[Comorbidity in rheumatoid arthritis: A focus on cardiovascular diseases].

Cardiovascular diseases (CVD) in patients with rheumatoid arthritis (RA) are ranked first in the structure of comorbidity and mortality. This review includes recent data on common pathogenic mechanisms of inflammation and atherosclerosis, the impact of traditional and specific risk factors, biomarkers of CVD in RA patients. Variants of CVD in RA, the possible pathogenic mechanisms of their development and methods of diagnosis and prevention are described.

[NERVOUS SYSTEM LESIONS ASSOCIATED WITH RELAPSING POLYCHONDRITIS: ANALYSIS OF ORIGINAL OBSERVATIONS].

Three clinical cases are described including two of relapsing polychondritis with lesions in the central and peripheral nervous system (one of long-standing aseptic lymphocytic meningitis and one of cranial neuropathy of 2, 5, 7, and 8 pairs) and the third case of the optic nerve lesion with amblyopia. The two former cases were successfully treated with high doses of corticosteroids, the third one with moderate doses of the same medications. The data from the current literature concerning variants of clinical manifestations, methods for diagnostics and treatment of neurologic manifestations of relapsing polychondritis are discussed.

[A rare combination of systemic scleroderma, sarcoidosis and psoriasis at advanced age].

We report a rare combination of systemic sclerosis, sarcoidosis, psoriatic arthritis and diverticulosis with severe complications in a 41-year-old male who has been treated by a rheumatologist since 10 years of age.

[Relapsing polychondritis].

Relapsing polychondritis (RP) is a systemic inflammatory condition leading to irreversible structural changes in cartilaginous tissue as a result of generalized proteoglycane decomposition. Auricular and nasal cartilage is usually the first to be affected at the onset of the disease which leads to episcleritis. At the later stages, the larynx and trachea become involved, vasculitis develops affecting the organs of hearing, coronary arteries, kidneys, meninges, and other organs. The disease has an intermittent, recurrent character. The clinical course of RP is irregular. The disease is a rare occurrence and difficult to diagnose. The present review is based on the publications by domestic and foreign authors. It is intended to enhance awareness of the clinical picture and peculiarities of RP among clinicians with a view to improving its diagnostics.

[Early diagnosis of Takayasu's disease (clinical case report)].

Nonspecific aortoarteritis (Takayasu s disease, obliterating aortoarteritis, disease of the missing pulse) is a systemic inflammatory disease of aorta and its branches, which leads to stenosis and ischemia of surrounding tissues. This disease is more common in young women and characterized by slowly progressive course with significant impairing quality of life. Etiology of the Takayasu's disease is unknown. Syndrome of the systemic inflammatory reaction with the clinical manifestations of the effects of lesions of the aorta and its branches at different anatomical levels (symptom: coarctation, abdominal ischemia, coronary, renovascular hypertension, lesions of the pulmonary artery) are criteria of this systematic process. Angiography can detect typical vascular changes due to a nonspecific aortoarteritis and remains the gold standard for its verification. The effectiveness of conservative therapy, surgical treatment, the prognosis for life is entirely determined by the detection of this insidious disease in the initial stages of its development. Until today, the early detection of non-specific aortoarteriite is not generally accepted and widely used, and therefore remain relevant.

[Causes of pain in the knee joint].

Pain in the knee joint is one of the commonest complaints for which people seek an advice of different medical specialists. The aim of this study was to elucidate the cause of pain in patients with the alleged diagnosis of "osteoarthrosis" and to develop the relevant diagnostic algorithm. The study included 214patients aged from 35 to 85 years with a pain level of at least 40 mm by the visual analog scale (VAS). Results of physical and X-ray examination provided indications for further studies that were performed by ultrasonographic (40.1%), arthroscopic (52.3%), and MRT(64.2%) techniques. One third of the patients were aged women with the body mass index > 40.1 and stage 3 osteoarthrosis (OA) in whom pain was attributable to primary osteoarthrosis. The remaining patients had pain of other origin. Ultrasound studies revealed rupture of the internal lateral ligament in 3, "pes anserinus" tendinitis in 5, and synovitis in 53 patients. MRT demonstrated traumatic and degenerative meniscal tear in 102 and rupture of the anterior cruciate ligament in 7 patients. Grade 3-4 chondomalacia of the femoral condyle was diagnosed in 24 patients. There was excellent (98.6%) agreement between MRT diagnosis and arthroscopic data on lesioned intra-articular structures, articular cartilage, and subchondral bone. Arthroscopy revealed traumatic and degenerative meniscal tear in 85% patients, injured anterior cruciate ligament in 8%, signs of synovitis in 52.6%, chondromalacia of the femoral condyle in 57.6%, and isolated pathology of patellofemoral articulation in 33% of the patients.

