Objective. To study prevalence of clinical and subclinical atherosclerosis signs in men with systemic lupus erythematosus (SLE) and antiphospholipid syndrome, to assess relationship between atherosclerotic vessel damage, risk factors, CRP and anti-cardiolipin antibodies (АСА) Material and methods. 62 pts were included. Mean age was 35,7+11,6 years, mean disease duration - 129,3± 102 months. Traditional and related to the disease risk factors were analyzed. To reveal atherosclerotic vessel damage carotid sonographic examination was performed. Serum CRP concentration was evaluated by high sensitivity nephelometric immunoassay. IgG and IgM АСА were assessed by solid-phase immuno-enzyme assay. Results. Sonographic signs of carotid damage was revealed in 58% of pts, clinical signs of atherosclerosis - in 42%. Pts were divided into two groups according to intima-media complex thickness (IMCT). Group I included 36 pts with atherosclerotic vessel damage signs (IMCT?0,9 mm). Group 2-26 pts with IMCT<0,9 mm. Mean age at the examination, age of disease onset, disease duration, smoking frequency damage index in group I pts were higher than in group 2 pts. Mean CRP concentration in atherosclerosis group was significantly higher than in group 2 (p=0,007). 19 pts had APS signs. 43 pts did not. CRP level significantly correlated with IMCT in SLE pts with and without APS (p<0,05). Pts with atherosclerosis had higher IgG АСА level though the differences were not statistically significant. Conclusion. Men with SLE with or without APS have high risk of atherosclerosis development. CRP elevation is associated with IMCT increase.

Objective. То study frequency and clinical significance of different antiphospholipid antibodies (APHLA): anti- cardiolipin (АСА), anti-?2 glycoprotein (AB2), anti-annexin V (AAV) and autoantibodies to oxidized low density lipoproteins (AOLDPL) in pts with systemic lupus erythematosus (SLE) with and without antiphospholipid syndrome (APS). Material and methods. 68 pts (14 male, 54 female, mean age 35,2+11,4 years) followed up in the Institute оГ Rheumatology were included. 45 of them had SLE and 23 - primary APS. 24 from 45 SLE pts had signs of APS. Only instrumentally verified thromboembolic events were recorded. 43 from 68 (63,2%) pts had history of thrombosis. АСА, AB2, AAV and AOLDPL serum level was examined with immuno-enzyme assay. IgG АСА level was in the Institute of Rheumatology of RAMS and in the Institute of Rfeumatology of Warsaw. Lupus anticoagulant was tested with phospholipids-dependent method in platelet depleted plasma. Results. IgG АСА were more frequently revealed in the Institute of Rheumatology of RAMS and were associated with the presence of APS. In the Warsaw laboratory IgG positivity in SLE was revealed in 29%, in SLE+APS - in 33%, in primary APS - in 39%. in half of the pts IgG АСА level was doubtful or low-positive. Thromboembolic events were associated with the presence of IgG AB2 (mean level 0,292 U of OP, median 0,157, minimum - 0,049, maximum 0,994, interquartile dispersion 0,251). Mean level in the absence of thrombosis was 0, 178 U of OP (median 0,112, minimum - 0,440, maximum 0,834, interquartile dispersion 0,100), p=0,003 according to Mann-Whitney test. There was no statistical dependence between IgG АСА, IgG AAV and Ihrom- boembolic events but very high levels of antibodies were present in the group of pts with thromboses. There was a correlation between SLE activity and high AOLDPL level. Mean value of SLEDAI scale in 16 SLE pts with high AOLDPL level was 22,6+4,34 compared with 8,37+3,52 (p=0,000I) in 22 SLE pts not having these antibodies. Conclusion. Presence of IgG AB2 is associated with thromboses independently of their localization. Presence of AOLDPL was associated with disease activity.

Objective. To characterize early damage index (EDI) and prove its usefulness for prognosis of systemic lupus erythematosus (SLE) outcome. Material and methods. 154 SLE pts followed up at the Institute of Rheumatology (1R) of RAMS between 1982 and 2001 were included. 47 from 154 pts examined at the 1R during the first 1,5 years from the beginning of SLE ("early disease period") were selected. Results. High frequency of cardiovascular (27,7%) and nervous (26%) system damage during the first 1,5 years of the disease was revealed. Musculoskeletal (12,8%), renal (10,6%) and eye (8,5%) damage was less frequent. EDI significance for prognosis of SLE outcome was shown.

Objective. To study hypertension prevalence in pts with rheumatoid arthritis (RA). Material and methods. Medical documentation of 1622 pts with RA (88% of all RA pts followed by city rheumatologists) was studied. Pts with proved hypertension were identified. Blood pressure in the other RA pts was measured during 5 days. 732 RA pts had hypertension and 886 pts did not. Results. Among RA pts olderthan 18 years hypertension was more frequent than in general population - 45,24%. Hypertension prevalence in RA pts increased with age. Maximal hypertension frequency was revealed in female RA pts aged 40 to 59 years.

