Preliminary results of interregional program “Social and economic consequences of rheumatic diseases” diagnostic stage are presented.Objective. Clinical examination of persons with joint pathology revealed during screening to determine the diagnosis.Material and methods. A group of persons, who had joint complaints at the examination or during the previous year, was randomly formed according to the results of screening. Thorough uniform clinical examination with participation of a qualified rheumatologist aimed to precise determination of rheumatic pathology character was performed in all cases. During screening 1755 from 2723 persons examined at diagnostic stage positively answered question about presence of joint swelling and 968 complained of pain in knee and hip joints.Results. In 1971 from 2723 persons (72,4%) different rheumatic diseases were diagnosed. Nonrheumatic pathology was revealed in 371 (13,6%), low back pain – in 218 (8%) persons. In 163 (6%) persons no disease was determined. Osteoarthritis (49%) and rheumatoid arthritis (3%) were the most frequent causes of joint complaints. Other RD were revealed in 20%.Conclusion. Preliminary results of program diagnostic stage demonstrated significance of joint pathology problem and allowed to get the first data about structure of RD among adult inhabitants of Russia.

Objective. Transforming growth factor β1 (TGF β1) prevails among growth factors in bone. It is produced by osteoblasts and is able to hamper osteoclast proliferation, activate and stimulate osteoblasts precursors proliferation and differentiation. At present several polymorphisms located in different regions of its sequence have been described for this gene. Several studies have shown an association between some polymorphisms of this gene and bone mass. The objective of the present study was to examine relationship between C-509T polymorphism located in gene TGF β1 promoter region with bone mineral density(BMD). There are only a few studies of relationship of this polymorphism with bone mass 23in European population. Such data for Russian population are not available.Material and methods. C-509T polymorphism was studied with PCR analysis in 159 pts with osteoporosis and in 152 healthy individuals. BMD was assessed in thoracic spine and standard regions of proximal femur with an X-ray bone densitometer.Results. C-509T allele frequencies and genotypes distribution were similar in osteoporosis and control. Mean femur neck BMD in women with osteoporosis was significantly higher in carriers of homozygote CC and heterozygote CT genotypes in comparison with homozygote TT genotype: 0,617±0,091 g/sm2, 0,626±0,064 g/sm2 and 0,555±0,074 g/sm2 respectively (p<0,005, ANOVA). Similar differences of BMD values between these genotypes were found in different femur regions and the whole femur. BMD analysis in CC+CT genotype carriers revealed presence of higher mean BMD values in all femur regions in comparison with TT genotype carriers among women with osteoporosis. Homozygote mutant genotype was not associated with fracture risk.

Objective. To assess possibility of magnetic resonance image (MRI) application for rheu- matoid arthritis (RA) activity and severity assessment.Material and methods. 100 pts with RA who fulfilled the 1987 ACR criteria with disease duration less than 12 months were included. Standard clinical examination with evaluation of tender and swollen joint counts, acute phase markers, hand and foot X-ray and hand MRI with 0,2 T Artoscan apparatus (ESAOTE Biomedica, Italy) were performed.Results. MRI showed hand joint synovitis in 94,5%, erosions – in 67,3% of cases. X-ray examination revealed erosions in only 20,8% of pts. Localization of erosions revealed by X-ray and MRI coincided in 36,4% of cases and in 61,8% of pts erosions were detected only by MRI. MRI confirmed clinical conclusion about presence or absence of metacarpophalangeal and wrist joint synovitis in 64,5% and 74,5% of cases respectively. In8,2% and 21,8% MRI revealed signs of synovitis in clinically intact joints. MRI synovitis score correlated with clinical and laboratory measures of disease activity – DAS 28 (r=0,37, p=0,001), CRP(r=0,30, p=0,001), ESR (r=0,42, p=0,001), HAQ (r=0,24, p=0,001). Weak correlation was revealed between ESR and presence of erosions (r=0,29), CRP, ESR and MRI signs of bone marrow edema (r=0,27, p=0,005 and r=0,29, p=0,002 respectively). Relationship between laboratory and clinical features was weaker and referred only to CRP level and swollen joint count (p=0,05).Conclusion. MRI signs may be used as additional and independent measures of inflammatory activity (particularly synovitis score) and severity of RA

