Cardiovascular complications (CVC) including myocardial infarction (MI), sudden death and stroke (ST) are the main cause of premature mortality in rheumatoid arthritis (RA). Chronic inflammation plays the key role in the development of CVC in RA. Objective. To analyze prevalence of cardiovascular diseases (CVD), significance of traditional risk factors (Rf), DMARDs and RA features in the development of clinical and subclinical signs of atherosclerosis (AT). To compare results with data of QUEST-RA. Material and methods. Traditional Rf and CVD frequency in RA pts were assessed with a questionnaire. Coronary heart disease, MI and ST were diagnosed according to medical documents. Subclinical signs of atherosclerosis were evaluated with carotid artery sonography. Results. Traditional CVD Rf were evaluated in 563 pts (496 female, 93 male) aged 54 (44-54) years with disease duration 72 (24-144) months. Clinical signs of AT were revealed in5,6%, subclinical – in 11% of RA pts. Hyperlipidemia was present in 82%, increase of intima-media thickness – in 51%, family strain of CVD – in 44%, hypertension – in 38% of pts with RA. Traditional Rf, extra-articular features of RA, CVC and early AT signs weremore frequent in men than in women (p<0,005). Thickness of intima-media complex in 11men exceed that in women (p<0,005). RA pts were divided into two groups (I – with CVD and II – without CVD) to assess relationship between traditional Rf and CVC. Frequency of traditional Rf (hypertension and increased intima-media thickness) in group I was higher than in group II. Relative risk of their development was 4,78 and 2,09 respectively (p<0,05). 38% of RA pts had extra-articular features of RA (OR=2,02; p=0,04). Thickness of intima-media complex correlated with duration of treatment with hydroxichloroquine and sulfasalazine (r=0,34; p=0,0002 and r=0,28; p=0,008 respectively). CVC were not associated with administration of other DMARDs.

Relationship of immunogenetic and immunologic markers and their influence on disease activity and radiological progression in patients with early rheumatoid arthritis. Objective. To study relationship of shared epitope (SE), anti-cyclic citrullinated peptide (ACCP) antibodies and IgM rheumatoid factor (RF) with disease activity and their prognostic significance in pts with early rheumatoid arthritis (RA). Material and methods. 98 pts with early RA (78 female, 20 male, mean age 47,9±13,7 years,mean disease duration 7,4±5,8 years) were included. 67 (68,4%) from them were RF positive 17and 63 (64,3%) – ACCP positive. 1 or 2 SE (SE+/SE- or SE+/SE+) was present in 63(64,3%) pts. SE was absent in 35 (35,7%) pts. 45 (45,9%) pts had ACCP+/SE+ combination.38 (38,7%) pts were SE, ACCP and RF positive. Activity of RA was assessed with DAS28 and functional status – with Russian version of HAQ questionnaire. C-reactive protein (hsCRP) and IgM RF level was evaluated by nephelometric immunoassay (NIA) with automatic analyzer BN-100, Dade Behring, Germany. ACCP2 was measured by NIA with commercial kits “Axis Shield Diagnostics”, Great Britain. Genomic DNA was isolated by salt extraction with sodium chloride. HLA DRB1 gene olygotyping was performed by polymerase chain reaction with kits “HLA-DR-TEX” (manufacturer SIA “DNA-Technology”, Moscow). Results. ACCP level in SE+/SE- and SE+/SE+ pts was significantly higher than in SE-/SE- pts (p=0,004). IgM RF level in SE+/ACCP+ pts significantly differ from the rest: 351,7±535,8IU/l and 67,8±140,7 IU/l respectively (p<0,001, Mann-Whitney test). After one year of follow up disease activity (DAS28) was significantly higher in SE positive pts, in homozygotes (p=0,017). At baseline radiological examination erosive arthritis was present in 25 (25,5%) pts with early RA. After 12 months erosions were revealed in 48 (48,97%) pts. Erosive changes in SE+/ACCP+ pts did not differ from the rest pts at baseline and after one year of follow up (p=0,08). Conclusion. Presence of SE is associated with high ACCP level, particularly in homozygotes. In SE+/ACCP+ pts IgM RF level was significantly higher. After one year of follow up high inflammatory activity was maintained in SE positive pts. Erosive changes progressed in 23,47% of pts during one year of follow up. SE+ and SE+/ACCP+ pts showed a tendency to faster progression (new erosions appeared almost twice more frequently).

