Rheumatoid arthritis (RA) is a classic autoimmune disease associated with the production of wide range of autoantibodies, and their detection has diagnostic and prognostic implication. The objective of this study was to estimate the diagnostic value of antibodies against modified citrullinated vimentin (AMCV) and nuclear antigen RA33 of the IgA rheumatoid factor (RF) versus the value of routinely used profile of autoantibodies in diagnostic work-up of RA. Material and methods. 253 patients with RA prehistory of varying duration were included into the study group. The control group was comprised of 92 patients, including patients with seronegative spondyloarthropathies and diffuse connective tissue diseases, as well as sex and age matched healthy controls. Serum levels of IgM and IgA RF, antibodies against cyclic citrullinated peptide (ACCP), ACMV, anti-keratin antibodies (AKA), antibodies against RA33 antigen (ARA33) and antinuclear factor (ANF) were measured in all patients and controls. Results and discussion. Diagnostic sensitivity of AMCV equaled 78%, ACCP — 77%, IgM RF — 71%, IgA RF — 43%, AKA — 43%, ARA33 — 31% and ANF — 31%. All anti-citrullinic antibodies (AKA, ACCP, ACMV) were significantly more commonly associated with IgM RF. Among RF and ACCP seronegative patients ACMV were found in 24% cases with 20 IU/Ml detection threshold, and in 21% — with 30 IU/Ml, allowing to increase diagnostic specificity of the test up to 91% with the increment of diagnostic threshold. Incidence of ARA33 was not significantly different among the RF and ACCP positive or negative subgroups, thus making ARA33 an independent RA marker. Specificity of this marker was 87,9%, thus making it inferior to RF and ACCP by a composite of diagnostic characteristics. Conclusions. Integrated measurement of ACMV and ARA33 is a rational approach at the second stage of serologic testing work-up in suspected cases of RA onset, when initial RF and ACCP tests were negative.

Objective — to evaluate the impact of tocilizumab (TCZ) therapy on progression of joint destruction and rheumatoid arthritis (RA) inflammatory activity in 48 weeks after initiation of treatment. Material and methods. 42 RA patients who received 6 intravenous TCZ infusions at dose 8 mg/kg given once every 4 weeks alongside with stable anti-inflammatory and glucocorticoid DMARDs were evaluated. EULAR criteria, as well as SDAI and CDAI disease activity indices were used to evaluate the efficacy of TCZ therapy. Radiographs of the hand and distal feet of each patient were obtained at baseline before initiating TCZ therapy and then at 48 weeks. Absence of radiographic progression was defined as total Sharp/van der Heijde score change ≤0. Results. At Week 48 the following values of indices — DAS28 — 4,69 [3,86; 5,44], SDAI — 17,8 [10,7; 29,5], CDAI — 17,1 [7,2; 26,2] — were corresponding to moderate disease activity and were significantly lower than the baseline values. Remission by DAS28 was observed in 11,9% patients, by SDAI — in 7,1%, and by CDAI — in 9,5%. Baseline median total Sharp/van der Heijde score equaled to 78 [46; 122], the number of erosions — to 10,5 [2; 35], and the number ofjoint space narrowing — to 67 [42; 98], while at Week 48 the values of these indices were — 80 [44; 130], 13,5 [1,5; 34] and 69,5 [38; 110], respectively, with signs of radiographic progression in 9 (22,5%) patients. There were no significant differences in the number of erosions and total Sharp scores in subgroups of patients with low, moderate or high disease activity by SDAI & CDAI and sustainable remission at Week 48. Conclusion. Clinical outcomes after 24-week TCZ therapy are indicative of its' clinical effectiveness and a potential to inhibit structural joint damage progression in RA patients.

Objective — to evaluate the relationship between antibody titers against modified citrullinated vimentin (AMCV), IgM rheumatoid factor (RF), interleukin (IL) 4, IL6 and IL8, and their correlation with rheumatoid arthritis (RA) activity indicators, systemic manifestations, evolution of disease activity and functional status in patients treated with methotrexate (MT). Material and methods. 76 RA patients were evaluated: 44 — were on MT, 32 — were not receiving DMARDs for <3 months. Serum IgM RF and C-reactive protein (CRP) levels were measured by immunonephelometry, AMCV, IL6, IL8 (ng/Ml) — by solid-phase immunoenzyme analysis. Results. There was no correlation between AMCV levels and RA activity measures (p>0,05). Higher AMCV titers were detected in patients with systemic manifestations vs patients without such symptoms (p=0,002). In subgroup of patients with baseline AMCV >500 U/Ml a significantly lower level of IL6 was observed (p=0,03) with a tendency for AMCV level reduction (p=0,06) and an increase in DAS28 scores after 12 mo of MT therapy (p>0,05). IgM RF titers were significantly higher in patients with high disease activity (p=0,0006) and in patients with systemic manifestations (p=0,04). Significantly higher IL6 levels (p=0,01) and a tendency to DAS28 measures reduction after 12 mo of MT therapy was observed in patients with baseline IgM RF >100 IU/Ml (p>0,05).

