[Aerobic exercise and fatigue indices in rheumatoid arthritis patients in the health resort care setting]. / Aerobnye uprazhneniya i pokazateli ustalosti u bol'nykh revmatoidnym artritom v usloviyakh sanatorno-kurortnogo lecheniya.

Fatigue is one of the most common symptoms of rheumatoid arthritis (RA). There is strong evidence that physical activity is an effective way to reduce fatigue. OBJECTIVE: To evaluate the effectiveness of aerobic exercise (walking) to reduce fatigue in RA patients in the health resort setting. MATERIAL AND METHODS: The study involved 102 female patients with RA (age 54.38±11.3 years, body mass index 20-29 kg/m2, DAS28-ESR ≤3.2, with severe fatigue of VAS ≥50) who received 21 days of health resort treatment. The health-improving and therapeutic complex includes dosed physical activity, aerobic exercises (walking). Visual analog scale (VAS0-100) and Bristol Rheumatoid Arthritis Fatigue Scale-Numerical Rating Scale (BRAF-NRS V2) were used to assess fatigue, and the 50-meter walking test was used to evaluate the functional status of patients. RESULTS: A correlation between walking duration and the number of steps at a distance of 50 m (p<0.001) as well as between these indices and fatigue (p<0.001) was shown. A positive effect of a standard three-week medical rehabilitation program for patients with RA on fatigue NRS severity (p=0.003) and NRS effect (p=0.037), as well as on patients' functional status (reduced time spent on the 50-meter test, p=0.01) was demonstrated. When comparing groups of RA patients with low (group 1, <5000-6000 steps per day) and optimal (group 2, ≥7000-8000 steps per day) aerobic exercise, positive results were noted in the short term (at 3 weeks) (p<0.001). CONCLUSION: Aerobic exercise is a promising intervention for treating fatigue in rheumatoid arthritis patients. Medical rehabilitation in a resort setting is the best starting point to encourage performing regular physical activity, as well as the best way to develop exercise programs tailored to rheumatoid arthritis patients.

Sorption of Interleukins 12 and 23 Using the Developed Magnetocontrollable Ustekinumab-Based Sorbent.

The aim of the study was to assess the sorption capacity of Ustekinumab, a drug based on interleukins 12 (IL-12) and 23 (IL-23), when using it with a magnetocontrollable sorbent. MATERIALS AND METHODS: To reduce the concentration of proinflammatory cytokines (IL-12, IL-23), the blood of patients with psoriatic arthritis was passed through magnetocontrollable polyacrylamide granules (MPG) of spherical shape with the particle size of 10-100 µm, obtained by emulsion polymerization. Perfusion was performed through a 10 ml column equipped with an electromagnet, into which MPG with immobilized antibodies to IL-12 and IL-23 was added. Ustekinumab, a commercial drug with concentration of monoclonal antibodies equaling 0.2 mg per 1 ml of saline was used as the source of antibodies to these interleukins. The specific sorption capacity of MPG was determined using a column filled with the granules in a volume of 0.2 ml and inducing their subsequent interaction with 1 ml of IL-12 and IL-23 solutions with increasing concentrations.The heparinized blood of 10 patients with psoriatic arthritis of various degrees of activity, who had no parenteral administration of IL-12/IL-23 inhibitors (Ustekinumab) for 12 months, was subjected to in vitro treatment. The blood of 10 healthy donors was used as the control; the perfusion procedure was similar. RESULTS: Digital parameters were measured for each sample before and after the interaction between the sorbent and blood plasma. There was a significant decrease in cytokines from the baseline - by 99.8% (in donors) and by 99.9% (in patients). When using a carbon sorbent, their concentration decreases by 92.6% from the baseline. As a result of sorption, blood cell counts did not change reliably, which is an additional positive aspect of this procedure. CONCLUSION: The maximum possible decrease in the level of cytokines has great practical importance, since they play a leading role in the pathogenesis of psoriatic arthritis. The use of a synthesized Ustekinumab-based sorbent is a highly effective way of removing them simultaneously from blood plasma.

[Serum nesfatin-1 as a marker of systemic inflammation in rheumatoid arthritis.]

