Vol 49, No 2 (2011)
Articles
V A Myakotkin,
M Yu Krylov,
I A Guseva,
E V Chetina,
N V Toroptsova,
O A Nikitinskaya,
E Yu Samarkina,
L I Benevolenskaya,
V A Myakotkin,
M Yu Krylov,
I A Guseva,
E V Chetina,
N V Toroptsova,
O A Nikitinskaya,
E Yu Samarkina,
L I Benevolenskaya
15-20 850
Abstract
Polymorphisms of 21 genes involved in the processes of bone remodeling were studied on samples of 150 to 265 postmenopausal healthy women in a control group and those of 175 to 269 patients with osteoporosis (OP). In a Moscow sample of postmenopausal women, the genotypes of OP susceptibility were found to be the CT genotype of the low-density lipoprotein receptor-related protein 5 (LRP5) gene, the GG genotype of the leptin (LEP) gene, the XX genotype of the estrogen receptor a (ER-a) gene, the Ff genotype of the vitamin D receptor (VDR) gene, the HH genotype of the a1 polypeptide chain of type II collagen gene and the GG genotype of the aromatase (CYP19) gene. The interaction of a number of genes to develop OP susceptibility was ascertained to be compliant. For example, the carriage of the CTxx genotypes of the LRP5/ERa genes, the CTGG genotypes of the LRP5/CBFA genes, the CCGA genotypes of the TGF/31/CYP19 genes, and the CCAA genotypes of the TGF/31/OPG genes increases a risk for OP by 7.7, 4.1, 6.2, and 2.7 times, respectively.
The genotypes increasing the risk of spinal osteoporotic fractures were AG of 163A/G polymorphism in the osteoprotegerin (OPG) gene, TT of 509C^T polymorphism in the TGF/31 gene, and BB of BsmI polymorphism in the VDR gene (OR = 4.9, 3.9, and 4.4, respectively). The genotype of a risk for osteoporotic fractures at other sites was AG of A19G polymorphism in the LEP gene (OR = 2.6).
The genotypes increasing the risk of spinal osteoporotic fractures were AG of 163A/G polymorphism in the osteoprotegerin (OPG) gene, TT of 509C^T polymorphism in the TGF/31 gene, and BB of BsmI polymorphism in the VDR gene (OR = 4.9, 3.9, and 4.4, respectively). The genotype of a risk for osteoporotic fractures at other sites was AG of A19G polymorphism in the LEP gene (OR = 2.6).
21-24 834
Abstract
Objective: to estimate bone mineral density (BMD) in males with different clinical types of rheumatoid arthritis (RA). Subjects and methods. The study enrolled 80 patients having a valid diagnosis of RA (mean age 55.2±1.4 years; disease duration 7.2±0.6 years). A control group included 84 apparently healthy men matched for age (56.7±0.9 years). BMD was measured by dual-energy X-ray absorptiometry using a stationary Exceell XR-46 bone densitometer (Norland, USA).
Results. In the patients with RA, the BMD values in both the femoral neck and lumbar spine were significantly lower than those in the control group. Thus, the males with RA had a femoral neck BMD of 924.66±14.03 g/cm2, which is equal to 2.34±0.10 standard deviations (SD) as evidenced by the T-test, while the control group had this index of 1007.85±16.84 g/cm2, which is equal to 1.54±0.12 SD as shown by the T-test (p<0.001 and p<0.001). In the study group, the lumbar spine BMD was 1045.51±21.89 g/cm2, which is equal to -1.15±0.12 SD as indicated by the T-test, and in the control group that was 1123.19±19.74 g/cm2, which is equal to -0.65±0.10 SD as evidenced by the T-test (p = 0.006 and p<0.001). The highest risk of osteoporosis was noted with high RA activity, X-ray stages III-IV, and Functional Class III-IV.
Discussion. The presence of RA in males negatively affects BMD, but enhanced activity, higher X-ray stage and functional class are additional risk factors for BMD reduction, which are associated with the disease itself.
