Objective. To evaluate basic trends and variability of the course of rheumatoid arthritis, to reveal parameters of long-term prognosis. Material and Methods. 238 pts with RA (30 male, 208 female) were followed for (M±o) I5,5±6,4 years. They were investigated with standard clinical and laboratory methods. X-ray evaluation was done by Larsen method. Functional disability was investigated by Stanford Health Assessment Questionnaire. Results. At 2002 162 (68,1%) pts continue following up, 47 (19,7%) pts died, 29 (12,2%) patients were lost to follow-up. The activity of disease had a tendency to decrease, but X-ray changes and functional lesions developed. According to the dynamics of disease, 4 subgroups of pts were defined: 1st subgroup (16,3% of pts) with stable low activity and slow X-ray progression; 2nd subgroup (27,3%) with high initial activity and slow progression, 3rd subgroup (34%) with low or moderate activity and fast progression; 4th subgroup (22,5%) with persistent high activity of disease and fast X-ray progression. The subgroups differed significantly by severity of functional lesions, by frequency of secondary amyloidosis and by frequency of lethal outcomes. The main clinical signs of unfavorable course of disease were large joint involvement during first 2 years, the development of extraarticular changes during first 5 years and the development of joint erosions during first 2 years. Conclusion. Some simple clinical signs in the first years of disease (large joint involvement, the development of joint erosion and extraarticular lesions) allow to predict the course and long-term outcomes in the pts wit rheumatoid arthritis.

Objective. To study clinical and immunological features of rheumatoid arthritis (RA) early stage. Material and Methods. 130 RA pts aged 16 to 80 years (mean age 52,5 years, 105 female and 25 male) were examined. 55 pts had disease duration up to 1 year, 34 - between 1 and 3 years and 41 - more than 3 years. Standard clinical, laboratory and radiological examination was performed in all pts. In 43 pts with earlv RA T and В cell receptors were studied with monoclonal antibodies against CD3, CD72, CD4, CD8, CDI6. Results. The most frequent initial symptoms preceding characteristic RA picture were arthralgia (39,2%), fever (34,6%) and body weight loss (24,6%). Mono- or oligoarticuiar onset with subsequent quick transformation into polyarthritis within one year revealed in 61,5% of pts was the usual feature of early RA. The most frequent false diagnoses in early RA were osteoarthritis (in 25,1%), reactive arthritis (in 24,9%) and gout (in 4,6%). Male pts had longer morning stiffness, higher levels of C-reactive protein, more pronounced functional disability, T and В cell immunity activation than female. Conclusion. Understanding of essential clinical and immunologic features of early RA will allow to diagnose the disease in time.

Objective. To compare bone mineral density (BMD) in pts with systemic lupus erythematosus (SLE), treated and untreated by glucocorticoids (GC). Matherial and Methods. 30 females with reliable SLE were examined (APA, 1982), 15 had GC (prednisolone 7.5-60mg/day, median cumulative dose 10.7±6.6g) (1st group), 15 others did not take GC (2nd group). Groups were comparable by age, SLE course duration, body weight. All were females with normal menses period. BMD was assessed in low back vertebral region and femoral neck in standard projections on dichromatic X-ray densitometer QDR-1000 Plus (Hologic, USA) in absolute values (g/cm2) and T-index. Results. BMD in low back was statistically reliably lower in the 1st group as compared with the 2nd (0,918±0,118 and 1,036±0,156; p=0,027). In the left femoral neck there were no differences in mineralization of bone tissue (0,769±0,167 and 0,807±0,227; p=0,568), BMD decreasing in the studied bone region reliably prevailed among pts of the 1st group (n=ll) as compared with the 2nd (n=2) (p=0.003). Conclusion. SLE pis treated by GC demonstrated reliably lower indices of BMD in LI-L4 as compared with pts who were not treated by GC.