The purpose of this study was to determine the level of nesfatin-1 (NF-1) in the blood serum of healthy volunteers and patients with rheumatoid arthritis (RA) to establish the threshold for normal values of this parameter and to reveal the relationship between the level of NF-1 and clinical manifestations of RA. We examined 170 people, of which 110 patients with RA and 60 donors who made up the comparison group. The mean level of serum nesfatin-1 in healthy subjects was 31.61 ± 3.17 ng/ml (M ± σ). The level of normal values of nesfatin-1 in healthy individuals, defined as M ± 2σ, was from 25.27 to 37.95 ng/ml. These studies showed the relationship between the concentration of NF-1 and the severity of clinical manifestations of RA. We found that a higher serum level of NF-1 was characteristic of patients with a more severe clinical course of the disease. The data obtained indicate that high level of NF-1 positively correlates with higher concentrations of C-reactive protein and ESR. This data indirectly proves the proinflammatory effect of NF-1 and confirms the hypothesis about the primary role of systemic inflammation in the pathogenesis of RA.

[Irisin as a new marker for the early diagnosis of low-traumatic fractures in rheumatoid arthritis.]

The aim of this study was to study the relationship between serum irisin level and the presence of low-traumatic bone fractures in rheumatoid arthritis (RA) patients. We examined 170 people including 110 RA patients and 60 healthy individuals as comparison group. The serum irisin level was determined with solid-phase enzyme-linked immunosorbent assay using ELISA Irisin test system (BioVendor, cat. No. RAG018R). The average level of irisin in the group of healthy individuals was 20.49 ± 4.82 µg/ml (µ±σ). The level of normal values, defined as M ± 2σ, was 10.85-30.13 µg/ml. Decreased irisin level was detected in 41 of 110 patients with RA diagnosis (37% of cases). This group of patients had higher RA activity degree (DAS28), extra-articular manifestations, disease duration from 5 to 10 years, greater class of functional joint's failure, lower level of 25 (OH) -vitamin D. There was also a reliable relationship between serum irisin level and presence of low-fracture bone fractures in the anamnesis.

[The nicotinamide-phosphoribosiltransferase as a marker of systemic inflammation under osteoarthrosis.]

The purpose of study is to establish the level of visfatin (Nampt, nicotinamide-phosphoribosiltransferase) in blood serum of healthy volunteers for determination of the level of normal values of of the given parameter specific to healthy people. Besides, the given parameter also was analyzed in patients with osteoarthritis. The sampling consisted of 152 individuals. Out of them, 92 patients with primary osteoarthritis and 60 healthy individuals. The level of Nampt in blood serum of healthy people was detected by using commercial test-systems (RaiBiotech, cat. № EIA-VIS-1). The average level of Nampt in blood serum of healthy people made up to 2,43±0,17 ng/ml (M ± m). The level of normal values of Nampt in healthy people detected as М ± 2σ, made up to from 0 to 5.07 ng/ml. The study data proved the relationship between concentration of Nampt ans expression of clinical manifestations of osteoarthritis. It is demonstrated that higher level of Nampt in blood serum was typical for patients with more severe clinical course of disease. The obtained data testify that high level of Nampt correlates positively with higher concentrations of C-reactive protein and ESR that indirectly testifies in behalf of anti-inflammatory character of action of Nampt and substantiates hypothesis about primary role of systemic inflammation in pathogenesis of osteoarthritis.

[The influence of chronomagnetic therapy on the parameters of the quality of life in the patients presenting with the diseases of the musculoskeletal system at the balneological and health resort-based stage of the rehabilitative treatment].

