The efficiency and safety of therapy with abatacept in combination with methotrexate were studied in patients with rheumatoid arthritis. The performed therapy was shown to reduce the activity of an immune inflammatory process and the magnitude of articular syndrome and to improve the patients' functional status.

Objective: to study the effect of a drug of omega-3 polyunsaturated fatty acids (omega-3 PUFA) in patients with early undifferentiated peripheral arthritis (UPA) on the development of rheumatoid arthritis (RA), the induction of remission, the use of disease-modifying antirheumatic drugs (DMARDs), the immunological manifestations of the disease during a 12-week follow-up. Subjects and methods. The study enrolled 40 patients with UPA and a symptom duration of less than 12 months, who took nonsteroidal anti-inflamma tory drugs (NSAIDs) and omega-3 PUFA (Vitrum Cardio Omega-3) as one capsule twice daily for 12 weeks. A control group comprised 20 patients with UPA receiving therapy with NSAIDs for 3 months. The groups did not differ significantly (p > 0.05) in age (42.98±10.81 and 48.25±13.92 years), the duration of symptoms (6.73±2.81 and 5.95±2.54 months), the number of patients positive for rheumatoid factor [14 (35%) and 7 (35%)] and antibodies to cyclic citrullinated peptide [9 (22.5%) and 7 (35%)] patients, the duration of morning stiffness (35.6±25.82 and 37.0±19.15 min), the number of swollen (3.08±1.39 and 3.30±1.21) and tender (3.63±1.63 and 3.85±1.69) joints, and DAS 28 (4.21±0.65 and 4.35±0.63). Results. The use of omega-3 PUFA did not affect significantly the incidence of RA and the use of DMARDs. Clinical remission and low DAS28 were considerably observed in the study group patients, but no statistical significance was achieved. The dose of NSAIDs, including on-demand drugs, was decreased in 22 (55%) and 4 (20%) patients in the study and control groups, respectively (p = 0.013). At 12 weeks, the study group showed signifi cant reductions in the number of tender joints, the duration of morning stiffness, erythrocyte sedimentation rate, DAS 28, and interleukin 6 levels (p < 0.05); no significant changes were found in the control group. There were no significant differences in the frequency of undesirable events. Conclusion. Omega-3 PUFAs contribute to the control of the activity of an inflammatory process, show some immunomodulatory properties, and can optimize the use of NSAIDs in patients with early UPA.

Objective: to study the efficacy and safety of the endothelin 1 receptor inhibitor traclir in patients with pulmonary hypertension (PH) asso ciated with systemic connective tissue diseases. Subjects and methods. The study included 4 patients: 3 with scleroderma systematica and 1 with exanthematous lupus erythematosus. The diagnosis of PH was established on the basis of right heart catheterization data and after exclusion of all its other causes of HP. In addition to hemodynamic evaluation, the female patients underwent echocardiography (EchoCG), lung function tests, 6-minute walk test, and blood biochemical study (determination of uric acid levels). Traclir was given in a dose of 62.5 mg twice in the first 4 weeks of the study and then in a dose of 125 mg twice for the subsequent 12 weeks. Every 4 weeks, the levels of transaminases were monitored and a pregnancy test was carried out in patients of fertile age. Results. After 16-week intake of the drug, all the female patients were found to have obvious positive changes as a longer 6-min walk test distance and two female patients had improvement in the functional class of PH. Estimation of hemodynamic parameters suggested a posi tive effect in all the female patients, as confirmed primarily by an increase in cardiac index and a reduction in pulmonary vascular resist ance. According to EchoCG data, there was a substantial increase in tricuspid annular plane systolic excursion; other parameters had no informative value. During traclir therapy, there was also an increase in lung diffusion capacity and a reduction in uric acid levels. There were no adverse events throughout the trial. Conclusion. Thus, the experience with traclir used in patients with PH associated with systemic autoimmune diseases suggests its high effi cacy and safety.

