[The working classification and early diagnostics of ankylosing spondylitis].

A work classification of ankylosing spondylitis is presented including such novel concepts as the stage of the disease (instead of sacroiliitis), extra-axial and extra-skeletal manifestations. Modern approaches to the evaluation of disease activity are described Extensive explanations of these notions are presented together with the recommendations on formulation of diagnosis. The advent of new and more eficacious methods of visualization as well as more sensitive and specific criteria for inflammatory nature of back pain are considered The authors modified the traditional criteria for ankylosing spondylitis and developed their version to be verified in clinical practice in this country.

[The efficiency and safety of adalimumab treatment in patients with active rheumatoid arthritis unresponsive to standard therapy: Russian national study results].

AIM: To confirm the efficacy and safety of adalimumab (ADA) added to the standard antirheumatic therapy performed in patients with rheumatoid arthritis (RA) of moderate and high activities. SUBJECTS AND METHODS: The open-labeled multicenter study enrolled 100 adult patients (11 men, 89 women; mean age 50.9 +/- 11.1 years) with active RA according to the ACR criteria (1987) despite their treatment with disease-modifying antirheumatic drugs, the average number of which in the history was 2.1 per man. At baseline, DAS28 CRP was as many as 6.2 +/- 0.84 scores; C-reactive protein (CRP) was 37.1 +/- 34.7 mg/l. In accordance with the indications officially registered in the European Union and the Russian Federation, ADA was given in a dose of 40 mg 2 weeks. Before administration of the drug, every patient underwent screening examination for tuberculosis, which used a tuberculin test and chest X-ray. The screening covered a period of the treatment up to 24 weeks and its subsequent period within 70 days after administration of the last dose of ADA in order to study its safety. RESULTS: DAS28-CRP scores decreased from 6.14 +/- 0.86 (at baseline) to 3.39 +/- 1.1 (by the end of the study). At 12 weeks, 22% of the patients achieved a low RA activity (DAS28-CRP < or = 3.2 scores); 14% achieved clinical remission (DAS28-CRP < or = 2.6 scores); at 24 weeks, these were 37 and 25% of the patients, respectively. There were differences in effectiveness in terms of the baseline disease activity. At 24 weeks, ACR20, ACR50, and ACR 70 responses were achieved in 88, 67, and 26% of the patients, respectively. The HAQ functional index reduced from 1.9 +/- 0.6 (at baseline) to 1.081 +/- 0.64 (at 12 weeks) and 1.04 +/- 0.68 (at 24 weeks) scores. Twenty-four patients were recorded as having 40 adverse reactions (AR), including only one severe AR (septic arthritis). There were no cases of tuberculosis. CONCLUSION: The Russian multicenter study demonstrated the high clinical efficacy of ADA in patients with the moderate and high activity of RA unresponsive to standard therapy, as well as its satisfactory safety.

[Osteoarthrosis and peripheral vein diseases of lower extremities: characteristics of concomitant pathology].

AIM: To estimate the prevalence and impact of lower extremity peripheral vein diseases on the course of articular syndrome in osteoarthrosis (OA), to reveal the specific features of concomitant pathology, and to substantiate the necessity of its therapeutic correction. SUBJECTS AND METHODS: One hundred and fifty-eight patients with the valid diagnosis of OA (by the American College of Pheumatology criteria) were followed up. Their mean age was 56.4 +/- 9.6 years. Lower extremity peripheral vein diseases were detected in 51.3% of the patients with OA, which permitted identification of 2 patient groups comparable for the major parameters. During the examination, the clinical parameters of articular syndrome were assessed at the start and 2 months after therapy. RESULTS: The higher intensity of the pain syndrome, lowered functional activity, and more common synovitis were observed in the patients with concomitant diseases of joints and veins as compared with those without signs of venous insufficiency. After therapeutic measures, joint pain, synovitis, and lower functional activity persisted in the patients with concomitant diseases. Reexamination showed that most patients with concomitant pathology needed analgesic therapy; in Group 2 without a history of vein diseases, the dose of nonsteroidal anti-inflammatory drugs (NSAID) could be halved in 21 (27.3%) patients; 37 (48.0%) patients were in no need of continuous use of NSAID. CONCLUSION: Impaired peripheral venous blood flow reduces the efficiency of therapy for OA, which makes it necessary to timely detect lower extremity varices and to perform goal-oriented therapy in such patients.

