Objective. To evaluate role of inflammation in pathogenesis of cardiac autonomic dysfunction assessed by heart rate variability (HRV) analyses, in patients (pts) with systemic lupus erythematosus (SLE). Material and methods. 75 female pts with SLE aged before 55 years were included. Control group consisted of 32 healthy women of comparable age. Clinical symptoms, activity degree and main cardiovascular risk factors were assessed. Common carotid duplex scanning with measurement of intima-media thickness, echocardiography, 24 h ECG ambulatory recording with determination of time domain parameters, evaluation of serum inflammation markers level (CRP, IL-6, TNFa) were performed. Results. HRV time domain parameters adjusted by McanNN - SDNNn%, SDNNin%, rMSSDn%, pNN50% in women with SLE were lower than in healthy control. HRV parameters inversely correlated with inflammation markers in SLE (p<0,05). SLE pts were divided into 4 groups: 1 (n=12) - pts with low HRV parameters and high level of IL-6; 2 (n=13) - low HRV and normal IL-6; 3 (n=6) - normal HRV and high IL-6; 4 (n=44) - normal HRV and IL-6. SLEDA1 2K, left atrium size, levels of markers of inflammation in group 1 were higher, then in group 4 (p<0,05). Hypertension, dyslipidemia, smoking and subclinical atherosclerosis of carotid arteries were more frequent in group 2 compared to group 4 (p<0,05). Conclusion. These results suggest important role of autoimmune inflammation in pathogenesis of cardiac autonomic dysfunction in SLE pts with high disease activity and traditional cardiovascular risk factor, atherosclerotic changes - in low SLE activity. HRV, traditional cardiovascular risk factors and inflammatory markers combined measurement can help to identify subjects at risk of cardiovascular mortality among SLE pts.

Objective. To assess rheumatologic aspects of modern infectious endocarditis (IE) and to determine role of anti-inflammatory therapy in complex treatment of the disease. Material and methods. 50 pts with IE (24 female, 26 male aged 16 to 60 years were included). Primary IE was diagnosed in 15, secondary - in 35 cases. 7 pts had acute and 43 — subacute course. 40 pts had definite and 10 — probable IE. Results. Mean period till correct diagnosis establishment was 112± 116,5 days. Diagnostic difficulties were more frequent in subacute variant of IE (p=0,03). Heart diseases prevailed among cardiac risk factors (p=0,0l). Clinical picture of IE was very polymorphous. Glucocorticoids (GC) were administered to 21 pts in addition to antibiotics due to signs of organ immunopatology and high laboratory measures of immune activity. Positive effect of glucocorticoids was achieved in 64% of pts. Conclusion. Development of immunological changes complicates timely diagnosis of IE and requires exclusion of different diseases including rheumatic pathology. IE treatment strategy does not exclude administration of GC low doses for prominent immunopathological signs in addition to massive antibacterial therapy.

Objective. To assess frequency of immunogenetic (HLA-DRB I allels) and immunologic - anti-cyclic citrullinated peptide antibodies (ACCP), IgM rheumatoid factor (RF) - parameters and their significance as markers of early rheumatoid arthritis (RA). Material and methods. HLA-DRB 1 alleles, ACCP and IgM RF were evaluated in 95 pts with early RA who fulfilled ACR criteria 1987 with disease duration 2 years or less. In 85,3% of them disease duration was <12 months. 135 blood donors without autoimmune diseases and relevant compromised inheritance. Basic low-resolving oligo-typing of HLA- DRB 1 gene and high-resolving oligo-typing of HLA-DRB 1*04 alleles was performed with multiplex polymerase chain reaction. ACCP2 and IgM RF levels were evaluated by immunoenzyme assay and nephelometric immunoassay with commercial kits. Results. Early RA group showed higher frequency of HLA-DRB 1 allele than control group (45,3% and 15,6% respectively, OR=4,5, 95% Cl 2,3-8,7). *05, *06 and *07 alleles in RA group were significantly less frequent than in control. *0401 allele was most frequent (25,3%) among HLA-DRB 1*04. Double dose SE+/SE+ (double set of any from *01,*0401, *0404, *0405, *0408, *10) was revealed in 33,7% of RA group pts and in 5,2% of cases in control group (OR=9,3, 95% Cl 3,7-24,6, p=lxl0 7). Absence of SE alleles (SE-/ SE-) in RA group was negatively associated with RA development (OR=0,28, 95% Cl 0,20, 5). In RA pts homozygote *0401/*0401 genotype was significantly more frequent among SE+/SE+ genotypes than in control group (17,8% and 1,5% respectively, OR=14,5, 95% Cl 3,1-93,4, p<0,0001). In RA group ACCP diagnostic level was revealed in 60,0% of cases, IgM RF — in 71,6% of cases. Most close relationship existed between ACCP and RF (r =0,66, p<0,05), less prominent — between SE and ACCP (r s=0,34, p<0,05). Correlation relationship between SE and RF was not revealed. In presence of at least one SE allele RF concentration was 280,4±414,3 lU/ml, in absence — 83,1 + 176,1 lU/ml (p<0,01). ACCP level in SE presence and absence was 56,2±44,6 lU/ml and 27,5±41,2 IU/ml respectively (p<0,01). Conclusion. HLA-DRB 1 (SE+) allele, ACCP and RF are significant markers of early RA development risk but ACCP and RF have diagnostic significance.

