aleksandrova E.N., Novikov A.A.


Progress in the laboratory diagnosis of systemic autoimmune rheumatic diseases (SRAD) is caused by the ever increasing clinical introduction of new highly productive methods for immune analysis using computer-aided systems and multiplex proteomic technologies. The urgent problem in the laboratory diagnosis of SRAD is the standardization of current methods for the detection of autoantibodies (autoAb), including the preparation of international reference materials for the calibration and external quality assessment of immunological assay. New autoAb technologies have a higher analytical validity than the previously used classical techniques immunodiffusion, agglutination, and immunofluorescence; however, their diagnostic sensitivity and specificity for SRAD have been poorly studied. Particular emphasis is laid on the standardization of the methods for examining antinuclear antibodies (ANAb), the major serologic marker of SRAD. According to the EULAR/ACR guidelines, indirect immunofluorescence reaction (IIFR) using human HEp-2 cells as substrate is the gold standard and a primary screening ANAb method. New methods for solid-phase analysis (enzyme immunoassay, multiplex test systems, etc.) cannot substitute the primary screening of ANAb using IIFR-HEp-2 as they identify antibodies to the limited number of antigens, increasing the number of false- negativ/RESULTS: The computer-aided systems for interpreting cell fluorescence tests contribute to the standardization and enhancement of the efficiency of detection of ANAb and other autoAb by IIFR. The use of complex diagnostic indices based on the multiparametric analysis of laboratory biomarkers in the serum makes it possible to most fully and objectively assess complex molecular mechanisms for the pathogenesis of SRAD, thus radically improving the early diagnosis, the estimation of the activity and severity of disease, the prediction of the outcomes of a pathological process and the response to treatment.
Terapevticheskii arkhiv. 2014;86(5):4-9
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Association between bone mineral density and erosive and destructive changes in patients with rheumatoid arthritis: Preliminary results

Petrova E.V., Dydykina I.S., Smirnov A.V., Podvorotova M.M., Taskina E.A., Dydykina P.S., Glukhova S.I., Alekseeva L.I., Nasonov E.L.


AIM: To obtain information on and to study an association between the erosive and destructive changes in the hand and foot joints, bone mineral density (BMD) in different parts of the skeleton and the X-ray alterations in the thoracic and lumbar vertebrae of patients with rheumatoid arthritis (RA)/MATERIAL AND METHODS: The investigation enrolled 66 women with a valid RA diagnosis, whose mean age was 51.6±9.6 years and the disease duration was 13.2±9.1 years. All the patients underwent clinical, laboratory, and X-ray studies assessing the progression of joint changes by the Sharp/van der Heijde method and estimating the vertebral body deformity index by the Genant technique, and BMD in 3 skeletal regions by dual-energy X-ray absorptiometry employing a Holovic Discovery A device/RESULTS: With X-ray higher-stage RA and higher Sharp total scores, regardless of age, there was a decrease in BMD in all skeletal areas and an increase in the number of patients with deformities of vertebrae and osteoporosis (OP) in at least one of the analyzed skeletal part. Thus, OP was found in 29% of the patients with Stages I and II RA and in 65% of those with Stages IV; deformities of vertebrae were in 12 and 22%, respectively. Comparative analysis of BMD and erosive and destructive changes in the patient groups different in age at onset of the disease has established that its young onset (from 16 to 30 years) and long duration have a negative effect on bone status. Femoral neck BMD in these patients is significantly lower than that in patients who were ill at older age (31-50 or over 50 years) (0.661±0.080, 0.739±0.111, and 0.713±0.120 g/cm2, respectively) and the Sharp total score was higher (181.1±91.3, 100.5±71.5 and 103.9±74.5, respectively). The patients' mean age in these groups at the study inclusion was 46.7±12.1, 51.9±6.7, and 60.3±3.3 years, respectively./CONCLUSION: With the longer disease duration, regardless of the age of patients with RA, there are increases in both Sharp total scores, X-ray RA stage, and the number of patients with OP, deformities of thoracic and lumbar vertebrae (however, there is no evidence of significant differences), BMD decrease in all skeletal parts.
Terapevticheskii arkhiv. 2014;86(5):10-17
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Diagnostic value of the determination of angiogenic factors and cytokine composition parameters in the serum and urine of patients with scleroderma systematica

Rebrov A.P., Patrikeeva D.A., Zakharova N.B., Karpova O.G., Oksen'chuk A.N.