[Combination of modern physiotherapeutic methods in rehabilitation of patients with osteoarthrosis and rheumatoid arthritis after arthroscopic surgery on the knee joint].

Duration of the rehabilitation period after arthroscopic surgery on the knee joint was reduced by the use of a combination of two modern physiotherapeutic modalities, local cryo-aerotherapy and electrostimulation of smooth muscle components of vascular walls using a Lymphavision apparatus (5-7 sessions). This treatment was given to 55 patients with osteoarthrosis following arthroscopic meniscal resection and abrasive chondropasty and to 20 ones with rheumatoid arthritis after arthroscopic total synovectomy. All patients reported alleviation of pain and oedema in the affected joint. The rehabilitation period was 2-5 days shorter than after the traditional treatment.

[Using hyaluronic acid drugs in local intra-articular therapy of osteoarthrosis in the knee joint].

AIM: To assess efficacy of intraarticular injection of ostenil in knee joint osteoarthrosis. MATERIAL AND METHODS: Sixty patients with gonarthrosis of x-ray stage I-III (mean age 65 years, mean duration of the disease < 7 years) on chondroprotectors and nonsteroid anti-inflammatory drugs (NAD) in a standard dose received a course (3-5 weekly intra-articular injections) of 2 ml injections of ostenil. Assessment of the arthrologic status (VAS, Leken's index, WOMAC index, HAQ index, subjective and objective evaluation of the disease symptoms, need in NAD) was made initially, 5 weeks and 12 months after the treatment. RESULTS: Significant improvement was seen in 60% patients. Pain and stiffness in the knee joint relieved 2-fold. The function improved less. OA severity by Leken's index decreased by two degrees. 20% patients stopped intake of NAD, 32% had no need in taking NAD regularly. Subjective and objective assessment (by the patient and by the doctor) of the symptoms severity improved twice. Twelve months later the arthrological status worsened but not to the baseline. CONCLUSION: Hyaluronic acid drugs act long, are effective and safe for local intra-articular therapy of gonarthrosis.

[The preliminary results of using tramal in rheumatoid arthritis patients]. / Predvaritel'nye rezul'taty ispol'zovaniia tramala u bol'nykh revmatoidnym artritom.

Patients suffering from active rheumatoid arthritis (RA) were examined for the analgesic effect of tramal. All the patients were administered basic therapy and nonsteroidal anti-inflammatory drugs. Tramal produced a beneficial effect in 79% of the patients. The stable analgesic effect ensued on days 3-5 since the onset of continuous treatment. Provided the drug was administered for a short period of time (not more than 14 days), addiction to tramal was not recorded. Only 11% of the patients demonstrated tramal-induced side effects (drowsiness, dizziness, skin itch), seen in cases where the daily dose exceeded 300 mg.

[Changes in indices of inflammatory activity in patients with rheumatoid arthritis during early stages of basic therapy with leflunomide]. / Dinamika pokazatelei vospalitel'noi aktivnosti u bol'nykh revmatoidnym artritom na rannikh étapakh bazisnoi terapii leflunomidom.

AIM: To assess leflunomide efficacy and tolerance in patients with rheumatoid arthritis (RA) during the first four months of the treatment. MATERIAL AND METHODS: The study included 200 RA patients treated in four Moscow clinical centers. Leflunomide was given in a dose of 100 mg/day for 3 days, then 20 mg/day for 16 weeks. The activity of the disease according to the criterion DAS 28 was assessed before the treatment and 4, 8, 12 and 16 weeks after the treatment start. RESULTS: RA activity diminished considerably after one month of leflunomide treatment. Later, the articular syndrome continued to improve. A significant improvement by DAS 28 was observed after 16 weeks of the treatment in 65% (129 of 200) patients, high RA activity persisted only in 17 of 90 patients. CONCLUSION: Leflunomide reduces articular inflammation and raises RA patients' quality of life at early stages of the treatment. This reduction continued for 4 months of the study. Therefore, adequate assessment of leflunomide efficacy should be made only after 4-6 months of therapy.