[Prognostic value of some serological markers of rheumatoid arthritis in assessment of x-ray outcome of the disease].

AIM: To specify significance of some serological markers for diagnosis and x-ray prognosis of rheumatoid arthritis (RA). MATERIAL AND METHODS: A total of 115 RA patients with the disease history not longer than 4 years were examined for serum antibodies to cyclic citrullated peptide (ACCP), rheumatoid factor (RF), antikeratine antibodies (AKA) using enzyme immunoassay and indirect immunofluorescence. RESULTS: ACCP, AKA, IgA-RF, IgM-RF were detected in 79.15%, 47.8%, 64.3%, 89.6% patients, respectively. ACCP was found to be directly correlated with negative x-ray changes in hand and foot joints. ACCP specificity reached 97%, the highest specificity (up to 100%) being in determination of RF and ACCP. CONCLUSION: ACCP is an independent factor increasing significance of x-ray indices and thus allowing prognosis of x-ray outcome of RA.

[Hemostasis in patients with rheumatoid arthritis].

AIM: To study hemostasis with reference to rheumatoid arthritis (RA) activity, extraarticular manifestations and vascular damage. MATERIAL AND METHODS: We studied hemostasis in 104 RA patients. The following parameters were tested: partial thromboplastin time activation (PTTA), fibrinolytic activity (FA), prothrombin index, lupus anticoagulant (LA), mean platelet volume (PV), antibodies against cardiolipin (aCL) and antibodies against beta2-glycoprotein 1 (alphabeta2-GP1). The disease activity index was estimated by DAS-28 including tender and swelling joints count, erythrocyte sedimentation rate and disease global activity rated by the patient. RESULTS: We found out an increased number of platelets in 54.4%, prolongation of FA and PTTA in 72.5 and 12.5% patients. The rest blood coagulation tests were normal in most the examinees. The LA antibodies were absent, while aCL and alphabeta2-GP1 antibodies were identified in 10.6 and 14.4%, respectively. The number of platelets increased while hemoglobin decreased in relation to higher disease activity and PV was significantly lower in patients with extraarticular manifestations. No significant influence of vascular damage or comorbidities on hemostasis was found. CONCLUSION: No relation was established between coagulation factors and the disease activity except for increased number of platelets in patients with higher activity and lower PV in patients with extraarticular manifestations. However, patients with aCL and alphabeta2-GP1 need constant monitoring because of the risk to develop thrombosis.

[Antineutrophil cytoplasmic antibodies in patients with diffuse diseases of connective tissue]. / Antineitrofil'nye tsitoplazmaticheskie antitela u bol'nykh s diffuznymi bolezniami soedinitel'noi tkani.

AIM: To investigate the significance of antibodies against neutrophil cytoplasmic antigens (ANCA) in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SS), their relations with the syndromes and laboratory indices. MATERIAL AND METHODS: The sera from 277 patients suffering from connective tissue disease and 31 healthy persons were examined. Of patients, 103, 126 and 48 had RA, SLE and SS, respectively. The patients in each group were subdivided into ANCA positive (ANCA+) and ANCA negative (ANCA-). The patients were matched within the groups by age, sex and disease duration. There were 41 such pairs in RA group, 23 in SLE and 13 in SS group. Questionnaires and laboratory tests (ANA, RF, a-DNA, a-MPO, a-Scl-70, a-PR3, a-CL) were used in the examination. RESULTS: The sensitivity of ANCA in SLE patients group was as high as 58.7%, specificity--93.5%. In other groups ANCA were less frequent. ANCA were significantly associated with skin vasculitis and ANA prevalence but the disease activity in SLE was not related to this feature. Anemia and antibodies against cardiolipin were found significantly more frequently in ANCA positive RA group. In SS group the inverted clinical association with kidney damage was seen but a-DNA were more prominent in ANCA+ group. Subspecificity for a-MPO and a-PR3 and lactoferin by ELISA were revealed less often than a-ANCA by immunofluorescence. Only two SLE patients with a-lactoferin antibodies were evidently different in prognosis while the other ones did not differ in the disease course within their group. CONCLUSION: The ANCA pattern in connective tissue diseases is found rather often but only few clinical and laboratory associations could be established such as skin vasculitis and ANA domination in SLE group, anemia and a-CL in RA group and a-DNA in SS ANCA+ groups. The validity of ANCA test is not so significant as it is in vasculitis patients.

