A bstract. Objective. To study the efficacy and tolerability of Remicade in RA Material and methods. 20 reliable RA pts compatible to criteria for inclusion into the study and without exclusion criteria. 18 women and 2 men aged 30-60 and older wilh disease term from 3 lo 10 years and longer. In 14 pts RA activity was of 2" J and in 6 pts оГ 3d degree. All pts long period to the beginning of the study had methotrexate in dosage of 7.5-10 mg/week and NSAID, 4 pts had metipred 4-8 mg/day. Remicade was administrated i.v. in droplet in dosage 3 ml/kg of body weight per 250.0 ml of physiological solution lor 2 hours in 0.2, 6, 8 weeks (total 9 infusions for 54 weeks). Results. Full course of Remicade therapy on the background of methotrexate was carried out in 19 pts. All pts demonstrated speedy (after I м infusion) positive effect as reliable decrease of the number of inflamed joints, period of morning stiffness and ESR. Results of 54-weck course assessed as «excellent» in 9, «good» in 8 and «satisfactory» in 2 pts. In 6 cases remission was observed. Remicade tolerabilily was satisfactory. Only in 1 pts during the 7"' infusion bronchospasm and attack Quincke’s oedema she was excluded from further study. Transient hypotension was noticed in 2 pts. In 3 cases infection exacerbation developed (otitis, pneumonia) which required antibiotics use.

Objective. To study mineral density of bone tissue (BMD) in female pts with Sjogren's syndrome (SS) depending on menstrual statute and to evaluate the effect on it of long-term (for 5 years and more) therapy by prednizolone in dosage 2.5-5 mg/day on the state of bone tissue. Material and methods. 120 female pts aged 30-63 were examined by densitometry of low back and femoral neck with «Hologic 1000». Results. Comparison of obtained results with reference base data enabled to reveal negative effect of prednizolo- nc on bone tissue mineralization, clearly demonstrated at the beginning of glucocorticosteroid therapy in peri- menopausa. It was also noted that menopausa began earlier in pts taking prednizolone (at 43.9±5.1 y/o) as compared with untreated ones (at 4S.9±4.5 y/o); there were notable effect of the age of menopausa beginning on BMD and lower effect of the duration of postmenopausa. Rare (3.3%) development of osteoporosis in women of reproductive age associated with long-term non-correctable hypergammaglobulinemia and damage of renal tubular apparatus.

Objective. To investigate the several parameters of femoral neck geometry associated with hip fracture risk in Siberial population. Material anil methods. 51 patients (39 women and 12 men: aged 60-90 years) with hip fractures and 102 persons (78 women, 24 men) without fractures (control group). Bone mineral density (BMD) was measured by dualenergy X-ray absorptiometry (DPX-IQ, Lunar, USA) in lumbar spine and in the hip (femoral neck, trochanter, Ward’s triangle) of the contralateral hip to the fracture. BMD was not significant in both groups. We measured hip axis length (the distance from greater trochanter to inner pelvic brim), the femoral neck axis length (the distance from the trochanter to ihe apex of the femoral head), neck width and the neck/shaft angle on the scan printout. Results. The hip axis length was longer in the women with the hip fractures (56,3±3,9 mm vs.53,7±3,7 mm, p<0,001), the femoral neck axis length (49,1 ±3,6 mm vs.46,3±3,l mm, p<0,001), mean femoral neck width (14,9±1,8 mm vs. 16,1±1,6 mm, p<0.01). The mean neck width was significantly greater in man with fractures cases that in controls (16,6±2,1 mm vs. I8,7±l,5 mm, p< 0,001). Neck shafl angle was not significant in both women and men with fractures and in controls. Conclusion. The hip axis length, the femoral neck axis length and the neck width in women and femoral neck width in men is significant independent predictors of hip fractures independently of BMD.

Objective. To establish the frequency and the type of the neurologic manifestations in pts with primary Sjogren’s syndrome in Bulgarian population. Material and methods. For the period of five years 65 pts with primary Sjogren’s syndrome fulfilling the European clasification criteria for diagnosis were observed. There were evaluated the neurological and the internal status. Electromyography, computer tomography, audiometric investigations were realised. Results. In 28 patients (43,06%) neurological manifestations and diversious in the diagnostic tests were found. Some of the manifestations showed a relapsing character (neuropathy of the n. trigemini), some of them showed a partial disability (mononeuritis multiplex). Conclusion. The engagement of the nervous system occurs in a great number of patients with primary Sjogren’s syndrome. The prognosis of the neurologic manifestations depends on Lhe accurate diagnosis and treatment.

