[Psychopharmacotherapy for depression in rheumatic patients].

AIM: To study attitude towards the disease in rheumatic patients during antidepressant therapy and during further follow-up. SUBJECTS AND METHODS: Examinations were made in 122 patients with degenerative joint and vertebral column disease (DJVCD) and in 30 patients with rheumatoid arthritis (RA) and concomitant affective disorders during antidepressant therapy for 3 months. RESULTS: Statistically significant differences were found between all components of the type of attitude towards disease (TATD) in patients with DJVCD or RA before the use of antidepressants. In the patients with RA, the mean value of adaptive types of TATD was significantly lower and that of disadaptive types significantly higher. After 3 months of treatment, the TATD profiles came closer. Only three components (anosognosia, hypochondriasis, and dysphoria) in the pattern of TATD remained significantly different after 6-month therapy. CONCLUSION: According to the TATD data, both the patients with DJVCD and those with inflammatory diseases of the locomotor apparatus showed unidirectional changes in attitude towards disease with a significant increase in the adaptive components and a reduction in the disadaptive ones.

[Neutrophile apoptosis in patients with chronic rheumatic heart disease].

The purpose of the investigation was to study peculiarities of the functioning of neutrophile granulocytes in chronic rheumatic disease (CRD) complicated by cardiovascular pathology. The subjects of the study were 80 patients with CRD of the heart with valvular defects, accompanied by arterial hypertension (AH) and cardiac arrhythmias: 37 men (mean age 53.6 +/- 9.7 years) and 43 women (mean age 56.2 +/- 9.6 years). The control group consisted of 25 healthy donors. Isolated peripheral blood neutrophiles were cultivated during 6 hours. The level of nitric oxide (NO) production was measured. Functional cell activity was studied by chemoluminiscent assay. The degree of apoptotic readiness was studied by immunocytochemical method, determining bak marker expression on cell membrane surface. In CRD the processes of oxygen-dependent neutrophile metabolism were found to be intensified, which was accompanied by intensified reserve abilities and decreased NO synthesis and apoptotic activity. Functional cell activity in patients with a background of AH was characterized by lowered granulocyte NO production. Intensified production of active oxygen metabolites, observed in paroxysmal cardiac fibrillation, evidences the hyperactivity of the pro-oxidative system, leads to fast myocardial cell membrane lesion and the development of structural changes forming abnormal automatism and trigger activity. Neutrophiles isolated from patients with CRD were in a state of priming, the feature of which was high biocide cell potential. The lowering of apoptotic readiness evidences high mobilization abilities of neutrophiles. The synthesis of NO as one of autoregulation factors is a protective mechanism directed against the cytotoxic activity of phagocytes. The stimulation of granulocyte NO production can lower the oxidative stress intensity and leukocyte aggression and stabilize the course of the disease.

[Incidence rates of articular pain in urban and rural population of Russia (preliminary data)].

AIM: Screening of the population sample for articular pain and swelling. MATERIAL AND METHODS: A screening questionnaire for detection of arthritides and arthralgias was filled in for each adult rural and urban citizen aged over 18 years from 15 RF regions. Rural population was covered with a complete examination, urban one was examined by formation of a representative sample from general population. The screening covered a total of 31424 persons, mean age of whom was 47.6 +/- 17.6 years. Among them 14001 lived in the cities and 17423 in the villages. 61% respondents were women. RESULTS: Prevalence of arthralgias in the population reaches 46%. While the symptoms alleviated with time in 8%, they became chronic in the rest. The articular complaints rate in the population is sex-related and depends on the age. In persons under 20 years arthralgia occurs in 9%. Urban citizens have articular pains more frequently than rural population--43 and 33%, respectively. CONCLUSION: Pilot results of the screening program demonstrate prevalence of arthralgias in Russia and the importance of joint pathology problem in Russia.

[Articular hypermotility syndrome (AHS): clinical characteristics and specific features of AHS-related rheumatoid arthritis and osteoarthritis]. / Sindrom gipermobil'nosti sustavov: klinicheskaia kharakteristika i osobennosti revmatoidnogo artrita i osteoartroza, razvivshegosia na ego fone.