Results. In the patients with RA, the BMD values in both the femoral neck and lumbar spine were significantly lower than those in the control group. Thus, the males with RA had a femoral neck BMD of 924.66±14.03 g/cm2, which is equal to 2.34±0.10 standard deviations (SD) as evidenced by the T-test, while the control group had this index of 1007.85±16.84 g/cm2, which is equal to 1.54±0.12 SD as shown by the T-test (p<0.001 and p<0.001). In the study group, the lumbar spine BMD was 1045.51±21.89 g/cm2, which is equal to -1.15±0.12 SD as indicated by the T-test, and in the control group that was 1123.19±19.74 g/cm2, which is equal to -0.65±0.10 SD as evidenced by the T-test (p = 0.006 and p<0.001). The highest risk of osteoporosis was noted with high RA activity, X-ray stages III-IV, and Functional Class III-IV.
Discussion. The presence of RA in males negatively affects BMD, but enhanced activity, higher X-ray stage and functional class are additional risk factors for BMD reduction, which are associated with the disease itself.
25-29 1251
Abstract
Objective: to compare the efficiency and tolerability of combination disease-modifying therapy with methotrexate (MT), sulfasalazine (SS), and hydroxychloroquine (HC) with that of MT monotherapy in patients with rheumatoid arthritis (RA).
Subjects and methods. Sixty patients with RA, who had received no disease-modifying anti-inflammatory drugs, were enrolled in a 24-month open-label study. The patients were randomized into two groups at a 1:1 ratio. Group 1 received combination therapy with MT (its starting dose was 7.5 mg weekly), SS (2.0 g/day), and HC (200 mg/day); Group 2 had MT therapy. If there was no remission, the dose of MT was gradually increased from 7.5 to 17.5 mg weekly. The basic efficiency rate was a 50% improvement according to the American College of Rheumatologists criteria (ACR 50), which persisted at 9 months of therapy to the end of the study in the absence of adverse reactions (AR) requiring the therapy in question to be discontinued.
Results. At 24 months of therapy, the effect corresponding to ACR 50 was observed in 16 (59.3%) of the 27 patients in Group 1 and in 11 (40.7%) of the 27 patients in Group 2 (p = 0.174). This effect persisted at 9 to 24 months in 9 (33.3%) patients in Group 1 and in 2 (7.4%) in Group 2 (p = 0.039). These patients had no AR that required treatment correction. By the end of the study, remission (DAS < 1.6) was seen in 6 (22.2%) patients in Group 1 and in 2 (7.4%) in Group 2 (p = 0.259). The groups showed no significant differences in the progression of X-ray signs of joint destruction. The assessment using the Sharp method indicated that the median erosion scores increased by a point in Groups 1 and 2; the median joint-space narrowing score rose by 8 and 7 points and the median total score increased by 10 and 6.5 points, respectively. There was a functional improvement in both groups. The median HAQ dropped from 1.5 to 0.5 scores in Group 1 and from 2.0 to 0.75 scores in Group 2. The tolerability of combination therapy and MT therapy did not differ greatly. Only 4 (13.3%) patients in Group 1 and 7 (23.3%) were withdrawn from the study because of AR.
Conclusions. Combination disease-modifying therapy with MT, SS, and HC is more effective than MT monotherapy. Tolerability was comparable for both treatments.
Subjects and methods. Sixty patients with RA, who had received no disease-modifying anti-inflammatory drugs, were enrolled in a 24-month open-label study. The patients were randomized into two groups at a 1:1 ratio. Group 1 received combination therapy with MT (its starting dose was 7.5 mg weekly), SS (2.0 g/day), and HC (200 mg/day); Group 2 had MT therapy. If there was no remission, the dose of MT was gradually increased from 7.5 to 17.5 mg weekly. The basic efficiency rate was a 50% improvement according to the American College of Rheumatologists criteria (ACR 50), which persisted at 9 months of therapy to the end of the study in the absence of adverse reactions (AR) requiring the therapy in question to be discontinued.
