180 women with primary postmenopausal osteoporosis (OP) (mean age 67,5+7,8 years) were included. 118 postmenopausal women without osteoporosis and osteopenia (mean age 63,8±8,1 years) formed control group. Higher frequency of LRP5 gene CT genotype was revealed in pts with OP in comparison with control (OR=2,2; p=0,005). Tendency to increase of gene BMP4 AA genotype and gene TGFfi CC genotype was found in pts with OP in comparison with control. But the difference was not statistically significant. OP pts showed accumulation of CTCC (gene LRP5 and TGFfil combination) and CTAV (gene LRP5 and BMP4 combination) compounds increasing risk of the disease by a factor of 4 (p=0,0004) and 2,5 (p=0,035) respectively. Association was revealed between LRP5 and TGFfil (r=0,26; p=0,001), between polymorphisms of these genes and alkaline phosphatase level (r=0,22; p=0,004 and r=0,16; p=0,04 respectively), between gene BMP4 polymorphisms and serum osteoprotegerin concentration (r=0,2; p=0,0l6). Combined LRP5/TGF$1 genotype was associated with femur neck BMD (r=0,20; p=0,014) and LRP5/BMP4 - with trochanter BMD (r=0.16; p=0,055). Carriers of gene LRP5 CT genotype, gene TGFfil TT genotype and gene BMP4 W genotype had lower mean BMD values in femur neck and trochanter.

Objective. To assess frequency distribution of estrogenic receptor (ER)a and ERfl gene polymorphisms and their influence on bone mineral density (BMD) in groups of postmenopausal women with and without osteoporosis (OP). Material and methods. 200 residents of Moscow and Moscow region were divided into two groups considering BMD values according to WHO criteria; OP group and healthy control group Results. Differences of genotype and their combinations frequency distribution between OP and control groups show presence OP risk and protector genotypes. ER gene important role in pathogenesis of postmenopausal osteoporosis and possibility to use these genetic markers for assessment of risk of OP development in Russian population was confirmed.

Strontium ranelate (Bivalos) is a new drug with dual mechanism of action for the treatment of postmenopausal osteoporosis (OP) Objective. To assess efficacy and tolerability of bivalos in women with postmenopausal osteoporosis in a one year multicentre open study. Material and methods. 60 postmenopausal women (mean age 63,6+5,7 years) with spine OP (mean T-criterion -3,1 ±0,4 SD) received strontium ranelate2 g/day during a year. 5 visits were performed (scrining, inclusion, 3, 6 and 12 months). Markers of bone metabolism were evaluated at inclusion, 3 and 12 months. Densitometry was performed at scrining and after 12 months. At all visits pain in spine was assessed with a 5 point scale and adverse events were recorded. Results. BMD increase in lumbar spine was +4,68%, in femur neck - +2% and in general femur value — +3,1% after 12 months of treatment (p<0,01) in comparison with baseline level. Among pt completed the treatment BMD increase in spine above 2% was achieved in 78% of pt. In 41% from them it exceed 6%. BMD increase in femur neck above 2% was achieved in 41% and in general femur value — in 67% of pts. 11% of pts showed deterioration in studied skeleton regions and did not respond to the therapy. During the treatment osteogenesis marker increased by 19,6% and bone resorption marker decreased by 16,7%. Adverse events related to strontium ranelate administration appeared in 9 (15%) pts including diarrhea, leg spasms, myalgia, shortness of breath and dry cough, nausea, gastric ulcer exacerbation. The drug was withdrawn due to adverse eventsin only 3 (5%).