AIM: To study the associations of the concentration of interleukins (IL) 1Β, 6, 8, 10, monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-α, vascular endothelial growth factor (VEGF) in the serum and urine with the clinical features of scleroderma systematica (SDS)/MATERIAL AND METHODS: The investigation enrolled 51 patients with a valid SDS diagnosis. The serum and urinary concentrations of interleukins, TNF-α, MCP-1, and VEGF were measured by solid-phase enzyme immunoassay/RESULTS: The patients with SDS were found to have higher serum and urine concentrations of proinflammatory cytokines and VEGF than in the comparison group. There were relationships between the levels of VEGF and proinflammatory cytokines and the disease duration, clinical forms, and clinical manifestation of SDS/CONCLUSION: Higher serum VEGF levels in patients with SDS may be used to estimate the magnitude of endothelial dysfunction. Estimation of serum IL-6 concentrations may be employed to determine the degree of sclerosis progression; that of MCP1 for the activity of fibrosing alveolitis. Quantitative analysis of urinary IL-6, IL-8, and VEGF levels in patients with SDS may be used to evaluate tubulointerstitial inflammation and to predict the development of interstitial fibrosis.
Terapevticheskii arkhiv. 2014;86(5):18-25
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Cardiovascular diseases in patients with rheumatoid arthritis during long-term methotrexate therapy

Gerasimova E.V., Popkova T.V., Novikova D.S., Nasonov E.L.


AIM: To compare the prevalence of risk factors, clinical and subclinical manifestations of cardiovascular diseases (CVD) and their complications in methotrexate (MT)-treated and untreated patients with rheumatoid arthritis/MATERIAL AND METHODS: The investigation enrolled 193 patients (168 women and 25 men) less than 60 years of age (mean age 49 [44; 53] years) with RA. The patients were divided into 2 groups: 1) 69 patients who received MT in a dose of 15.1 [10.2; 21] mg/week for at least 12 months (mean disease duration 25 [18; 48] months); 2) 124 patients who did not take MT. The patient groups were matched for age, gender, disease duration, RA activity, and the rate of rheumatoid factor (RF) seropositivity and extraarticular manifestations/RESULTS: Dyslipidemia was significantly less frequently identified in MT-treated patients (35/69 or 51%) than in MT-untreated ones (85/124 or 69%; p=0.01). The serum from the patients treated with MT exhibited higher high-density lipoprotein cholesterol concentrations ((1.8 [0.9; 2.0] mmol/l) than in those untreated with MT (1.2 [1.0; 1.6] mmol/l; р=0,047). In Group 1, hypertension (49%) and diabetes mellitus (3%) were slightly rare than in Group 2 (62 and 13%, respectively; p>0.05). Carotid atherosclerotic plaques were found in 19 and 16% and intima-media thickness (IMT) enlargement was seen in 53 and 56% of the patients in Groups 1 and 2, respectively. Silent myocardial ischemia was diagnosed in every 10 patients; heart disease (exertional angina, myocardial infarction) was in every 5 patients in both groups. Aortocoronary bypass surgery was performed in 2 (3%) patients from those who received MT and had experienced MI and in one (1.6%) patient from the MT-untreated group/CONCLUSION: Long-term MT therapy was associated with the lower rate of dyslipidemia, but it failed to affect the incidence of CVD in patients with RA.
Terapevticheskii arkhiv. 2014;86(5):26-31
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Bosentan: A considerable increase in the survival of patients with pulmonary hypertension associated with systemic rheumatic diseases

Volkov A.V., Iudkina N.N., Nikolaeva E.V., Kurmukov I.A., Glukhova S.I., Nasonov E.L.


