Objective. To study heart damage in pts with ankylosing spondylitis (AS) by ECG and echocardiography (EchoCG). Material and methods. 344 pts with definite AS not older than 60 years without comorbid cardiac diseases examined in the Institute of rheumatology during 2005-2008 were included. ECG with 12 leads was performed in all pts and transthoracic EchoCG – in 101 pts. Results. Rhythm and conductivity disturbances were revealed in 67 from 344 (19,5%) pts: atrioventricular (a/v) heart block was present in 20 (5,8%) pts (16 had 1, 2 – 2 and 3 – 3 stage of a/v heart block). 27 (7,8%) pts had intraventricular heart block. EchoCG signs of aortal valve changes were revealed in 45 from 101 (44,5%) pts: thickness or dilatation of aorta – in 36 (35,6%), aortal valve cusps thickness – in 32 (31,7%), mitral – in 15 (14,8%). Local thickness in the form of a comb beneath aortal valve on the back wall of aorta basis at the site of its junction with basis of mitral anterior cusp – “subaortic bump” was found in 10 (10%) pts. Frequency of a/v heart block among pts with changes of aorta and cardiac valves was significantly higher than in pts without such changes. On the other hand frequency of aorta and cardiac valves changes in pts with a/v heart block was significantly higher than in pts without a/v heart block (p=0,0027) what shows relationship between conductivity disturbances and aorta and cardiac valves damage in AS. Conclusion. Cardiac pathology in AS is characterized by frequent (44,5%) damage of aorta basis and aorta-mitral junction zone in combination with thickness of aortal and mitral valves and conductivity disturbances.

Objective. To assess relationship of high sensitivity C reactive protein (hsCRP) level in pts with antiphospholipid syndrome (APS) with clinico-laboratory features and cardiovascular pathology. Material and methods. 206 pts were included. 58 from them had primary APS (PAPS), 72 –systemic lupus erythematosus (SLE) with APS and 76 – SLE. 29 from 76 pts of the latter group were positive on anticardiolipin antibodies (ACA) – SLE with antiphospholipid antibodies (APhL) and 47 – low positive or negative on ACA – SLE without APhL. 72 persons without autoimmune diseases were included into control group. CRP (with high sensitivity immuno-nephelometric assay), APhL (with solid phase immuno-enzyme assay), plasma lipids were evaluated, sonography with measurement of intima-media complex (IMC) thickness of common carotid arteries, carotid artery bulbs and internal carotid arteries, electrocardiography (ECG), echocardiography (EchoCG), Holter ECG monitoring were performed. Results. HsCRP serum level in pts was significantly higher than in control: 2,55 [0,71; 7,04] mg/l (varied from 0,15 to 39,85) vs 0,68 [0,26; 1,97] mg/l (varied from 0,1 to 9,61), p<0,001. Most high hsCRP concentration was found in SLE with APS (p=0,02). HsCRP level in pts with PAPS with history of combined or isolated arterial thrombosis was significantly higher than in pts with SLE and APS having the same localization of thrombosis. HsCRP concentration less than 3 mg/l correlated with duration of postthrombotic period in pts with PAPS. HsCRP level also correlated with triglyceride concentration, body mass index, summated coronary risk and magistral arteries IMC thickness. Conclusion. HsCRP elevation in pts with APS was associated with development of combined and arterial thrombosis as well as with traditional risk factors of atherosclerosis.

Assessment of influence of traditional cardiovascular risk factors and inflammation on arterial wall structural characteristics in psoriatic arthritis. Objective. To assess possibility of traditional cardiovascular risk (CVR) factors application as markers of subclinical atherosclerosis in pts with psoriatic arthritis (PA). Material and methods. 130 pts with PA (51 male and 79 female) without clinical signs of coronary heart disease (CHD) and stroke. were included. Mean age was 43 years (39-48 years), mean PA duration – 7 years (2 months-42 years), mean psoriasis duration – 15 years (5,5 – 26 years). PA activity was assessed with DAS4. Age, total cholesterol (TC), high density lipoprotein (HDLP), low density lipoprotein (LDLP), C-reactive protein (CRP), fibrinogen, systolic blood pressure, body mass index (BMI), atherogenity coefficient (AC), relative risk of CHD development, presence of diabetes and smoking were evaluated. Mean and maximal intima-media complex thickness (IMCT) of common carotid arteries was examined with duplex scanning. Results. TC, LDLP and AC elevation was revealed in all and BMI elevation – in one third of pts. In 55% of pts CVR was mean and higher, in 23,5% CVR was absent and in 21,5% CVR was below mean. CVR significantly correlated with mean and maximal carotid arteries IMCT (R=0,48, p<0,00001 and R=0,41, p<0,00001) and fibrinogen (R=0,22, p<0,011). In women CVR correlated with fibrinogen (R=0,27, p<0,16), BMI (R=0,35, p<0,16), mean and maximal carotid arteries IMCT (R=0,50, p<0,00001 and R=0,38, p<0,0005 respectively) and psoriasis duration (R=0,30, p<0,006). In men CVR did not correlated with fibrinogen. CVR did not correlated with DAS4 and CRP. Conclusion. CVR in PA is not connected with traditional markers of inflammation andindex of clinical disease activity.