Objective. To assess neurohumoral relationship state in pts with systemic vasculitis (SV) and systemic connective tissue diseases. Material and Methods. 54 pts with rheumatic diseases (RS) were included: 18 with systemic lupus erythematosus (SLE), 16 with systemic sclerosis, 20 with systemic vasculitis (SV). Mean age was 49,3 5,4 years. Disease duration varied from 5 to 10 years. Control group consisted of 20 healthy persons. 24- hours ECG monitoring, heart rate variability (HRV) spectral analysis, functional (clinoorthostatic sign) and exercise ECG testing (isometric exercise, dynamic load, veloergometry) were performed. Plasma histamine level, histaminase activity, plasma serotonin, tryptophan-5-hydrolase, oxytriptophandecar- boxylase, MAO levels were examined to assess vasoactive amine system state. Vasoactive amine system slate was assessed on histamine/serotonin ratio. Histamine/histaminase, serotonin/MAO, histaminase/MAO ratios were used to judge inhibitory activity. Results. Compared with control pts with RS showed marked and significant decrease of ergotropic mediators (noradrenaline, adrenaline) and their metabolites concentration which correlated with HRV. Increase of histaminase that processes appropriate biogenic amine excess quantity was found in all forms of RS. More intensive than in healthy persons monoamine metabolism accompanied by their degradation acceleration resulted in enhanced MAO activity (significant in polyarteritis). LF/HF index reflecting summated activity of autonomic influences on heart rate showed significant prevalence of sympathetic effect in SV (3,46 0,31, p<0,05), CRV analysis showed adequate autonomic supply only in 11,7% of pts with RS. Conclusion. Exercise testing in dynamic analysis of quantitative HRV indices should be performed to determine autonomic reactivity ю assess homeostatic possibilities and adaptation reserve in pts with RS.

Objective. To safety of NSAlDs concerning their prohypertensive effect and to devise tactics of management of pts with osteoarthritis and concomitant hypertension. Material and Methods. 98 pts with gonarthrosis and coxarthrosis of stage II-III with pain syndrome and concomitant hypertension of stage 1-II.Diclofenac, ketoprofen, arthrotec and meloxicam were administered. Control group pts received tramal in addition to the treatment. Hypertension was conlrolled with enalapril monotherapy. Results. Groups treated with diclofenac, atrhrotec, meloxicam and ketoprofen showed a tendency to deminution of number of pis with normal decrease of blood pressure (BP) in night hours ("Dipper") and increase of number of pts with insufficient BP nighl fall ("Non-dipper"). These changes may be connected with prohypertensive effect of these drogs. This tendency was more prominent in groups treated with diclofenac and arthrotec. Nimesulid inspite of its marked prohypertensive effect did not impair circadian rhythm of BP. Central analgesic tramal did not possess prohypertensive effect and did not increase BP. Conclusion. According to increase of prohypertensive effect study NSAlDs can be arranged as follows: tramadol, ketoprofen. meloxicam. nimesulid, arthrotec, diclofenac.

Objective. To assess efficacy of De-Nol in NSAID-induced gastropathies. Material and Methods. 45 pts with rheumatic diseases taking NSAID with gastric and/or duodenal ulcer up to 1 cm of size or multiple (>10) gastric erosions (MGE) confirmed with endoscopy were included. They were randomized to receive De-Nol 240 mg twice a day with amoxicillin 2 g/day and furosolidon 400 mg/day (subgroup la) or De-Nol 240 mg twice a day as monotherapy (subgroup lb). Group 2 patients were treated with ranitidin 150 mg twice a day. Demographic parameters, nosological structure, treatment of the main disease and gastrointestinal changes stmcture in these groups did not significantly differ. Elderly women with rheumatoid arthritis and gastric ulcer were prevalent. HP was revealed in 73,3% and 90% of pts. Dyspepsia and heartburn were present in 90% and 93,3% respectively. Therapy efficacy was assessed after 4 weeks. Preventive effect was assessed in 2 months after the successful treatment course. Preventive doses of the drugs were equivalent to ? of treatment doses. Results. 3 pts from group 1 and 1 pt from group 2 were lost to follow up. I pt from group I stopped De-Nol prematurely because of adverse event (diarrhea). Ulcer and erosion healing was achieved in 22 from 26 pts of group I (86.6%) and from 7 from 14 pts of group 2 (50%), p=0.036. After the course of therapy remained in in 4 pts of group 1 (15,4%) and 9 pts of group 2 (64,3%), p=0.003. 3 pts receiving De-Nol had adverse events (2 - diarrhea, 1 - wind). Antihelicobacter effect was assessed in 7 pts of subgroup la. Eradication was achieved only in 3. Antiulcer effect in subgroup la and lb did not differ (88,8% and 82,4% respectively, p=0,732. HP was present in 12 from 20 pts (60%) of subgroup lb. Antiulcer therapy was effective in 6 from 7 of HP-negative (85,7%) and in 8 from 10 of HP positive (80%) pts, p=0,S4l. Preventive effect was assessed in 15 pts of group I and 5 pts of group 2. Relapse frequency was 13,3% and 20% respectively. Conclusion. De-Nol is effective in NSAID-induced gastropathies and its effect does not depend on HP.

