Aim of study: To investigate the relation between patterns of basic treatment and the outcome of disease in patients with rheumatoid arthritis (RA). Material and methods: We studied retrospectively two groups of patients with RA (1987 ACR criteria): 1) main group - died (72 patients, mean duration of disease from the onset to death 12.8±0.9 years); 2) control group - alive to 1999 with duration of disease at least 15 years (90 patients, mean follow-up period 19.4±0.47 years). Results: Some patterns of basic treatment were observed: 1) "passive ” strategy - only hydroxychloroquine or sulphasalazine during many years; 2) "inteirupted " treatment - early treatment gold or cytotoxics, but when improvement occurred, therapy with DMARD was interrupted for 1-2 years or more, after that re-started etc.; 3) “emergency” strategy’ - 7-10years of "passive" treatment, after that se\>ere destruction and/or amyloidosis appeared, and cytotoxics started; 4) typical "pyramid " strategy; 5) "active " strategy - early start of treatment with active DMARD (melotrexate, gold) with consecutive change of DMARDs without interruption of basic treatment (very close to "sawtooth ” strategy). The most of died patients were treated with "passive ” and "interrupted" strategies, but the most of patients in control group were treated with "pyramid” and "active" strategies. Conclusion: active strategy of basic treatment has a positive influence on the survival ofpatients with R.A.

Aim of study: complex pancreas study in rheumatoid arthritis (RA). Material and methods: 120 RA pts were examined clinically Pancreas US-and biochemical study (level of a-amylase and lipase of blood serum by kinetic-calorimetric method) was performed in this grouh. Results: 50.8% of pts demonstrated increase of pancreas echo, in 23.3%- widened Wirsung s duct, in 45%- single small focal indurations, more often in the body and cauda pancreatis. Decrease of lipolitic and amylolytic pancreas activity is characteristic for RA, especially in systemic process and long-term disease. Clinical and functional disturbances are connected with morphological changes.

Aim of studdy: To assess the frequency of practical application of different basic drugs in rheumatoid arthritis (RA). Material and methods: Tlxe study was conducted basing of questionner of pts and analysis of ycases by randomized sampling among 103 consequent pts (M:F= 13:90) with reliable RA (ARA, 1987) in rheumatologic department of Clinical Hospital Nol in Ekaterinburg. 74% of pts under study demonstrated systemic manifestations: anemia (in 47 pts), lymphadenopathy (in 34), rheumatoid nodules (in 15), Sjogren s syndrome (in 4), nephropathy (in 4), vascular disturbances including Raynaud s phenomenon, capillarites (by 1 pt). Results: In the course of disease basic therapy was prescribed to 88 out of103 (85.4%) pts and one and the same patient could take different basic drugs. Aminochinoline drugs prevailed, after them more frequent were immunodepressants and gold preparations. More rarely pts had sulfasalazin, cuprenil and wobenzym. In general, in 133 out of 184 cases of prescribing basic drugs they were canceled. The reason for cancellation were: prevalently absence of the drug in the pharmaceutical stores (in 48 cases) averagely in 8 months of taking the drug; then they insufficient efficacy (44 cases) averagely in 1.3 year. In 18 cases pts themselves stopped treatment averagely in 3.5 months of drug taking. Conclusion: In the majority of cases of basic drugs cancellation in RA the cause is their absence in sail especially on free of charge prescription. Cases ofself-cancellation of the drug demonstrate the need of explaining to pts the necessity> of long-term taking disease-modifying drugs.

Summary Aim of study: To study the vibration sensitivity (VS) in rheumatoid arthritis (RA) depending on the clinical peculiarities of the disease. Material and methods: The study included 67pts (M:F=7:60) with reliable RA (ARA criteria, 1987). 55 out of 67 pts were positive on rheumatoid factor (RF), 20 pts had the 1st stage of activity, 32 - 2nd, 15 - 3d, corticosteroids were taken by 21 pts. Study of vibration sensitivity was done by electronic biotensiometer (EG Electronic, USA) in three points of lower extremities: dorsal foot surface, front al crural surface in the area of tibia bone crest in medial tertiary> level, knee calycle. Results: Frequency of VS disturbance was measured in parallel with clinical and laboratory indices and was in case of the 1st stage of activity 40%, in 2nd - 75% and in 3d - 93.3%. It was found that VS changing in great majority of cases allows to diagnose the lesion of peripheral nervous system as compared with other clinical changes. Assessing VS dynamics in the course of the therapy on the clinical stage and using NSAIDs and intraarticular injections of corticosteroids was not accompanied by the reliable dynamics of the index understudy. Clinical improvement of articular syndrome and disappearing of systemic manifestations was not associated with the improvement of VS indices. Conclusion: VS disturbance in RA pts is associated with the stage of activity and severity of the disease. Association of VS disturbance with systemic manifestations enables us to study VS in RA as an additional diagnostical test of revealing of systemic symptoms.

