Vol 80, No 5 (2008)

Aim. To assess joint and extraarticular wrist lesions in RA patients with arthrosonography in the disease duration up to 6 months. Material and methods. 38 RA patients aged 40 ± 10.5 years (25 females and 13 males) entered the study. These patients and 20 controls without musculoskeletal pathology matched by age and sex have undergone sonographic examination of the wrists and extrajoint structures. Results. The following ultrasonographic signs of intra- and extra-articular inflammation were determined: joint cavity expansion, the presence of anechoic/hypoechoic synovial fluid, effusions, synovial thickening, digital flexor and extensor tenosynovitis, incongruous articular surfaces, bone erosions. Conclusion. Wrist arthrosonography is an informative diagnostic method in early RA as it detects bone erosions, alterations in the cartilages, muscles, tendons and ligaments.

Aim. To assess cytokine-producing activity of T-lymphocytes of peripheral blood and synovial fluid in rheumatoid arthritis (RA). Material and methods. The study group consisted of 58 RA female patients aged 28-53 years (mean age 42.1 ± 2.9 years) with at least 5-year history of RA (mean 10.7 ± 4.9 years). The control group consisted of 37 healthy women matched by age. Spontaneous production of IL-2, IL-4, IFNgamma (IFNγ) and TNFalpha (TNFα) by CD3+ and CD3- lymphocytes was estimated after 4 hours of incubation in 37°C with phorbol-12-myristate-13-acetate (PMA, 50 ng/ml, Sigma, France), ionomycin (1 mcg/ml, Sigma, France) and brefeldin A (10 mcg/ml, Sigma, France). Results. In RA there is a decrease in a relative and absolute count of peripheral blood T-lymphocytes which occurs spontaneously and due to nonspecific stimulation of synthesizing IL-4, TNFα and IFNγ. IFNγ-producing lymphocytes (CD3+IFNg+/CD3+IL-4+=4.45 ± 1.56) prevail in the synovial fluid in RA, but count of lymphocyte IFNγ, IL-2 and TNFα+ in the synovial fluid is lower than in peripheral blood. Conclusion. One of the causes of low count of TNFα, IFNγ and IL-4 producing T-lymphocytes in peripheral blood is migration of relevant TC-subpopulations to the affected joints. Migration of TC1-lymphocytes into the synovial fluid does not result in their prevailing count in the synovial fluid vs peripheral blood.

Aim. To evaluate objectively therapeutic potentialities of a novel method of biological therapy - blocking interferon gamma (IF-γ) - by means of a comparative analysis of using antibodies to IF-g (anti-IF-γ) and tumor necrosis factor alpha (anti-TNF-α) in resistant rheumatoid arthritis (RA). Material and methods. A double blind trial included 55 patients with resistant RA. They received 5 intramuscular injections of anti-IF-y (n = 20), anti-TNF-a (n = 20) and placebo (15 patients). The results were assessed on the treatment day 7 and 28. Results. 16 patients withdrew because of the treatment uneffectiveness (2 from the group on anti-IF-g, 3 - on anti-TNF-α, 11 - on placebo). To the treatment day 28 the patients given anticytokines achieved significant improvement of all clinical indices while placebo group had no improvement. The highest response was observed in the group on anti-IF-γ (ACR 70). As shown by ultrasound investigation, a significant reduction of the synovial membrane thickness took place also in administration of anti-IF-γ Most frequent side effect of the anticytokine therapy was mild dermatitis at injection site on treatment day 8-11. Conclusion. Therapeutic efficacy of anti-IF-γ was comparable with efficacy of anti-TNF-α and even was superior in some aspects. The block of IF-γ holds much promise in the treatment of RA.