Objective. To study joint complaints frequency and rheumatoid arthritis (RA) prevalence among republic of Ingushetia residents. Material and methods. Questionnaire study of a random population ofNasran city residents (4000 people) and general questionnaire study of several refugee temporary settlements (2000 people) with subsequent examination of all 270 people having joint swelling during the last year. Results. Knee and/or hip joint pain frequency among Ingushetia residents is 27,6%. It increases with age and reaches 100% among people older than 70 years. About 12% of people had history of joint swelling during the last year or earlier, 2% had joint swelling during the last year. Prevalence of RA among Ingushetia residents is 0,56% Conclusion.

Objective. To assess efficacy and safety of leflunomide in the treatment of early rheumatoid arthritis (RA). Material and methods. 30 pts with RA aged 18 to 67 years were examined. 17 pts with disease duration less than 6 months (mean 3,6±2,6 months) were included in group 1 and 13 pts with disease duration from 6 months to 3 years (mean 1,8+1,3 years) - in group 2. DAS 28, ACR criteria, patient's general health, pain, HAQ, Keitel functional test and laboratory indices were used as outcome measures. Leflunomide was administered 20 mg/day during 12 months. Results. Significant decrease of RA activity indices was achieved during 3 months in both groups. Group 1 pts showed progressive improvement during the whole period of the treatment. Group 2 pts had the most prominent decrease of activity after 6 months of the treatment. Later some of them showed tendency to deterioration of several parameters. In 10 (58,8%) pts of group I clinical remission was achieved by the 6th month. The treatment was stopped because of adverse events in 4 pts. Serious adverse events were absent. Conclusion. Leflunomide (arava) is a highly effective and well tolerated disease modifying drug for the treatment of early RA. Leflunomide was more effective in pts with disease duration less than 6 months.

Objective. To study actovegin efficacy in the treatment of chronic skin ulcers due to ulceration of tophuses in pts with chronic tophaceous gout. Materials and methods. 6 pts with chronic tophaceous gout aged 52 to 77 years with disease duration from 6 to 20 years with longstanding persisting skin ulcers due to tophuses ulceration were included. In addition to allopuri- nol, steroid and nonsteroidal anti-inflammatory drugs they were treated with actovegin 20% intravenously and local applications of 2% actovegin gel. Clinical examination was performed before and after the course of therapy- Results. Two from six pts showed healing of single chronic ulcers to the end of the treatment course. In the remaining pts ulcer count and size decrease was achieved. Conclusion. Actovegin administration in combined therapy of chronic skin ulcers in pts with chronic tophaceous gout promoted healing of the defects in all cases.

Objective. To assess clinical efficacy and tolerability of "Karmolis" liquid (KL) in pts with osteoarthritis (OA) and rheumatoid arthritis (RA). Material and methods. 230 RA pts and 123 OA pts were included. KL was applied on the most damaged joint surface 10 ml 4-5 times a day with subsequent massage. The course of the treatment continued for three weeks. Joint pain at rest, at movement and at palpation so as joint swelling were used as efficacy measures. Treatment efficacy was assessed at day 1, 7, 14 and 21. Possibility of NSAID dose decrease was also recorded. Results. KL administration provided significant decrease of joint pain at rest, at movement and at palpation already to day 7 as in RA as in OA pts. The improvement then persisted during the rest period of treatment. Joint swelling disappeared to the end of the treatment in 141 from 209 RA pts having such changes at baseline. 74% of RA pts considered KL efficacy very good and good. Synovitis signs disappeared after the treatment with KL in 52 from 65 OA pts. Vfcry good and good results were achieved in 102 (83%) of OA pts. 76 RA pts (33%) and 73 OA pts (53%) could decrease NSAID dose. Adverse events were very seldom and did not require treatment termination. Conclusion. KL in effective in complex treatment of RA and OA. It decrease pain and inflammation and may be recommended for wide administration in the treatment of inflammatory and degenerative joint diseases.

Objective. To study efficacy and safety of ibandronat, highly active nitric-containing bisphosphonat in 3-year treatment of pts with postmenopausal osteoporosis using different doses and schemes of treatment. Material and methods. The study was performed as a part of a multicenter double blind placebo-controlled randomized clinical study (BONE study). 85 female aged 55 to 80 yeare with 5-year or longer duration of postmenopausal period having from one to four vertebral fractures and lumbar bone mineral density (BMD) from - 2,0 to -5,0 SD according to T-count were included. The pts were randomized onto three groups: 1 - placebo, 2 - ibandronat 2,5 mg daily, 3 - ibandronat 20 mg every other day during the 24 days (12 doses) every 3 months. Results. After 3 years of treatment pts of group 2 and 3 showed significant increase of lumbar, femoral neck and total femoral BMD (5,9% and 5,8%, p<0,01, 2,0% and 1,9%, 3,3%(p<0,01 and 2,2% respectively). Ibandronat was well tolerated and its adverse events of were comparable with placebo.