Articular and extraarticular manifestations of AHS were studied in 114 AHS patients. Locomotor complaints were getting more frequent and serious with progression of AHS. Rheumatoid arthritis arising in the presence of hypermotility was characterized by minor symptoms and destructive changes and was not very active. Functional performance of the joints was not much affected. Osteoarthrosis in AHS presence ran with more pronounced symptoms, with early emergence of degenerative changes in the joints, primarily, of the lower limbs.

[Effectiveness of non-steroidal anti-inflammatory and psychotropic drugs in patients with rheumatoid arthritis]. / Effektivnost' nesteroidnykh protivovospalitel'nykh i psikhotropnykh sredstv u bol'nykh revmatoidnym artritom.

The authors provide the data on comparative efficacy of different non-steroidal anti-inflammatory agents (220 studies), psychotropic drugs (32 cases) and combined therapy (58 cases). All the studies were made by the double blind method with the use of placebo (38 cases). As for the psychotropic drugs, use was made of the tranquilizer relanium, mild activating neuroleptic sonapax, and tricyclic antidepressant amitriptyline. Combined therapy with nonsteroidal anti-inflammatory and psychotropic drugs appeared the most efficacious. It is suggested that this is connected both with potentiation of the analgesic effect of the antirheumatic drugs and with the action on the psychological distress playing a definite role in the disease development.

[Rheumatoid arthritis: an evaluation of treatment efficacy and some aspects of the physician-patient dyad]. / Revmatoidnyi artrit: otsenka éffektivnosti lecheniia i nekotorye aspekty diady vrach--bol'noi.

The contribution of conventional therapeutic factors and such factors as psychotherapy, psychotropic drugs, psychological characteristics of the dyad "physician-patient" to overall treatment efficacy was measured in 111 patients with rheumatoid arthritis. Among non-traditional factors psychocorrection proved most effective. The skill of the physician to communicate with the patient, to inform him or her about the disease was found unsatisfactory. Special training in medical education to communicate with the patient is needed.

[The interrelation of vascular, neurological and functional disorders in the hand of rheumatoid arthritis patients]. / Vzaimosviaz' sosudistykh, nevrologicheskikh i funktsional'nykh narushenii v kisti u bol'nykh revmatoidnym artritom.

The hands of 45 RA patients were studied for vascular, neurological and functional characteristics. The patients underwent functional tests, dopplerography (to study regional arterial flow) and electroneuromyography (to study the peripheral nerves). Induration and defective elasticity of the vascular wall in the radial and ulnar arteries were disclosed in 74% of the cases. Digital arteries suffered occlusive lesion of degree III-IV in 46% of the examinees. One-third of the patients showed signs of polyneuropathy. Among functional defects, the upper grasp incompetence appeared the first. It is stated that parallel affections of the vascular, neurological and functional origin contribute to deficient functional performance of the hand in RA patients.

[The clinico-echocardiographic characteristics of heart involvement in seronegative spondylarthritis (Reiter's disease, Bechterew's disease and psoriatic arthritis)]. / Kliniko-ékhokardiograficheskaia kharakteristika porazheniia serdtsa pri seronegativnykh spondiloartritakh (bolezni Reitera, bolezni Bekhterova, psoriaticheskom artrite).

As many as 136 patients (76 with Bechterew's disease, 40 with Reiter's disease and 20 with psoriatic arthritic) and 35 practically healthy persons were examined by echocardiography combined with electro-, phonocardiographic and by clinical, x-ray and laboratory methods. 62 patients were examined over time (within a period from 1 to 4 years). Echocardiography was used to study in detail the central and intracardiac hemodynamics, the status of the valvular apparatus of the heart and of the aorta. The different clinical characteristics of the disease were established to make a concrete contribution to the development of cardial pathology. The disease duration is the most significant characteristics. A long-term prospective follow-up coupled with echocardiographic examinations made over time enabled one to specify the structure of heart damage in patients suffering from Bechterew's disease, Reiter's disease and psoriatic arthritis depending on the hypothetic nature of the damage.