Aim. To examine correlation between IL-18 concentration, SLE manifestations and atherosclerotic vascular affection. Material and methods. We examined 162 SLE female patients (age 26-43 years, mean age 35 years, duration of SLE 28-204 months, mean duration 96.0 months) and 64 healthy controls (women aged 30.0-45.0 years, mean age 35.5 years). We analysed correlation between IL-18 concentration, SLE symptoms, classic risk factors for cardiovascular diseases, subclinical and clinical signs of atherosclerosis. Results. IL-18 in blood serum of SLE patients was much higher than in the control group (p < 0.00001). A positive correlation exists between IL-concentration and the disease activity by scale SLEDAI-2K, the level of antibodies to IgG cardiolipin, ESR, SLE, titers of antibodies to double-chain DNA, concentration of creatinin, urine, glucocorticoids dose taken by the patients at examination. In SLE patients with stomatitis, hematological, immunological disorders, a positive test for antinuclear factor, IL-18 was much higher than in patients without the above signs. No significant correlation was seen between IL-18 concentration, subclinical and clinical signs of atherosclerosis, of risk factors, there was a negative correlation between total cholesterol concentration, LDLP and HDLP cholesterol. Conclusion. In SLE patients a high IL-18 level reflects activity of the basic disease and is not related with vascular atherosclerosis.

Aim. To assess features and peculiarities of postmenopausal osteoporosis (OP) in women with normal body mass, overweight and obesity. Material and methods. Dual energy X-ray absorptiometry of the lumbal spine (Lunar DPX) and distal radius X-ray absorptiometry (DTX 200) were performed during cross-section study of 730 symptomatic postmenopausal women. Results. OP was diagnosed in 253 (34.7%) women, 30.5% of them had normal body mass, 43.2% had overweight and 26.3% were obese. Among them 227 had atraumatic fractures at the age over 50 years. Obese OP patients had significantly higher frequency of arterial hypertension, chronic heart failure, osteoarthritis and glucose metabolism disorders than osteoporotic patients with normal body mass. Fracture frequency did not differ between groups with normal body mass, overweight and obesity. Conclusion. Excessive body mass did not decrease fracture risk in women with postmenopausal OP.

Aim. To characterize prevalence and features of low back pain (LBP) in Moscow outpatients. Material and methods. The questionnaire designed in the Rheumatology Institute of Russian Medical Academy was used in the trial performed for a month with participation of 1300 Moscow outpatients aged 18 to 50 years. Results. LBP is a frequent cause of consulting a physician in an outpatient practice. Most of the outpatients complained of acute and subacute moderate or severe LBP. This pain often caused disability. Of diagnostic tools most frequent was x-ray investigation of the spine. Conclusion. Spinal osteochondrosis is the most frequent diagnosis made in LBP outpatients. Detectability of threat marks in LBP patients is not more than 10%.

Aim. To evaluate ST depression in hypertensive patients with electrocardiographic signs of left ventricular hypertrophy (LVH), correlation of ST segment changes with heart rate (HR) and blood pressure (BP) during Holier monitoring (HM) and bi-functional ECG and BP monitoring (BFM), and to compare ST depression and local left ventricular contractility during stress-echocardiography in hypertensive patients with unaffected coronary arteries according to the data of coronary angiography. Material and methods. We examined 344 hypertensive patients without clinical signs of ischemic heart disease. Correlation between ST segment depression and ECG signs of LVH was evaluated in 192 patients. 180 patients underwent HM, 122 - BFM and 30 hypertensive patients with normal coronary arteries according to the data of coronary angiography underwent stress-echocardiography. Results. According to the data of 12 lead ECG 40 cases of ST depression were found, with LVH signs in 26 (65%) of these patients. During HM in 34 of 180 patients 2 types of ST depression were found: type 1 - short periods of transient ST depression without persistent ST depression was fond in 8 patients; type 2 - persistent ST depression more than 1 mm during the whole time of recording - in 26 patients. In 7 of 8 cases of type 1 and in 5 of 26 cases of type 2 ST depression had rhythm-dependent character. During BFM in 9 cases ST depression during HR or BP increase was found. In 2 cases ST depression during BP increase was unrelated to HR increase which may be consequence of systolic myocardial strain syndrome. In 7 of 30 hypertensive patients with normal coronary arteries and without local myocardial contractility disturbances according to the data of stress-echocardiography positive criteria of ischemia were found. Conclusion. The cause of ST segment depression in hypertensive patients more often are secondary disturbances of repolarizaion processes related with LVH development. In some cases such patients during HM show rhythm-dependent valuable ST depressions. In BFM cases of left ventricular myocardial strain syndrome are found, similar cases are also seen in stress-echocardiography. However, in some cases one fails to define the reason of ST changes even approximately. One of the factors leading to disturbances of repolarization processes in hypertensive patients may be disturbances of microcirculation at the level of prearteriols and capillaries.