[New potentialities in symptom-modifying therapy of osteoarthrosis].

AIM: To examine efficacy and tolerance of the drug Bora-Bora in patients with osteoarthrosis. MATERIAL AND METHODS: Bora-Bora and nimesulid were given to 20 patients with a verified diagnosis of osteoarthrosis (OA). 20 control patients received nimesulid alone. Treatment efficacy was evaluated by quantitative parameters of articular syndrome, indices of periarticular muscles affection estimated before the treatment, 2, 6 and 8 weeks after the start of the treatment. Ultrasonic investigation of the joints and periarticular tissues was conducted before and after the treatment course. RESULTS: The response to Bora-Bora was seen on day 10 of therapy. Bora-Bora attenuated pain syndrome in the joints and periarticular tissues, improved joint function more effectively than nimesulid (p < 0.05). Bora-Bora is a good anelgetic. It is well tolerated and can be recommended for OA treatment.

EPR spectrometer for clinical applications.

This article describes an EPR spectrometer specifically designed and constructed for EPR spectroscopy in humans. The spectrometer is based on a permanent magnet, suitable for measurements at 1200 MHz. The magnet has a full 50 cm gap between the poles, which facilitates accurate and comfortable placement of the subject for the EPR measurement at any location on the human body. The bridge includes features to facilitate clinical operations, including an indicator for phasing of the reference arm and a 2 level RF amplifier. Resonators with holders for each type and site of measurement have been developed that comfortably position the resonator and the patient and prevent artifacts due to motion. The initial applications for which the spectrometer has been designed are for oximetry using loops on the surface, oximetry using implanted resonators for measuring deep sites, and measurements in the teeth for determination of exposures to clinically significant doses of ionizing radiation.

[Comparative study of the effect of dimephosphon monophosphonate and xydiphone biphosphonate on the histomorphometric indices of rat vertebra in a model of glucocorticosteroid osteoporosis]. / Sravnitel'noe izuchenie vliianiia monofosfonata dimefosfona i bifosfonata ksidifona na gistomorfometricheskie pokazateli stroeniia pozvonkov krys pri modelirovanii gliukokortikosteroidnogo osteoporoza.

The efficacy of monophosphonate dimephosphon and diphosphonate xydiphon was compared by experiments in rats with an osteoporosis model induced by the chronic administration of prednisolone. The glucocorticosteroid decreased the total density of trabecules (in both bone and cartilage tissues) in histological micropreparations of lumbar vertebrae and reduced the total bone cell count and the calcium content in the bone tissue. Dimephosphon, administered on the prednisolone background over the same period of time, normalized the total relative density of trabecules (by increasing the cartilage content), the total bone cell count, and the calcium content. Under the same conditions, xydiphone normalized the total relative density of trabecules (by increasing the bone content), but did not influence the prednisolone-decreased content of cartilage, total cell count, and calcium content in the vertebrae. Thus, the test results reveal a significant advantage of dimephosphon over xydiphone.

[Ximedon-electrophoresis in rehabilitation of patients with systemic scleroderma]. / Ksimedon-élektroforez v vosstanovitel'nom lechenii bol'nykh sistemnoi sklerodermiei.

A double blind placebo-controlled trial performed in 56 patients with scleroderma systematica showed effectiveness of a domestic drug ximedon--a pirimidine compound--applied during electrophoresis on the affected skin, limbs. The addition of ximedon-electrophoresis to rehabilitation program for scleroderma systematica improved the condition in 77.8%, microhemocirculation in 72.2%, reduced the area of the affected skin by 9.8% (p < 0.05), skin induration in 55.6% of patients.

[An analysis of the reasons for relaparotomy in the surgical clinic]. / Analiz prichin relaparotomii v khrirugicheskoi klinike.

The results of surgical treatment of 4,078 patients who underwent operation in 1985-1989 were studied. Due to the occurrence of complications in the early postoperative period, 182 relaparotomies were carried out in 164 patients. The main indications for relaparotomies were advanced underlying disease, surgical errors (tactical, technical), changes of the patients' immune status. Early diagnosis, timely operation with the use of technically correct manipulations, and the application of a full complex of intensive therapy measures in the postoperative period are important in the prevention of complications.

[The function of the effector cells of inflammation in rheumatoid arthritis]. / Funktsional'noe sostoianie kletok-éffektorov vospaleniia pri revmatoidnom artrite.

