Objective. To assess frequency and significance of atherosclerosis and connected with it cardiovascular disturbances (CVD) risk factors in pts wilh systemic lupus erythematosus (SLE). Material and methods. 99 pts (mean age 35,9± 10,8 years, mean disease duration 106± 115,5 months) were examined. Classical risk factors were analyzed. Coronary complications risk was assessed with "Scheme of individual total (general) coronary heart disease (CHD) clinical signs risk determination”. Duplex scanning of common carotid arteries was performed. C-reactive protein (CRP) was evaluated by high-sensitivity immune-enzyme assay with Bender MedSystems commercial kits. Results. 92% of SLE pts had at least one classical atherosclerosis risk factor, most often - dislipidemia (DLP) or hypertension (HT). Subclinical atherosclerosis signs characterized by increase of intima-media complex thickness and DLP were more frequent in pts with HT than without HT (p=0,00l and p=0,008 respectively. Total CHD clinical signs risk in group with atherosclerosis features was higher than in group of pts without atherosclerosis (p=0,0001).A positive correlation between total risk of coronary complications and CRP concentration (r=0,27, p=0,02). Conclusion. Classical and some "ersatz" risk factors are of considerable significance in atherosclerosis and connected with it CVD progression. Multiple-factor analysis of different indices and evaluation of their role in the CVD development in SLE pts are essential for examination of mechanisms of early atherosclerosis development.

Objective. Rertrospective analysis of clinical and laboratory features of primary (PAPS) and secondary (SAPS) antiphospholipid syndrome (APS) in systemic lupus erythematosus (SLE). Material and methods. 280 pts (96 male, 184 female) with SLE were included. 142 had SAPS and 84 (24 male, 60 female) - PAPS. Mean age was 31,2±ll,l years and mean disease duration - 8.6+7,2 years. PAPS pts mean age was 35,6±9,9 years and mean disease duration - 1 1,9±8,5 years. Peripheral vessels USDG and echocardiography (EchoCG) were performed to verify vascular complications. Anticardiolipin antibodies (АСА) and lupus anticoagulant (LA) served as serological markers of APS. Results. In 75% of pts the disease began with SLE signs, in 17% - with ARS signs and in 8% - with thrombocytopenia. 5 from 138 SLE pts without APS showed LA and APS clinical signs during follow- up. In 54% from 142 SAPS pts the disease began with an SLE sign, in 34% - with an APS sign and in 12% - with thrombocytopenia. At the onset of PAPS thrombocytopenia was much more seldom - in 5 from 84 pts. The rest had other APS signs at presentation. 8 pts showed PAPS transformation into SLE, Thrombotic complications frequency among SLE pts was 42%. They were significantly more frequent in APS (76% in PAPS and 90% in SAPS) than in SLE without APS (6%), x 2=I3I, p<0,000l. There was heart disease association with APS. Heart disease was present in 43% of PAPS pts, 27% of SLE+APS pts and only in 2% of SLE pts without APS. Neurological signs spectrum in PAPS and SLE+APS was similar but stroke in PAPS was significantly more frequent (46%) than in SAPS (26%). Digital necroses, nail bed infarctions and purpura, which probably develops with participation of inflammation, were not characteristic for PAPS. Conclusion. Our data shows difficulty of PAPS verification, possibility of its transformation into SAPS what proves necessity of clinical and laboratory monitoring for this pts category. Beside that despite of similarity of the two forms of APS some distinct features of PAPS and SAPS were revealed.