AIM: To evaluate the short-term efficacy of the nonselective endothelin receptor antagonist bosentan in the treatment of pulmonary hypertension (PH) associated with diffuse connective tissue diseases (CTD), as well as its effect on survival in both monotherapy and in combination with other PH-specific agents/MATERIAL AND METHODS: The study included 20 CDT-associated PH patients who had been hospitalized in 2009-2013. All the patients had valid diagnoses of scleroderma systematica (SDS) (n=18) or systemic lupus erythematosus (SLE) (n=2). Bosentan was given in an initial dose of 62.5 mg/day twice for 4 weeks, then 125 mg/day twice/RESULTS: Eighteen patents completed therapy at 16 weeks. One patient with Functional Class (FC) IV PH associated with SDS died after 10 weeks of treatment because of PH progression; bosentan was discontinued in another patient following 4 weeks because of the enhanced activity of transaminases. The patients who had completed the investigation showed a significant FC decrease (from 2.9±1.0 to 2.4±1.0 following 16 weeks; р=0.03), an increase in 6-minute walking distance (from 298±140 to 375±94 m; р<0.002), a significant reduction in mean pulmonary artery pressure (from 48.2±15.0 to 42.8±12.0 mm Hg; p=0.002), and pulmonary vascular resistance (PVR) (from 819±539 to 529±220 din/sec/cm-5; p=0.003). Right atrial pressure fell from 9.8±7.0 to 8.8±7.0 mm Hg; however, the changes were insignificant. There was a significant rise in cardiac index from 2.64±0.95 to 3.26±0.75 l/min/m2 (p=0.005) and a significant decrease in uric acid levels from 562±254 to 469±194 µmol/l (р=0.006). Overall 1-, 3-, and 5-year survival rates in patients with PH in the presence of CTD from PH onset were 100, 93, and 72%, respectively, in their treatment with endothelin receptor antagonists and differed significantly from the historical control group (87, 30, and 4%, respectively) when PH-specific therapy was unavailable/CONCLUSION: The survival of the bosentan-treated patients with SDS and PH becomes similar to that in the patients with classical SDS. Analysis of the findings revealed the association of survival with lower PVR at 16 weeks of bosentan therapy, which is indicative of the need for hemodynamic monitoring of therapeutic effectiveness.
Terapevticheskii arkhiv. 2014;86(5):32-39
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Long-term follow-up of patients with refractory systemic lupus erythematosus during rituximab treatment

Tsanian M.É., Solov'ev S.K., Torgashina A.V., Aleksandrova E.N., Radenska-Lopovok S.G., Nikolaeva E.V., Khrennikov I.B., Nasonov E.L.


AIM: To evaluate the impact of anti-B-cell therapy on the clinical and immunological parameters of systemic lupus erythematosus (SLE) activity, on the time course of changes in these parameters during long-term follow-up, and on the tolerability of repeated rituximab (RTM) therapy cycles/MATERIAL AND METHODS: RTM was given to 97 patients with high activity of SLE refractory to treatment with glucocorticosteroids (GCS) and cytostatics. The follow-up lasted 18 (12-36) months. The most common clinical manifestations of SLE were lupus nephritis (LN) (62%) and skin (33%) and nervous system (22.7%) involvements. Clinical SLE activity was assessed applying the SLE disease activity index 2000 (SLEDAI2K); therapeutic effectiveness was evaluated using indicators, such as partial response (PR), complete response (CR) and exacerbation. The exacerbation was classified as moderate and severe using the Selena-Sledai Flare index (SFI)/RESULTS: Depletion was identified in 78% of the patients with SLE immediately after RTM therapy. During 3.5 years of follow-up, the effect of RTM was seen in 82% of the patients after repeated RMT therapy cycles (CR 56% and PR 28%). Exacerbations were observed in a total of 24 (24.7%) patients; the exacerbation lasted 12 (12-24) months after RTM therapy: of them 17.5% with LN and 7.2% with extrahepatic manifestations of SLE (exacerbations occurred 12 (12-24) and 18 (6-48) months after RMT therapy). In 24 exacerbated patients, B cells recovered at 6 (3-12) months. A year after RMT therapy, a group of 35 patients who were observed to have complete B cell depletion achieved CR statistically significantly more frequently than a group of 20 patients who had B-cell recovery (65.7 and 30% respectively, p=0.03). CR was observed significantly more often in patients after repeated RTM therapy cycles than those who had received only one RTM therapy cycle (p=0.02). The long-term follow-up showed a reduction in SLEDAI2K, normalization of laboratory values, and a decrease in the daily dose of GCS. Most patients tolerated well both the first and repeated RTM therapy cycles/CONCLUSION: According to the results of the long-term follow-up, RTM therapy is a highly effective treatment option for SLE patients in whom the previous standard therapy with GCS and cytostatics was previously ineffective. The 3.5-year follow-up showed a good tolerability of RTM and revealed no increase in the risk of infectious complications or adverse reactions.
Terapevticheskii arkhiv. 2014;86(5):40-49
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The specific features of gout in the elderly

