During 1995-1999 autumn-winter periods 300 teenagers with signs of acute respiratory disease (ARD) were examined. 38% from them had group A p-hemolytic streptococcus (GABS) and elevation of anti- streptolysine-O antibodies titers what comply with definite streptococcal infection criteria. Arthritis was revealed and immunologically characterized in 35 teenagers with streptococcal pharyngitis. Pts with non streptococcal pharingitis did not have arthritis. These results allowed to describe clinical and immunological signs of poststreptococcal arthritis for the first time in our land. These signs included asymmetrical non migrating arthritis lasting from 8 to 156 days with primary involvement of large (knee) and less frequently - small joints. Synovitis manifested with joint pain and swelling. It was confirmed by US examination and differed from migrating arthritis in acute rheumatic fever (ARF). According to WHO recommendations teenagers with definite streptococcal infection received combined treatment - single injection of bicillin-5 with subsequent treatment with fenoximethylpenicilline. Cultures and blood immunologic examination in a month and later after treatment gave negative results in 90,5% of pts. Described disease or syndrome associated with acute upper respiratory infection in teenagers differ from ARF.

Interferon system in patients with rheumatoid arthritis infected with hepatitis В and С viruses. R.M. Balabanova, E. V. Vratskih, T.P. Ospelnikova, V.l. Kiseleva Objective. To assess interferon (IFN) status state in pts with rheumatoid arthritis (RA) associated with hepatitis В and С viruses and cryoglobulinemia (CGM). Material and methods. IFN status was assessed in 74 pts with definite RA divided in 4 groups: infected with viruses of hepatitis С (HCV) and В (HBV) (respectively group 1 and 2), RA with CGM (group 3), RA without hepatitis В, С and CGM. IFN status indices were assessed with micromethod in hole heparinized blood. Results. Hepatitis viruses carriers (groups 1 and 2) had significantly elevated circulating IFN level and deep immunocytes IFN producing ability down regulation. In HBV+ RA pts and IFN production decrease was maximal (degree III), in HCV+ RA pts - weaker (degree II). Conclusion. IFN status examination in pts with RA associated with hepatitis viruses and CGM has not only theoretical but also practical importance. Actuality of further study of this problem is determined by necessity of appropriate treatment selection considering IFN system pathology.

Objective. To study course features and gestation ourcomes in pts with systemic lupus erythematosus (SLE). To assess gestation influence on SLE course and gestation outcomes for fetus and mother. Material and methods. 27 gestation course and outcomes were followed up in 26 women with SLE admitted to Tyumen regional clinical hospital in 1995-2001 years. SLE was diagnosed according to ACR 1982 criteria. Statistical analysis was performed with MS Excel 7.0. Results. SLE exacerbated during gestation in all examined women. Autoimmune process activity increased in most pts after the end of gestation independently on its outcome and required intensive treatment methods administration. Negative perinatal SLE influence on fetus was noted even at favorite prognosis for mother. Programs of immunosuppressive therapy are administered in SLE during gestation. Conclusion. SLE presence worsens gestation course and outcomes determining high percent of medical and spontaneous abortions, exerts negative perinatal influence on fetus. Gestation appearance in pts with SLE as a rule lead to disease exacerbation as during gestation as after delivery. Presented intensive therapy programs allow to ameliorate gestation outcomes for mother and for fetus in SLE.

