Objective. To study role of inflammation and disturbances of blood cholesterol transport system in atherosclerotic damage development in rheumatoid arthritis (RA). Material and methods. 84 RA pts with mean age 48 years and mean disease duration 87 months were included. Control group consisted of 15 humans of comparable age and sex without rheumatic diseases. Carotid sonographic scanning was performed to reveal vascular atherosclerotic damage. Cholesterol (CL), triglycerides (TG) and high-density lipoprotein cholesterol (HDLC) serum levels were evaluated with colorimetric and photometric methods, CRP, apoAl and LP(a) levels were assessed by immunonephelometric method. Results. Dyslipidemia (DLP) frequency analysis showed differences only for LP(a). Increase of LP(a) and TG concentrations in RA was more frequent than in control. CL and HDLC levels did not differ. Intima-media complex (IMC) thickness in RA and control was the same. Atherosclerotic plaques (AP) in RA were more frequent. RA pts showed negative correlation between IMC thickness and HDLC, as well as between HDLC values, apoAl and CRP. LP(a) level correlated with DAS4. There was no association between concentrations of CL, TG, HDLC, low-density lipoprotein cholesterol (LDLC), apo В and Al, LP(a) and extra-articular RA features and glucocorticoid administration. In pts with high LP(a) level AP were more frequent, activity of RA, apo B, LDLC levels were higher than in pts with normal level of this LP. LP(a) values in pts with AP were higher than in pts without AP (p<0,05). Conclusion. Chronic inflammation in RA plays an important role in disturbances in blood cholesterol transport system. LP(a) level increase is a risk factor of atherosclerotic vascular damage.

Objective. To study different variants of osteolysis in pts with psoriatic arthritis (PA) and to reveal their relationship with other clinico-radiological features of joint damage. Material and methods. 370 pts with definite PA having different variants of joint damage were included. Radiological examination of bones and joints (in some cases large picture frame) was performed. Morphological evaluation of synovial biopsies was done in 34 pts with PA and 10 pts with rheumatoid arthritis (RA). Results. Different types of osteolysis were revealed in 80 (21,6%) pts. Osteolytic variant of joint damage was present in 29 pts. 33 pts had acral, 48 — intra-articular osteolysis and 16 - true bone atrophy. Frequency and intensity of bone resorption were associated with severity of PA. Acral osteolysis correlated with arthritis of distal interphalangeal joints and onychodystrophy. Intra-articular osteolysis was most often present in distal interphalangeal joints of hands and metacarpophalangeal joints (39,6% and 41,7% respectively). Characteristic feature of PA was combination of prominent resorption with formation of bone ankylosis and periosteal reaction. Ankylosis was present in 33,3% of pts with intra-articular osteolysis and in 60% of pts with combination of different osteolysis variants. Systemic reaction of microcirculation in synovial biopsies was most prominent in osteolytic variant: marked thickening of capillary and venule basal membrane with high level of acid phosphatase, increased capillary and precapillary blood flow with stasis features, vascular lymphocyte and macrophage infiltration, productive vasculitis with annular wall thickening, thrombovasculitis and villi deep layer sclerosis. Conclusion. Different variants of osteolysis show bone involvement in PA. Acral and intra- articular osteolysis association with bone ankylosis and periostitis proves their common pathogenetic entity.

Objective. To study relationship of anemic syndrome with inflammation activity measures in pts with rheumatoid arthritis (RA). Material and methods. 177 pts with RA fulfilled 1987 ACR criteria were included. 132 from them had anemia at the examination. Results were processed with complex of descriptive, structural and multivariate statistics. Results. Close relationship of RA clinical features with erythropoiesis disturbances clinically manifesting with anemia development was proved. Critical hemoglobin level (<113 g/1) was determined at which pathological processes in erythron leading to the development of anemia begin significantly influence severity of immunopathological rheumatoid process. Diapasons of disease activity measures were revealed associated with anemia presence or absence in pts with RA. Diagnostic value of studied measures diapasons for prognosis of anemia development in RA was determined. Conclusion. The results of the study allow developing criteria for prognosis of anemia appearance in RA pts with normal blood concentration of hemoglobin. Such method could help to reveal early disturbances of erythron and improve RA treatment schemes with erythropoiesis modulating drugs.