Microcirculatory disturbances – relationship with peripheral vascular reactivity and structure- functional properties of endothelium in systemic sclerosis. Objective. To assess basal capillary blood flow and examine degree of microcirculatory disturbances depending on plasma endothelin 1 content and structure-functional status of endothelium in pts with systemic sclerosis (SS). Material and methods. 31 pts with SS (31 female and 3 male) with mean age 48±2,1 years and disease duration 9,9±1,3 years and 15 healthy persons match on age and sex were included. Laser Doppler flowmetry, assessment of plasma endothelin-1 (ET1), peripheral blood circulating endothelial cells (CEC), endothelium-dependent (EDVD) and endothelium-independent vasodilatation (EIVD) was performed. Results. All pts with SS had decrease of capillary perfusion and disturbance of peripheral vessel reactivity in comparison with healthy persons. Microcirculatory disorders intensity in SS was shown to depend on plasma ET1 level. Basal values of ET1 concentration were significantly higher in comparison with control group. Peripheral microcirculation measures tightly correlated with plasma ET1 and CEC what point to systemic character of capillary blood flow disturbances in SS. Conclusion. Microcirculatory disorders intensity in SS depends on degree of structure-functional endothelium changes on peripheral and systemic vessel levels.

Objective. To assess possible relationship between osteoporosis and cardiovascular diseases in women of postmenopausal period considering clinical and laboratory data. Material and methods. 98 postmenopausal women aged 45 to 70 years were included (50 in osteoporosis group and 48 in control group). Diagnosis of osteoporosis was confirmed by densitometry (values for spine and proximal femur less than -2,5 SD and more than -1 SD by T criterion respectively). Main risk factors of osteoporosis and cardiovascular diseases were assessed with questionnaires, biochemical measures of lipid and mineral metabolism were evaluated. ECG, EchoCG, carotid arteries and lower extremities vessels Doppler ultrasonography and densitometry were performed. Results. In most cases significant differences between groups were not revealed. Women of control group had later beginning of menopause (50 vs 48 years, p=0,005) and more children in families (2 vs 1, p=0,01). Differences on other risk factors were not revealed. Mineral and lipid metabolism measures, data of ECG and Echo CG did not differ between groups. Doppler ultrasonography (comparison of intima-media complex thickness) showed differences between groups only for right common carotid artery (0,75 vs 0,78, p=0,02), right common carotid artery bulb (0,96 vs 1,03, p=0,02) and left femoral artery (0,81 vs0,75, p=0,04). Conclusion. Cross-sectional cohort study did not reveal definite relationship between osteoporosis and cardiovascular diseases. Further complex studies with clinical, instrumental and biochemical methods are necessary.

Objective. To compare efficacy and safety of nimesulide and paracetamol in treatment of patients with osteoarthritis (OA) during 12 months. Material and methods. 40 women (mean age 66,8±5,1 years) with knee osteoarthritis (II-III stage according to Kellgren-Lawrence) having intensive pain (>40 mm on VAS) were included. Group 1 pts (n=20) received nimesulide 200-100 mg/day. Group 2 pts were treated with paracetamol till 3 g/day. WOMAC was used as efficacy measure. Safety was assessed with endoscopic examination of upper gastrointestinal tract, ECG, blood pressure and ECG Holter monitoring, clinical and biochemical blood parameters. Statistical significance of differences was assessed with Student’s t-test, χ2 and Fisher exact test Results. WOMAC index decreased during treatment from 1182,7±345,9 to 698,4±351,1 for nimesulide and from 1136,4±313,8 to 1031,6±21 for paracetamol (p<0,05). There were 6 cases of gastrointestinal complications and 4 cases of hypertension development or deterioration in each group. Coronary heart disease developed or deteriorated in 4 patients receiving nimesulide but not in control group. Liver function tests did not deteriorated during treatment with nimesulide. Conclusion. Nimesulide was more effective than paracetamol in treatment of OA. But risk of cardiovascular complications development during treatment with NSAIDs requires serious attention. Nimesulide did not induced liver damage during long term treatment.