Tsurko V.V., Eliseeva M.E., Vorob'ev P.A.


AIM: To determine the specific feature of gout at its onset in the elderly/MATERIAL AND METHODS: The investigation included 100 patients (74 men and 26 women) with primary gout on the basis of the criteria proposed by S. Wallace et al. (1977). The patients were divided into 2 groups: 1) 51 patients aged over 60 years; 2) 49 patients aged less than 60 years. In Groups 1 and 2, the mean age at gout onset was 66.1±4.8 and 41.6±10.0 years, respectively. A comparative retrospective analysis was made to analyze the detection rate for the site of onset gout, the pattern of arthritis, the number of tophus forms, the use of diuretics, small-dose acetylsalicylic acid (ASA), comorbidities, such as hypertension, type 2 diabetes mellitus (T2DM), obesity, chronic renal failure, coronary heart disease, chronic heart failure, and prior myocardial infarction/RESULTS: The disease duration in both groups averaged 8 years. In Groups 1 and 2, first metatarsophalangeal joint arthritis was diagnosed at its onset in 77 and 61%, respectively. In these groups, chronic arthritis was also diagnosed in 19 (37%) and 19 (39%). Examinations revealed tophi in 21 and 37% of cases in Groups 1 and 2, respectively. The administration of diuretics was recorded in 25 (49%) and 17 (35%) patients in these groups. Group 1 patients took low-dose ASA more frequently than Group 2 ones (19 (37%) and 7 (14%) patients, respectively; p=0.013). Hypertension was identified in 23 (45%) examinees in Group 1 and 17 (40%) ones in Group 2. Both groups were matched for the number of patients with obesity (41 and 43%) and for that of patients with T2DM (15 and 10%, respectively). There were significant differences between the compared groups in the incidence of coronary heart disease, myocardial infarction, and chronic heart disease/CONCLUSION: The patients' age of gout onset does not affect substantial differences in the clinical features of gout with its comparable duration in the young and elderly patients. The main clinical features of gout are unique to both young and elderly patients. Cardiovascular diseases are more common at gout onset in the elderly.
Terapevticheskii arkhiv. 2014;86(5):50-55
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Analgesia in hemophiliac patients during orthopedic surgery

Shulutko E.M., Levchenko O.K., Gorodetskiĭ V.M., Gemdzhian É.G., Koniashina N.I., Krechetova A.V.