Objective. To study relationship between serum level of hs-CRP, bone mineral density (BMD) and cardiovascular disturbances in patients with rheumatoid arthritis (RA). Material and methods. 132 pts with RA with mean age 50 years (45-53 years) and mean disease duration 132 months (48-216 months) were examined. BMD was evaluated by dichroic X-ray densitometry in femur neck with Gologic apparatus. CRP concentration was assessed by high sensitivity nephelometric immunoassay with latex amplification with BN 100 analyzer (Dade Behring, Germany). Results. Mean BMD value in pts with RA was lower than in control group —1,4 SD and -0,45 SD respectively (p=0,00001). Normal BMD, osteoporosis and osteopenia were revealed in 38%, 47% and 15% of pts respectively. Clinical and subclinical signs of atherosclerosis in RA were more frequent than in control: coronary heart disease (CHD) and stroke (ST) in 25% and in 6% respectively (p=0,004), plaques (P) and intima-media complex (IMC) thickening in 65% and 35% respectively (p=0,003). In groups with osteopenia and osteoporosis ST and CHD revealed after RA development were more frequent, (p<0,05), RA duration was longer (p=0,02), hs CRP concentration was higher (p=0.001). Frequency of subclinical signs of atherosclerosis (P and IMC thickening) in groups with normal and decreased BMD was similar. Pts with combination of osteopenia and osteoporosis (n=81) had higher frequency of CHD and high hs-CRP than pts with normal BMD (p<0,05). Mean hs-CRP level in RA was significantly higher than in control. Mean hs-CRP values in normal BMD, osteopenia and osteoporosis were 7,02 (2,4-14,5) mg/1, 9,3 (4,4-22) mg/1, 15,3 (8,6-36,2) mg/l respectively (p=0,001). 65 pts with mean hs- CRP level 3,9 (1,8-7,02) mg/l had higher BMD value than 67 pts with mean hs-CRP level 22 (12,6-34) mg/l (-1,75 SD and -1,0 SD respectively, p=0,016). Frequency of clinical, subclinical signs of atherosclerosis and traditional risk factors did not differ in different groups. The pts were divided into 4 groups depending on hs-CRP level: 33 ptswith hs- CRP<3,9 mg/l, 33 pts with hs-CRP 3,9-9,01 mg/l, 34 pts with hs-CRP 9,01-22,1 mg/l, 33 pts with hs-CRP>22,l mg/l. Age, duration of disease, frequency of clinical and subclinical signs of atherosclerosis did not differ in these groups. Increase of hs-CRP concentration was associated with decrease of BMD and IMC (p<0,05) Conclusion. Decrease of BMD in RA pts is accompanied by increase of clinical signs of atherosclerosis and hs-CRP level. Increase of CRP may reflect inflammatory activity of the disease and may be a marker of atherosclerosis.

To assess results of 24 hours’ monitoring of blood pressure (MBP) in women with hypertension (H) in postmenopause depending on bone mineral density (BMD). Material and methods. 50 women with confirmed diagnosis of H with duration more than a year (main group) and 27 women without H of comparable age. BMD was evaluated with dual-energy x-ray absorptiometry (bone densitometer Excell XR-46 (Norland, USA) using T criterion (WHO, 1994). MBP was performed with monitor MnCDP (BPLab, Russian Federation). Statistical analisis was done with “Statistica” 6.0 (StatSoft, USA) Results. T criterion values in women with H were significantly lower than in women with normal blood pressure. Mean T-criterion in women with H was -1,47± 1,05, and without H —0,79±0,85 (p=0,003). Women with osteopenia had circadian rhythm of diastolic blood pressure “non-dipper”.

Objective. To reveal short course of glucocorticoid (GC) therapy efficacy predictors in pts with gout arthritis. Material and methods. 59 pts with tophaceous gout (crystal-verified diagnosis) and arthritis of three and more joints lasting more than a months in spite of treatment with sufficient doses of nonsteroidal anti-inflammatory drugs were included. Median age of pts was 56 [48;63], median disease duration - 15,2 years [7,4;20], median swollen joint count at the examination — 8 [5; 11]. The patients were randomized into 2 groups. Methylprednisolone was administered in one of them, betamethasone — in the other. Results, four variants of treatment response were described: full resolution of arthritis — 24 (41%), recurrent exacerbation — 28 (48%), insufficient arthritis resolution — 2 (3%) and clinically insignificant (unresponders) — 5 (8%) pts. Pts in group with arthritis recurrence at the entry were significantly younger than pts with resolved arthritis (52 [47;60] and 59 [52;68] respectively, U-test p=0,02), had more inflamed joints (9 [7,5; 11 ] and 5 [4;9[ respectively, U-test p=0,02), longer duration of last exacerbation (52 [8;52[ and 13 [7,5;52J respectively, U-test p>0,05), higher values of pain, joint index and swelling index (U-test p<0,04). Pts with insufficient arthritis resolution and unresponders had most severe gout course. Conclusion. The study allowed to reveal features which determine efficacy of short course of GC therapy in pts with protracted and chronic gout arthritis: inflamed joint count, duration of the last exacerbation and chronic renal insufficiency. Proposed an algorithm allowing to predict efficacy of GC short course in each pt.