Objective: to comparatively assess risk factors for gout in male and female patients with this condition. Subjects and methods. The study enrolled 340 gouty patients (289 men and 51 women) examined in the period 2002 to 2009. The diagno sis corresponded to the criteria developed by S.L. Wallace. The mean age was 52.3±11.4 years for the women and 52.3±10.4 years for the men. The study group included female patients with gout and a comparison group comprised male patients with this condition. All the patients were interviewed using a questionnaire to identify risk factors for gout: the regular use of diuretics or alcoholic beverages before the onset of this disease, the presence of arterial hypertension (AH), and menopause in women. Results. The intake of diuretics before gout was reported by 57% of the women and 19.7% of the men (p < 0.00001). The drugs were given to all the men according to medical indications; 10 of 29 women took diuretics to lose weight. Alcohol was consumed more than twice week ly by 17.6% of the women and 33.6% of the men (p = 0.032). The median weekly alcohol consumption was 2 (range 1-4) conventional units (CU) in the women and 4 (range 2-10) CU in the men (p = 0.002). AH occurring the onset of gout was found in 30 (59%) women and 136 (47%) men (p = 0.13). Menopause developing prior to the onset of gout was noted in 26 (51%) women. Conclusion. Among possible causes of gout, the use of diuretics is more common in the women than in the men, moreover, the former take them unfairly in one third of cases. The women consume alcohol less frequently and in smaller quantities, but the rate of female intake of alcoholic beverages is associated with younger age at the onset of gout. In early menopause or amenorrhea, gout more frequently occurs at a young age. AH is a common risk factor for gout in both the women (59%) and the men (47%).

Subjects and methods. One hundred and eighty-three patients with valid rheumatoid arthritis (RA) were examined to study the specific fea tures of chronic pain syndrome. The DN4 neuropathic pain diagnostic questionnaire was used to divide all the patients into 2 groups: 1) 78 patients with the neuropathic component of pain (NCP) and 2) 105 patients without the latter. Results. A clinical neurological examination could reveal peripheral nervous system lesion in 96% of Group 1 patients and in 4% of Group 2 ones. The patients with NCP were ascertained to be older, they were longer ill with RA, had higher clinical, X-ray stages and functional class, as well as higher pain intensity. However, no differences were found between the two groups in the values of disease activity (DAS 28) and erythrocyte sedimentation rate. There was a high rate (71%) of depressive disorders, the prevalence and degree of which in RA patients were determined by the characteristics of disease severity and did not depend on the presence of NCP. Discussion. The performed study demonstrated that, along with an obligate nociceptive mechanism, the patients with RA had neurogenic and psychogenic components of pain in 43 and 71% of cases, respectively. Consequently, chronic pain syndrome in RA is commonly mixed and both the activity of the inflammatory process and the magnitude of neurogenic and psychogenic components should be borne in mind for optimal pain control.

Objective: to study the course of rheumatoid arthritis (RA) in able-bodied patients according to the data of a hospital registry. Subjects and methods. A group of 423 (65.9%) able-bodied patients (18-60-year-old men and 18-55-year-old women) was singled out in the reg istry of inpatients (n=642). The study was performed using 70 parameters including sociodemographic, clinical laboratory, and functional signs. Results. In the study group, the able-bodied patients with RA aged less than 30 years were 5.2%; those aged 31 to 40, 41 to 50, and over 50 years were 14.9, 46.6, and 33.3%, respectively. There was a female preponderance (79.0%) in the all age groups. The disease duration of less than 1 year was observed in 7.6 cases; that of 1 to 2, 2 to 10, and more than 10 years was in 14.2, 44.4, and 33.8% of cases. The age peak of onset was noted at 31-50 (44±5.0) years of age. Among the examinees, 55.1% of the patients were unemployed; 54.5% were disabled, including 34.5% who had Groups I and II disability. Seropositive RA was recorded in 93.6% of cases; second- and third-degree activity of the pathological process in 79.7%; erosive arthritis (Stage II–IV RA) in 83.4%; Functional Class III or IV in 85.6%. Conclusion. The findings suggest that RA is an urgent problem for able-bodied persons, which determines the need for improving its early diagnosis at the primary health care level with the further effective monitoring of the course of the disease and the efficiency of therapy.

Objective: to estimate the value of clinical parameters of uveitis for the diagnosis of spondyloarthritis (SA). Subjects and methods. One hundred and five uveitis patients referred by ophthalmologists to the Research Institute of Rheumatology, Russian Academy of Medical Sciences, in 2007–2009 were examined. X-ray study of the pelvis and lumbar spine, HLA-B27 test, and objective examination were performed in all the patients to detect inflammatory back pain, arthritis, and enthesitis. Results. The diagnosis of SA was verified in 60 patients: 24 had ankylosing spondylitis, 2 had reactive arthritis, and 38 had undifferentiat ed SA. The diagnosis of SA was discarded in 45 patients. Subsequent examination of these patients diagnosed BehНet's disease in 2 of them, sarcoidosis in 1, toxoplasmosis in 4, virus infection-associated uveitis in 8, Fuchs' syndrome in 1, and unspecified uveitis in 29. There was unilateral uveitis in 51 (85%) of the 60 patients with SP and in 26 (58%) of the 45 patients without SP (p = 0.0033); alternat ing eye lesion in 30 (50%) of the 60 patients with SP and in 4 (8.9%) of the 45 patients without SP (p = 0.00001); anterior uveitis in 57 (95%) of the 60 patients with SP and in 32 of the 45 patients without SP (p = 0.0017); posterior uveitis in 6 (10%) of the 60 patients with SP and in 20 (44%) of the 45 patients without SP (p = 0.0001); panuveitis in 2 (3.3%) of the 60 patients with SP and in 10 (22.2%) of the 45 patients without SP (p = 0.0039), acute recurrent uveitis in 15 (33.3%) of the 45 patients without SP and in 44 (73%) of the 60 patients with SP (p = 0.0001). The age at onset was less than 30 years in 38 patients with SP and in 19 patients without SP (p = 0.04). Conclusion. The estimation of the location and course of uveitis is important in diagnosing SP that is probable in patients with acute anteri or unilateral uveitis with alternating eye lesion, which occurred before the age of 30 years.

