[Prevalence of rheumatoid arthritis in Russia (according to epidemiological findings)].

AIM: To define the prevalence of rheumatoid arthritis (RA) from the data of an epidemiological study. SUBJECTS AND METHODS: During a questionnaire survey of 37057 adults of Russia, patients with complaints of articular swelling (n = 4975) were selected; of the latter a group (n = 3420) was randomly formed to be clinically examined by rheumatologists in order to detect RA. The 1987 ACR criteria were used for its diagnosis. RESULTS: According to the data of the questionnaire survey, RA was diagnosed in 159 (4.6%) of the 3420 patients with complaints of articular swelling. The prevalence of RA in Russia averaged 0.61%. Among the respondents who complained about articular swelling during the questionnaire survey, 258 (7.5%) respondents considered to have RA before rheumatological examination. While comparing the diagnoses reported by the respondents during the survey and the final diagnosis established by a specialist, RA was confirmed only in 61 (24%) patients. Out of all the identified patients with RA (n = 159), only 61 (38%) were aware of their diagnosis. In RA patients with less than one-year articular complaints (n = 24), 17% were familiar with their diagnosis; the diagnosis was first made in the others (n = 20). Among the patients with long-term articular complaints (n = 135), 42% were aware of their diagnosis. CONCLUSION: The epidemiological survey indicated that the number of patients with RA were twice higher than those given in the official statistics of the Russian Federation (671,000 versus 300,000, respectively). In outpatient practice, RA is correctly diagnosed only in 38% of cases. There is a significant hyperdiagnosis of this disease. The duration of articular complaints affects the establishment of the diagnosis of RA.

[Administration of monoclonal antibodies to B-lymphocytes (rituximab) in rheumatoid arthritis in Russia].

AIM: To assess efficacy and tolerance to anti-B-cell drug rituximab in therapy of rheumatoid arthritis (RA) by the data of RF register of this drug. MATERIAL AND METHODS: Rituximab was studied in 42 patients with high RA activity. 37 patients received rituximab according to a conventional scheme: 2 intravenous 1000 mg infusions with a 2-week interval. The rest patients received 2 intravenous 500 mg infusions. The response was evaluated by DAS28 index. RESULTS: Rituximab administration resulted in almost complete elimination of B-cells from peripheral blood. This produced a significant positive effect manifesting with reduction in the number of inflamed and painful joints. This trend was evident to observation week 8 reaching maximum to week 24. Clinical response correlated with decline of inflammation as shown by ESR and CRP. According to DAS28 index, good and satisfactory results were registered in 8 weeks in 62% patients, in 16 weeks--in 86%, in 24 weeks--in 100%. Rituximab tolerance was good. CONCLUSION: Effective treatment with rituximab for rheumatoid arthritis opened a new perspective in antirheumatic biological therapy and demonstrated an important role of B-cells in the disease development. This drug is recommended for wide use in the treatment of severe rheumatoid arthritis resistant to prior therapy including TNF-alpha blockers.

[Vitrum osteomag in prevention of osteoporosis in postmenopausal women: results of the comparative open multicenter trial]. / Vitrum osteomag v profilaktike osteoporoza u zhenshchin v postmenopauze: rezul'taty sravnitel'nogo otkrytogo mnogotsentrovogo issledovaniia.

AIM: To investigate efficacy, tolerance and safety of the drug vitrum osteomag one tablet of which contains 600 mg calcium (1500 mg calcium carbonate), 200 IU of cholecalcepherol, 40 mg of magnesium, zinc (7.5 mg), copper (1 mg), manganese (1.8 mg) and boron (250 mcg) in women with osteopenia for prevention of osteoporosis. MATERIAL AND METHODS: A multicenter comparative open trial of vitrum osteomag influence on mineral bone density (MBD), change of pain syndrome in bones, index of calcium-phosphorous metabolism covered 334 postmenopausal women with osteopenia. MBD was measured in low-back spine and proximal part of the hip with DEXA method. All the patients were divided into 3 groups: 125 women taking 2 tablets of vitrum osteomag daily for 12 months (group 1); 111 women taking 1500 mg calcium carbonate (group 2); 96 women--control group (only observation). RESULTS: Vitrum osteomag relieved pain in the back and joints, had a positive effect on bone density (+1.5%) and proximal parts of the hip (0.6-0.93%) exceeding the effect of calcium carbonate only which preserves the initial MBD in low back spine but does not prevent bone loss in the hip. MBD dynamics in patients given vitrum osteomag differs essentially from one in the control group (from -1.9 to -2.91%) which demonstrates a reliable preventive anti-osteoporotic effect of this medication. The drug increases the level of general and ionized calcium in blood but does not cause hypercalcemia lowering the level of parathormone in blood. The rate of side effects in group 1 was 14.4% and did not differ much from that in group 2 (16.2%). CONCLUSION: The results of the study allow to recommend vitrum osteomag for prophylaxis of a rapid loss of bone tissue mineral density.

[Proximal hip fractures and their medico-social sequelae]. / Perelomy proksimal'nogo otdela bedra i ikh mediko-sotsial'nye posledstviia.

The aim of the trial was to study basic osteoporotic fractures in the proximal femoral bone in persons over 50 in the population of Irkutsk in 1997 as well as to evaluate short- and long-term outcomes of hip fractures and relevant social consequences. The mean incidence rate of femoral fractures was 167.1 per 100.000 (male 127.7, female 190.1 per 100,000). Male/female ratio was 1:1.5. Prevalence of femoral fractures increased in persons over 70 years of age and older, being maximum at the age over 80. Six months after the fracture 22 of 172 patients died, the mortality being for males and females 12.8%. To the end of the year the mortality increased to 23.3%, to the end of the second year--to 32.6% (30.5% for males and 33.6% for females). Surgical treatment was conducted in 72.7%, skeletal extension in 37.8%, osteosynthesis in 33.7%, arthroplasty in only 1.2%. The patients displayed low functional abilities, daily activity and self-attendance. 6, 12 and 24 months after the treatment 90.7, 74.2 and 60.3% patients, respectively, required outsider's service. A program must be designed of osteoporosis prevention and medico-social rehabilitation for patients with osteoporotic fractures.

[Prospective epidemiological study of rheumatism in the Irkutsk Region]. / Prospektivnoe epidemiologicheskoe issledovanie revmatizma v Irkutskoi oblasti.

The changes in the prevalence and primary incidence of rheumatism in the region were analyzed by the epidemiological surveys and notifications made in 1961 to 1994. During this period, the primary incidence rates showed a 70-fold decrease, mainly due to those among females and children. The paper presents changes in the pattern of risk factors of rheumatism and defines the prevalence decrease rate of rheumatism in three follow-up periods. A comprehensive rehabilitation programme for rheumatic patients has been worked out.