Objective: to study the rate of metabolic syndrome (MS) and its components among gout patients in different regions of the Russian Federation. Subjects and methods. This cross-sectional multicenter study enrolled 2277 gout patients, including 1963 (86.2%) men and 314 (13.8%) women, from 12 independent medical centers in different regions of the Russian Federation. The patients over 18 years of age who met the classification criteria for gout, elaborated by S. Wallace et al., were included. The diagnosis of MS was established on the basis of Adult Treatment Panel III (ATP III) criteria. The presence of MS, its individual components and comorbidities were recorded. Results. The total rate of MS in the patients with gout was 57%; however, it varied substantially (from 15 to 77%) in different centers. Among the comorbidities, arterial hypertension was most common (in three fourths of the patients), coronary heart disease (CHD) and type 2 diabetes mellitus were less common (43 and 25%, respectively); 15% of the patients had sustained myocardial infarction, renal and cardiac failure was also observed in 15%. In the gout patients, MS was associated with the presence of CHD. Conclusion. The patients with gout were observed to have a high rate of MS (57%), its components, and cardiovascular diseases. The findings suggest that there is a relationship between the presence of MS and the development of CHD.

The author studied in detail the specific features of the clinical manifestations reflecting a granulomatous inflammatory response and necrotizing polyangiitis, by using her experience in following up 70 patients with granulomatosis and polyangiitis (Wegener's), and analyzed their early symptoms, premorbid background, and possible predictors. Granulomatous inflammation and its related clinical manifestations (primarily orbital pseudotumor and subfold granuloma of the larynx) was demonstrated to tend over time to occupy a dominant place in the clinical picture of the disease while the proportion of the symptoms apparently related to necrotizing vasculitis was generally decreased. Interpretation of mechanisms for the development of granulomatosis with polyangiitis (Wegener's) may be of value for the further elaboration of an optimal treatment strategy.

Objective: to analyze «rheumatic» symptoms in patients with infective endocarditis (IE) and to investigate the specific features of the disease and hemodynamics in patients with prior rheumatic valvular disease Subjects and methods. The study included 184 patients with documented IE. The rate of “rheumatic” manifestations, such as joint, muscle, and skin lesions, visceral disorders, and laboratory changes, was estimated. Central hemodynamic parameters were studied in patients with IE in the presence of rheumatic heart disease. Results. Locomotor apparatus lesion was noted in 44.8% of the patients with IE, cutaneous hemorrhagic vasculitis in 18%, pericarditis in 10%, pleurisy in 19%, glomerulonephritis in 60%, leukopenia in 9%, thrombocytopenia in 32%, elevated C-reactive protein levels in 92%, circulating immune complexes in 72%. Glomerulonephritis and hemorrhagic vasculitis more frequently develop in injection drug users (p < 0.0001). Rheumatic heart disease was pre-ceded by IE in 24 patients (13% among the all patients and 27% among those with secondary IE). In the patients with secondary IE evolving in the presence of prior rheumatic heart disease, pulmonary artery systolic pressure (PASP) and cardiac arrhythmia rates were significantly higher than those in primary IE (62.5 and 53 mm Hg; p < 0.05; 62 and 32%; p < 0.025). Conclusion. The «rheumatic» manifestations were common in patients with IE and require their differential diagnosis with rheumatic diseases. Their degree correlates with systemic in-flammatory disease activity. In the patients with IE and prior rheumatic heart involvement, PASP and the frequency of arrhythmias are higher than in those with primary IE.

Objective: to study the pattern of impaired regulatory mechanisms of the mammalian target of rapamycin (TOR) signaling pathway, by monitoring gene expression in the blood of patients with osteoarthrosis (OA) at different stages of the disease. Subjects and methods. The study covered 33 outpatients with OA, 14 patients with this condition prior to knee joint endoprosthesis, and 27 healthy individuals (controls) (mean age 58.0+7.4, 56.5+8.9, and 55.0+8.3 years, respectively). Total RNA was isolated from their blood and used to determine the level of gene expression by a real-time polymerase chain reaction for AMP-activated protein kinase (AMPK), hypoxia-inducible factor-1α (HIF1α), the rate-limiting proteins of the hexosamine signaling pathway — glutamine-fructose-6-phosphate amidotransferase and acetylglucosaminyltransferase, as well as the glucose transporter GLUT1 and steps 6 and 7 glycolytic pathway components — glucose-6-phosphate dehydrogenase and phosphoglycerate kinase-1, respectively; the lipogenesis-related genes — fatty acid synthase (FAS) and the activity of the pentose phosphate pathway — glucose-6-phosphate dehydrogenase in the blood of patients with OA at different stages of the disease. Results. Analysis of gene expressions showed that in the OA patients with a low expression of the mTOR gene (a LOW subgroup), the expression of AGT and GLUT1 genes proved to be significantly lower and that of the AMPK gene was higher than in the healthy individuals. In the OA patients with a high expression of the mTOR gene (a HIGH subgroup), the expression of all the genes under study was much higher, except for the FAS gene; moreover, the greatest expression excess as compared to the controls was observed for the AMPK and HIFlα genes. In the patients with endstage disease (an ES subgroup), the expression of all the study genes, including the FAS gene, turned out to be higher than in the healthy individuals. Conclusion. The development of OA is accompanied by a considerable decrease in the efficiency of energy metabolism. At the same time, in the patients with a low mTOR gene expression, energy deficiency may be due to decreased cellular metabolite transport. It may be caused by the deficiency of the end electron acceptor oxygen in the patients with a high mTOR gene expression and the pathological redistribution of energy substrate in favor of lipogenesis cannot be ruled out in those with end-stage disease.