Objective. To detect anticardiolipin antibodies (АСА), anti-p2-GPl antibodies, C3 and C4 complement components in immune complexes including those containing АСА in skin and muscle eluates of pts with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Material and methods . In 7 pts (6 female and I male, 2 with primary APS, 3 with SLE+APS and 2 with SLE) skin and muscle biopsies were taken. 6 from 7 pts had thrombotic complications. Eluates were obtained from frozen skin and skeletal muscle biopsies (size was 1,5x0,5 and 0,5x0,5 respectively). Because of small size of biopsies it was not possible to use traditional methods of tissue pounding such as sharp homogenization of tissues in homogenizers with pulverizing and subsequent process of freezing-unfreezing which lead to large protein loss and make impossible serological tissue analysis. Application of acid eluates method by T.E.W. Feltkamp and J,H. Boode of own modification allowed to minimize tissue protein loss and perform serological tissue analysis. Results. Serum of all 7 pts contained antiphospholipid antibodies - IgG-ACA in 3, combination of IgG- und IgM-ACA in 5. In 5 from 7 eluates lgG АСА exceeded 0,109 OO units were revealed. They contained СЗ, C4 and different protein products mostly immunoglobulines. Anti-(I2GP1 antiboddie;. were absent. Conclusion. For the first time presence of АСА in tissues of APS pts was showed which may be of particular interest in studying morphogenesis of local tissue disturbances with participation of immune complexes containing АСА.

Objective. To examine the distribution of HLA-DRBI alleles frequency in pts (pts) with protracted rheumatoid arthritis in Russian population. Material and methods. 44 pts with RA (ACR criteria) with a mean age 53,7 yrs (30-72), a mean disease duration 13,6 yrs (5-31) were included. 95% of pts were taken a monotherapy or combination of DMARDs. Radiographic damage assessment in wrists and foots was examined by Larsen method. HLA- DRBI typing was performed using PCR method. 135 health donors were a control group. Results. 27 RA pts had HLA-DRB*04 alleles (45,5%) , in control - in 12,6 %, respectively (p<0,0005, OR=6,3). DRBI*04 positive pts were 24 RF(+), along 12 RF(-) pts DR4-positive were 7 pts (74% versus 58%). Radiographic destruction was equally severe both in DR4(+) pts anf DR4(-) pts, 92% and 71% respectively (NS). Retrospective analysis of determination of the influence of DMARD choice showed that Amimalarics were applied at the onset of disease. At the present time Methotrexate was frequently administered both in all pts (p<0,0012) and in 12 DR4(+) pts (44%) in comparison with 3 DR4(-) pts (18%), (NS). The DR(-) pts who had moderate joint damage were taken Sulphasalazine. Combination therapy with DMARD and steroids was used more active in pts with DRB1*04 (NS). HLA-DRBI*04 had an association with factor of beginning time of DMARDs therapy (r=0,32, p<0,04) and a functional activity (r=0,35, p<0,05). Conclusion. The previously results showed that RA in Russian population is associated with a high frequency of DRBI*04 alleles and low frequency of DRBI*07 which had a protective role for disease course. HLA-DRBI*04 possibly could be included in the list of prognostic factors of RA. Large prospective long-term investigations are needed for the determination of specific genetic markers at the onset of RA that may be valuable for predicting the disease severity and selecting appropriate therapy.

To study clinical significance of von Willebrand factor antigen (WFA) in antiphospholipid syndrome and systemic lupus erythematosus (SLE). Material and methods. Serum concentration of WFA was determined with immune-enzyme assay in 21 pts with primary APS (PAPS), 39 SLE pts with APS, 68 SLE pts and 56 healthy donors. Results. WFA level in PAPS, SLE+APS and SLE was significantly higher than in donors. WFA concentration in serum of SLE pts without APS significantly exceeded that in PAPS. WFA concentration elevation was revealed in 52,4% of PAPS, 56,4% SLE+APS and 73,5% SLE pts. There was no association between WFA level, thromboses and obstetric pathology in PAPS and SLE. WFA concentration increase in SLE with APS correlated with IgM anticardiolipin antibodies and SLEDAI activity index (p<0,05), in SLE - with SLEDAI and ECLAM activity indices (p<0,05). WFA level in SLE pts with renal disease was significantly higher than in SLE pts without renal disease. There was a direct correlation between WFA level and ESR (p<0,05) so as with CRP (p<0,05) in SLE. There were no significant differences of WFA level in SLE pts with and without atherosclerotic plaques. WFA level did not correlate with intima-media complex thickness. Conclusion. Development of immunopathological processin SLE and APS is associated with WFA hyper production. WFA elevated level reflects inflammatory activity of the disease in SLE but is not associated with presence of thrombotic and atherothrombotic complications in APS.