[Prostaglandins in the blood serum of patients with rheumatoid arthritis]. / Prostaglandiny v plazme krovi u bol'nykh revmatoidnym artritom.

Radioimmunoassay was used to study the content of prostaglandins in blood plasma of patients suffering from rheumatoid arthritis (PGE in 133 and PGF2 alpha in 102 patients). It has been established that as compared to the control group subjects, it is appreciably elevated and reflects the degree of inflammatory process activity, being pronounced to a greater measure in persons not receiving glucocorticoids than in hormone-dependent patients. A relationship has been revealed between the content of PGE and PGF2 alpha and certain clinical and laboratory characteristics (disease standing, intensity of exudative component of inflammation, the presence of humoral and cellular immunity disorders, anemia, and some visceral lesions), which may be of definite importance in the assessment of the patient's status. The time-course of changes in blood plasma prostaglandins reflects on the whole the dynamics of the disease activity, being related to a greater degree to the application of nonsteroidal antiinflammatory agents than of glucocorticoids.

[Rheumatoid arthritis: cyclic nucleotides in the blood plasma]. / Revmatoidnyi artrit: tsiklicheskie nukleotidy v plazme krovi.

The content of cyclic nucleotides in blood plasma was measured in 151 patients suffering from rheumatoid arthritis. As compared to the control, the patients demonstrated a significant decrease of the cAMP content and a rise of the cGMP content. The disease standing was found to produce an appreciable effect on the cAMP content. RA patients untreated with glucocorticoids manifested significant correlations between the content of cyclic nucleotides and some characteristics of inflammation and of the immune status. At the same time the majority of such correlations may be lost under conditions of hormonal dependence, which is likely to attest to dysregulation of inflammatory process. In the course of the treatment, the content of cAMP in the plasma increase is attended by a reduction increases in 63.8% of the patients. In the majority of them, that of the level of circulating immune complexes, thereby supporting the relationship between immunopathological and metabolic disorders at the cellular level.

[Use of high doses of glucocorticoids in patients with rheumatic diseases]. / Primenenie vysokikh doz gliukokortikoidov u bol'nykh s revmaticheskimi zabolevaniiami.

Short-term application of high doses of glucocorticoids removes the acuity of the generalized patterns of systemic rheumatic diseases. This is documented by the reported data and analysis of the authors' own 15 observations. The dose of glucocorticoids, duration of their application and administration routes are determined by the degree of the pathological process activity and by the organs concerned (kidneys, central nervous system). If the effect attained is doubtful, repeated courses of intensive treatment with glucocorticoids are indicated in some cases.

[Tumor necrosis factor-alpha and kidney damage in rheumatoid arthritis]. / Faktor nekroza opukholi-alpha i porazhenie pochek pri revmatoidnom artrite.

AIM: To investigate clinical significance of tumor necrosis factor-alpha (TNF-alpha) and kidney damage in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: 94 patients (84 women and 10 men, mean age 45.2 +/- 11.9 years and the disease duration 7.5 +/- 6.5 years) with RA and 20 donors were examined. In 37(39.4%) and 57(60.6%) patients radiological stages I-II and III-IV, respectively, were determined. TNF-alpha and C-reactive protein (CRP) were measured by ELISA. RESULTS: Serum levels of TNF-alpha in patients with RA appeared significantly higher than in donors (10.9 +/- 22.1 pg/ml vs 0.6 +/- 2.0 pg/ml, p < 0.001). 33 (35.1%) of 94 patients had TNF-alpha levels above 6.6 pg/ml. High serum levels of TNF-alpha correlated significantly with the presence of nephrotic syndrome (r = 0.22, p = 0.03) caused by secondary amyloidosis. There were no correlations between high levels of TNF-alpha and sex, age, disease duration, stages and clinical activity in patients with RA. Positive correlation was found between high levels of TNF-alpha and ESR (r = 0.30, p = 0.003), CRP (r = 0.37, p = 0.0001). CONCLUSION: Thus, TNF-alpha may be involved in pathogenesis of amyloidosis in RA.

