Vol 84, No 5 (2012)

Aim. To evaluate tocilizumab (TLZ) effects on blood lipids composition and severity of carotid arteries (CA) atherosclerosis in rheumatoid arthritis (RA) patients after 24 week TLZ treatment. Material and methods. Before and 24 weeks after TLZ treatment 43 RA patients (33 women and 10 men) were examined by DAS 28 index, for blood serum concentration of cholesterol, triglycerides (TG), LPHD and LPLD cholesterol. The drug was injected intravenously in drops in a dose 8 mg/kg each 4 weeks. Results. A 24 week TLZ treatment produced satisfactory and good anti-inflammatory effects in RA patients. Hypoalphalipoproteinemia incidence and atherogenicity index (AI) reduced 3 and 5 times, respectively (p < 0.05). Elevated levels of cholesterol, TG, LDPL cholesterol occurred with the same frequency before and after TLZ treatment. Cholesterol rose by 11.6%, LPHD cholesterol by 48.9%, TG lowered by 7%, AI by 31.9% (p<0.05). LDLP cholesterol decreased. Blood lipids composition shifts were associated with marked reduction in the disease activity: decreased concentration of C-reactive protein, IgM rheumatoid factor, DAS28 index, improvement of the patient’s functional status. Maximal thickness of the intima-media complex of CA increased by 8.2%. Atherosclerotic plaques were revealed before and after treatment in 17 (41,4 %) patients from 41, in 5 (12,2%) patients the plaques arose after 6 months and in 5 (12,2%) patients the number of plaques increased. Conclusion. Because of both positive and negative effects of IL-6 receptor inhibitors on blood lipids, combined treatment of RA must include statins for correction of dyslipidemia.

Aim. To study survival of patients with a natural course of pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SS). Material and methods. Twenty SD patients with PAH and 71 SS patients free of PAH were followed up for 10 years (1998-2008) when therapy with specific pulmonary vasodilators was not available. Survival curves for both groups were plotted by Kaplan-Mayer method. Results. One-, 3and 5-year survival were 85, 25 and 5%, respectively, in the SS-PAH group and 99, 82 and 77% in the SS group, respectively. The differences were significant (р < 0,001). Survival median in the group SS-PAH was 32 months. Conclusion. The above evidence is comparable to the results obtained earlier and demonstrate a fatal outcome of the disease in the absence of therapy with specific pulmonary vasodilators.

Russian and foreign data on development of atherosclerosis in patients with primary vasculitis are analysed. The discussion covers the role of risk factors, features of pathogenesis of atherosclerosis in primary vasculitis, diagnostic and therapeutic methods in this disease.

Aim. To study risk factors of knee joint osteoarthrosis (KJO) progression within 5 years since the disease onset. Material and methods. We examined 158 females with primary KJO (by ACR criteria). Each patient’s record contained demographic and disease history information, pain score in the knee joints by visual analog scale and joint status. All the patients have undergone standard rhoentgenography of the knee joints in two projections and two-energy x-ray densitometry of the lumbar spine, the neck of the femur (NF), subchondral condyles of the femur and of the tibia. Results. We found factors promoting rapid progression of gonarthrosis within the first 5 years of the disease: high body mass index and mineral bone density (MBD) in subchondral parts of the tibia, low MBD in NF and bone marrow edema in the tibia. Conclusion. We revealed factors contributing to rapid progression of gonarthrosis in initial disease. MBD of the axial skeleton and subchondral MBD among them. Using established variables it is possible to distinguish a cohort of patients with initial signs of OA who need earlier treatment. This is of practical importance and can improve the disease prognosis.

Aim. To estimate the levels of of plasminogen (Pg) and inhibitor of plasminogen activators of type 1 (IPA-1) in patients with antiphospholipid syndrome (APS) and to reveal correlations between their content and clinical-laboratory characteristics of APS. Material and methods. A Pg level was measured in 78 APS patients: 35 of them had systemic lupus erythematosus (SLE), 43 had primary APS and 19 with idiopathic thrombosis (IT). IPA-1 was detected in 63 APS patients: in 26, 37 and 18 patients, respectively. The control group consisted of 10 subjects free of autoimmune disease and thrombosis. The patients were matched by age. Pg and IPA-1 levels were estimated kinetically. The Pg level was stratified: normal (1.5-2.0 mcM, high (above 2.0 mcМ), low (under 1.5 mcM). Thromboses in the past occurred in 67 patients: arterial (n=32), venous (n=53), of combined localization (n=14). Results. Of 78 APS patients, Pg level was normal in 34 (44%), high in 20 (25%), low — in 24 (31%). Of 43 primary APS patients, low Pg was in 8 (19%), of 35 patients with SLE+APS — in 16 (46%) patients. A Pg concentration (1.59 [1.4; 1.98] mcM) was significantly less in APS patients with thrombosis than in patients with IT (2.4 [1.74; 2.99] mcM). Pg tended to lower levels than in the controls (1.95 [1.63; 2.26] mcM). IPA-1 varied in primary APS from 0.45 to > 1 nM, in SLE+APS from 0.44 to >1 nM, in IT —from 0.65 to 0.81 nM. The levels of active IPA-1 in all the patients with APS and IT were higher than in healthy donors and varied from 0.44 to >1 nM. Most of APS patients had high level of IPA-1 — 52 (83%) (IPA-1 from 0,1 to 1), of them 22 (85%) patients with SLE+APS and 30 (73%) — with primary APS. 11 (17%) APS patients had high IPA-1 ( >1), of them 4 (15%) with SLE+APS and 7 (27%) with primary APS. All IT patients had moderately high IPA-1 level. Conclusion. A low level of Pg in APS patients was seen significantly more frequently than in IT patients and controls and was associated with thrombosis, primarily arterial. Moderate high IPA-1 occurred in 83% of 63 APS patients, high in 17%. IT patients had moderately high IPA-1. High IPA-1 was associated in APS with thrombosis, primarily arterial.

The article present literature and original data on rare cases of postprandial angina which is a symptom of postprandial syndrome. The latter is characterized with dyslipidemia, endothelial dysfunction, proinflammatory and prothrombogenic shifts in the blood.

Systemic vasculitis (SV) pathogenetically associated with anti-neutrophilic cytoplasmic antibodies (ANCA) is the subject of intensive research in present-day rheumatology. There were noticeable changes in ANCA-associated SV (ANCA-SV) nomenclature in 2011 as well as mid-term success was achieved in the study of biological anti-B-cell therapy in this disease. European recommendations on rituximab administration in ANCA-SV have been developed. Russian Register of ANCA-SV patients on rituximab treatment is presented. State-of-the art in ANCA-SV research is reviewed.