Quantitative (primary and general morbidity) and qualitative (labor losses, invalidization, price of the diseasis, living standard of pts) parameters characteristic for muscle-skeletal and connective tissue diseases (MSD) in Russia for the last decade are analyzed. It is demonstrated that these diseases present serious social problem, reducing economic, labor, defense and psychological potential of Russia.

The aim of the study was to investigate whether serum levels of interleukin-4 ( IL-4) reflects the clinical disease status and laboratory features of systemic sclerosis (SSc). IL-4 was measured by ELISA in forty patients wilh SSc. We revealed IL-4 (Ю-lOOOpg/ml) in sera from 12 of 40 pts (30%). These pts had significantly less duration of disease, the progression of skin and visceral involvement by the time of investigation and a trend lo the greater frequency of lung fibrosis. There was no correlation of IL-4 level with type of SSc. The pts with increased scrum levels of IL-4 had higher levels of circulated immune complexes, y-globulins, but the levels of acute phase reactants (CRP, fibrinogen) were lower compared with the of others. We suggest that serum IL-4 may serve a biologic marker for the progression of skin and lung fibrosis, but the results require confirmation in longitudinal study.

Objective. To give clinical and x-ray characteristics of joint syndrome in Sjogren's disease. Methods. 150 patients with Sjogren's disease were included. Clinical and retrospective radiological examinations were performed. Progression of hands and feet joints radiological damage was assessed using Larsen's scale. Results. Arthralgia was present in 76%, light morning stiffness - in 42,7% (more often lasting less then 20 min), Al the admission arthritis was noted in 16,7%. Hand small joints damage was prevalent. 36% of patients had history of arthritis. Its development was accompanied by purpura in one third of cases. Painful hand joint contractures were noted in 9,3%, diffuse hands oedema in 4,6%, ulnar deviation of the metacarpophalangeal joints in 0,7%, Jaccoud's arthropathy in 0,7%. Single surface erosions of hands were revealed at the X-ray examinations in 7 patients (4,7%). Early development of osteoarthrosis was noted. Larsen index ranged from 0 to 29 at the first and from 0 to 37 at the second examination (after 4.7 years). Conclusion. Joint syndrome in Sjogren's disease is characterized by light morning stiffness of short duration, arthritis which is usually not erosive and more often affects small joints оГ hands. Painful joint contractures and diffuse hands oedema are less frequent.

Objective. To study of lipid-hormonal interrelations in women with nonspecific aorloarteriitis (NAA) depending on age and activity's degree of immuno-infiamatory process. Materials. 85 women at the age of 16-55 were investigated, level of lipids and sexual hormones was studied in blood plasma. Results. In patients with NAA antiatherogenic system of lipids above atherogenic was predominanate. Negative correlation was found between levels of estradiol and progesterone and level of atherogenic lipoproteins. It was determined, that considerable reduction of level of total cholesterol and LDLP occurs as far as increasing of activity of immuno-inflammatory process. Conclusion. The levels of lipids are controled by condition of sexual hormones’ balance. Low level of total cholesterol and LDLP is able to be considered as an additional marker of disease’s activity ill women with NAA.

Aim: To estimate the bone mineral density (BMD) in patients with dilVerent variants of rheumatoid arthritis (RA). Materials and methods: The study included 65 patients with the acknowledged RA, who were not treated with corticosteroids, basic remedies and antiosteoporosis therapies. The group comprises 26 women оГ reproductive age (I group) and 28 women in postmenopause period. The investigations were held with the computer tomograph “Tomoscan” Philips. Results: The comparative analysis of BMD disorders frequency in the studied groups shows that in RA women of postmenopause period osteopenia accounts for 57,1%, osteoporosis - for 32,1% of patients, which is twice as often as in premenopausal women period: 30,8% and 15,4% respectively. BMD levels in RA are correlated with rheumatoid lactor, destructive tendency in bones and high activity of disease.