[Intra-articular administration of glucocorticoids in rheumatoid arthritis from the doctor and patient's viewpoint]. / Vnutrisustavnoe vvedenie gliukokortikoidov pri revmatoidnom artrite--otsenka vracha i bol'nogo.

Based on the opinions of 20 expert rheumatologists from two rheumatological hospitals a number of important assumptions are provided relative to the intraarticular administration of glucocorticoids in patients suffering from rheumatoid arthritis. The viewpoints appeared to be many and varied even within the frameworks of the same hospital. The ranging of some rehabilitation factors in certain parameters (efficacy, danger, availability, and so forth) demonstrated that the technique of intraarticular punctures is an effective and popular enough method for the treatment of patients suffering from rheumatoid arthritis. The doctors' assessments of the method were on the whole higher as compared to the patients' assessment (66 patients with rheumatoid arthritis). There were appreciable differences in the correlation ratios among the doctors as regards the assessments "effective--ineffective" and "I know it very well based on my own experience"--I know it poorly". These differences (from 0.10 to 0.89) evidence the existence of both authoritative doctors and doctors who rely on the generally accepted opinions rather than on their own experience, accounting for controversies in subjective estimates.

[The serum level of soluble interleukin-2 receptors in patients with rheumatoid arthritis]. / Syvorotochnyi uroven' rastvorimykh interleikinov-2-retseptorov u bol'nykh revmatoidnym artritom.

Rheumatoid arthritis is a systemic chronic inflammatory disease characterized by development of severe destruction of the joints caused by uncontrollable activation of cellular immunity. Activated T-lymphocytes synthesize interleukin-2 (IL-2) and specific membrane soluble receptors (sIL-2r) for this cytokine. The level of sIL-2r release is proportional to the number of molecules expressed on the membrane of activated immunocompetent cells. The data are provided for 59 patients with a significant RA diagnosis according to criteria of the American Rheumatology Board. Serum sIL-2r level was measured by enzyme immunoassay. It was found higher in RA patients than in controls (p < 0.001). Concentrations of sIL-2r increased with activation of RA. It is suggested that determination of sIL-2r extends potentialities of laboratory diagnosis of RA activity which is important for evaluating effectivity of the treatment and RA prognosis.

[The problems, mental disorders and quality of life of rheumatoid arthritis patients]. / Problemy, psikhicheskie narusheniia i kachestvo zhizni bol'nykh revmatoidnym artritom.

There were 157 patients with rheumatoid arthritis. Of these, only 65 patients (41.4%) failed to show any factor at the disease onset, which could be estimated as provoking. Psychoemotional factor was most common (in 47.7% of cases). Later the indicated factor played a more important part: only 5.1% of the patients denied or doubted it. In most cases, the distress was caused by family relations. There was an appreciable difference in the intensity of the problems in family and single patients. Affective disorders (neurotic and hypopsychotic depressions) were mostly recorded among mental disorders. The life quality determined in accordance with the self-estimation of the "health" and happiness" noticeably depended both on biological factors (pain intensity, the degree of damage to the bones and joints, and the disease stage) and on social factors--the educational level and social position. The degree of personality merits defined according to the self-estimation of the "mentality" and "character" appeared higher in persons with higher education and in patients suffering from erosive arthritis. The data obtained provide evidence for the necessity of psychosomatic orientation of practicing physicians.

[THe treatment of patients with chronic disease: the viewpoint of the physician and of the patient (exemplified by rheumatoid arthritis)]. / Lechenie bol'nykh khronicheskim zabolevaniem: tochka zreniia vracha i bol'nogo (na primere revmatoidnogo artrita).

The opinions of the experts and the patients with rheumatic arthritis in relation to the disease treatment and preventive measures have been analyzed. The views of the physicians coincided more frequently than those of the patients. It is emphasized that patients benefit from group and individual training, especially from individual conversations.