Objective. To study the prevalence of osteoarthritis and joint complaints among urban and rural inhabitants Material and methods. Simultaneous cross-sectional epidemiological study among inhabitants of Revda town and nine rural settlements of Nevijansk farmland in the Sverdlovsk region. Results, questionnaire-based survey showed that the prevalence of joint pain and complaints of joint swelling was higher in the rural population (44,9% and 16,7% correspondingly) compared to town population (26,4% and 6,7% correspondingly), p<0,05. Prevalence of OA in town (11,4%) and in rural population (11,2%) was similar. Higher prevalence of joint complaints in rural population is attributed to higher rate of soft tissue and vertebral involvement, and platypodia. Prevalence of OA in women was almost 3 times higher than in man (town women — 17,8%, town men — 3,7%; rural women — 15,7%; rural men — 5,4%). Age-specific features were also identified. Prevalence of OA in rural population was higher in age group under 50 years (3,18% in town population compared to 7,66% in rural population for age group 41 -50 years), but after 70 years prevalence of OA became significantly (p<0,05) higher in town population (40,34% in town population compared to 20,51% in rural population forage group 71-80 years), and started to decrease in rural population. Conclusion. Joint complaints (pain and swelling) arc common signs in both rural and town population in the Urals, Ihey are more prevalent in older age groups and in rural population. OA prevalence was similar in town and rural population, because joint complains in rural populations were attributed to soft tissue and vertebral involvement, and platypodia.

Objective. To assess frequency of knee and/or hip joint pain in Saha (Yakut) republic niral inhabitants. Material and methods. Population eross-sectional epidemiological study was performed in 7 rural settlements. 3401 inhabitants filled the questionnaire (53,9% - female, 46,1% - male, mean age 44,4± 14,1 years). 52,5% of them were in middle age (30-49 years). Completeness of the study was 82,4%. Results. Frequency of pain in knee and hip joints was 44,8%. 38,9% of respondents experienced pain in current year. People with longstanding pain were older (mean age 50,2+13,7 years) than people without pain (mean age 40,9+13,5 years). Pain was more frequent in female (OR= 1,5) and positively correlated with age (p=0,86, p=0,007), particularly in women (p=0,93, p=0,0009). Maximal frequency of pain (56,6%) was found in respondents aged 70-79, minimal — 18-19 years. Conclusion. High frequency of knee and hip joint pain was revealed in Saha (Yakut) republic rural inhabitants in history and in current year. Pain was more frequent in female and increased with age.