Objective. To assess prevalence (on appealability), symptomatology and course of Behcet's disease in republic оГ Dagestan. Material and methods. All pts admitted in a specialized department during 3 years were included (in all 21 pts - 9 female and 12 male). Assessment of clinical symptoms and course of the disease in comparison with other authors data. Results. High morbidity of Dagestan population in comparison with other regions of Russian Federation (for example with Yaroslavl) was showed. Eye disease was significantly more frequent in female and thrombophlebitis - in male.

Objective. To reveal in a population sample people with joint pain and swelling. Material and methods. A screening questionnaire for revelation arthritis and arthralgia was filled for each adult resident of 18 years or older. Screening examination was performed in country and city samples. Universal examination was performed among country residents, representative sample was formed for city residents. Results. 23438 residents were screened, mean age was 48,1 ±17,6 years. Women were prevalent - 60%. 8016 were city and 15422 - country residents. Joint pain prevalence was 45%, joint swelling - 27%. These symptoms disappeared with time in 7% and 6% respectively. In other people they became chronic. Population prevalence of joint complaints is connected with sex and depends on age. In people younger than 20 years of age prevalence of joint pain was 9% and swelling - 3%. Conclusion. Preliminary analysis of the screening part of the study showed scale of the joint pathology problem and allowed to get the first data on prevalence of arthralgia and arthritis in Russia.

Objective. To assess efficacy melatonin administered for correction of sleep disturbances in pts with rheumatoid arthritis (RA). Material and methods. 3-weeks randomized controlled study of melatonin (Melaxen, Unipharm) 3 mg/day (in the evening) in 20 RA pts with sleep disturbances was performed. Control placebo group included 10 pts comparable with study group. Effect of the drug on insomnia so as on the main clinical and laboratory indices of RA activity was scored. Results. To the end of follow up study group pts showed improvement of sleep quality in comparison with initial. Frequency of such insomnia signs as feeling of dissatisfaction with night sleep, tiredness persistence after sleep and unpleasant feelings during sleep significantly decreased. The general result of treatment with melaxen was assessed by pt and doctor as improvement or significant improvement in 47,4-63,2% of cases. Morning stiffness, swollen and tender joint counts so as pain intensity significantly decreased during treatment. Improper drug tolerability was noted in only one pt. Signs of insomnia and RA activity did not change in placebo group. Conclusion. Melatonin is an effective and safe drug for correction of sleep disturbances in RA pts. It also showed capacity to decrease inflammatory activity of RA.

Objective. To assess efficacy and safety of combined chondroprotective ARTRA preparation ("Unipharm Inc" USA) in pts with gonarthrosis Material and methods. 90 pts with knee joint osteoarthritis (OA), 11-111 radiological stage according to Kellgren-Lawrence and prominent pain syndrome requiring regular treatment with NSAIDs were included. 45 pts received ARTRA and diclofenac sodium, 45 control pts were treated only with diclofenac sodium during 6 months. Clinical examination was performed before, after 30, 120 and 180 days of treatment. Efficacy was assessed according to conventional criteria of assessment drugs assigned for OA treatment. Results. ARTRA proved to be a new effective drug for OA treatment. It provided decrease of pain and stiffness in damaged joints so as significant improvement of functional state. Systematical ARTRA administration allows decreasing NSAID dose or completely withdrawing such drugs in many pts. ARTRA showed good tolerability and safety so as long aftereffect.