Objective: to evaluate the efficacy and safety of the zinaxin-glucosamine sulfate (ZGS) complex versus meloxicam in patients with knee osteoarthrosis (KOA). Subjects and methods. The 12-week, prospective, open-label, randomized clinical and instrumental study enrolled 40 patients with bilater al Kellgren and Lawrence stage I– IV KOA on X-ray. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and knee joint ultrasound data were assessed during the study over time (before and 4 and 12 weeks after treatment). Results. The main symptoms of KOA were considerably alleviated during the administration of ZGS and meloxicam. The same effect was achieved at week 4 of treatment and increased throughout the study. Both groups showed significantly reduced stiffness (p<0.001), which indirectly confirmed that the compared drugs had anti-inflammatory activity. The changes in the WOMAC index by the functional activity scale and the total WOMAC score suggested an increase in the positive effect of ZGS and meloxicam. The total assessment of the results of treatment with ZGS showed improvement and considerable improvement in 100% of cases; meloxicam was demonstrated to have no effect in 5.3% of the patients. The anti-inflammatory activity of ZGS and meloxicam was evidenced by knee joint ultrasonography. Conclusion. The analgesic and anti-inflammatory effects of ZGS are comparable with those of meloxicam on pain, stiffness, and functional activity. Dynamic ultrasonography of the knee joints provides support for the fact that ZGS has anti-inflammatory properties. The high effi cacy of ZGS is combined with the absence of adverse reactions. ZGS may be recommended as an alternative treatment for KOA.

Objective: to evaluate the efficiency of surgical treatment and the quality of life (QL) in patients with rheumatoid arthritis (RA) and elbow damage. Subjects and methods. Fifty-three patients who had undergone elbow synovectomy and debridement were examined 11±5.2 years postoper atively. Clinical and X-ray studies of the operated joint were conducted and its function and QL were assessed using the Mayo Elbow Score, Oxford Elbow Score, HAQ, and EQ-5D. Results. A control examination revealed the larger volume of elbow movements than that preoperatively. The preoperative and postoperative flexion of the elbow was 96.3±21.6 and 127.5±11.7° , respectively (p ≤ 0.05) and its extension was 37.1±8.7 and 17.3±6.9° , (p ≤ 0.05). According to the Mayo Elbow Score and Oxford Elbow Score, there was joint function improvement in the late periods. The mean Mayo index score preoperatively was 25.0±14.5 and the mean score postoperatively was 79.4±6.4. The mean preoperative and postoperative Oxford index scores were 13.8±4.8 and 32.2±8.6, respectively (p ≤ 0.05). The mean HAQ index score preoperatively was high (2.36±0.56). Postoperatively, there was substantial functional improvement in patients with a reduction in HAQ score to 1.67±0.22; the difference in the scores being 0.69 before and after treatment, which corresponded to the significant positive effect of therapy (at least 50% clinical improvement according to the American College of Rheumatology (ACR) criteria). The preoperative and postoperative EQ-5D scores were 019±0.028 and 0.53±0.07, respectively; the Δ EQ-5D score being equal to 0.34, which was indicative of a marked QL improvement in patients after surgical treatment (70% clinical improvement according to the ACR criteria). In the late postoperative period, pain in the affected elbow was reduced by almost twice: according to the visual analogue scale it was 73.8 and 40.6 mm preoperatively and postoperatively, respectively (p≤0.01). Analysis of some EQ-5D scales revealed that there was postoperative psychoemotional improvement; the patients had virtually no difficulty with self-care and day-to-day activity. Conclusion. Synovectomy with debridement and resection of the radial head causes pain relief, a larger volume of movements, improved function and QL in patients with RA in the late postoperative period.