Objective. To assess efficacy, safety and aftereffect duration of continuous and intermittent treatment of patients with knee osteoarthritis with “Teraflex”. Material and methods. 100 outpatients (2 groups 50 pts in each) mainly women (99 pts) with knee osteoarthritis 0I-III stage according to Kellgren-Lawrence) fulfilling ACR criteria aged 45 to 73 years (mean age 57,8+7,39 years) with pain at walking 40 mm and more on visual analog scale (VAS), regularly receiving NSAIDs for 30 days during previous 3 months were included. Follow up duration was 12 months (9 months — treatment and 3 months follow up to assess drug effect in both groups). Group 1 pts received continuous treatment with “Teraflex” during 9 months. Group 2 pts received the drug during 3 months, then treatment was interrupted for 3 months and after that 3-months course was repeated. Ibuprofen was given as a rescue medication 400 mg trice a day with possibility of subsequent decrease of dose. WOMAC index (assessment of pain, stiffness and functional disability), walking speed (15 m), efficacy assessment by doctor ant pt (improvement, absence of response, deterioration), status assessment by doctop and pt (very good, good, moderate, bad, veiy bad), daily requirement in NSAIDs, knee joint sonographic examination data were used as outcome measures. Results. Analgesic effect was achieved in both groups already after 1 month of therapy. At three months not only pain but also stiffness, joint function, WOMAC summated index and walking speed significantly improved in both groups. This improvement was maintained till the end of treatment in both groups. But group 2 pts at 6 months (before the beginning of the second course of treatment) showed small increase of pain in damaged joint and summated WOMAC index which significantly differed from group 1 pts. At the end of treatment and in 3 months after the end of treatment these measures did not significantly differed in both groups. At the end of treatment 34% on pts of both groups completely discontinued ibuprofen what also shows similar efficacy of both treatment schemes. Only 2 pts had adverse events. Epigastric pain appeared in 1 pt of group 1 after 4 months and disappeared after the drug was withdrawn. 1 pt of group 2 discontinued the treatment because of allergic reaction (papulous itching rash) after 1,5 months of treatment. Conclusion. Intermittent treatment with teraflex (3 months courses of treatment with 3 months breaks) and continuous drug administration showed equivalent influence on pain, joint function, NSAID dose decrease and aftereffect duration.

An open controlled study of efficacy and tolerability of a complex drug Calcemin Advance (CA) in osteopenia in postmenopausal women was performed. 100 women (mean age 58,7±4,5 years) were included. They were randomized into 2 groups. 50 pts of group 1 received CA and 50 pts were included in control group. Bone mineral density (BMD) analysis after 12 months showed stable BMD in pts receiving CA (0,16±4,19%). In control group BMD decreased in all assessed sites, particularly in lumbar spine (-1,63+4,47%, p=0,013). In this group significant decrease of pain was achieved already after 3 months of treatment and was maintained till the end of the study. CA significantly influenced bone remodeling markers. CA is well tolerated. Adverse events appeared in 10% of pts and did not required drug withdrawal.