Objective. To assess efficacy and safety of intramuscular (im) and paravertebral (pv) alflutop injections in pts with chronic vertebrogenous lumbar ischialgia. Material and methods. 83 pts with lumbar ischialgia syndrome (44 male, 39 female) aged 31 to 56 years (mean 43,1 ±5,2 years) were included. Disease duration varied from I to 7 years (mean 3,5± 1,9 years), duration of the present exacerbation - from 1 to 4 months (mean 2.4±0,8 months). Vertebroneurologic diagnosis was made according to H. Hall criteria. Pts were randomized into 4 groups. 32 pts of group Al received im, 23 pts of group A2 - pv alflutop injections. 14 pts of group Bl and 14 pts of group B2 received im and pv placebo injections respectively. Treatment results were scored by the doctor. Pts assessed spine pain changes on visual analog scale. Quantitative assessment of verbal syndrome was performed with Waddle scale. Results. Im alflutop injections provided good or fair effect in 61%, pv - in 69% of pts (significantly better than placebo). Effect was evident during the first 2 weeks of treatment and persisted for 3 months after its termination. The best results were achieved in pts with facet syndrome, the worst - in spinal stenosis. Drug tolerability was good in both modes of administration.

Objective. To study effect of etanercept, an antagonist of serum A amyloid production in the AA amyloidosis treatment in juvenile idiopathic arthritis (JIA). Material and methods. Etanercept was administered to all pts with AA amyloidosis admitted to Garmisch-Paterkirchen pediatric rheumatological clinic beginning with 2000. C-reactive protein (CRP), degree of proteinuria and serum creatinin were used as preliminary outcome measures. Results. 11 pts with seronegative JIA (6 boys and 5 girls) were included in the study. Mean follow up duration was l,9±l.01 years. 8 children had systemic, 2 - olygoarticular and one - polyarticular disease onset. Before the study all pts had CRP level elevation (1,03-8,29 mg/dl, mean 4,53 mg/dl). 8 from 11 had marked proteinuria (364-7400 mg/24 hours, mean 1186 mg/24 hours). 2 from 11 had serum creatinin elevation. During etanercept treatment CRP level normalized in 2 and significantly decreased in 4 pts. Proteinuria decreased in 4 from 8 pts. Significant change of creatinin level was not achieved. One girl who did not have improvement during etanercept treatment showed CRP normalization and decrease of proteinuria when the drug was changed to infliximab. Conclusion. Treatment with etanercept provided improvement in almost 2/3 from 11 pts with JIA and AA amyloidosis. Etanercept may be the drug of choice in pts with normal creatinine level in the absence of proteinuria. When it fails another tumor necrosis factor antagonist such as infliximab should be used. It is necessary to extend volume and duration of the study to get more reliable data on etanercept efficacy in JIA pts with AA amyloidosis.

Objective. To assess sandimmun neoral (SN) efficacy and safety in pts with juvenile chronic arthritis (JCA). Material and methods. 25 pts (20 girls, 5 boys) aged 3 to 15,5 years (mean 9,7±3,7 years) with JCA were included. 12 from them had systemic and 13 - joint form of the disease. 92% of pts had polyarthritis and 8% - oligoarthritis. Mean duration of the disease was 5,22+2,5 years (1,5-9,5 years). SN dose varied from 0,5 to 5 mg/kg/day (mean 2,9±l,l mg/kg/day). Treatment duration ranged from 1 month to 5 years. Results. Good and fair effect was achieved in 48% of pts. Swollen joint count significantly decreased particularly after a year of treatment. Laboratory indices of inflammatory activity did not decrease significantly. In 52% of children response to the treatment was unsatisfactory or absent. Half of the pts (52%) had adverse reactions during the treatment with SN. Blood creatinine level elevation was the most significant (8 pts). The reason for the treatment termination was absence of the effect in 8, creatinine elevation - in 2 and financial problems - in 5 pts. Conclusion. Treatment with SN was effective in half of the pts particularly in joint form of JCA.In the whole drug tolerability was good, while half of the pts had adverse reactions which usually did not required treatment termination.

Arava (leflunomide) was administered to a pt of 39 years of age with definite according to ACR criteria diagnosis of SLE after insufficiently effective treatment with glucocorticoids (intravenous dexam- ethason in total dose of 120 mg and methypred orally 20 mg/day). She received leflunomide (arava) 100 mg/day during the first 3 days and than 20 mg/day. Changes of clinical (arthritis, arthralgia, capillari- tis, fever) and laboratory (ESR.CRP, ANA, anti-DNA, ACL, seromucoid) indices showed good efficacy and tolerability of the drug in this SLE pt.