AIM: To develop an effective and safe analgesic regimen (by minimizing the proportion of narcotic analgesics) in hemophiliac patients in the perioperative period during high-trauma surgeries (total knee and hip replacements)/MATERIAL AND METHODS: The prospective study included 24 patients aged 22 to 57 years (median age 38 years) with severe congenital hemophilia A (n=22) and B (n=2), who had undergone knee (n=18) or hip (n=6) replacements in the Hematology Research Center, Russian Ministry of Health of the Russian Federation, in 2013. Two analgesic regimens (a) paracetamol with trimeperidine; b) paracetamol and ketamine with trimeperidine) were used. To assess pain intensity, the authors used scoring scales: a visual analogue scale (VAS) and a numeric rating scale (NRS). The effect of paracetamol on hemostasis was evaluated on the basis of thromboelastogram and coagulogram readings. Possible paracetamol hepatotoxicity was assessed analyzing liver enzymes/RESULTS: An interview has shown that 66% of the hemophiliac patients regularly take analgesics for chronic pain syndrome, among them 29% use narcotic analgesics. It is difficult to achieve perioperative analgesia in these patients. The dosage of narcotics can be decreased (that of trimeperidine on an average from 80 to 45 mg/day) in the early postoperative period if non-narcotic analgesics, such as paracetamol 4 g/day, are incorporated into the analgesic regimen. Paracetamol promotes pain relief to moderate and mild (not more than 40-50 VAS scores and 3-4 NRS scores), without affecting hemostasis (the thromboelastogram readings differed statistically insignificantly; the coagulation index was 0.6-1.6) and without having a hepatotoxic effect/CONCLUSION: The systemic use of analgesics in hemophiliac patients considerably makes postoperative analgesia difficult. The use of paracetamol with trimeperidine within the first 24 hours after high-trauma surgeries in hemophiliac patients (even if they have hepatitis C) is rather effective and safe.
Terapevticheskii arkhiv. 2014;86(5):56-61
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Differential diagnosis of rheumatic diseases and blood cancers involving the nasal cavity and accessory sinuses

Vasil'ev V.I., Sokol E.V., Sedyshev S.K., Gorodetskiĭ V.R., Aleksandrova E.N., Logvinenko O.A., Pal'shina S.G., Rodionova E.B., Radenska-Lopovok S.G., Probatova N.A., Kokosadze N.V., Pavlovskaia A.I., Kovrigina A.M., Varlamova E.I., Safonova T.N., Borovskaia A.B., Gaĭduk I.V., Mukhortova O.V., Aslanidi I.P., Nasonov E.L.


AIM: To provide the clinical, laboratory, radiological, morphological, and immunomorphological signs that permit the differential diagnosis to be made in patients with involvement of the nasal cavity and accessory sinuses (NCAS)/MATERIAL AND METHODS: In the period 2009 to 2013, the Laboratory for Intensive Therapy for Rheumatic Diseases, V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences, associated the disease onset with NCAS involvement in 39 (7.6%) of 512 examinees. NCAS involvement was present at disease onset in 100% of the patients with natural killer (NK) cell lymphoma (NK/T lymphoma), in 84.5% of those with Wegener granulomatosis (WG), in 29.5% of those with IgG4-related disease (IgG4-RD), and in 17.5% of those with sarcoidosis. Such an onset could be extremely rarely observed in histiocytosis/RESULTS: Despite the similar clinical manifestations, NCAS involvements in NK/T lymphoma of nasal type and WG at disease onset show clear differences in the laboratory and systemic manifestations of these diseases. The patients with lymphoma have no characteristic laboratory abnormalities at disease onset, except the 100% presence of Epstein-Barr virus (EBV) DNA in blood and, only as a tumor grows, fever appears and there are elevated C-reactive protein and lactate dehydrogenase levels and pronounced destructive changes in the facial bones with mandatory hard palate destruction; at the same time the signs of systemic involvement are virtually absent. The patients with WG at disease onset have fever, high erythrocyte sedimentation rate, elevated C-reactive level, significant anemia, leukocytosis and 90% are found to have anti-neutrophil cytoplasmic antibodies with the rapid development of systemic manifestations: involvements of the lung, kidney, and peripheral nervous system. Destructive changes in the facial bones are minimal and hard palate destructions are absent. The patients with IgG4-RD, sarcoidosis, and juvenile xanthogranuloma have similar clinical and laboratory manifestations in the absence of hemorrhagic nasal discharge, nasal septal perforation, and facial bone destruction, with the practically involvement of the salivary/lacrimal glands and orbital regions. A third of the patients are observed to have different allergic manifestations, moderate eosinophilia, and signs of autoimmune disorders (the presence of rheumatoid and antinuclear factors, hypergammaglobulinemia). Elevated serum IgG4 levels are characteristic of IgG4-RD/CONCLUSION: Blood anti-neutrophil cytoplasmic antibodies, EBV DNA, and IgG4 levels should be determined in all patients with NCAS involvement. Mini-invasive incision biopsies of the nasal mucosa, orbital regions, and major salivary glands should be done, by morphologically verifying the diagnosis of sarcoidosis, histiocytosis, and WG and by making an immunomorphological examination to diagnose NK/T lymphoma and IgG4-RD.
Terapevticheskii arkhiv. 2014;86(5):62-72
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Hormonal aspects of the development of obesity and metabolic syndrome in ethnic groups (by the population of the Chuvash Republic)