Results. At 24 months of therapy, the effect corresponding to ACR 50 was observed in 16 (59.3%) of the 27 patients in Group 1 and in 11 (40.7%) of the 27 patients in Group 2 (p = 0.174). This effect persisted at 9 to 24 months in 9 (33.3%) patients in Group 1 and in 2 (7.4%) in Group 2 (p = 0.039). These patients had no AR that required treatment correction. By the end of the study, remission (DAS < 1.6) was seen in 6 (22.2%) patients in Group 1 and in 2 (7.4%) in Group 2 (p = 0.259). The groups showed no significant differences in the progression of X-ray signs of joint destruction. The assessment using the Sharp method indicated that the median erosion scores increased by a point in Groups 1 and 2; the median joint-space narrowing score rose by 8 and 7 points and the median total score increased by 10 and 6.5 points, respectively. There was a functional improvement in both groups. The median HAQ dropped from 1.5 to 0.5 scores in Group 1 and from 2.0 to 0.75 scores in Group 2. The tolerability of combination therapy and MT therapy did not differ greatly. Only 4 (13.3%) patients in Group 1 and 7 (23.3%) were withdrawn from the study because of AR.
Conclusions. Combination disease-modifying therapy with MT, SS, and HC is more effective than MT monotherapy. Tolerability was comparable for both treatments.
L P Anan'eva,
L V Teplova,
V N Lesnyak,
O A Koneva,
O B Ovsyannikova,
M N Starovoytova,
O V Desinova,
L P Ananyeva,
L V Teplova,
V N Lesnyak,
O A Koneva,
O B Ovsyannikova,
M N Starovoitova,
O V Desinova
30-39 793
Abstract
Objective: to estimate the detection rate of interstitial lung injury (ILI) and to characterize its manifestations from high-resolution computed tomography (HRCT) data in patients with systemic scleroderma (SSD).
Subjects and methods. One hundred and thirty-eight patients with SSD (mean age 47±13 years, median disease duration (from the onset of the first signs but for Raynaud's phenomenon) 6 (range 2.5-11) years; mean systolic pulmonary artery pressure 25 (range 25-32) mm Hg) were examined. Chest HRCT was performed on a Siemens Somatom Emotion 6 apparatus.
Results. ILI was found in 82% of the patients with SSD. The detection rate for ILI did not depend on the duration of SSD and was high just in the first years of the disease. The patients with lung injury at the onset of SSD were significantly older than those without lung injury (39 and 31 years, respectively; p < 0.03); and the rate of lung fibrous changes was higher in the older subjects who had the same duration of SSD. Lung parenchymal damage was symmetrical and characterized by the high detection rates of linear and reticular changes (100%), frosted glass symptom (64%), bronchiectases (58%), and signs of honeycomb lung (33%). There was a strictly sequential spread of CT changes from the basal segments of the lower lobes to segment VI and then to the overlying portions. When ILL afflicted the overlying portions, there was an increase in the frequency of the symptoms of irreversible fibrosis.
Conclusion. Chest HRCT reveals the characteristic symptoms of ILI and reflects different phases of a fibrosing process in the lung. It is essential to make an in-depth examination using HRCT in all patients with SDD, irrespective of its clinical form in the earliest periods for the timely detection and treatment of ILI.
Subjects and methods. One hundred and thirty-eight patients with SSD (mean age 47±13 years, median disease duration (from the onset of the first signs but for Raynaud's phenomenon) 6 (range 2.5-11) years; mean systolic pulmonary artery pressure 25 (range 25-32) mm Hg) were examined. Chest HRCT was performed on a Siemens Somatom Emotion 6 apparatus.
Results. ILI was found in 82% of the patients with SSD. The detection rate for ILI did not depend on the duration of SSD and was high just in the first years of the disease. The patients with lung injury at the onset of SSD were significantly older than those without lung injury (39 and 31 years, respectively; p < 0.03); and the rate of lung fibrous changes was higher in the older subjects who had the same duration of SSD. Lung parenchymal damage was symmetrical and characterized by the high detection rates of linear and reticular changes (100%), frosted glass symptom (64%), bronchiectases (58%), and signs of honeycomb lung (33%). There was a strictly sequential spread of CT changes from the basal segments of the lower lobes to segment VI and then to the overlying portions. When ILL afflicted the overlying portions, there was an increase in the frequency of the symptoms of irreversible fibrosis.
Conclusion. Chest HRCT reveals the characteristic symptoms of ILI and reflects different phases of a fibrosing process in the lung. It is essential to make an in-depth examination using HRCT in all patients with SDD, irrespective of its clinical form in the earliest periods for the timely detection and treatment of ILI.