Objective. To study joint mobility range among urban population aged 18 to 30 years and to assess association of joint and other connective tissue structures disorders clinical signs with hypermobility. Material and methods. 769 randomly selected individuals aged 18 to 30 (mean - 25,56) years (419 female and 350 male) were examined. Hypermobility was assessed with 9-point Beighton scale. Examination included skin stretchability evaluation at elbow back surface, determination of flat feet, high palate, joint pain and deformities of knee joints, joint luxation and subluxation, hand and feet vasospastic disturbances, cardiac pain, oculist examination. Methods of variational statistics were used (x2, Student's test, Spirmen's correlation). Results. Hypermobility incidence and joint mobility in population aged 18 to 30 years in Orenburg largely comply with data received in Moscow. Joint mobility up to 5 points in women and up to 4 points in men is usual for persons of this age and in absence of additional clinical symptoms cannot be considered as pathological. Knee joint deformities, presence of high palate, cardiac pain accompanied by signs of vegetative dysfunction, hand and feet vasospastic disturbances are significantly connected with degree of joint mobility and in some cases can help in hypermobility syndrome diagnosis.

Objective. To assess hemodynamic disturbances in pts with low back pain syndrome (LBPS). Material and methods. 57 pts with LBPS were examined (12 female and 45 male) aged 18 to 53 years (mean age 36,7 years). Spine osteochondritis was diagnosed in most of them. 34 had subacute and 23 - chronic LBPS course. In 32 pts peripheral hemodinamic indices were examined with tetrapolar rheo- vasography by “ARM-RhEO" apparatus. In 25 pts total local blood flow was assessed in pain points with laser-Doppler fluometry (LDF-2 apparatus). 35 healthy individuals of comparable age and sex were included in control group. Results. 77% of pts showed small vessels tone decrease most prominent in pts with subacute LBPS course. Arterial wall elasticity diminution was revealed in 63% of cases, significant reduction of blood filling level - in 82%, venous flow-out obstacle - in 87%. There was a connection between degree of local blood flow increase in back pain points and (PI) score: 0,19 V in pts with PI>60 u and 0,13 V in pts with PK40 u (in control group - 0,08 V, p<0,05) what shows perifocal edema in most painful points. Conclusion. Revealed regional hemodynamic and microcirculation disturbances can objectively confirm participation of hemodynamic disturbances in pain syndrome genesis and serve as a basis for perfection of LBPS treatment methods.

An analysis of interleukin-10 (IL-10) gene polymorphism associative link with clinical variability in Kasakhs. 49 pts with systemic lupus erythematosus were included (48 female and I male). Promotive IL-10 gene region determined by a point variable in 627 locus was assessed with restrict fragment length polymorphism method using restrictase Rsal. The results showed allele IL-10 gene polymorphism significance in disease risk determination, clinical variability and features of pathological process course in Kasakhs.

Objective. To study vasoregulating function circulating endothelial cells (CEC) number in blood of patients with rheumatoid arthritis (RA) with different activity and clinical features. Material and methods. 102 pts with RA aged 17 to 55 years were examined. RA was diagnosed according to ACR criteria. Mean disease duration was 7,2+0,6 years. 29 pts had I, 59 - II and 17 - 111 activity degree. 17 pts had Raynaud’s syndrome. Control group consisted of 26 healthy volunteers. Endothelium damage was assessed by CEC content in peripheral blood according J. Hladovec method. Vasoregulating function of vascular wall was assessed by flow-dependent and nitroglycerine-induced dilatation. Results. Flow-dependent vasodilatation was decreased (p<0,02) and CEC number was increased (p<0,01) in RA pts comparing with control group. Endothelium damage degree and vascular tone regulation disturbances depended on activity, presence of systemic features and duration of RA. Conclusion. Blood CEC number measurement can be used for assessment of endothelium damage in RA. Pts with RA have disturbance of vasoregulating function of endothelium and its degree depends on activity and duration of the disease.