Objective. To study features of bioenergetic processes in synovial fluid (SF) in osteoarthritis (OA) and to reveal influence of chondroitin sulfate (Structum) on these processes. Material and methods. SF bioenergetic parameters were analyzed in 15 pts with knee OA receiving structum. SF bioenergetics was assessed with classic enzyme tests and polarographic analysis of oxygen consumption speed by SF cells. Physiological biochemical measures were compared during exacerbation and after treatment. Results. SF pH in OA is significantly shifted to the acidic diapason and bioenergetic processes are transformed with decrease of synovial tissue cells energetic potential (decrease of ATP level and engaging reserve energetic mechanism of creatine phosphate spending). Pharmacological correction of SF cells energetic metabolism can be achieved with chondroprotector structum. Conclusion. SF bioenergetics in OA is changed with glycolysis activation, engaging reserve bioenergetic mechanisms, creatine phosphate catabolism up regulation, and increase of dissociation between respiration and oxidative phosphorylation. pH shift to more acidic zone (from normal 7,4 to 6,85 in OA) is a trigger of OA exacerbation. Substitutive therapy with polyanionic drug structum normalizes SF pH and bioenergetic parameters already after three months.

Objective. To study quality of life (QL) measures in pts with early knee osteoarthritis (OA) with SF-36. Material and methods. 102 outpatient pts with early knee OA were included. Mean age was 48,3± 12,7 years, mean OA duration - 10,5±7,9 months. 33,3% of pts had 0, 42,6% - I, 20,5% - II stage of knee OA. According to sonographic examination of knee joints the patients were divided into two groups: group I without synovitis and group II — with synovitis of the knee joints. 50 healthy volunteers were included in control group. QL was assessed with SF-36. Results. All QL measures in early knee OA pts were lower than in control. There was significant difference of physical functioning, role physical functioning (RPF), social functioning (SF) and role emotional functioning (REF) (p<0,05). Pts of group II had significantly lower RPF and REF than group I pts (p<0,05). Conclusion. QL of pts with knee OA decrease at early stage of the disease what requires administration of proper therapy as soon as possible after verification of the diagnosis.

Objective. To perform a comparative assessment of methotrexate and sulfasalazine efficacy when administered as monotherapy and in combination with low doses of GC in early RA considering disease activity and erosions development in joints of hands and feet. Material and methods. 124 pts with RA fulfilled ACR criteria were included. This group consisted of 29 males and 95 females with mean age 43,2+12,8 years and disease duration less than 2 years (mean 7,7+4,3 months). 79 from them (63,7%) had rheumatoid factor. Pts were randomized to receive methotrexate 10-20 mg/week (63 pts of group 1 — 50,8%) or sulfasalazine 1500-2000 mg/day (61 pts of group 2 — 49,2%). Prednisolone (PS) 10 mg/day was added to the treatment in pts with high activity of the disease. 27 (42,9%) pts of group 1 and 27 (44,3%) pts of group 2 received PS. DAS 28 was calculated at baseline, after 6 and 12 months of treatment. X-ray of hands and feet was performed at baseline and after 12 months. Results. 53 pts of group 1 (84,1%) and 52 pts of group 2 (85,2%) completed the study. In group 1 DAS 28 decreased from 5,25±1,18 to 3,45±1,23 (p<0,001) after6 months and to 3,17+1,13 (p<0,001) after 12 months. In group 2 DAS 28 decreased from 4,82+0,99 to 4,27±1,07 (p<0,001) after 6 months but after 12 months it increased to 4,60±1,37 and did not significantly differ from baseline level (p=0,295). DAS 28 ingroup 1 after 6 (3,45+1,23) and 12 months (3,17± 1,13) was significantly lower than in group 2 (respectively 4,27± 1,07 and 4,60+1,37, p<0,001). DAS 28 in pts receiving methotrexate and PS after6 (3,46±1,39) and 12 months (3,09+1,10) was also significantly lower than in pts receiving sulfasalasine and PS (4,81 + 1,0 and 5,02+: 1,39 respectively, p<0,001). New erosions appeared in 7,4% of pts receiving methotrexate with PS and in 36% of pts receiving sulfasalazine with GC. Conclusion. Methotrexate administered in combination with GC low doses is an optimal method for treatment of early RA providing decrease of activity and delay of joint erosions development.