Objective. To compare efficacy of different variants of combined disease modifying treat- ment in rheumatoid arthritis (RA). Material and methods. 46 pts with RA (group 1a) received methotrexate 7,5 mg/week, hydroxychloroquine 200 mg/day, diclofenac 100 mg/day. 36 pts (group 1b) were treated with the same doses of methotrexate and hydroxychloroqune combined with low doses of glucocorticoids (GC). 60 pts with RA were included in group of comparison. 36 from them (group 2a) received methotrexate and diclofenac, 24 (group 2b) – methotrexate, diclofenac and low doses of GC. Folic acid 1-2 mg/day 5 days a week was prescribed to all pts. Efficacy assessment was performed after 6 and 12 months of treatment. Joint inflammation score was used as outcome measure. Results. In group 1a after 6 months good response was achieved in 21,4%, moderate response – in 67,8% and no response – in 10,7%, in group 1b – in 33,3%, 63,3% and3,3%, in group 2a – in 8,3%, 70,8% and 20,8% respectively. In group 2b good response was achieved in 38,3% and moderate – in 61,1%. In group 1 pts significant improvement was achieved earlier and more frequently (p<0,01). After 12 months in group 1b pts good response was more frequent than in group 1a and 2b pts. Adverse events appeared mainly during the first 6 months of treatment in pts not receiving folic acid. Conclusion. In pts receiving combined disease modifying treatment of RA with methotrex- ate and hydroxychloroquine good response was more frequent and no response was less frequent than in those receiving monotherapy with methotrexate.

Efficacy of intraarticular glucocorticoid injections in knee osteoarthritis (OA) is considered to be proved. But authors do not know randomized studies comparing efficacy of intraarticular and periarticular injections of triamcinolone acetonide.Objective. To assess efficacy of intraarticular and periarticular injections of mixture of triamcinolone acetonide (TA) and a local anesthetic (LA) solution in comparison with injections of LA only in pts with knee OA. Material and methods. 86 pts participating in a two-center randomized double blind study ELITA (Efficacy of Local Injection Therapy of osteoArthritis) were included. Each knee joint with pain value higher then 40 mm (on VAS) was randomized for either intraarticular or periarticular injections of novocaine 0,5% 10 ml or its mixture with TA 20 mg. Periarticular injections were performed in regions of ligaments, muscles or tendons insertions. “Pain”, “Activity” and “Functional status” WOMAC scales were assessed at baseline, in 4, 8, and12 weeks after treatment. Results. LA injections were performed in 21 pts (group 1 – control). TA and LA mixture was injected in both knee joints of 8 pts (group 4). Periarticular injections of TA and LA mixture were performed bilaterally in 5 pts (group 6). Group 4 pts had significantly better effect than group 1 pts after 4 (“Pain” and “Functional status” scales) and 8 weeks (“Functional status” scale). Group 6 pts had better results than group 1 pts after 4 (all scales), 8 (“Pain” and “Activity” scales) and 12 weeks (“Activity” scale). In group 6 pts treatment was more effective than in group 4 pts after 4 (all scales), 8 and 12 weeks (“Activity” scale). Conclusion. Efficacy of TA and LA mixture intraarticular and periarticular injections in comparison with isolated LA injections was demonstrated. Effect persisted for at least 8 weeks. Periarticular injections were more effective than intraarticular.

Objective. To study comorbid depression influence on course of rheumatoid arthritis (RA)and antidepressants efficacy in such pts. Material and methods. 70 pts with RA (all women) fulfilled the 1987 ACR criteria with comorbid depression disturbances were included. 30 from them received course of treatment with antidepressants (main group). 20 refused proposed therapy (main control group). 20 RA pts without depression were included in an additional control group which was also followed up. Hamilton scales of depression and anxiety were used. Results. Baseline clinical measures did not significantly differ between study groups. Antidepressants application in main group pts was accompanied by significant improvement of tender and swollen joint count, morning stiffness duration, pain intensity (score),functional disability index (FDI) after 3 months (<0,001,<0,001, <0,01, <0,001,<0,001). This improvement further increased to sixth month of follow up. Comparison of main and additional control groups showed better outcome in the absence of comorbid depression and its negative influence on results of treatment. Conclusion. Effective treatment of depression with modern antidepressants (selective inhibitors of reverse serotonin capture) in pts with RA improves clinical course of the disease, its prognosis and pts quality of life.

A case of an adverse skin reaction to leflunomide in a pt with juvenile chronic arthri- tis is described. Literature review of leflunomide induced skin reactions is presented. Leflunomide administration guidelines are discussed.