Objective. To assess homocystein (HC) level in systemic lupus erythematosus (SLE) with antiphospholipid syndrome (APS) and its relation to thrombosis development and blood lipide spectrum disturbances. Material and methods. 32 pts (12 male and 20 female) with mean age 36 12 years and mean disease duration 13 11 years were included. 8 pts had SLE without APS, 13 - SLE with APS and 11 - primary APS (PAPS). All pts were divided into 2 groups depending on blood HC level. 26 pts with HC level more than 12 mcg/d! were included In group 1 and 6 pts with HC level less than 12 mcg/dl - in group 2. HC level was measured with high efficacious liquid chromatography (HELC). Lipid-protein blood spectrum was assessed in all pts. Results. Elevated HC level was revealed in 26 from 32 pts: in 16 with SLE (including 12 pts with APS) and in 10 with PAPS. HC concentration did not depend on APS presence, but frequence of hyperhomocysteinemia (HHC) significantly associated with APS and thrombotic complications. 20 from 26 (76,9%) pts with HHC had thrombosis history. Only I from 6 (16,7%) pts with normal HC level had thrombosis history (exact Fisher test p=0,02). HC level did not depend on age and sex. Changes of blood lipid-protein indices were revealed in most pts. Lipid spectrum disturbances were confined largely to cholesterol elevation due to increase of atherogenic lipoproteins cholesterol. Only 22% of pts showed decrease of antiatherogenic lipoproteins concentration. Bblood lipid-protein spectrum indices did not depend on HC level. Conclusion. HHC is present in 84,6% of pts with APS (primary and secondary). In pts with APS HHC is more frequent than in pts without APS. HHC is associated with thrombotic complications. HHC and lipid-protein spectrum disturbances are independent risk factors of thrombotic complications in pts with SLE and APS.

Objective. To assess early administration and efficacy of 3 disease modifying antirheumatic drugs. Material and methods. 92 pts with rheumatoid arthritis (RA) aged 17 to 45 years (mean age 34,9±8,5 years) were included. Disease duration did not exceed 6 months (mean 3,5±1,9 months. All had 2-3 activity degree and did not received glucocorticoid therapy (systemic or local) and did not have severe concomitant diseases of internal organs. Results. Diagnosis of RA was confirmed during follow up in 90 pts. In 2 pts after 6 months diagnosis was changed to systemic lupus erythematosus. 30 pts received delagil for 3 months without improvement. Treatment with sulphasalazine for 3 months was not effective in 23 from 30 pts. 7 pts had subjective improvement during first 3 months but at 6 month effect was lost. Methotrexate administration provided improvement (DAS change 1,6). Clinical and laboratory remission was achieved in 6 pts. Number of bone erosions in pts treated with methotrexate was significantly less and depended on time of therapy beginning and features of disease onset. Conclusion. Methotrexate was most effective from the 3 drugs in early RA particularly when administered during first 3 months of the disease.

Objective. To study efficacy of antibiotics from two different groups - asitromycin/sumamed (macrolid) and lomefloxacine/maxaquine (ftorquinolone) in urogenous rheactive arthritis (URA) and peripheral variant of ankylosing spondyloarthritis (PVAS) with signs of urogenital Chlamidia inflammation. Material and methods. 86 pts were examined: 51 with URA (including Reiter’s disease - RD) and 35 with PVAS. Diagnoses of URA, RD and PVAS were definite in all pts. 43 pts received sumamed in total dose of I5g, 43 - maxaquinum - 24g total. Treatment efficacy was assessed according to clinical and laboratory indices changes immediately after the end of treatment and then in 1 and 3 months. Results. Similar significant decrease of swollen and tender joint counf as well as laboratory activity indices accompanied by disappearance of urogenital inflammation signs was seen in URA and PVAS. Conclusion. Antibiotics administration for chlamidiosis is indicated in all cases of URA and PVAS with urogenital inflammation signs.