Objective. To assess efficacy and tolerability of leflunomide in elderly pts with rheumatoid arthritis (RA). Material and methods. 46 pts with RA aged 65 years and older (35 female and 11 male) were included in a retrospective study. All pts received leflunomide according to standard scheme or in combination with methotrexate, infliximab, rituximab. Ritchie index, DAS 28, ESR, anemia intensity, platelet count and functional disability (HAQ) were used as activity measures. Mean follow up period was 11 months. Statistica 7 program was used for data processing. Results. Ritchie index, DAS 28 and HAQ significantly decreased during follow up. Level of laboratory markers of inflammation, serum creatinine and glomerular filtration rate did not significantly changed. NSAIDs and glucocorticoid requirement decreased by 50%. The drug was withdrawn due to adverse events (hypertension, diarrhea, toxic hepatitis) in 6 pts. Conclusion. These results show high efficacy and good tolerability of mono- and combined disease modifying therapy with leflunomide and allow to recommend it as drug of choice for treatment of rheumatoid arthritis in elderly pts

Objective. To study efficacy and tolerability of Normase® (lactulose, Doctor Reddy’s laboratories) for correction of stool disturbances in pts with rheumatic diseases (RD). Material and methods. 50 pts with RD (female with mean age 64,2+19,6 years) suffering from constipation (stool frequency less than 3 times a week) at least for 3 months were included. Lactulose 30 ml was administered once a day in the evening. In the absence of effect dose was increased to 60 ml, in case of prominent effect — decreased to 15 ml. Duration of treatment was 2 weeks. Dejection frequency from 8 lh to 14 ,h day and changes of general health connected with bowels function (on VAS) were used as outcome measures. Results. Results of treatment were assessed in 48 pts. Two pts were lost to follow up, in two the drug was withdrawn due to adverse events (haemorrhoidal bleeding increase in one and prominent wind in another). Stool normalization was achieved in 12, significant improvement (increase of dejection frequency at least by 50%) — in 19 (39,6%), insignificant improvement (increase of dejection frequency less than by 50%) — in 9 (18,7%) pts. In 6 pts (12,5%) effect was absent. Mean dejection frequency significantly increased from 1,8+0,4 to 4,1 ±1,7 times a week (p<0,001) Conclusion. Lactulose is effective and relatively safe drug for treatment of chronic constipation in pts with RD and can be recommended for wide administration in rheumatological practice.

Objective. To determine frequency of anti-cyclic citrullinated peptide antibodies (ACCP) and anti-modified citrullinated vimentin antibodies (AMCV) elevation and their diagnostic significance in children with early juvenile arthritis (JA). Material and methods. ACCP were evaluated in serum of 80 pts with early JA (36 girls, 44 boys, mean age 8,5±5,03 years), AMCV — in 85 pts with early JA (49 girls and 36 boys) aged from 1,5 to 16 years (mean age 8,7±4,9 years). Disease duration in all children was less than 6 months. Control group included 54 grown up pts with early rheumatoid arthritis (RA), 27 - with undifferentiated arthritis (UDA) and 37 conditionally healthy children. АССР was assessed by immuno-enzyme assay (IEA) with commercial kits “Axis Shield Diagnostics" (Great Britain), upper normal limit 5,0 U/ml. AMCV was examined by IEA with commercial kits “Orgentec Diagnostics” (Germany), upper normal limit — 25 U/ml. Results. ACCP was elevated in 7 children with early JA (8,8%). Frequency was higher than in healthy children but lower than in grown up pts with early RA and comparable with UDA. In juvenile rheumatoid arthritis (JRA) ACCP were more frequent than in juvenile chronic arthritis (JCA). Concentration was higher in rheumatoid factor (RF) positive pts with polyarticular JA. AMCV level was elevated in in 23 (27,1%) pts with early JA (more frequent than in healthy donors but less frequent than in grown up pts with early RA and UDA). AMCV was significantly more frequent in JRA than in JCA and in RF positive than in RF negative pts. AMCV concentration in JA was higher than in healthy children but lower than in grown up pts with RA. It was also higher in RF+ than RF- JA. ACCP and AMCV correlated with swollen joint count, tender joint count and RF. AMCV also correlated with ESR and CRP. Conclusion. In pts with early JA ACCP and AMCV are equally or more frequent than RF. In spite of low sensitivity they have high specificity for JRA in contrast to JCA. Assessment of ACCP itself or in combination with RF and AMCV is of significant importance for prognosis of polyarticular joint damage with risk of significant functional disability development and timely administration of proper quite often aggressive therapy in early stage of the disease.