Objective. To assess ovarian function and its changes during therapy with cyclophosphan (CPh) in pts with systemic lupus erythematosus (SLE). Material and Methods. 44 pts with SLE aged 16 to 45 years with intact menstrual cycle were examined. 18 from them had received CPh earlier (mean cumulative dose 5,7 g), 26 had been never treated with CPh. Mean age, disease duration and activity (according to SLEDAI) as well as glucocorticoid (GC) doses were similar in both groups. Blood sex hormones - follicle-stimulating hormone (FSH), lutropin (LT), prolactin, estradiol, progesterone were tested with immune-enzyme assay. Each pt was examined by a gynaecologist, pelvis minor ultrasonography was performed, basal temperature was measured during 3 months Results. CPh treated pts had lower mean progesterone levels but higher FSH and LT than pts that had not received CPh. Intensity of these changes depended on cumulative dose of CPh and age of pts. Failure of menstrual cycle lutein phase was found with similar frequency in both groups and achieved in average 63%. Oligomenorrhea and more than twofold menstrual cycle shortening were present more frequently in pts treated with CPh (p<0,05). Conclusion. Treatment with CPh increase risk of ovarian dysfunction in pts with SLE. Failure of menstrual cycle lutein phase does not exclude autoimmune genesis of oophoritis in SLE.

Objective. To investigate the distribution of alkaline phosphatase (ALPL), acid phosphatase I (ACPI), receptor lipoprotein low density (LDLR) and vitamin D binding protein (GC) genotypes in osteoporotic ana nonosteoporotic postmenopausal women and the possible associations these genotypes with bone mineral density (BMD). Material and methods. In this study ALPL, ACPI, LDLR and GC genotypes were determined by polymerase chain reaction (PCR) or PCR-RFLP analysis. Results. We observed significant the associations between BMD of the femoral neck and SS and 2F GC genotypes (0.696 ± 0.010 and 0.654 ± 0.020 gr/cm 2, p < 0.05) but not with lumbar spine in the osteoporotic women. The associations weren't observed between ALPL, ACPI. LDLR genotypes and BMD. Conclusion. These new data showed important role of the GC gene in determination of bone mineral density of the femora! neck in postmenopausal women with osteoporosis.

Objective. To improve quality of diagnosis of systemic lupus erythematosus (SLE) and systemic sclerosis (SS). Material and methods. 30 pts with SLE and 30 with SS were included. Besides complex clinical, instrumental and laboratory examination activity and isoenzymes of succinate dehydrogenase (SDG), fumarate hydrase (FH), malate dehydrogenase (MDG), cytochrome oxidase (CO) were evaluated trice (at admission, after two weeks and at discharge) with original methods. 30 healthy persons were included in the control group. Results. SLE and SS pts had significant changes of energy metabolism enzymes depended on clinical features of the disease. Enzyme indices at minimal activity of SLE and SS were more informative than most of traditional laboratory tests. Comparative analysis of enzyme indices in SLE and SS pts revealed some features with along with clinical, instrumental and traditional laboratory data should be consider in diagnosis of these diseases. Enzyme indices correlated with changes of pts clinical state what allow to use them as criteria of treatment efficacy.

Objective. To examine prevalence of AA-amyloidosis in pts with rheumatic diseases (RD) admitted in Institute of Rheumatology of RAMS Methods. Retrospective analysis of histologically confirmed AA-amyloidosis frequency for 11-year period (1991-2001) was done. Biopsies of diflerent organs were performed in 3048 pts. Results. AA- amyloidosis was present in average in 19% of pts. Problem of statistic and classification of AA-amyloidosis was discussed. Conclusion. Early lifetime AA-amyloidosis diagnostic will allow to improve prognosis in pts with RD. AA-amyloidosis problem in these diseases is topical and is waiting for its solution.

Objective. To characterize gastric mucosa (GM) state in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Material and methods. Gastroscopy (GS) with GM biopsy and histological examination was performed in 85 pts (65 with SLE and 20 with primary APS). 26 from 65 pts with SLE had secondary APS. 21 SLE pt before inclusion did not receive glucocorticoids (GC). H. pylory and its cytotoxicity gen CagA, HSV-I, CMV were examined in GM samples with PCR. Results. The most frequent GS-feature in pts with SLE and ARS was antral gastritis (82%). In 25% of pts erosions and in 8% - hemorrhages of GM were present. Erosions localized mostly in stomach (25%), in 7% of cases they were present in duodenum. In APS pts epigastric pain and GM erosions were more frequent than in SLE without APS. H.pylory in GM was revealed in 70-81%. In 42% of pts it was present in combination with HSV-1 and/or CMV. In more than half of pts with antral gastritis and GM erosions revealed H. pylory was CagA-positive. GC therapy did not influence frequency of GM erosions and hemorrhages formation. Conclusion. The most frequent GS-features in pts with SLE and ARS were antral gastritis and GM erosions. Epigastric pain and GM erosions were more frequent in pts with APS.