Objective. To study influence of artrofoon on clinicolaboratory measures in pts with rheumatoid arthritis (RA). Material and methods. 119 RA pts (97 female, 22 male) were included. 104 of them were seropositive. Mean age was 52,3± 11,2 years, mean disease duration — 6,87+5,89 years. Disease activity level varied from 1 to 3 stage. Most pts had II or III radiological stage of RA. Usual clinical and laboratory examination of pts was performed at baseline and then after 1, 3, 6 and 12 months of treatment. Quantitative examination of serum cytokines was done using biochip technology method of Randox Laboratories Ltd (Great Britain). During the study all pts received standard treatment with disease modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs (NSAIDs). The following NSAIDs were used: diclofenac in 54 pts (not more than 100 mg/day), nimesulid 200 mg/day in 37 pts, other NSAIDs - in 28 pts. The pts were divided into 2 groups. 91 pts of group 1 received artrofoon besides standard treatment. 28 pts of group 2 received only standard treatment. Results. Administration of artrofoon was accompanied by significant decrease of tumor necrosis factor a and interleukin (IL)ip levels after 3, 6 and 12 months of treatment, increase of IL4, IL10 and vascular endothelial growth factor to 6th month, decrease of epidermal growth factor to 12th month of treatment in comparison with control. These changes were accompanied by decrease of laboratory (ESR, CRP) and clinical measures of disease activity (VAS, Ritchie index, morning stiffness). Adverse events were absent in the main group of pts. Conclusion. Artrofoon exerted positive influence on the main clinicolaboratory and immunologic measures in pts with RA. Maximal effect was reached after 6 months of treatment. A part of pts decreased NSAID dose during treatment with artrofoon. The drug was well tolerated and safe during 12 months of treatment. Artrofoon can be administered with other drugs used in the treatment of RA.

Objective. To assess efficacy, local and systemic tolerability of balsam “Mercana-Artrovit warming” (BMAW) containing methylnicotinat, mint and eucalyptus ethereal oils, propylene glycol extracts of eucalyptus, linden, nettle, elecampane, common wormwood, tansy, terpentine oil in knee osteoarthritis (KOA) Material and methods. 60 pts were included in a two-week double blind placebo controlled randomized study. BMAW 5 ml was administered in 30 pts (the main group) twice a day (in the morning and in the evening) on the target knee joint. 30 pts of control group received placebo containing only components of stuff. Demographic and clinical parameters in the main and the control groups were comparable. Inclusion criteria: age from 40 to 70 years, pain intensity in the target joint at least 40 mm on VAS, I-III radiological stage according to Kellgren, Leqesne score 4-10, treatment with NSAIDs during the previous 3 months. Exclusion criteria: indications for intra-articular glucocorticoid injection, clinically significant disturbances of internal organs function and skin damages in the region of knee joint. Clinical efficacy was assessed by WOMAC index, pain at movement and at rest, time of 15 meters walking, general assessment of efficacy (separately by the pt and by the doctor). Frequency and character of adverse events was registered. Results. Local BMAW administration provided statistically significant decrease of WO MAC summated score (p=0,008), pain at movement (p<0,001) and at rest (p<0,005). So analgesic effect of the drug is sufficient for improvement of functional activity of pts with KOA. General efficacy assessment was significantly higher in the main group (Fisher exact test, p<0,005). Placebo did not significantly change efficacy measures. Adverse events were absent in both groups. Conclusion. The results of the study allows to recommend BMAW for local therapy of KOA

Objective. To determine minimal clinically significant changes of quality of life (QL) measures in pts with rheumatoid arthritis (RA) and to develop criteria for therapy efficacy assessment by QL measures. Material and methods. 258 pts with RA fulfilled ACR criteria and receiving standard antirheumatic therapy were assessed at baseline and after 6 months of follow up. The mean age was 51,4± 11,6 years, duration of the disease varied from 1 to 18 years (mean 9,0±8,7 years). 58,8% of pts had rheumatoid factor. 39,9% of pts had moderate and 54,3% - high activity of the disease according to DAS 28. 50,4% of pts had III or IV radiological stage, 42,7% of pts had III or IV functional class (FC). All pts filled validated HAQ, EQ-5D and SF-36 questionnaires. Therapy efficacy was assessed by ACR criteria. Minimal clinically significant changes (MCSC) were calculated according to effect value (EV). EV accordance to difference of QL measures before and after treatment was determined. Results. Minimal difference of values which was interpreted by pts as significant was 0,22 for HAQ, and 0,10 for EQ-5D. Therapy efficacy assessment can be done with following HAQ diapasons. Treatment is not effective if HAQ decrease is less than 0,22. Weak improvement corresponds to HAQ decrease from 0,22 to 0,36. 0,36<AHAQ<0,8 shows moderate improvement and AHAQ£0,8 can be interpreted as good effect. Therapy efficacy assessment with EQ-5D can be performed as follows. Therapy is not effective when AEQ- 5D<0,1. 0,1<AEQ-5D<0,24 corresponds to weak, 0,24<AEQ-5D<0,31 — to moderate and AEQ-5D>0,31 to good clinical response. Conclusion. General QL questionnaires EQ-5D and SF-36 are less sensitive than HAQ in assessment of therapy efficacy.