Summary Aim of study: Control ofpossible antidestructive effect of low doses of corticosteroids (CS) on the background of basic therapy of rheumatoid arthritis (RA) by methotrexate (MT). Materials and methods: Preliminary results from 38 out of planned 80 patients (all females) aged 23-68 and disease duration from 0.5 to 20 years with reliable RA (ARA criteria, 1987) observed during a year. Exclusion criteria for the study were: ulceral disease ofstomach or duodenum and patients with IV radiological stage of the disease. Patients were divided into 2 groups: 1st group included 19 pts who had MT and CS in dosage of 10 mg/ day and the 2tul -19 pts having as the basic therapy only MT. Taking NSAID was allowed in both groups. To assess therapeutic effect clinical, laboratory> and radiological indices were used. Results: In the 1st group 5 out of 19 pts demonstrated decrease of Larsen index mainly on account of the decrease or disappearing of cystic clearings and of periarticular osteoporosis. In the 2nd group such decrease was observed only in one patient. But Larsen index decrease did not correlate with expected disappearing of erosions, growing of erosions in both groups practically did not differ (2.0 and 2.4 correspondingly). Conclusion: Low doses of corticosteroids taken by RA pts in combination with MT promote the regression of bone-cartilage destruction assessed by Larsen index.

A relationship between X - ray joints changes and functional activity of classical pathway complement components in R4 was investigated. 31 patients with the moderate activity ofRA (ARA 1987) have been examined. Disease duration was 4,5lyear±3,84 (SD). X-ray stage was estimated by Steinbrocker (I-II-III-IV). II patients were in II stage, 8 in III stage, 12 in IV-stage. Concentration of C3 and C4 components have been evaluated by radial immunodiffuision, functional activity of complement components (Clq. C1-C5) - using a microhemolilical systems. High correlation values between functional activity C1-C4 complement components and X-ray stage of disease were obtained (Spearman correlation: 0,38<R<0,7 [10 5<p<0,03]). Thereby high FA of classical pathway complement components is associated with severe joints destruction. Correlation ofC3, C4 concentration was not significant. This fact can be resulting from the phenomenon that complement classical pathway take part in joints destruction in RA. The feature of relationship can be ascribed to both primary high FA of complement classical pathway in patients with se\'ere joints destruction and local consumption of complement at early stage ofjoints destruction.

Basing on the data of home and foreign literature and on the long-term experience of pediatric rheumatologists, terminologic and classification aspects of Juvenile rheumatoid arthritis (JRA) are presented. Approaches to developing of diagnostic and classification of JRA criteria in future are described.

168 patients aged 4-15 years were endoscopically examined aiming at the study of prevalence and structure of NSAID - gustropathy in children with rheumatic diseases. Serious injury of mucous of upper gastrointestinal tract (erosions and ulcers) were found in 21% of children with prevalent localization in the region of the bulb of duodenum and in 50% ofpatients surface changes were revealed. In the group under study there were no reliable dependence between the degree of subjective and objective symptoms of NSAID - gustropathy and no associations of peculiarities of endoscopic changes with the character and duration of medicamentong therapy. The experience of Famotidin using ( Famosan, Pro.Med.CS. Praha c.s.) in 40 children with most pronounced manifestations of drug-induced gastroduodenopathies demonstrated its high efficacy, manifested in quick ceasing of complaints in all patients, healing of erosions and ulcers in great majority of patients with absence of side-ejfects.

Summary Aim of study: Comparative study of clinical efficacy and tolerability of pulse-therapy (PT) by glucocorticosteroids and methotrexate in RA pts and frequency of side effects and aggravations. Material and methods: 31 pts with seropositive RA (M:F=4:27) with disease activity 2-3 were examined. 16 pts had pulse-therapy by dexaven in dosage of 2 mg/kg of weight for 3 consecutive days, 15 pts of the 2nd group had methypred in classic dose of1000 mg No3. After PT on the 7th and 30th day pts had PT by methotrexate 100 mg and dexaven 16 mg. Therapy effect was evaluated after PT, in a month, 6 month and a year. During examination the following parameters were registered: severity of arthralgia, morning stiffness duration, grip strength, number of inflamedjoints, Ritchie's, Li, Landsbery indices, extra-articular manifestations. ESR, hemoglobin content, leukocytes, fibrinogen, seromucoid, C-reactive protein, CIC, RF were determined. Results: After PT in both groups arthralgia, morning stiffness, number of inflamed joints considerably subsided. Dynamics of medial indices of activity decreased by 2-3 times. Side effects after the procedures were minimal and were stopped without additional treatment.

Summary The patient with primary antiphospholipid syndrome (PAPS), who had two out of three pregnancies with intrauterine premature fetus death, was observed. During the last gestation she had corporeal cesarean section, and alive premature girl was extracted. The diagnosis of PAPS was verified basing on relapsing thromboses, repeated premature fetus death and antiphosphilipid antibodies in absence of some autoimmune disease. The peculiarity of this case was late diagnosis of the syndrome, first two episodes of thromboses were not timely diagnosed (diagnoses were as follows: appendicitis, apoplexy of ovary). Only on the background of the third pregnancy the thrombotic genesis of abdominal syndrome was determined. The specter of intensive therapy was suggested which allowed to prevent the development of "catastrophic ” variant of PAPS developing and to keep the child alive.