Brief information about modem osteoarthritis treatment with simple analgesics, NSAIDs and chondroprotective drugs is presented. Results of a clinical study of ARTRA in combination with diclofenac (31 pts) comparing with diclofenac only (31 pts) for the treatment of knee osteoarthritis ofll-lll stage are discussed. ARTRA was administered 2 capsules a day during a months and than 1 capsule a day during 5 months. A mean therapeutic dose of diclofenac was given to all pts. ARTRA with diclofenac was more effectively than diclofenac monotherapy improved WOMAC functional index and suppressed pain on visual analog scale and WOMAC. ARTRA was well tolerated.

Objective. To study outcome and prognosis in pts with juvenile idiopathic arthritis (JIA). Material and methods. 239 JIA pts with disease duration of 10 years and more were analyzed. 80 children and adolescents before 18 years old (66 girls and 14 boys) were included in group 1. Arthritis clinical and laboratory activity, radiological stage and functional status according to Steinbroker and CHAQ questionnaire were assessed. 159 grown up pts (109 female and 50 male) suffering from JIA from childhood were included in group 2. They were examined using Stanford Health Assessment Questionnaire (HAQ) and a specially developed social status questionnaire. Results. Half pts of group 1 had recurrence of the disease during examination but activity in most cases did not exceed stage I or 2 (54% and 31% respectively). Joint destructive changes were revealed in 50% of pts. 80% of pts had radiological signs of secondary osteoarthritis. Amyloidosis was revealed in 2 from 27 pts with systemic type of JIA. 68% of pts had 1 or 2 functional class. 1/3 of pts did not have functional limitations (CHAQ=0). 13% of pts had maximal disability with CHAQ ranging from 2,1 to 3,0 (pts with polyarticular and systemic types of JIA. Most grown up pts (59%) considered their health as good. Substantial part of them worked or learned. 10 pts did not worked because of the disease (1,5%). 61% of pts did not have functional limitations (HAQ=0). 32% of pts were disabled. Most of them had 3 or 2 disability degree and had possibility to work. Conclusion. Substantial part of pts with longstanding JIA have stabilization of the disease or remission. Recurrent course of the disease was characterized by decrease of activity. Most children and grown ups with longstanding disease have relatively benign functional outcome. Pts with polyarticular and systemic types of JIA require especial attention because they have maximal risk of joint destruction with severe disability.

Objective. To study prevalence of joint pain and swelling among children of Bashkortostan republic (BR). Material and methods. A questionnaire study was conducted in 2 cities and 4 country districts of BR. A questionnaire developed by the Institute of rheumatology of RAMS and adapted for children was used. 43907 children aged 0 to 17 years were included. Results. 5490 children and/or their parents (12,5%) reported joint pain, 754 children (1,7%) - swelling. In general pain and swelling were revealed in 5533 children (12,6%). Joint pain and swelling prevalence was higher in urban than in country population. Joint pain predominated in girls, swelling - in boys. Swelling and pain frequency increased with age. It reached maximum by adolescence (12-17 years) but differences in joint pain frequency between children aged 12 to 14 and 15 to 17 were not statistically significant. Conclusion. Joint complaints (pain and/or swelling) are quite frequent among children and adolescents (12,6%). At present the second phase of the study is being conducted: advanced clinical, laboratory and instrumental examination of children having joint symptoms.

PFAPA (periodic fever, aphtous stomatitis, pharingitis, cervical adenitis) or Marshall’s syndrome is one of the rare periodic fever conditions appearing in children. Its cause is unknown. This syndrome may continue for several years. During interictal period the child is quite well, grows and develops normally. The disease should be differentiated from Behcet’s disease, cyclic neutropenia, familial Mediterranean fever, familial Ireland fever, hyperimmunoglobulinemia D syndrome, systemic juvenile idiopathic arthritis, chronic tonsillitis, some infectious diseases. Many drugs are used for the treatment of PFAPA syndrome: antibiotics, non-steroidal anti-inflammatory drugs, chloroquin, antiviral drugs, glucocorticoids, cimetidin. Tonsillectomy is used quite often. Analysis of the literature data shows that best results may be achieved with tonsillectomy (sometimes in combination with ade- notomy). PFAPA in a child of 2 years age diagnosed for the first time in Russian pediatric rheumatology is described.

Correction of hip flexion contracture in a patient with ankylosing spondylitis was performed by a relatively low traumatic operation on soft tissues - subspinal myofascioiomy of left hip muscles with partial elongation of quadriceps straight part and left hip joint capsulotomy which provided correction of pt bearing.