[A new chondroprotector--polyvinylpyrrolidone for treating osteoarthrosis patients]. / Novyi khondroprotektor--polivinilpirrolidon dlia lecheniia bol'nykh osteoartrozom.

The authors demonstrate the role of chondroprotector therapy in the management of patients with osteoarthrosis (OA). They suggest the use of the polymeric drug polyvinylpyrrolidone as artificial synovial fluid. The drug is administered intra-articularly and is capable of replacing pathological synovial fluid. It has been established that 10 and 20% polyvinylpyrrolidone solutions possess high viscosity and low compressibility, they are isolated from the articular cavity for 6 to 7 days and manifest antiarthrosis action in chondrocytic cultures. The short- and long-terms results of the clinical trials of polyvinylpyrrolidone solutions allow recommending them for the treatment of OA.

[The effect of intra-articular treatment with corticosteroids, polyvinylpyrrolidone and dimethyl sulfoxide on the composition of the synovial fluid in patients with rheumatoid arthritis]. / Vliianie vnutrisustavnogo lecheniia kortikosteroidami, polivinilpirrolidonom i dimetilsul'foksidom na sostav sinovial'noi zhidkosti bol'nykh revmatoidnym artritom.

Synovial fluid (SF) contained by the knee joint from 102 patients (80 with rheumatoid arthritis, 12 with osteoarthrosis, 10 with posttraumatic arthritis) and controls was studied for cytosis, activity of acid phosphatase, N-acetyl-beta-D-glucosaminidase, and cAMP and cGMP content. In 18% of the cases, the local corticosteroid treatment of patients with RA produced no beneficial effect. To treat RA and OA patients, dimethylsulfoxide (DMSO, 5 ml of 20% solution) and polyvinylpyrrolidone (PVP, 5 ml of 15% solution) were administered intra-articularly. In OA patients, injection of DMSO and PVP provided a good therapeutic effect. In RA patients, injection of DMSO produced a beneficial antiinflammatory action but it appeared short-term. The use of PVP in RA patients with pronounced local process enhanced synovitis symptoms, entailed an increase of the SF amount and cytosis, did not reduce the activity of lysosomal enzymes, and produced a negligible effect on the level of cyclic nucleotides. A mixture of DMSO (1 ml of 100% solution) and PVP (5 ml of 15% solution) applied to the treatment of RA patients exerted a favourable action on the local process in the joint, namely reduced all the parameters mirroring the intensity of inflammation.

[Efficacy of polyvinylpyrrolidone solutions of various concentrations in patients with rheumatic diseases of the joints]. / Izuchenie éffektivnosti rastvorov polivinilpirrolidona razlichnykh kontsentratsii u bol'nykh s revmaticheskimi zabolevaniiami sustavov.

Twenty-six experimental animals, 93 patients with osteoarthrosis (OA) and 30 patients with rheumatoid arthritis (RA) were examined. Intraarticular injection of both 15% and 20% polyvinylpyrrolidone (PVP) solutions suppressed the development of experimental arthrosis in rabbits, which manifested in a decrease of the degenerative changes in the cartilaginous tissue of the joints. The clinical examination has demonstrated that the use of different concentrations of PVP produces an equally marked effect in OA. In the group of RA and OA patients given placebo the time-course of changes in the clinical data was pronounced less powerfully. PVP turned out to be effective in secondary synovitis, to influence the immunologic responses occurring in synovitis, and to exert a beneficial action on the rheological properties of the synovial fluid. The drug is completely eliminated from the articular cavity and the body during 5 days.