Objective — to evaluate associations between fluctuating interleukin 6 (IL6) levels and clinical manifestations of osteoarthritis (OA). Material and methods. Totally 81 patients aged 47—73 y.o. with OA diagnosis, meeting ACR criteria, were evaluated. Anthropometric measurements, duration of the disease, degree of functional disability, IL6 levels and joints radiographs were assessed in all patients. Correlation between different IL6 secretion levels and the severity of OA clinical course and of pain syndrome was also analyzed. Results and discussion. Elevated IL6 levels were associated with more pronounced radiographic structural damage, greater degree of functional disability, presence of synovitis and more severe pain syndrome. Therefore, elevated IL6 levels are associated with unfavorable clinical course of OA.

Osteoarthritis (OA) is the most prevalent pathology in routine rheumatologic practice. The concept of calcium-containing crystals deposition within articular cartilage and paraarticular tissues remains the centerpiece among existing theories on the pathogenesis of OA. Objective — radiographic structural analysis of articular cartilage microcrystallization phenomenon in patients with OA and avascular necrosis of femoral head (ANFH). Material and methods. Overall 80 patients after total hip replacement procedure due to coxarthrosis or ANFH were enrolled into this study. The control group included 20 patients with total hip arthroplasty for femoral neck fractures. X-ray diffractometer and scanning electron microscope were used to detect crystal deposition. Results. Cartilage mineralization was observed in 92% of patients with advanced OA and in 100% of ANFH patients. The analysis revealed predominance of calcium phosphate monobasic crystals. X-ray diffraction can be used for practical and investigational purposes.

Objective — assessment of efficacy, local and systemic tolerability of adhesive therapeutic «Wantong ARTIPLUS » (WA) patch, containing 9 herbal and 9 ancillary components in patients with osteoarthritis (OA) of knee joints (KJ). Material and methods. 50 patients with VAS pain scores ≥40 mm in «target» KJ, I—III radiographic stage of OA, with at least 4 weeks intake of nonsteriodal anti-inflammatory drugs (NSAIDs) during last 3 months, with no other rheumatologic disease or severe concomitant conditions were included into the double blind placebo-controlled randomized 2-week study. All patients from the study and the control groups (25 patients each) were applying WA or placebo adhesive patch, which had to be changed every 24 h, to one («target») KJ. Placebo patch contained only adjuvant components. Clinical efficacy and tolerability were evaluated by degree of pain attenuation during walking in «target» KJ, by period of time until onset of clinical improvement (from patient's diary), by complete withdrawal or NSAIDs dose reduction, as well as by rate, nature and severity of adverse events. Results. Local application of WA resulted in significant pain reduction while walking (р<0,00001), and general clinical improvement (р=0,00005). 76% of patients in the study group achieved either dose reduction or complete withdrawal from NSAIDs (р<0,01). No significant changes were observed in any of evaluated parameters in the control group using placebo-patches. Therapeutic WA adhesive patch has demonstrated apparent analgesic activity and good tolerability in patients with KJ OA, therefore it can be recommended as a remedy for local analgesia.

Objective — to evaluate potential input of different factors in the development of left ventricular hypertrophy (LVH) in patients with gout. Material and methods. 57 male patients with gout were included into the study. Echocardiography was performed in M- and B-modes and left ventricular myocardial mass index (LVMMI) was calculated for each patient. LVH was defined as LVMMI >115 g/m 2. Results. LVH was detected in 23 (40,4%) out of 57 patients. LVH was associated with advanced age, arterial hypertension, obesity, hyperuricemia and increased C-reactive protein levels.

Complicated forms of reflux-esophagitis, i.e., erosive esophagitis and Barrett's esophagus (BE) — are common types of visceral pathology in systemic scleroderma (SSD), which require adequate therapy and follow up. Although real prevalence of esophageal involvement in SSD in Russian patients remains uncertain. Objective — to identify prevalence of erosive esophagitis and BE, and to quantify gastro-intestinal (GI) symptoms in patients with SSD. Material and methods. During 1 year (December 2009 — January 2011) all consecutive SSD patients, hospitalized to FSBI «SRIR» RAMS, after signing informed consent, were subjected to esophagogastroduodenoscopy with biopsy of esophageal mucosa in upper 1/3. Totally 123 patients were examined (96,8% females, 3,2% males, aged 50,5±13,1 years). Esophageal mucous was evaluated for presence of pathologic changes and BE (intestinal metaplasia in biopsy samples was a BE diagnostic criterion). SODA questionnaire was used to quantify GIT symptoms Results. Erosive esophagitis was detected in 30 (24,3%) patients, BE — in 11 (8,9%). In 80% of patients marked changes in esophageal mucosa were associated with typical symptoms (heartburn, regurgitaion, dysphagia), while in some cases (in 3 patients) erosive esophagitis and BE were asymptomatic. Quantitative evaluation of symptoms with SODA questionnaire demonstrated clear correlation between subjective assessment and severity of esophageal pathologic changes. In patients with erosive gastritis and BE the SODA «pain» and «non-pain» parameters scores were significantly higher and satisfaction in dyspepsia management was lower (p<0,05), then in individuals without erosions and mucosal inflammation. Here was no clear correlation between esophageal pathology and SSD type (limited, diffuse), age, duration of the disease, presence of pulmonary interstitial lesion and Sjogren's syndrome. Patients with erosive esophagitis were significantly more often (36,6%) using proton pomp inhibitors as compared to individuals without apparent esophageal pathology (22,0%; p<0,001). Conclusion. Erosive esophagitis is diagnosed in each 4th patient with SSD.EB is also quite common in this pathology, predetermining the necessity of regular endoscopic check-ups in all SSD patients. SODA questionnaire is a useful tool to evaluate the severity of upper GIT symptoms in SSD patients during follow up.