Markova T.N., Kichigin V.A., Madianov I.V., Semakina S.M., Diomidova V.N.


AIM: To study the specific features of the hormonal status in the development of obesity and metabolic syndrome (MS) in different ethnic groups. Materials and methods. The prevalence of obesity and MS was studied in Russian and Chuvash people, the relationship of MS to body mass index (BMI), the levels of insulin, dehydroepiandrosterone sulfate (DHEAS), and testosterone, and insulin resistance (IR) was assessed/RESULTS: The prevalence of obesity and MS depends on ethnicity and gender (these are more common in the Russians than in the Chuvashes, in the women than in the men). Overweight and obesity versus normal weight are characterized by the higher rate of MS, hyperinsulinemia, and low DHEAS concentrations. The obese men have decreased testosterone levels. The lower DHEAS levels are associated with the presence of MS (association factor +0.36) rather than with the development of obesity (association factor +0.07). In the Russians versus the Chuvashes, the development of MS is more frequently associated with the fall of DHEAS levels and less frequently with the development of IR/CONCLUSION: The incidence of MS increases with higher BMI, accompanies by IR and hyperinsulinemia. MS in the Russians is associated with the lower DHEAS concentration.
Terapevticheskii arkhiv. 2014;86(5):73-77
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Clinical efficiency of combined therapy using adaptol for atopic dermatitis

Orlov E.V., Konnov P.E., Arsen'eva A.A.


AIM: To study the effect of the daytime anxiolytic adaptol on the efficiency and tolerability of combination treatment for atopic dermatitis (AD)/MATERIAL AND METHODS: Eighty patients with different clinical forms of AD were examined and then divided into 2 identical groups. The patients' mean age was 30.7±11.2 years; the mean disease duration was 20.2±12.8 years. Group 1 patients (n=40) received standard treatment involving disintoxication therapy, prednisolone 30-60 mg/day, antihistamines, phototherapy (20 sessions), topical steroids and topical emollients. Group 2 patients (n=40) took additionally adaptol as 3 tablets (1500 mg) daily. The efficiency of therapeutic measures was evaluated in 2 steps: by taking into account the changes in the scoring atopic dermatitis index (SCORAD) and the Dermatology Life Quality Index (DLQI) scores 4 weeks following the initiation of treatment and once more after 12 weeks/RESULTS: There was a tendency for the more pronounced decrease in SCORAD scores in Group 2 (using adaptol) versus Group 1 (standard treatment) to 9.8±2.57 and 10.8±2.64, respectively. There were drops in SCORAD scores by 4.1 and 3.6 times, respectively. Twelve weeks after 12 weeks of treatment initiation was 7.1±2.13 scores in the adaptol group; on the contrary, this indicator increased slightly due to evolving recurrences and amounted to as many as 11.9±2.41 scores on the average. In Group 1, DLQI improved by 73% following 4 weeks and decreased by 1% after 12 weeks while in Group 2, it improved by 81% following 4 weeks and continued to improve up to 85% after 12 weeks/CONCLUSION: Comparison of examined dermatology indices in AD patients receiving standard treatment and treatment including adaptol gives proof to the great value and efficiency of using adaptol during an exacerbation and in the postrecurrence period.
Terapevticheskii arkhiv. 2014;86(5):78-82
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Radiodiagnosis and knee joint replacement in hemophilic arthropathies in Kazakhstan residents

Abdrakhmanova Z.S., Rakhimzhanova R.I., Zhunusov E.T., Pivovarova I.A., Sultangereev A.B., Zagurskaia E.A., Kaldybaev M.M., Zhansagimova Z.S.