Literature digest is presented concerning to gastrointestinal and cardiovascular safety of selective COX- 2 inhibitors including results of Russian clinico-endoscopic study of celebrex efficacy and tolerability in osteoarthritis (OA). Celebrex was administered to the pts with risk factors of gastrointestinal and cardiovascular adverse events development. Results of longstanding treatment of pts with OA and rheumatoid arthritis (RA) which were prospectively followed up are presented. Celebrex was shown to have high efficacy (about 90% responders) and good tolerability independently on age, duration of treatment and daily dose. Esophagogastroduodenoscopy revealed ulcer development in 4% pts with OA with history of ulcer and in 2,4% pts with RA.

Objective. To study efficacy and safety of nimulid. Material and Methods. 33 pts with different rheumatic and vascular diseases were included in an open clinical trial of nimulid. Nimulid was administered 100-200 mg/day during 30 days. Disease modifying therapy was remained unchanged. Clinical and laboratory parameters were assessed before the start and after the end of therapy. Results. Significant improvement of all joint symptoms was achieved. 22(66,6%) pts showed good and 11(33,3%) - fair effect. Adverse events revealed in 5(7%) pts were mild and did not lead to the drug withdrawal. All adverse events were completely reversible. Conclusion. Our data show high efficacy and good tolerability of nimulid in this pts category.

Objective, To study efficacy and safety of Vitrum Osteomag (VO) in prophylaxis of osteoporosis in pts with rheumatoid arthritis (RA) during 12 months. Material and Methods. 50 female with osteopenia confirmed with densitometry were included aged 50 to 70 years in the menopause for more than 2 years receiving small doses of glucocorticoids (<15 mg/day). In an open randomized comparative study of efficacy and safety of VO was administered to 25 pts per os a tablet twice a day and 25 pts received calcium carbonate powder 1000 mg/day for prophylaxis of steroid osteoporosis in RA pts consuming normal quantity of calcium with food. Results. After one year of therapy in pts treated with VO lumbar and femoral BMD was significantly higher than in those receiving calcium carbonate. Tolerability of the drug was good. Conclusion. VO stabilizes BMD in postmenopausal RA pts receiving glucocorticoid therapy and may be included in complex therapy for prophylaxis of steroid osteoporosis.

Juvenile chronic arthritis is a severe disease leading in substantial percent of cases to disability more often caused by deformities of knee,hip or hand joints. Rehabilitation of such pts is usually performed in orthopedic departments after supression of inflammation. Results of complex functional treatment application in pediatric rheumatological department are presented. Improvement of functional status in significant percent of cases is described.

A case of quite successful administration of intravenous immunoglobulin as a component of programmed intensive therapy in a patient with systemic sclerosis and signs of fibrosing alveolitis.

A case of sarcoidosis involving parotid and lacrimal glands and trigeminus is described.

A case of Kaposi's sarcoma development in a pt with Wegener's granulomatosis during immunosupres- sive treatment with cyclophosphane and prednisolone.