Objective — to define more precisely the potential of magnetic-resonance imaging (MRI) in the early diagnosis of coxitis in patients with spondyloarthritis (SpA). Material and methods. Hip (coxofemoral) joint (HJ) MRI (in T1 and T2Fat Sat; 1,5 T modes) was performed in 60 patients with ankylosing spondilitis (AS) and SpA: clinical signs of coxitis were present in 37 patients, while remaining 13 patients without coxitis were included into the control group while 10 healthy subjects without SpA made formed a healthy control group. The following parameters were monitored: pain intensity — by the numeric rating scale (NRS 0—10), distance between the ankles, radiographic changes (RCh) by BASRI index, presence of intraar-ticular exudate by US-examination. Active coxitis was defined as pain (during active and/or passive movement and/or pain at rest) in hip joint after exclusion of enthezitis-related pelvic or greater trochanteric pain. Results. Cases of AS and SpA aged younger than 20 y.o. predominated in the cohort patients with coxitis (55,2%). Bilateral coxitis was diagnosed in 81% patients. Median (Me) of disease duration was 12 [25th; 75th percentiles — 1; 132] months. Pain intensity in hip joint measured by NRS was 3 [2; 5]. RC were not found (BASRI-hip=0) in 20 (29,8%) affected joints, 47 joints met the criteria of I—III BASRI-hip stage. RCh were not present in patients without coxitis (BASRI-hip=1) in 9 (28,7%) joints. The most prevalent inflammatory changes (ICh) in patients with coxitis following MRI data were: exudation in the articular space >7 Ml (54%), bone marrow edema (BME) in the acetabular region (39%), cysts of the acetabular roof (32%), capsule thickening (25,5%), BME of the femoral head (13,4%), cysts of the femoral head (10%). There was a significant correlation between pain intensity measured by NRS and prevalence of ICh (Spearman's rank correlation R=-0,29; t=-2,46; p=0,01). BME of the femoral head and/or of the acetabular roof were seen significantly more often in patients with RCh (in 64 and 25% joints, respectively; p=0,0005). BME of the acetabular roof was 3-fold more common than BME of the femoral head (39 and 13,4%; p=0,001). Femoral head cysts were detected in 15% of joints in the subgroup of patients with RCh, and in 8,5% of joints in the subgroup of patients without RCh (p=0,4). Acetabular roof cysts were seen only in patients with RCh (32%). Overall ICh were detected in 55 (82%) joints in patients with coxitis and in 4 (12,1%) — without coxitis (BME — 1; exudation — 3). In patients without SpA and AS exudation was detected in 5 joints. Conclusion. ICh in hip joint can be detected by MRI before the development of structural damage. The most common area for detection of early inflammatory changes, i.e., BME is the subchondral space of acetabular roof.

Persistent interest to Abatacept (ABA) keeps growing due to continuous inflow of consistent efficacy and safety data from successful clinical trials. The objective of our retrospective trial was to evaluate ABA efficacy and safety in treatment of juvenile idiopathic arthritis (JIA) in biologic-naive patients. 20 patients aged 3—17 y.o. were included into the study. All included cases had a long duration of the disease, high values of clinical and laboratory indicators of JIA activity corresponding to moderate and severe course of arthritis. 70% achieved improvement in ACR 30 after average 8 months treatment with ABA (duration range 3—20 mo). Best clinical responses were observed in patients with systemic JIA subtype (but without obvious clinical manifestations) in all 3 cases out of 3 included, and polyarticular subtype — in 9 patients out of 11. 6 patients (30,0%) discontinued treatment. Main reasons for discontinuing treatment were absence or lack of efficacy — in 4 cases, poor adherence — in 1 case, and adverse reactions — in 1 case. Hopefully these data will help practicing physicians with adequate choice of treatment.