Obyective. To assess of functional , structural and metabolic changes of RBC in patients with systemic vasculitis. To estimate influence of RBC abnormalities on blood viscosity and hemostasis. Materials and methods. Blood samples of 75 pis with Henoch-Schonlein Purpura (HSP) and 15 pts with microscopic polyarteritis (MPA) were tested. The levels of ATP transporting enzymes and lipid peroxide oxidation (LPO) in erythrocyte's membranes were assessed. The degree of erythrocyte membrane stability was estimated by test of osmotic and acidic membrane resistance. Results. Suppression of Na +, K +, Ca + activated ATP transporting enzyme in pts with MPA and renal form of HSP was found. This group of patients was also characterized by LPO activation, decreased osmotic and their acidic resistance of erythrocytes and their marked hyperaggregation. Conclusion. The assessment of structural and functional changes of erythrocytes helps to estimate abnormalities of blood viscosity and wo adjust management and predict prognosis in pts with systemic vasculitis.

Objective. To determine the importance of von Willebrand factor antigen as marker of endotheliae damage at the patients with systemic lupus erythematosus (SLE). Material and methods. 30 women from authentic SLE by criteria ACR, in the age of 20-45 years, with duration of disease not exceeding 5 years are surveyed. More than half of surveyed women had chronic current and 2 degree of activity of disease. Control group have made 20 practically healthy, comparable on age. A functional condition of endothelium estimated by means of brahial arthery dilatation. Concentration von Willebrand factor antigen in blood was determined with I FA. Results. At the pts with SLE the concentration von Willebrand factor antigen authentically is higher, than in group of the control. The high concentration von Willebrand factor antigen correlates withdu- ration of disease, inflammation activity, pathology of kidneys and functional condition of endothelium. Conclusions. The high concentration von Willebrand factor antigen in blood can serve a marker of a kidney pathology and dysfunction of endothelium at the pts of SLE

Selectivity of nonsteroidal anti-inflammatory drugs (NSAID) and connected with it treatment adverse events are discussed. Effecacy, tolerability and problem of a selective NSAID nise (nimesulid) optimal dose selection in inflammatory and non inflammatory rheumatic diseases are considered.

Objective. To assess efficacy, tolerability and safety of 1% Tizol gel in monotherapy and in combination with diclofenac (0,5%) and hydrocortisone (0,05%) in rheumatoid arthritis (RA). Material and methods. 88 RA pts with exudation in damaged joints were included in the study. They were randomized into 3 groups. Group I (30 pts) received local therapy with 1% Tizol gel. Group U (30 pts) - a complex drug contained 1% Tizol, diclofenac 0,5% and hydrocortisone 0,05%. Group 111 served as control and was treated locally with 1% diclofenac gel (Hiperion S.A., Rumania). Preparations were administered as thin layer on the whole surface of the inflamed joint trice a day for 14 days. Efficacy was assessed after the course of treatment. Pain intensity (VAS), joint circumference and functional impairment degree (WOMAC index) were used as outcome measures. Laboratory examination included complete blood count, hepatic enzymes level and urinanalysis. Results. Local therapy provided decrease of pain and joint circumference, increase mobility and allowed to diminish NSAID dose. Good effect was achieved in group I and II (53% and 60% respectively). Local effect of the drug in group 1 lasted in average 2,5 hours according to pts' opinion. Tolerability of the local therapy was good in ail pts. Systemic adverse events were absent. Conclusion. 1% Tizol gel and its combination with diclofenac (0,5%) and hydrocortisone (0,005%) are effective for local therapy of RA, decrease pain and inflammation in damaged joints. They can be used for treatment of inflammatory joint diseases particularly in pts with concomitant gastrointestinal diseases, hypertension absence of possibility of oral administration of NSAIDs and/or necessity of decrease of their dose.

Considering membrane-reparative properties of a new phospholipid hepatoprotector Phosphogliv (FG) its therapeutic efficacy was assessed in 9 pts with psoriatic arthritis (PA) accompanied by prominent disturbances of blood rheology. FG was given 0,6 g a day during 3 months. Significant decrease of erythrocyte aggregation resulting in increase of erythrocyte aggregation formation time and diminishment of their hydrodynamic resistance without changes of whole blood general caisson viscosity was achieved. Significant improvement of Richie index, tender joint count and pt assessment was noted. The results prove availability of PG administration in PA therapy and possibility of enlargement PG application area owing to membrane-reparative properties of contained in it polyunsaturated phosphatidilcholin in combination with immunomodulating and anti-inflammatory action of glycyrrhizinic acid.

