Objective. To get objective information characterizing demographic, social and clinical status of Russian pts with rheumatoid arthritis in real life clinical practice. Material and methods. Cross-sectional epidemiologic observational study without any intervention in routine clinical practice (including administration of studied therapy and special methods of examination) was performed. It was based on cross-sectional collection of clinical data of pts actively visited the doctor or hospitalized during period from 01.03.2009 to 07.05.2009. 1810 pts with RA were included in 22 cities of Russian Federation during this time. Results. New data about clinical features of RA and therapeutic approaches in real-life clinical practice of rheumatologists were obtained. Modern social and demographic characteristics of population of pts with rheumatoid arthritis were got. RA pts in Russia were shown to have higher activity and severity of the disease than in other countries. Conclusion. Presented data can be used for development of perspective programs on improvement of specialized service for pts with RA.

Objective. To study prevalence and clinical picture of distal parts of bronchial tree(bronchiolitis) in pts with rheumatoid arthritis (RA). Material and methods. 104 nonsmoking pts with RA and 100 pts without RA and chronic diseases of respiratory apparatus were included. General clinical examination, spirometry, bodyplethysmography, examination of lung diffusion capacity (LDC) and multispiralcomputed tomography (MSCT) of lungs were performed. Results. Direct and indirect bronchiolitis signs were revealed with MSCT in 36 (35%) ptswith RA and 1 pt of control group (p<0,01). Pts with signs of bronchiolitis complained of shortness of breath (69% of pts), cough (56%), phlegm discharge (56%), heavy breathing (25%). Obstructive lung ventilation disturbances were revealed in 19 (53%) RA pts with bronchiolitis. Restrictive disturbances and LDC decrease were present in 3 (8%) pts. High frequency of oligosymptomatic bronchiolitis course was found in RA pts. Bronchiolitis symptoms in RA pts coincided with signs of proximal bronchial tubes damage forming picture of diffuse damage of bronchial tree. Conclusion. Bronchiolitis is a prevalent variant of respiratory apparatus damage in pts with RA. Pts with MSCT signs of bronchiolitis often have cough, phlegm discharge, shortness of breath, heavy breathing. Lung ventilation disturbances of obstructive type are common but part of pts has normal lung functional measures or restriction. Oligosymptomatic forms of distal bronchial tubes damage are prevalent in RA pts. Lung MSCT is the main method of bronchiolitis diagnostics because bronchiolitis induces nonspecific clinical signs and RA pts have multilevel respiratory apparatus damage. MSCT reveals signs of distal bronchial tubes damage in 35% of RA pts.

Objective. To study vasoregulatory function of vascular wall in pts with systemic sclerosis (SS) and chronic scleroderma-related renal disease (SRD) and determine relationship with main measures of kidney functional state. Material and methods. 25 pts with SS (24 female) with mean age 46,4±10,7 years and mean disease duration 7,5±4,7 years were included. 24 pts (96%) had diffuse form and 17 pts (68%) – generalized stage of SS. 22 pts (88%) had chronic course of the disease with typical damage of vessels, heart, lungs and skin. SRD was revealed in 17 pts (68%). Sonographic method of Celermejer D. et al. (1992) was used for assessment of vascular endothelial function. 15 healthy persons without SS were included in control group. Results. Most prominent changes of brachial artery reactivity with insufficient vasodilatation and paradoxical vasoconstriction to reactive hyperemia were revealed in most pts with moderate and severe SRD. Conclusion. These changes of endothelium dependent and endothelium independent parameters in pts with SRD pointed to irreversible probably scleroderma-related vascular wall damage.

Features of diagnostics and course of anemic syndrome in rheumatoid arthritis patients Objective. To study features of anemic syndrome in rheumatoid arthritis (RA) pts, to estimate influence of disease modifying anti – rheumatic drug therapy efficacy on the course of anemic syndrome. Material and methods. 62 pts with definite RA and level of hemoglobin less than 130g\l for men and less than 120g\l for women were examined. Research of hemoglobin, red cells count, mean corpuscular volume (MCV), mean concentration of hemoglobin (MCH), serum iron and ferritin was carried out. In a part of pts serum transferrin receptor and erythropoietin concentrations was defined. 30 pts were examined after 6 month of disease modifying therapy. Results. In 49(79 %) of the pts the anemia was an easy degree of weight, MCH decreased in 33(53 %) of the pts and 15(24 %) pts had decreased values for MCV. Deficiency of iron in 16(26%) of pts has been established at research of concentration a ferritin, sTfR and an index sTfR \log ferritin. At the dynamic research after 6 month of disease modifying therapy the authentic gain levels of hemoglobin, red cells count and serum iron significantly increased in the pts with good and satisfactory effect of therapy. Сonclusion. Definition of MCH, MCV and ferrokinetic data for assessment of iron defi- ciency in the RА pts is necessary. sTfR and sTfR\log ferritin may be study for pts with normal and increased ferritin levels. The major factor influencing on the course of anemia of chronic disease in the rheumatoid arthritis pts is the course rheumatoid arthritis, that efficacy disease modifying treatment to control.