Objective. To investigate sodium fluoride (Ossin, "Grunental") influence on bone mineral density and metabolism in pts with rheumatoid arthritis (RA). Material and methods. An 6-month open controlled investigation was carried out. 30 women were included in 2 groups: premenopausal (aged 20-40 years) (PRM) and postmenopausal (aged 50-65 years) (PSM). 2 control groups were formed according to similar pairs method. Each contained 15 women of corresponding activity, disease duration and age. Pts received sodium fluoride 80 mg/day and Calcium Sandos 500 mg/day. Densitometry (QDR 1000 Hologic) and bone metabolism biochemical markers examination were performed at the beginning and at the end of the study. Bone phosphatase (BP) C- terminal propeptid of type I collagen (PICP), osteocalcin in serum, deoxypiridinolin and piridinolin in urine were measured with immunoenzyme assay ("METRA Biosystems”). Results. BP level increased during follow up in both PSM and PRM groups (from 22,9±I4,0 to 37,7+16,0, p<0,00l and from 20,7±8,9 to 26,7±12,6, p<0,05 respectively). There were no changes of other BM. 2,5% increase of lumbar BMD was detected in PRM group (p<0,05 - Fisher exact lest). Control group lumbar BMD decreased by 4,45%. Conclusion. Ossin significantly increased lumbar BMD in premenopausal RA pts.

Objective. To study efficacy and safety of diclofenac and Nise® application in pts with gonarthritis. Material and methods. 60 pts with gonarthritis were included (mean age 53,4±9,5 years, mean disease duration 7,4±6,8 years). Quality of life was assessed with 4 questionnaires: Modified Stanford Health Assessment Questionnaire (MHAQ), SF-36, Nottingham Health Profile (NHP), Knee injury and Osteoarthritis Outcome Score (KOOS). 30 pts of group I received diclofenac 75 mg/day, 30 pis of group 11 were treated with Nise® 200 mg/day for 10 days. Multi-vitamins "Decamevitum" and injections of Xantinoli nicotinatis were used as additional treatment. Results. Diclofenac and Nise® showed good analgesic and anti-inflammatory effect. Both provided quality of life improvement in pts with gonarthrosis. Nise® was better tolerated.

Objective. To study nise efficacy and safety in pts with rheumatic diseases (RD) with concomitant disorders of upper gastrointestinal tract (GIT). Material and methods. An open uncontrolled multicenter nise study was conducted on 600 pts (mean age 54,8 years) with RD (rheumatoid arthritis - RA, osteoarthritis - OA, spine osteochondrosis with radicular syndrome - ОС). 20% of pts had G1 diseases at inclusion. Nise® was administered 200 mg/day for 30 days. An additional examination (esophagogastroduodenoscopy - EGDS, US, laboratory investigation) was performed in 30 pts with RD (20 - OA, 10 - ОС, mean age 48,4 years) and concomitant GI disorders (gastric ulcer in remission, erosive duodenitis, chronic pancreatitis, cholecystilis). Results. Nise® was effective in 40% from 600 pts with RD. (% of pts had non severe GI adverse events. The drug was withdrawn due to dyspepsia in only 0,2% of cases. Pain syndrome was eliminated in 90% from 30 pts with RD and GI disorders. 25 from them completed the trial. Severe adverse events did not appear. EGDS did not revealed exacerbation or appearance of new GI ulcers. Conclusion. Nise® is an effective and relatively safe NSAID which can be administered in pts with RD and concomitant GI disorders with EGDS control.

Objective. To study efficacy and safety of "stepped" movalis therapy (parenteral administration of the drug during 3 days and subsequent oral therapy with 15 mg/day for 20 days). Material and methods. Clinical indices (pain at rest and al movement, functional disability and local inflammation degree) were assessed with 10-point scale in 30 pts with osteoarthritis and rheumatoid arthritis before treatment and at different stages of therapy. Assessment of systemic and local drug safety was performed. Results. Intramuscular movalis administration provided fast analgesic and anti-inflammatory response. Achieved significant improvement increased during the second stage of treatment with movalis (oral). Conclusion. The results of the study show high efficacy and safety of new movalis administration scheme.