Objective. To assess anemia prevalence in RA pts in 1979 and 1999 years. Material. Retrospective analysis of 327 case reports from RA pts admitted in the clinical department of Instituteof Rheumatology of RAMS for the first quarter of 1979 (n=115) and first quarter of 1999 (n=212) was done.Criteria for anemia were the falling of hemoglobin level lower than 120 g/1 for women and 130 g/1 for men.Results. In 1999 anemia prevalence in RA pts as compared with 1979 was doubled which to some extend depended on the activity of inflammatory process.Conclusion. It seems, that in the development of anemia in RA other factors beside inflammation take place, in particular therapy because ESR rise not always effected the prevalence of anemia in RA pts.

Objective. To improve both prophylaxis and treatment of NSA ID-associated gastroduodenopathies in osteoar- thritic patients. Material and methods. The study included 155 osieoarthritic pts., NSAID-therapy included ibuprofen, meloxi- cam or different forms of diclofenac. Endoscopy before investigation, on the 4-5"' day and on the 3 ,J week (with gastrobiopsy in 37) was performed, as well as basal intragastric pH study (in 57), basal cortisolemia level - immunoassay (in 124). Diagnosis of Helicobacter pylori (in 88) by ELISA and biochemical methods. Results. Taking into account both NSAID-therapy duration and its methods used, the risk-factors presented, patients’ Helicobacter pylori-status and their adrenal glands’ cortisol-productive function, it has been described the frequency of the revealed erosive-and-ulcerous lesions, as well as their clinical and endoscopic peculiarities. The efficacy of ulcers monotherapy with misoprostol has been evaluated. Conclusion. It is expedient first local, then prostaglandin-dependent gastroprotection while taking NSAID, both in Hp-negative and positive pts. Concomitant Helicobacter pylori-infection does not worsen 3-week NSAID- therapy gastric tolerability, but hypercortisolemia does so. Misoprostol proved to be expedient in ulserous gas- troduodcnopathy .

Objective. To assess the effect of selective NSAID Celecoxib on the indices of arterial pressure in RD pts with concomitant arterial hypertension and taking Enalapril. Material and methods. 10 pts (5-RA, 5 - OA) had daily monitoring of arterial pressure, assessment of renal functions against background of Celecoxib and Enalaplir therapy. Results. During combined therapy by Celecoxib and Enalapril arterial pressure, levels of creatinine and blood urine, minute diuresis, speed of glomerulal filtration was not practically changed. Nevertheless in 3 pts considerable increase of arterial pressure was observed. Conclusion. The majority of pts did not demonstrate negative Celecoxib effect on hypotensive Enalapril properties, the third of pts demonstrated increase of daily monitoring of arterial pressure, no negative effect on renal function was found.

Celebrex in dosage of 100-200mg/day for 14-20 days was prescribed to 36 SLE pts with symptoms of chronic painful vertebrogenic syndrome. Considerable or moderate lessening of pain syndrome was noticed in 91% of cases (up to 1-3 point by VAS with initial pain more than 4 points). Analgetic effect of the drug was demonstrated already on the 2nd day, the safety was good. Celebrex was recommended for long-term treatment of chronic painful vertebrogenic syndrome in pts with systemic lesions of connective tissue.

Objective. То study of tizol efficacy for local therapy of rheumatoid arthritis (RA). Materials and methods. 90 pts with active RA (2-3 stage of activity) age 41-54 (m=18, f—72). The method оГ double blind controlled comparison of 10 - days therapy with pure tizol, tizol with diclophenac (1%) and placebo (vaseline) was used. In order to evaluate skin permeability of tizol mass-spectrometry of synovial liquid was used. Results. Positive dynamic of joint syndrome under tizol and tizol with diclophenac therapy were showed. There were reduction of arthalgia, decreasing of morning stiffness, increasing of grip strenght. Erythrocyte sedimentation rate didn’t change. Adding of diclophenac to tizol amplified it's analgetic properties. Mass spectrum analysis showed that concentration of titanium in synovial fluid came approximately 10 times higher after 10 days of tizol therapy. Conclusion. The efficacy of local tizol and it’s compounds in inflammatory joint syndrome was showed. Diclophenac intensified analgetic effect of tizol. Efficacy and convenience of treatment, absens of side-effects, low price allow to recommend tizol - gel compounds for local treatment of inflammatory joint diseases.

There are the common principals of the rehabilitation after knee and hip replacements in accordance with particularities of the corse and medical treatment for concrete forms of the rheumatic diseases. Such factors of the surgical risk as osteoporosis, haemorrhage, decrease resistance to infection, accompanying heart diseases, cndo- crin system insufficiency were took into consideration for elaboration of the rehabilitation program. It has been emphasized the accuracy observance for the technology of the operation as the basis of the successful rehabilitation

The key questions of medical and social importance of soft tissue rheumatism, including their prevalence, the problems of their nomenclature, classification and unification of diagnostics as well are considered, the new versions of classification of soft tissue rheumatism and diagnostic criteria of primary fibromyalgia syndrome are olTered.