EFFECT OF AT ORVASTATIN ON THE TIME COURSE OF CHANGESIN INFLAMMATORY MARKERS IN SYSTEMIC SCLERODERMA
R T Alekperov,
E G Korzeneva,
E G Aleksandrova,
A A Novikov,
L P Anan'eva,
E L Nasonov,
R T Alekperov,
E G Korzeneva,
E G Aleksandrova,
A A Novikov,
L P Ananyeva,
E L Nasonov
40-46 1042
Abstract
Objective: to study the time course of changes in serological inflammatory markers in patients with systemic scleroderma (SSD) on long-term statin treatment.
Subjects and methods. The study covered 40 patients with SSD who were divided into a study group (n = 22) and a control one (n = 18). In the study group, in addition to the therapy performed atorvastatin was given in a dose of 10 mg/day in the first 6 months, 40 mg/day in 12 patients and in the former dose in 10 patients in the following 6 months. Enzyme immunoassay was used to measure the serum level of high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL) 6 in the study group at baseline and after 3, 6, 9, and 12 months of a follow-up and in the control group at baseline and after 12 months.
Results. In the study group, the content of hs-CRP was 5.54±4.41 ng/l and increased in 13 (59%) patients. After 3, 6, 9, and 12 months, the level of hs-CRP was 3.93±3.13, 2.95±2.27, 3.15±3.01, and 2.86±2.27 mg/l, respectively, and was significantly lower than the base-line value (p = 0.002). In the same periods, the concentration of hs-CRP decreased by 25, 37, 35, and 35% of the baseline level and remained higher in 10 (45%), 10 (45%), 9 (41%), and 6 (27%) patients, respectively. The level of IL-6 was elevated in 10 of the 14 patients and exceeded in healthy donors. Following 12 months, it decreased from 6.61±6.37 to 1.89±2.71 pg/ml (p = 0.038), and the rate of its increment reduced from 71 to 14% (p = 0.007).
In the control group, the levels of hs-CRP and IL-6 as the rate of their increment after 12 months, did not differ from the baseline values. In this group, the changes in the content of hs-CRP and IL-6 in that period were -0.42±2.32 mg/l and 0.14±4.15 ng/ml, respectively, and significantly less marked than those in the study group (p = 0.036 and p = 0.03, respectively). Conclusion. When long used, atorvastatin shows a stable anti-inflammatory effect in most patients with SSD.
Subjects and methods. The study covered 40 patients with SSD who were divided into a study group (n = 22) and a control one (n = 18). In the study group, in addition to the therapy performed atorvastatin was given in a dose of 10 mg/day in the first 6 months, 40 mg/day in 12 patients and in the former dose in 10 patients in the following 6 months. Enzyme immunoassay was used to measure the serum level of high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL) 6 in the study group at baseline and after 3, 6, 9, and 12 months of a follow-up and in the control group at baseline and after 12 months.
Results. In the study group, the content of hs-CRP was 5.54±4.41 ng/l and increased in 13 (59%) patients. After 3, 6, 9, and 12 months, the level of hs-CRP was 3.93±3.13, 2.95±2.27, 3.15±3.01, and 2.86±2.27 mg/l, respectively, and was significantly lower than the base-line value (p = 0.002). In the same periods, the concentration of hs-CRP decreased by 25, 37, 35, and 35% of the baseline level and remained higher in 10 (45%), 10 (45%), 9 (41%), and 6 (27%) patients, respectively. The level of IL-6 was elevated in 10 of the 14 patients and exceeded in healthy donors. Following 12 months, it decreased from 6.61±6.37 to 1.89±2.71 pg/ml (p = 0.038), and the rate of its increment reduced from 71 to 14% (p = 0.007).
In the control group, the levels of hs-CRP and IL-6 as the rate of their increment after 12 months, did not differ from the baseline values. In this group, the changes in the content of hs-CRP and IL-6 in that period were -0.42±2.32 mg/l and 0.14±4.15 ng/ml, respectively, and significantly less marked than those in the study group (p = 0.036 and p = 0.03, respectively). Conclusion. When long used, atorvastatin shows a stable anti-inflammatory effect in most patients with SSD.
ISSN 1995-4484 (Print)
ISSN 1995-4492 (Online)
ISSN 1995-4492 (Online)