[The results of the dynamic observation of patients with reactive Yersinia arthritis]. / Rezul'taty dinamicheskogo nabliudeniia bol'nykh reaktivnym iersinioznym artritom.

As many as 50 patients with reactive Yersinia arthritis were followed up. There were 4 men and 46 women. The mean age of the patients was 31.1 yr. The mean follow-up period was 30.8 months. In 72% of the cases, the disease was preceded by diarrhea. During the first examination, mono-oligoarthritis was detected in 78% of the patients. Extra-articular alterations (damage of muscles, ligaments, heart, skin changes, etc) were also recorded. The results of bacteriological analyses were positive in 22 out of the 50 patients. In 16 persons, Yersinia might be cultivated from the different biological media: blood, feces, urine, fauces, and synovial fluid. In 47 persons, arthritis took a chronic course. Persistence of antibodies of the types 03 and 09 seen for many years merits attention. Monoclonal anti-Yersinia antibodies were also detectable repeatedly. In 8 patients, in whom Yersinia were cultivated from a lot of the biological media, the disease ran an especially grave course. The role of circulating specific antibodies in patients with Yersinia arthritis and the trigger role they may play in the development of RA and ankylosing spondylarthritis requires further discussion.

[Clinico-immunologic characteristics of complicated and uncomplicated yersiniosis]. / Kliniko-immunologicheskaia kharakteristika oslozhennogo i neoslozhnennogo iersinioza.

Asymmetric affection of the major lower limb joints is a characteristic feature of the joint syndrome in yersiniosis-associated arthritis. The sacroiliac articulations are frequently (47% cases) involved. In addition, yersiniosis-associated arthritis concurs with the signs and symptoms of systemic disease--gastroenterocolitis, myocardiopathy and myocarditis, erythema nodosum, hepatitis, urethritis, conjunctivitis, myositis and myalgia, enteropathy; changes in the CNS typical for the astheno-neurotic syndrome are frequently present. Comparison of the immunological assay data in complicated and uncomplicated yersiniosis shows equally high levels of IgG and CIC. High anti-DNA antibody titres are more frequently found in the serum of uncomplicated yersiniosis patients. ELISA quantitation of specific IgA, IgM, and IgG class antibodies in yersiniosis-associated arthritis patients demonstrated persistence of all the three antibody classes or of IgA-IgG combination in cases with most severe of the joint syndrome. In the presence of cardiac disease, patients were found to have high titres of antibodies reactive with the cardiac interstitial tissue, while in authentically diagnosed myocarditis cases with the sarcolemma. The investigation findings strongly suggest a high degree of involvement of immune and autoimmune processes in the pathogenesis of arthritides secondary to Yersinia infection.

[Rehabilitation of patients with gout during outpatient follow-up]. / Reabilitatsiia bol'nykh podagroi pri dispansernom nabliudenii.

The authors presented the results of a 5-year follow-up of 50 gout patients who had been regularly (no less than 3-4 times a year) examined in outpatient clinics. Dispensary examinations of the patients resulted in a decrease in the level of uric acid and in the number of exacerbations of gouty arthritis, the reduction of the sizes of tophi or their disappearance. Regular examination and ultrasonic investigation made it possible to prevent in some cases attacks of urolithiasis, and to reduce 4-fold a disability time-period and to preserve working capacity in 96% of the patients. The study showed that in most of the patients with essential hypertension and coronary heart disease arterial pressure got stable and the number of angina attacks was on a decrease. The data obtained indicated a high efficacy and appropriateness of combined rehabilitation activities in gout patients.

[Echodiagnosis of the kidney lesion in gout]. / Ekhodiagnostika porazheniia pochek pri podagre.

An echographic study of the kidneys was performed in 24 men with proved gout aged 40 to 50 and a disease duration of 10-20 yrs. On the basis of case history data urolithiasis was noted in 4 patients, whereas by echodiagnosis it was found in 12. Cysts were detected in 6 patients with gout complicated by urolithiasis and in 1 patient without it. Echoroentgenography was shown to be a highly informative method in the diagnosis of urolithiasis and cystic regeneration of the kidneys opening up prospects for earlier treatment of complications in gout.

[Evolution of seronegative arthritis]. / Evoliutsiia seronegativnogo artrita.

The paper is concerned with the results of a follow up of 67 patients with seronegative arthritis. The average duration of observation was 7.6 yrs. Diagnoses in 4 patients were established on a repeated clinicolaboratory and x-ray study: ankylosing spondylitis, Reiter's syndrome, Yersinia arthritis and gonorrheal arthritis. A picture of seropositive rheumatoid arthritis was noted in 16 patients (24%). In 47 patients arthritis remained seronegative. Of them in 30 patients a course of disease did not differ from that of seropositive rheumatoid arthritis. Considerable progression of disease was noted at the acute onset of disease with multiple involvement of the joints and a high inflammatory and immunological activity of a process. A morphological investigation of the synovial bioptates in 20 patients did not reveal a classical picture of rheumatoid synovitis even in a prolonged course of seronegative rheumatoid arthritis. The authors defined two variants of morphological changes in the synovial tissue in this group corresponding to a benign and progressive course of seronegative RA.