Objective. To assess efficacy, safety and aftereffect duration of 6-week local therapy of “Chondroxid” gel in comparison with ‘‘Finalgel” in patients with knee osteoarthritis. Material and methods. 60 outpatients (2 groups 30 pts in each) mainly women (59 pts) with knee osteoarthritis (II-III stage according to Kellgren-Lawrence) fulfilling ACR criteria aged 45 to 70 years (mean age 57,3±6,3 years) with pain at walking 40 mm and more on visual analog scale (VAS), Lequesne index from 4 to 10 regularly receiving NSAIDs for 30 days during previous 3 months were included. Follow up duration was 8 weeks (6 weeks - treatment and 2 weeks follow up to assess drug effect).The pts used gels “Chondroxid”and “Finalgel” 3 times a day 9-11 cm of drug extruded at fully open tube orifice (3-4 g). Efficacy assessment was performed with common criteria: WOMAC index (assessment of pain, stiffness and functional disability), summated functional Lequesne index, walking speed (15 m), treatment efficacy assessment by doctor and pt (improvement, absence of response, deterioration), daily requirement in NSAIDs, knee joint sonographic examination data. Results. Definite analgesic effect was achieved with both drugs. “Chondroxid” gel provided faster improvement: pain significantly decreased already after a week of treatment (p=0,05). Significant improvement of stiffness, joint function and walking speed was achieved after 2 weeks of treatment and was maintained till the end of treatment in both groups (p=0,05). Summated WOMAC index changed in accordance with pain. Severity Lequesne index significantly decreased in both groups but provided more prominent improvement (p<0,015). Significant improvement of function and summated WOMAC index was revealed in the main group pts at the second visit (after 1 week of treatment) what confirmes fast effect of “Chondroxid” gel. Later effect in both groups was similar. In 2 weeks after the end of treatment aftereffect was maintained in both groups but in the main group decrease of pain was more prominent (100,2±58,6 mm vs 130,8±59,6 mm in control, p<0,05). Local adverse events appeared in 4 pts only during treatment with “Chondroxid” gel: in 3 pts — knee periarticular edema and in 1 pt the drug was withdrawn due to skin itch and hyperemia at the site of gel application. Conclusion. The results of the study showed that “Chondroxid” gel effect on pain and joint function in knee osteoarthritis is comparable with “Finalgel”, but “Chondroxid” gel acts faster and its aftereffect lasts longer than that of “Finalgel”.

Objective. To assess influence oflow energy laser radiation (LELR) on glycosaminoglycan (GAG) and vitamin С level in pts with osteoarthritis (OA). Material and methods. 82 pts with primary OA and 25 healthy volunteers signed informed consent were included in an open randomized prospective 12-month study. Inclusion criteria: unsatisfactory effect of previous drug therapy (DT), stable NSAID dose 3-5 days before and during LELR course, absence of comorbid hepatic and kidney diseases in stage of functional decompensation, malignant diseases, exclusion therapy influencing microcirculation, exercise therapy, physical therapy. Intra-articular injections were not done during 3 months before the study. Pts were divided into 2 groups. Group 1 received complex DT and LELR, group 2 - DT. clinical and laboratory parameters were used as efficacy measures. Statistical analysis was performed on personal computer IBM PC (OS — Windows EP Home Edition) with Microsoft office and STATISTICA 6.0 programs. Results. Analysis of the results showed significant improvement of most measures in comparison with traditional DT. LELR administration allowed to decrease chondroprotector and NSAID doses. Vitamin С decrease in serum of OA pts may be a risk factor of development and progression of this disease.

Objective. To assess efficacy of hospital stage of treatment including rehabilitation methods in pts with juvenile idiopathic arthritis (JIA) evaluating changes of some measures of functional status at admission and at discharge. Material and methods. 56 pts with different variants of JIA admitted to the pediatric department of the Institute of Rheumatology of RAMS and treated with medicaments and rehabilitation methods. Correction of anti-inflammatory therapy influencing functional status (NSAIDs dose increase, intra-articular injections of glucocorticoids) was done in 36 pts. In the rest of pts treatment with DMARDs was changed. Mean duration of hospital stay was 20 days. At admission and at discharge following measures were recorded: pain on VAS, dynamometry, 25 m walking time, contracture angle and amplitude of movement of joint causing disability and treated with rehabilitation methods (mean summated measures were assessed, localization was not considered). Results. Significant change of pain (29,04 mm+2,9 mm vs 9,92 mm±l,6 mm), contracture angle (19,33o±l 1,12 о vs 10,33 о ±8,34 о) and movement amplitude (71,5 о ±38,52 о vs 90,71 о ±38,52 о). Significant improvement (movement amplitude increase from 68,6±42,4 to 85,3±41,0 and angle of deformation decrease from 15±5,8 to 8,5±7,4) was achieved in 20 pts without correction of treatment influencing functional status. Conclusion. Functional status of pts with JIA improved as a result of complex treatment with medicaments and active rehabilitation methods. Importance of rehabilitation treatment in pts with JIA during hospital stay was shown.