Prostaglandin E2 role in inhibition of articular cartilage collagen degradation in patients with osteoarthritis. Objective. To assess prostaglandin E2 (PGE2) role in inhibition of type II collagen digestion in explants of articular cartilage of pts with osteoarthritis (OA). Material and methods. Explants of articular cartilage of pts with OA were cultured with PGE2 1pg to 10 ng/ml. Type II collagen digestion was assessed with immuno-enzyme assay. Gene expression was evaluated with PCR in real time. Results. PGE2 10 pg/ml as well as transforming growth factor β2 (TGFβ2) suppressed type II collagen digestion in explants of articular cartilage of pts with OA. This concentration of PGE2 did not suppress proteoglycan (aggrecan) degradation. Gene expression analysis in 5 OA pts showed that PGE2 10 pg/ml suppressed metallomonooxigenase (MMP)-13, MMP-1 and marker of chondrocyte hypertrophy type X collagen (COL10A1) as well as proinflammatory cytokines interleukine (IL)-1β and tumor necrosis factor (TNF)α. Naproxen, nonselective cyclooxygenase(COX)-2 and 1 inhibitor concentration from 5 to 30 mcg/ml blocked TGFβ2 induced collagen digestion inhibition proving that PGE2 mediate influence of this growth factor. Naproxen concentration 5 mcg/ml increased collagen degradation. Conclusion. The study showed that PGE2 is a chondroprotector because it is able to suppress selectively OA pts cartilage collagen degradation. Beside that cartilage chondrocyte hypertrophy in OA connected functionally with increased collagen digestion is also regulated by low concentrations of PGE2

Quality of life and psycho-emotional status of patients with psoriatic arthritis. Objective. To assess quality of life (QL) and psycho-emotional status of patients with psoriatic arthritis (PsA). Material and methods. 70 pts with definite PsA were included. QL was studied with SF-36. Psycho-emotional status of patients was assessed with Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Spielberger-Hanin Reactive and Personal Anxiety Scale. Results. All baseline QL measures in PsA pts were significantly lower than in control group (p<0,001). Decrease of physical health measures was most prominent. Majority of PsA pts had anxiety and depressive disorders and their intensity correlated with main clinical symptoms of PsA. Conclusion. Pts with PsA have lower QL measures than persons without joint pathology. Significant frequency and intensity of anxiety and depressive disorders require considering their drug correction.

Objective. To assess efficacy and safety of two-month therapy with Potentilla tincturecombined with diclofenac in pts with osteoarthritis (OA) in comparison with diclofenac monotherapy (control group). Material and methods. 60 pts with OA aged 50-75 years were randomly assigned into two groups 30 pts in each. Knee OA was diagnosed according to ACR criteria (1991). Pain at movement, WOMAC index (on VAS), efficacy assessment by physician and pt and diclofenac requirement were used as outcome measures. 1 tea spoon of Potentilla tincture diluted in 1/3 of water glass was given twice a day before meal as well as diclofenac 100 mg/ day during 2 months. Results. Combined therapy provided prominent decrease of pain which exceeded improvement in control group. Significant decrease of summated WOMAC index was achieved only in the main group. Conclusion. Combination of Potentilla tincture and diclofenac was significantly more effective than treatment with diclofenac alone in OA. Combined therapy provided more pronounced analgesic and anti-inflammatory effect than diclofenac monotherapy.

In the article is presented a detailed description of two rare cases of lymphoid neoplasia (αβT-cell large granular lymphocyte leukaemia and primary γδT-cell lymphoma of the spleen) in patients with rheumatoid arthritis. These examples illustrate several diagnostic problems we often face while searching for lymphoid tumors in patients with rheumatoid arthritis. A literature review is attached.