At present group A streptococcal infection remains one of the important problems of medicine. From the middle of the 1980-cs number of diseases with group A streptococcal etiology significantly increased in many countries of the world. It coincided with return of disappeared from circulation highly toxigcnic and virulent serotypes M-l, M-3, M-5, M-18. Oulbreaks of acute rheumatic fever were registered among civil and military persons in USA. Wide distribution of tonsillitis, pharingitis and streptoderma in USA and in countries of Western Europe is accompanied by increase of invasive group A streptococcal diseases (bacteriemia, sepsis, necrotizing fasciitis and myositis, toxic shock syndrome) affecting predominantly working age people with fulminant development and high mortality reaching 80%. Causes of group A streptococcal infection epidemiology changes are not quite clear. Decrease of macroorganism immune response to above mentioned serotypes may play a role because their distribution was low for several decades. Created during evolution ability of some group of A streptococcal strains lo develop structural changes increasing virulence may also be one ol the causes. Main groups of antibiotics using for treatment of group A streptococcal infection are penicillines, cephalosporines, macrolides and lincosamides. Now practically in all countries of the world (including Russia) high frequency of group A streptococcal strains resistant to tetracyclines, co-trimonasol, sulphanilamides and chloramphenicol is noted in patients with angina and pharingitis. So these drugs should not be used in this form of infcclion. Efficacy of penicillines in invasive forms of group A streptococcal infection is low because of insufficient expression of penicillin-binding proteins by the microbe. Clindamycine is more effective in such cases.

A bstract. Objective, to describe a series of pts with JRA/JCA and uveitis. Material and methods. The study included 81 pts with JRA and uveitis. There were 68 girls-84%, 13 boys-16%. We studied the clinical manifestations, the antinuclear antibodies (ANA) using HEP-2 cells for the 33 pts with uveitis and 46 pts without uveitis, HLA status was determined for 36 pts. Results. 85,2% of the children had arthritis before uveitis. The mean age at onset of arthritis was 3,5 year (range: 1-10 yrs), the mean age at onset of uveitis was 6 year (range: 2-15 yrs). The mean interval between the onset of arthritis and uveitis was 3,02 years (range: 3,5 yrs before arthritis onset to 12,5 yrs after). In 68,1% pts the diagnosis of uveitis was made within 5 yrs after onset of arthritis. 93% of pts had mono-oligoarticular onset, but 50% had poliarticular course. 23,5% of pts had functional disability 3-4 classes. Ocular complications were developed in 53.1%: cataracts-38,3%, band keratopathy-11,1%, glaucoma-2,5%. 93,9% of 33 studied children with arthritis and uveitis were ANA positive, 9,1% were RF positive. 18,1 % had HLA-DR8 (p<0,001), 83,3% - HLA-A2 (p<0,00l), HLA-B27 - 30,6 % (p<0,00l). Conclusion. Clinical and laboratory data of our pts suggest that: l)the combination of arthritis and uveitis would be named JCA with uveitis; 2) according our opinion JCA with uveitis is separate nosological form among the juvenile arthritides.

We report herein the results of the cross-cultural adaptation and validation into the Russian language of the parent’s version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile chronic arthritis (JCA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Russian CHAQ-CHQ were fully validated with 3 forward and 3 backward translations. A total of 146 subjects were enrolled: 86 patients with JCA (23% systemic onset, 39% polyarticular onset, 15% extended oligoarlicular subtype, and 23% persistent oligoarticular subtype) and 60 healthy children. The CHAQ clinically discriminated between healthy subjects and JCA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall wellbeing when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JCA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Russian version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JCA.