Objective. Clinicogenealogical investigation of the families of patients with antiphospholipid syndrome (APS). Material and methods. Families of 82 pts with APS fulfilled diagnostic criteria of S. Miyakis et al., 2006 (mean age 47,2±12,1 years, men:women ratio 1:10,7) were studied. “Severe” course of APS (43 patients) was characterized by presence of recurrent thrombotic events and/or thrombosis of several types and/or localizations. Clinicogenealogical investigation included pedigrees analysis (the number of relatives - 615). 46 individuals-relatives of 26 patients with APS (37 first-degree and 9 second-degree relatives, mean age 29,5±16,4 years) were followed up for 4 years. Incidence of “minor” features (livedo reticularis, neurological disorders, heart valves disease, thrombocytopenia) was studied, lupus anticoagulant (LA) test was performed. Statistical analysis was performed with Student’s t test and logistic regression analysis (SPSS 11.5.0). Results. Definite APS was diagnosed in 7 individuals, more frequently - in first-degree relatives and women (the most frequent form of inheritance - mother/daughter). “Minor” features were precursors of APS in 76% patients with APS. These features were found in more than half relatives. LA was detected in 39% of relatives. LA was 5-fold more prevalent in relatives of LA-positive patients with APS as compared with relatives of LA-negative patients. Primary prevention of thrombosis has been successfully conducted in patients with “minor” features of APS and/or positive LA (“pre-APS”). “Severe” course of APS was associated with the presence of cardiovascular diseases in family history (OR 0,32, CI0,11-0,97, multivariate analysis). Conclusion. Girls and first-degree relatives are at higher risk of APS development than boysand second- or third-degree relatives if APS is present in family history. LA, presumably, 39has inherited character. The role of clinicogenealogical method in APS: diagnosis of“pre-APS” and prediction of the disease course.

Results of screening and diagnostic stages of epidemiological study performed in Tatarstan republic in the context of inter-regional program “Social and economic consequences of rheumatic diseases” (RD) are presented. Objective. To study structure and prevalence of rheumatic diseases. Material and methods. 3272 rural (58,5% female) and 3043 urban (54,6% female) inhabitants were questionnaired. All respondents reported joint swelling and a random part of pts with joint pain were selected and examined. Results. RD were diagnosed in 81,1% (812 persons), non rheumatic diseases – in 8,4% (84 persons), low back pain syndrome – in 6,9% (69 persons), and in 3,7 (37 persons) diseases were not revealed. 498 rural and 504 urban inhabitants with previously revealed osteoarthritis, rheumatoid arthritis or other bone-joint diseases were further examined. Conclusion. Information about structure and prevalence of RD among adult inhabitants of Tatarstan republic with joint complaints was obtained.

60 Recombinant biological agents (RBA) are perspective medications for treatment of rheu- matoid arthritis (RA) but their wide administration is hampered by high cost. State paysfor treatment with RBA in Russia. Information about number of pts requiring biological therapy is necessary for planning and optimization of treatment. Objective. To develop methodology of determination of RBA requirement for treatment of pts with RA. Material and methods. 126 consecutive pts (mean age 53,5 years, male/female ratio1/5) with proved RA diagnosis (according to ACR 1987 criteria) admitted to Institute of Rheumatology of RAMS were included. After determination of clinical stage, activity, radiological stage, extra-articular features and pharmacological history each pt was assigned by a highly qualified expert to one of the following groups:1 (27 pts – 21%) – treatment with RBA is absolutely indicated, 2 (29 pts – 23%) – therapy with RBA is more likely indicated, 3 (54 pts – 43%) – the therapy is more likely not indicated, 4 (16 pts –13%) – treatment with RBA is absolutely not indicated. Results. Cluster analysis revealed following factors influencing expert opinion about advisability of administration of RBA to the pt: disease activity, clinical stage of RA, extra-articular features, rapidly progressing course of the disease, previous therapy with DMARDs including methotrexate dose till 15 mg/week, administration of full doses of methotrexate (15-25 mg/week). Scale for determination of treatment with RBA advisability score for the present pt was developed. Conclusion. The scale developed in the present study provides the possibility of objective determination of treatment with RBA requirement for RA pts in clinical practice.

Objective. To study clinical and laboratory manifestations of different variants of juvenile arthritis (JA) at the disease onset and during prospective two-year follow up. Material and methods. The study was performed as a part of Institute of Rheumatology early arthritis examination program RADIKAL. 130 pts with early JA (60,7% - girls) with disease duration from 2 weeks to 6 months (mean 2,9±1,6 months) aged 1,5- 16 years (mean 7,9±5,0 years) were included. 13 (10%) pts had systemic, 45 (34,6%) – polyarticular and 72 (55,4%) – olygoarticular variant of JA. General state, joint status, systemic and organ manifestation as well as immunological parameters (ANF, RF), disease activity, functional class (by Steinbrocker and CHAQ) were assessed at baseline, and after 6, 12, 24 months of follow up. Results. Oligoarticular variant prevailed at onset and after 2 years (57,6%-55,6%). Systemic features were noted in reduced form as single manifestations. Morning stiffness was absent in half of children and lasted more than 1 hour in 16,4% of pts. After 2 years number of pts with morning stiffness significantly decreased and its duration diminished. Rheumatoid nodules appeared in 1 pt after 1 year. Uveitis developed in 7 children (5,3%) and to the end of follow up it appeared in 2 more pts. Most of pts had minimal or moderate functional disability (FK 1,2 and CHAQ 0,1-1,5) during follow up. Disease activity at onset did not exceed 1 or 2 stage (80,2%) and after 2 years the disease was not active in half of pts. To the end of follow up remission was achieved in 59% of pts, more often in those who received disease modifying anti-rheumatic drugs. In 23,2% of pts mostly in those with polyarthritis JA continued to recur independently on treatment. Conclusion. Timely administered complex therapy hampered disease progression, induced remission and improved quality of life in most children with JA. Pts with olygoarthritis had most favorable course of the disease. Pts with polyarthritis required early administration of aggressive therapy.