UNLABELLED: The methods for the rehabilitative treatment play an important role in the management of the patients presenting with the diseases of the musculoskeletal system. One of these techniques is chronomagnetic therapy. AIM: The objective of the present study was to evaluate the influence of chronomagnetic therapy on the patient's quality of life. PATIENTS AND METHODS: The patients of the main group included 30 ones with osteoarthrosis, 30 with rheumatoid arthritis, 20 with ankylosing spondylitis, 6 with podagric arthritis, 6 with psoriatic arthritis, and 6 others with reactive arthritis. Each of these patients every day underwent 10 sessions of chronomagnetic therapy with the use of the Multimag apparatus («Kasimov Instrumental Plant¼, Ryazan). The patients of the comparison group (20 ones presenting with osteoarthrosis, 27 with rheumatoid arthritis, 15 with ankylosing spondylitis, 4 with podagric arthritis, 4 with psoriatic arthritis, and 4 subjects with reactive arthritis) received the identical chronomagnetotherapeutic treatment under the conditions of the «Vulan¼ balneological health resort located at Gelendzhik, Krasnodar Region. RESULTS: The patients of the main group presenting with osteoarthrosis were characterized by the most pronounced manifestations of the role physical and social behaviour and the associated enhancement of pain intensity. The patients with rheumatoid arthritis exhibited well apparent manifestation of role and emotional functioning as well as enhanced vitality. Positive dynamics of these characteristics (role physical and emotional functioning, vital activity) was documented in the patients of the comparison group presenting with osteoarthrosis, ankylosing spondylitis, and rheumatoid arthritis. In this group, the patients with osteoarthrosis, ankylosing spondylitis, and rheumatoid arthritis experienced the improvement of the major parameters of the quality of life characterizing the physical and mental components of the health status. CONCLUSION: The chronomagnetotherapeutic treatment at the stage of rehabilitation of the patients suffering from the diseases of the musculoskeletal system markedly improves the characteristics of physical health the disturbances of which may lead to the development of psycho-somatic disorders. Chronomagnetic therapy of the patients with the diseases of the musculoskeletal system under the conditions of a balneological health resort proved to be more effective in terms of improvement of the parameters of physical and mental health. The result of the subjective evaluation of the health status in such patients can be used as a marker of the effectiveness of chronomagnetic therapy and an indicator of remission of the disease.

[The efficacy and safety of etoricoxib versus meloxicam in the treatment of patients with gonarthrosis]. / Sravnitel'naya effektivnost' i bezopasnost' etorikoksiba i meloksikama v lechenii bol'nykh gonartrozom.

AIM: To evaluate the clinical efficacy and tolerability of etoricoxib and meloxicam in patients with gonarthrosis. SUBJECTS AND METHODS: A postregistration, open-labeled, prospective, comparative randomized study was conducted. 40 patients aged 37 to 75 years with primary knee osteoarthritis were examined. Therapeutic effectiveness was evaluated determining the functional index WOMAC with the use of a visual analogue scale (VAS). The tolerability of the drugs was assessed according to the opinions of a patient and a physician. RESULTS: Both drugs caused a reduction in WOMAC and VAS scores for pain and the severity of the disease. Etoricoxib demonstrated a significantly high rate of occurrence and completeness of its analgesic effect. Meloxicam showed a less pronounced decrease in joint stiffness and an insufficient analgesic effect. The incidence of side effects was similar in both groups. CONCLUSION: Both drugs demonstrated a good tolerability and a low incidence of side effects. The efficacy of etoricoxib was significantly higher than that of meloxicam.

[Experimental modeling of nucleoprotein disposal disorders in systemic lupus erythematosus].

The objective of this research was to adapt the experimental model simulating the nucleoprotein disposal disorders in systemic lupus erythematosus (SLE) for further study of its extracorporeal correction, as well as to assess validity of the model by short-term experiment. Twenty to female Wistar rats were intraperitoneally injected with the chromatin-containing extract from bovine liver followed by intravenous administration of anti-DNA antibodies derived from SLE patients. After these procedures plasma concentrations of anti-dsDNA, circulating immune complexes and DNA became sharply increased, together with distinct elevation of leukocytes. On the contrary, changes in erythrocytes, platelets, total protein concentration, creatinine, asparagine and alanine aminotransferase activities, as well as blood coagulation time were changed insignificantly. Using direct immunofluorescence of cryosections, we detected human IgG deposition in rat kidneys treated in accordance with the simulation protocol. Thus, our model reproduces essential DNA disposal disorders in SLE without any animal death or the life-threatening changes in examined markers during short-term experiment.

[Extracorporeal treatment of nucleoprotein disposal disorders using the systemic lupus erythematosus model: evaluation of efficacy and safety in a short-term simulated experiment].

Efficacy and safety of the extracorporeal blood perfusion through DNase I- and C1q-containing magnetic beads have been evaluated using the experimental model simulating the nucleoprotein disposal disorders in systemic lupus erythematosus (SLE). The study was performed using 20 rats in which the essential impairments of nucleoprotein catabolism typical for SLE were modeled. The animals were randomized into the experimental group and the placebo perfusion control group. Rats of the experimental group were characterized by the statistically significant reduction of increased levels of circulating immune complexes and plasma DNA as well as diminished levels of plasma creatinine and kidney IgG deposition as compared with placebo controls. During short-term experiment there were neither animal deaths nor substantial blood cell destruction and hepatotoxicity signs.