As many as 105 patients with rheumatoid arthritis were examined for function of tissue and circulating neutrophils. The effect of serum factors on the nature of inflammation and synovial fluid was estimated both in the joint and in the focus of aseptic inflammation. The defense mechanisms of regulating inflammation, different trends in the effects of serum and synovial fluid on cell migration and oxygen metabolism were revealed, relations between the phenomena under study and the disease activity and local inflammation were defined.

[Lipid peroxidation and state of antioxidant system in patients with systemic lupus erythematosus]. / Perekisnoe okislenie lipidov i sostoianie antioksidantnoi sistemy u bol'nykh sistemnoi krasnoi volchankoi.

Lipid peroxidation (LP) and antioxidant system (AS) have been investigated in 30 patients suffering from systemic lupus erythematosus (SLE). LP was assessed by plasma levels of intermediate (dienic conjugates) and end (malonic dialdehyde) LP products, AS by concentration of alpha-tocopherol and free fatty acids indicating the intensity of phospholipase hydrolysis. Shifts in AS and LP correlated with clinical SLE appearance. The paper discusses causes which may underlie the observed abnormalities and validity of antioxidant SLE therapy.

[Prevention and complex treatment of duodenal stump incompetence]. / Profilaktika i kompleksnoe lechenie nesostoiatel'nosti duodenal'noi kul'ti.

The results of surgical treatment of 1,069 patients for gastric and duodenal ulcer were studied. Duodenal stump incompetence (DSI) developed in 25 patients (6.3%) after the Billroth II operation; the incompetence was manifested by three clinical forms: infiltrative, primary-fistular, and perforative-peritoneal. Each form of DSI calls for specific tactics of treatment. The perforative-peritoneal form is most dangerous; during its operative management active aspiration-perfusion drainage of the zone of the stump must be installed and the duodenum relieved of a load as much as possible. Drugs reducing pancreatic function, postural drainage, and a diet is included in the complex of therapeutic measures in DSI. The wide introduction of organ-preserving operations into surgical practice will make it possible to avoid this threatening complication.

[Opsonic and anti-opsonic effects of the synovial fluid in patients with rheumatoid arthritis based on its effect on the complement-dependent adhesion of neutrophils]. / Issledovanie opsonicheskikh i antiopsonicheskikh éffektov sinovial'noi zhidkosti bol'nykh revmatoidnym artritom po vliianiiu na komplementzavisimuiu adgeziiu neitrofilov,

A method has been developed for the assessment of the synovial fluid (SF) complement-dependent opsonic characteristics basing on the intensity of neutrophil adhesion to SF-pretreated Sephadex granules. Examinations of 25 patients with rheumatoid arthritis have detected the lowest complement-dependent opsonization (CDD) in the patients with extraarticular symptoms. CDD showed a tendency to normalization over the course of intraarticular glucocorticoid therapy. No anti-opsonic effects of SF have been recorded. Examinations of 8 synovial exudates from patients with osteoarthrosis deformans have revealed SF CDD much higher than that in rheumatoid arthritis patients.

[A method of determining the magnitude of the intracellular reserve of heparin in the blood]. / Sposob opredeleniia velichiny rezerva vnutrikletochnogo geparina krovi.

The new method for assessment of the function of the blood anticoagulation system cellular component is based on the detection of the intracellular heparin amount that can be released into the blood stream. The technique involves the recording of changes in the blood plasma heparin levels after addition of lactobacterin, a nonspecific cell stimulant, to whole blood. The informative value of this method for the assessment of the blood anticoagulation system status is illustrated with examples.

[The clinical manifestations and pathogenetic characteristics of skeletal muscle involvement in rheumatoid arthritis]. / Klinicheskie proiavleniia i patogeneticheskie osobennosti porazheniia skeletnykh myshts pri revmatoidnom artrite.

The state of skeletal muscles was subjected to a comprehensive study in 106 patients with verified rheumatoid arthritis. Kinesthetic, thermography, electromyography, tensometry and morphohistochemical methods were employed together with determination of serum activity of creatine phosphokinase. The muscular syndrome of the disease was characterized by the presence of foci of myofibrosis manifesting as local painful indurations of different size and consistency. It has been shown that one of the mechanisms of muscular injury in rheumatoid arthritis is the neural reflex one: under the influence of pathological impulses from the damaged joint there occur tonic and dystrophic alterations in the muscle, vasomotor dysfunctions and derangement of the neurotrophic control.