AIM: To assess complex radiodiagnosis and highly specialized medical care as knee joint replacement (KJR) to patients with hemophilic arthropathies (HA) who live in the Republic of Kazakhstan/MATERIAL AND METHODS: The results of examination and treatment were analyzed in 40 patients with knee HA who were treated at the specialized Polytrauma Unit, Republican Research Center for Emergency Health Care. All patients with hemophilia A underwent joint X-ray study, computed tomography and magnetic resonance imaging (MRI), X-ray densitometry and ultrasound osteometry on admission and after KJR/RESULTS: Joint X-ray studies and computed tomography revealed that all the patients had Grades II-III arthroses with severe dysfunction of joints, their multiple involvements of different grades, which depended on the rate of recurrent hemarthrosis. Ultrasound study (USS) is the only mini-invasive method to control surgical hemostasis in hemophiliac patients after KJR. Osteodensitometry revealed osteopenia and osteoporosis in all the patients with hemophilia, which was a basis for prescribing calcium preparations in the early postoperative period for the prevention of instability of endoprosthetic components. We elaborated an algorithm for combination treatment in HA patients, which involved knee joint replacement/CONCLUSION: Highly specialized medical care to hemophilic patients and active introduction of the early surgical rehabilitation of the affected joint in their combination treatment contributed to the increased number of positiv/RESULTS: by restoring the quality of life in the patients: excellent, good, and satisfactory anatomic and functional results were obtained in 26.7, 51.1, and 22.2%, respectively. USS and MRI could evaluate joint changes in HA in detail, which plays an important role in the estimation of the course time of the disease, in the planning of endoprosthetic replacement, and in the timely prevention of severe complications of HA. Osteodensitometry makes it possible to monitor bone mineral density around the prosthesis and to postoperatively prevent endoprosthetic instability.
Terapevticheskii arkhiv. 2014;86(5):83-87
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Panniculitides in an internist's practice

Belov B.S., Egorova O.N., Savushkina N.M., Radenska-Lopovok S.G.


By panniculitides is meant a group of heterogeneous inflammatory diseases characterized by the involvement of subcutaneous adipose tissue. A diversity of their forms and variants of their course determines the need for careful patent examination to verify the diagnosis. The lecture gives a diagnostic algorithm and outlines principles in the differential diagnosis of panniculitides and its treatment approaches in current clinical practice.
Terapevticheskii arkhiv. 2014;86(5):88-93
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The current classification of systemic vasculitides

Beketova T.V.


Systemic vasculitides (SV) are severe multiorgan diseases whose early diagnosis and treatment can significantly improve prognosis. Improving the classification of SV may lead to a significant reduction in the likelihood of diagnostic errors. The presented paper deals with the results of the International Consensus Conference on the Nomenclature of SV (Chappel Hill, USA) in 2012. The nomenclature and definitions of the major forms of SV were revised and additional categories of vasculitis were included into the classification, by relying on the current trends in the practical use of terms, on the current ideas on the specific features of manifestations of diseases, and on achievements in studying the pathogenesis.
Terapevticheskii arkhiv. 2014;86(5):94-98
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Meloxicam: The golden mean of nonsteroidal anti-inflammatory drugs

Karateev A.E.


Nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used to treat acute and chronic pain in locomotor system (LMS) diseases. However, their administration may be accompanied by the development of dangerous complications as organic and functional disorders of the cardiovascular system (CVS) and gastrointestinal tract (GIT). Physicians have currently a wide range of NSAIDs at their disposal; but none of the representatives of this group can be considered the best. Thus, highly selective cyclooxygenase-2 inhibitors (Coxibs) are substantially safer for GIT; however, their use is clearly associated with the increased risk of severe cardiovascular events. Nonselective NSAIDs, such as naproxen or ketoprofen, are safer for CVS, but more frequently cause significant GIT organic and functional disorders. Moderately selective NSAIDs, such as meloxicam (movalis), conceivably could be the most acceptable choice for treating the majority of patients in this situation. This drug has been long and extensively used in global clinical practice and has gained the confidence of physicians and patients. The major benefits of meloxicam are its proven efficacy, convenient treatment regimen, relatively low risk of complications as organic and functional disorders of the GIT and CVD and good compatibility with low-dose aspirin.
Terapevticheskii arkhiv. 2014;86(5):99-105
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Subclinical interstitial lung disease associated with rheumatoid arthritis

Bestaev D.V.


Interstitial lung disease (ILD) in rheumatoid arthritis (RA) is its extra-articular manifestation. At the same time, ILD considerably worsens the prognosis of the disease. Mortality rates for interstitial pulmonary fibrosis are 6% of all-cause mortality in RA patients. ILD can be identified by clinical examination only in 2-6% of cases, by plain chest X-ray in 1-6%, and by high-resolution computed tomography in 50-60%. The paper deals with subclinical ILD and discusses the state-of-the-art of investigations in this area.
Terapevticheskii arkhiv. 2014;86(5):106-108
pages 106-108 views

Use of anti-B-cell therapy in case of antisynthetase syndrome as the severest subtype of polymyositis/dermatomyositis

Antelava O.A., Khelkovskaia-Sergeeva A.N., Tarasova G.M., Nikishina N.I., Lopatina N.E., Pal'shina S.G., Fedina T.P., Sazhina E.G.


Antisynthetase syndrome encompassing a symptom complex with severe interstitial lung disease is the severest subtype of polymyositis and dermatomyositis. The characteristic feature of antisynthetase syndrome is the insufficient efficiency of traditional therapy with glucocorticosteroids and cytostatics, which determines the prognosis of the disease and the need for new therapeutic approaches to treating these patients.
Terapevticheskii arkhiv. 2014;86(5):109-115
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Cardiovascular diseases and osteoporosis: What is common?

Fedorchenko I.L., Nebieridze D.V., Safarian A.S., Skripnikova I.A., Sobchenko K.E.


The review analyzes the possible effect of cardiac drugs on the course of osteoporosis (OP). The fact that atherosclerosis and OP share the mechanisms of development, among which the enhanced activity of the sympathetic part of the autonomic nervous system and endothelial dysfunction are most important, is beyond question now. In this connection, Β-adrenoblockers, nebivolol in particular, attract attention. Nebivolol is known to be a selective Β1-adrenoblocker that has an additional vasodilator property, by stimulating the synthesis of nitric oxide. This may serve to increase bone mineral density and slow down the progression of OP. At the same time, most investigations in this area are retrospective therefore fina/CONCLUSION: call for randomized prospective studies that will be able to evaluate more objectively the effect of cardiac drugs on the prevention of OP or its progression delay.
Terapevticheskii arkhiv. 2014;86(5):116-119
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The history of the Kazan School of Therapists (on the occasion of the 200th anniversary of the Kazan State Medical University)

Sozinov A.S., Abdulganieva D.I., Galiavich A.S., Khamitov R.F., Khusnutdinova L.A., Khalfina T.N., Shamsutdinova N.G., Kirillova É.R.


The history of the Kazan School of Therapists numbers two centuries of scientific achievements and discoveries. German Professors F.H. Erdman and K.F. Fuks laid the groundwork for clinical teaching continued by Russian therapists N.A. Skandovsky, N.A. Vinogradov, A.P. Kazem-Bek, N.K. Goryaev, and other distinguished scientists. The prominent scientists of the 20th century made great contributions to the development of modern therapy; the names of M.N. Cheboksarov, Z.I. Malkin, A.G. Teregulov, and I.G. Salikhov are known and they are respected by the world medical public.
Terapevticheskii arkhiv. 2014;86(5):120-122
pages 120-122 views

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