Assessment of joint pain in teenagers with juvenile arthritisObjective. To assess mean total pain score in teenagers with juvenile arthritis (JA) and its values in groups differing on sex, variant of course, activity measures, degree of functional disturbances. To assess advisability of application of these parameters in real clinical practice. Material and methods. 73 pts with JA (mean age 14,7±1,7 years, mean disease duration7,2±4,4 years) were included. 18 from them had systemic, 42 – polyarticular and 13 – olygoarticular variant. 16 pts were examined repeatedly with interval exceeding one year. Total quantity of examinations was 94. 17 pts were examined at admission and at discharge. Pain was measured on visual analog scale (VAS) and on McGill Pain Questionnaire (83 examinations) including 3 scale: sensor (description of pain), affective (their influence on emotional state) and evaluative (verbal assessment of pain intensity). General health assessment on VAS was performed in 59 pts (in 8 from them at admission and at discharge). Summary mean measures and their values in groups differing in sex, course variant, activity measure, functional class at pts admission to and at discharge from the Institute of Rheumatology of RAMS. Statistical treatment was performed with Biomed program(descriptive statistic, χ2, Student’s pared test). Results. Mean pain score on VAS in all teenagers with JA was 31,3±17,3. It was significantlyhigher in boys with systemic variant (in comparison with polyarticular), in pts with ESR elevation above 30, in pts with functional class 3 and higher at admission to the department. Pain score was significantly lower in pts with olygoarticular variant in comparison with mean value and with value in polyarthritis. Pain above 70 mm on VAS was found in pts with polyarticular damage in systemic and polyarticular variants in active phase of the disease and in severe functional disability. Summated (on sensor and affective scales) mean pain score value was 2,4±1,4. Summated mean range of pain (4,4±3,2) was significantly higher than pain score (2,4±1,4). Conclusion. Teenagers with JA had moderate (on their assessment) pain, more intensive in active phase of the disease and in disabled pts. Pain had emotional tint. Pain measurement should be performed repeatedly (at admission to and at discharge from hospital) to assess results of treatment.

Objective. To determine indications to and efficacy of arthroscopic synovectomy (AS) via anteriolateral portal in rheumatoid arthritis (RA) with knee joint synovitis. Material and methods. 139 pts with RA and knee joint synovitis were included. Kneeswelling, pain, restriction of movement score (from 0 to 3) were assessed at baseline and at the end of the study. Coefficient of conservative treatment inefficacy (duration of treatmentwithout significant improvement) was counted. Value of this coefficient multiplication by the sum of the above mentioned measures was used to determine indications to AS. AS was indicated in 111 cases (79,9%). It was performed in 72 pts (group 1). In 39 pts of group 2 this operation was not performed. 28 pts without indications to AS (group3) continued conservative treatment. Before the operation and after 6 months pts filled SF-36 questionnaire to assess quality of life. We used Russian version of SF-36 which was prepared to assess quality of life of Saint Petersburg adult inhabitants. This version possesses necessary psychometric features and is appropriate for conducting studies of quality of life and health status of Russian population. Results. AS provided significant improvement. All Clinical measures in group 1 showed similar mean improvement approximately by 1 (from 0,83 to 0,95, p<0,001). Integral measures (physical health and psychological health) in group 1 pts were higher (by 3,4 and 3,8 respectively). In group 3 all clinical measures values decreased to 0-1 while 30,8-48,7% assessments in group 2 pts showed 2 and in 5,1% - 3 for restriction of movement. Conservative treatment in rheumatoid synovitis is not equally effective for all pts. It does not provide sufficient effect in presence of indications to synovectomy. On the other hand in pts with less severe form of the disease not having indications to synovectomy such therapy provides fast and significant clinical improvement during 6 months of follow up. Conclusion. In pts with rheumatoid synovitis of knee joint having indications to this operation AS provides better results than conservative treatment only.

Behçet’s disease (BD) is a systemic vasculitis of unknown origin characterized by ulcerous damage of oral and genital mucosa as well as eyes and skin. Other organs (nervous system, lungs, joints, gastro-intestinal tract) are rarely involved. Damage of vessels of all sizes and types is a feature of this vasculitis. Review of main lung BD manifestations (pulmonary artery aneurisms, arterial and venous thrombosis, parenchymatous lung damage) and own description of a pt with BD with multiple pulmonary aneurisms are presented.