Objective. To study efficacy and safety of Iwo doses of melox (meloxicam) in pts with rheumatoid arthritis (RA) and osteoarthritis (OA). Material and methods. An open uncontrolled study of melox was performed on 20 pts with chronic rheumatic diseases: 10 with RA and 10 with OA, 18 female and 2 male, mean age respectively 57,5±11,1 and 65,0±7,6 years, mean duration of the disease - 11,1 ±9,9 and 5,6±6,2 years. 90% of RA pis had 2nd activity degree and 1I-IV stage of the disease. 6 pts of OA group had gonarthritis and 4 - coxarthri- tis, 7 pts had 11 and 3 - 111 radiological stage according to Kellgren classification. The drug was administered orally during 4 weeks. Initial dose was 7,5 mg/day. In case of insufficient efficacy it was increased till 15 mg/day in 5 days. Results. All 20 pts completed 4-weeks study. There were no adverse events leading to withdrawal of melox. In 10 pts dose was increased from 7,5 to 15 mg/day - 2 with OA and 8 with RA. According to opinion of pts and investigators efficacy and tolerability were good or fair in 100%. Conclusion. The results of the study confirm that selective COX-2 inhibitors such as melox are effective, have good safety and usually do not cause serious adverse effects.

Objective. To assess efficacy and safety diclofenacol 1% liniment application in comparison with diclo- ran plus. Material and methods. An open controlled 2-weeks trial of diclofenacol 1% liniment on 30 pts with active joint syndrome (group 1) compared with dicloran plus 1% gel on 20 pts (group II). Pts age ranged from 16 to 79 years, mean disease duration was 8,2 1,5 years. Most pts had II activity degree. Results. Diclofenacol 1% liniment applications decreased pain at rest and at movement and circle of aim joints. In pts with RA effect was more prominent. Dicloran plus provided equivalent results. Local effect of diclofenacol appeared in average after 31,5 min. (from 10 to 73 min) and lasted during 118,3 min (from 50 to 240 min.). Diclofenacol allowed to decrease dose of oral NSAIDs in 43,3% of pts and dicloran - in 40% of pts. Diclofenacol safety was good without local and systemic adverse events. Conclusion. Diclofenacol 1% liniment manufactured by Hiperion S.A. (Rumania) can be recommended for wide administration in treatment of joint diseases particularly in pts with concomitant gastrointestinal diseases and hypertension.

Objective. To analyse incidence and clinical features of rheumatic fever (RF) in children of Sakha (Yakut) republic in 1974-2001 years. Material and methods. Sakha (Yakut) republic Ministry of Health Protection reports for 1999-2001 years. Case histories of 75 children admitted to pediatric cardiologic department of republic hospital №1. Results. In 2001 RF and chronic rheumatic heart diseases (CRHD) part among all rheumatic disease constituted 45,5%. RF incidence was 0,5 for 1000 children (in 1974 - 0,36 %o), acute (primary) RF - 0, 2 %o, CRHD - 0,8%c including 0,5%o with rheumatic heart disease (RHD). More than 60% of children admitted in 2001 were 4-10 years old. 65% of children were admitted in winter and early spring months. In 45,2% of admitted pts RF attack was connected with infection history (in 1974 - 76,2%). In primary as well as in repeat RF attack rheumatic process in nearly 80% of cases had signs of I or II activity degree. Primary RF attack ended with RHD formation in 25%, repeat - in 80% of children.

Knee and hip joint endoprothesis (EP) outcomes were studied in 40 old and senile pts (mean 67,3 years) with rheumatic diseases in comparison to 101 pts of young and middle age (mean 42,7 years). Risk in EP of larege joints was determined by the presence and severity of concomitant diseases, mainly by cardiovascular and respiratory diseases. Mortality in old group achieved 6% in comparison with 1% in pts of young and middle age. Fatal outcome was noted in pts with history of coronary heart disease and myocardial infarction as well as in pts with chronic respiratory diseases. The following data were described: long-term results of knee and hip joints EP, quality of life assessment, functional assessment of operated joints according to HAQ, Harris, Insall and Wallly criteria.