Objective: to study the pattern of impact of abdominal obesity on the clinical manifestations of osteoarthrosis (OA) in women. Subjects and methods. Forty-three patients aged 48 to 73 years, who had been diagnosed as having osteoarthrosis in accordance with the American College of Rheumatology criteria, were examined. Anthropometric characteristics, the duration of the disease, the degree of functional failure, and the levels of adipocytokines (adiponectin, interleukins (IL)-4 and -6) were estimated and X-ray study of the joints conducted. The nature of effects of adipokines on the course of OA and the degree of arthralgies were determined. Results and discussion. In abdominal obesity, the level of adiponectin and anti-inflammatory IL-4 was lower and that of proinflammatory IL-6 was higher than those in femoral-gluteal obesity. The elevated IL-6 level was associated with severer X-ray changes, more functional failure, and more obvious joint pains. At the same time, IL-4 and adiponectin levels were decreased in severe OA. Thus, abdominal obesity is accompanied by the change in the secretion of IL-6, IL-4, and adiponectin, which are in turn associated with the unfavorable course of OA in women.

Objective: to evaluate the efficacy and safety of immard in rheumatoid arthritis (RA) in outpatient practice. Subjects and methods. The open-labeled uncontrolled trial enrolled 30 patients with the reliable and valid diagnosis of RA of varying duration. Immard was used in patients with early RA or as an additive agent when a disease-modifying anti-rheumatic drug (mainly methotrexate) was ineffective. The effect of immard was evaluated 3 months of its intake of 400 mg from the number of swollen and tender joints, patients' and physicians' total ratings of disease activity on a visual analogue scale, from ESR values, C-reactive protein (CRP) levels, and DAS28 scores. Results. There was a significant decrease in the number of swollen joints and DAS28 scores in the patients receiving a combination of methotrexate and immard. No significant reduction in ERS and CRP levels was revealed during the follow-up period.

The systemic manifestations of rheumatoid arthritis (RA) are fairly diverse. They are associated with high disease activity and an increased risk for deaths, primarily from cardiovascular events. Objective: to study the frequency and spectrum of extra-articular manifestations of RA. Subjects and methods. The trial enrolled 119 patients, including 110 women and 19 men (mean age 47.4+4.3 years), with the reliable and valid diagnosis of RA (mean duration 9.4+3.3 years). The patients were divided into 2 groups: 1) 78 patients with the extra-articular manifestations of RA (a study group); 2) 44 patients without these signs (a comparison group). Clinical, laboratory, instrumental, and morphological studies were made using current diagnostic methods. Results. By and large, the extra-articular manifestations of RA are closely associated with its activity and joint lesion severity. The study group most commonly had anemia (71.4%), rheumatoid nodules (29.4%), generalized amyotrophy (26.9%), lymphadenopathy (26.1%), prolonged fever (24.4%), and rheumatoid vasculitis (18.5%). The development of extra-articular manifestations was associated with the activity and late diagnosis of RA and rheumatoid factor seropositivity.

Objective: to study the evolution of systemic juvenile arthritis (JA) in adult patients. Subjects and methods. The trial covered 19 patients (7 men, 12 women; mean age 28.8+9.1 years) with systemic JA who had fallen ill in childhood (at the age of 1 to 16 years). The duration of the disease was 11 to 53 years (mean 24.7+11.4 years). Its systemic manifestations at the onset included fever (n = 18), rash (n = 8), lymphadenopathy (n = 7), hepatolienal syndrome (n = 8), pericarditis (n = 1). At the onset, oligoarthritis was present in 9 (47.4%) patients; polyarthritis was in 7 (36.8%) and 3 patients had only arthralgies. Results and discussion. The rate of systemic manifestations was decreased over the course of the disease and they were detected only in 3 patients by the moment of the trial. At the examination, almost half (n = 9) had no active arthritis, 10 had inflammatory changes in the joints. At the trial, the total scores of inflammatory disease activity were retained in the vast majority (n = 17); however, its magnitude was low or modest. The mean HAQ score was 1.2. More than half of the patients had retarded physical development or disproportionate body build. X-ray changes were absent or minimal in 4 patients; there were erosions in 5, ankyloses in 3, and Stage IV sacroiliitis in 2. Six patients presented with aseptic necrosis of the heads of the femur and humerus. Nine patients received nonsteroidal anti-inflammatory drugs; 7 took glucocorticoids, and 7 had disease-modifying anti-rheumatic drugs, mainly methotrexate. At the study, the disease activity steadily remained low in 5 patients; 1 patient achieved complete remission; an exacerbation was seen in 13 of the 19 patients. 5-to-23-year remissions were recorded in 11 (57.9%) patients over the course of the disease. Conclusion. The patients with long-term JA tend to develop polyarthritis. Despite the severity, remaining inflammatory activity, and recurrent course of arthritis, the magnitude of its systemic and articular manifestations is reduced in most patients over time. During the disease, there may be long-term remissions; however, one third of the patients develop an erosive process and almost half do aseptic necrosis, which is the ground to continue active therapy.