Objective. To evaluate influence of combination therapy with prospidin (P) and methotrexate (MTX) on X-ray progression, functional status (FS) and quality of life (QL) in patients with rheumatoid arthritis (RA) in comparison with MTX monotherapy. Material and methods. 143 RA pts (129 female and 14 male) were studied. Of them, there were. Mean age was 45.5±5.l years. Average duration of the disease was 4.5 years. 20 pts had II and 123 - 111 degree of RA activity. The second X-ray stage according to Steinbroker dominated. 72 pts of group I received P+MTX combination therapy. The therapy included intravenous drip-feed of P 200-300 mg per week in 200ml of 5% glucose and MTX 10 mg per week 1M. The maintaining therapy included P 100-200 mg per week IM and MTX 10 mg per week. 71 patients of group II received MTX monotherapy 10 mg per week. X-ray progression assessment was performed according to Sharp method. FS was evaluated with the HAQ questionnaire, Lee test. QL was evaluated with SF-36 scale. Pts were examined before and after I, 2, 3, 6 and 12 months of treatment. Results. There was no increase of X-ray progression of the disease in case of P+MTX therapy as compared with MTX monotherapy. Both methods resulted in improvement of FS parameters and physical health. Combination therapy significantly improved psychological health as well.

Arthrosonography of 74 knee joints performed in 37 pts with rheumatoid arthritis before treatment with xefocam (Nicomed) in 34 revealed signs of intra and extra-articular inflammation with presence in 100% fluid in fore part of the joint, increase B. Suprapatellaris size and thickening of synovial membrane. Fluid in lateral parts was revealed in 33 joints and in back part - in 22 joints. Semimembranosus muscle tenosynovitis was revealed at 22 joints. After xefocam administration (intra-articular injections 8 mg once a week for 3 weeks) signs of intra-articular inflammation decreased in 28 and extra-articular - in 21 joints. So xefocam provides anti-inflammatory effect and can be used for treatment of synovitis.

Objective. To study efficacy and safety of different schemes of alflutop (AT) administration in pts with osteoarthritis (OA). Material and methods 45 pts (40 womene and 5 men) with knee or hip OA or nodular form of the disease were included. Mean age was 60,3± 10,0 years, mean disease duration - 8,0±6,0 years, mean duration of the last exacerbation - 5,6±5,4 months. Pts with 2 (27 pts) and 3(15 pts) X-ray OA stage and 2 functional class (30 pts) prevailed. Pts were devided into 3 comparable groups, 15 pts in each. Pts of the group 1 received AT I ml/day intramuscularly (im) during 3 weeks, group 2 pts received intra-articular (ia) injections of AT 2 ml twice a week for 3 weeks and then im for 20 days. In group 3 ia (6) and im (20) injections were performed^simultaneously. During 12 months of follow up every pt received 2 appropriate courses. Results. 41 pts completed the study. AT significantly decreased joint pain at rest and at movement measured visual analog scale and WOMAC index in all groups. It also improved functional activity of pts (according to WOMAC index). Improvement according to doctor assessment was achieved after the second course in 78% of pts in group I, in 92% in group 2 and in 86% in group 3. Sonography of knee joints showed significant decrease of synovial membrane thickness (as a sign of synovitis) as well as increase parts of intra-articular hyaline cartilage thickness in group 2 and 3 pts. There was no radiological progression year of follow up. Tolerability was good. The drug was stopped due to adverse events in only 3 pts (dermatitis at the site of injection-1, increase of joint pain after intra-articular injections- 2) . In 3 other pts side effects were mild, and treatmend was continued. Conclusion. Combined Im and AT administration provides anti-inflammatory, analgesic and possible chondroprotective effect in OA pts.

Sonographic (SG) examination of hip joints was performed in 100 pts with juvenile chronic arthritis (JCA) with different forms, activity and duration. SG signs of hip joint inflammation in JCA were identified. SG features in pts with different disease duration, form and activity were revealed. SG changes of clinically unchanged hip joints were noted which may be of important significance for early diagnosis of coxitis. More wide use of arthrosonography in pediatric rheumatology was proved.

The role of rheumathology as a section of clinical medicine is consider in the article. It is presented the structure of rheumathology service in the Karelian Republic. Authors evaluate diagnostic possibility of rheumathology service and bring yourself data of the role of osteoscintigraphy in the differential diagnostics of rheumathoid arthritis and osteoartritis. Authors consider main therapeutic interference under rheumatic diseases and present own original strategies of local therapy by rheumathoid arthritis and osteoartritis. In the article are brought data about an efficiency of x-ray local therapy and blinding local therapy by rheumathoid arthritis, lumbricant local therapy by osteoartritis.