Absiract. Objective. To study possibility of application of sparing methods of joint deformity surgical correction and their elfect on the disease course in children with juvenile chronic arthritis (JCA). Methods. 30 children receiving complex drug and rehabilitation treatment were followed up in pediatric department of the Institute of Rheumathology of RAMS. There were patients with JCA, juvenile rheumatoid arthritis, juvenile ankylosing spondilitis. Activity of the disease ranged from I to 3 stage at the time of surgery. Following operations were performed: distraction systems application, operations on tendons, ligaments and muscles, diagnostic arthroscopy, reconstructive operations on distal parts of upper and lower extremities. Effect of surgery on activity of the disease was assessed using clinical and laboratory parameters including ESR, seromucoid, CRP, alpha-2 globulin. Durability of improvement was registered. Radiological data were analysed. Results. Functional results were good and stable (at least during the 1st year after the operation). Exacerbations of the disease were absent. Conclusion. Early and late results of surgery allowed to recommend wide practical use of employed methods.

Abstract, Objective. To assess the synchronous intensive therapy (SIT) effect on clinical and laboratory signs in patients with systemic lupus erithematosus (SLE). Methods. SIT was performed in 30 SLE patients with unfavorable manifestation of the disease: lupus nephritis, neurolupus, cytopenia. The first stage of the treatment consisted of 3 consecutive (PA) procedures with 4-5 days intervals. Alter each PA procedure mcthylprcdnisolone 1,0 was given and after the second one — cyclophosphane (Cph) 1,0, Prednisolone dose did not exceed 40 mg/day per os. During the second stage Cph 1,0 was giveu monthly and prednisolone dose was slowly diminished till 10 mg/day to the 3 month of the treatment. Clinical efficacy was assessed after 1 and 6 month of intensive treatment and then every year. Results. In all cases SIT provided fast decrease of the disease activity after the 1st month. By the end of the 1“ stage manifestations of the lupus vasculitis, nephritis, neurolupus and cytopenia disappeared. After 6 month 93,3% of patients achieved medication-induced stabilization. Complications were absent. Conclusion. SIT is a very effective and safe method of treatment of severe SLE forms.

Under analyses of Nise its high efficacy and good safety in treatment of osteoarthril is exposed.

Efficacy and tolerability of soluble nimesulid (nimesil) 200 mg/day was assessed in 30 patients with rheumatoid arthritis during an 8-weeks controlled study. Nimesil showed significant analgetic and antiinflammatory effects confirmed by decrease of pain, swollen and painful joint count. Effect was considered as good in 77% of cases. The drug was withdrawn in 3 patients because of side effects (gastrointestinal in 2 and face oedema in I)

Objective. To assess intramuscular ketonal application efficacy in joint syndrome. Methods. 30 patients with different joint diseases were included. Intramuscular monotherapy with ketonal was given for 7 days. Before and after treatment pain at rest and at movement was assessed using visual analog scale. Results. Mean pain at movement before treatment was 76 mm, after treatment - 47 mm. Pain at rest was 54 mm and 24 mm respectively. In 14 patients efficacy was considered by the physician as good and in 15 - as fair. The drug was well tolerated in all cases. Conclusion. Intramuscular application of ketonal is highly effective and well tolerated treatment in different joint diseases.

Movalis is a selective inhibitor of cyclooxigenase-2 and an effective NSAID. Its application enables us lo considerably reduce the risk of ihe development of side effects. Economic advantages of Movalis as compared with Voltaren arc formed by its lower price (considering exchange rate) and proved capability to reduce expenses on the treatment of complications.

The case of severe form of Weber-Christchen’s disease in 31 year old man is described. The difficulty of diagnosis for the fist half a year is stressed - until characteristic nodes in subcutaneous layer appears. The diagnosis is confirmed by the data of biopsy of the node which revealed typical multinuclear macrophages with foamy cytoplasm (lypophages). The peculiarity of this case if the resistance of the disease to the combined treatment by high doses of GCS, cyloloxics and Sandimmune.

Bstract. Case report of two sislers with primary Sjttgren’s syndrome combined with Basedow’s disease is described. Immunological studies revealed HLA-DR3 antigen which reliably more often is found in pts with above autoimmunic diseases. Some clinical peculiarities of the process of SjOgrcn’s syndrome stipulated by genetic and exogenous factors.