[Non-invasive diagnosis of lesions of peripheral blood vessels in patients with diabetes mellitus]. / Neinvazivnaia diagnostika porazheniia perifericheskikh sosudov u bol'nykh sakharnym diabetom.

Clinical examination of 51 diabetes mellitus patients with the disease running a severe, moderate and light course included ultrasound dopplerography to measure arterial and venous pressure on the malleolus and photoplethysmography to evaluate arterial pressure in the great toe. There appeared a relationship between the disease severity and venous pressure, toe pressure index, pressure gradient malleolus--toe. The closest correlation was with the venous pressure. At late stages of diabetic angiopathy calcinosis of the arterial wall distorts real value of malleolar systolic pressure necessitating multimodality investigation of peripheral vessels in diabetic patients.

[Clinico-immunological aspects of renal lesions in rheumatoid arthritis]. / Kliniko-immunologicheskie aspekty porazheniia pochek pri revmatoidnom artrite.

The aim of this study was to examine the incidence of different renal lesions in rheumatoid arthritis (RA) and to determine their relationships with the type of previous drug therapy and with the specific features of immune disorders. Ninety four patients, 84 (89.9%) females and 10 (10.6%) males) with RA whose mean age was 45.2 +/- 11.9 years and duration of the disease 7.5 +/- 6.5 years were examined. Most of them had degrees 2 and 3 PA (62.7 and 24.4%, respectively). Systemic manifestations were encountered in 60 (63.8%) patients. Eighty one patients took nonsteroidal antiinflammatory drugs (NSAID) continuously: 18 patients for a year, 32 for 5 years, 14 for 6 to 10 years, and 17 for over 10 years. All the patients underwent clinical, laboratory, and instrumental study of partial functions of the kidney. Immunological study involved solid-phase immunoassay of IgA and IgM rheumatoid factor, von Willebrand factor antigens (WF:Ag), C-reactive protein. The serum concentrations were measured by the Mancini method. Changes in urinalysis and/or signs of decreased glomerular and tubular functions were found in 69 (73.%) patients, 25 (26.6%) had arterial hypertension. Tubular dysfunctions were more common [31 (32.9%) patients]. Signs of early renal failure were detected in 20 (21.2%) patients. There were no cases of acute renal failure. Amyloidosis, glomerulonephritis, pyelonephritis were diagnosed in 5 (5.3%), 16 (17%), and 13 (13.8%) patients, respectively. The above renal lesions were concurrent in some patients. Renal lesion correlated with the progression and severity of RA, the presence of systemic manifestations, and age. There was no relationship of both 5- and 10-year use of NSAID to the symptoms of renal disease. The use of these drugs for over 10 years was concurrent with the signs of chronic renal failure and arterial hypertension. Analyzing immunological disorders showed an association of increased erythrocytic sedimentation rates and WF:Ag with amyloidosis, that of higher IgA concentrations with proteinuria and tubular dysfunctions. It is concluded that renal lesion is common in RA, there is a predominance of tubular interstitial changes. In rare cases nephropathy is characterized by a benign course and fails to result in uremia. The symptoms of renal diseases are largely associated with RA progression and severity and the patients' age. Prolonged continuous use of NSAID may contribute to the development of renal failure. Different immune mechanisms are involved in the pathogenesis of glomerular and tubular nephropathy in RA.

[Nimesil effectiveness in rheumatoid arthritis]. / Effektivnost' nimesila pri revmatoidnom artrite.

Clinical efficiency and safety of nimesil were studied in the multicenter open clinical trial of 52 patients with verified rheumatoid arthritis. Nimesil was given for 12 weeks in a daily dose 200-400 mg in addition to basic therapy. Clinical and laboratory parameters were assessed after 4 and 8 weeks of the treatment and after its end. The treatment produced a significant positive response of the articular syndrome. Marked improvement was registered in 11 (23.4%) patients, improvement--in 33 (79.2%) patients. Side effects were reversible and occurred in 8 (15.3%) patients. In 5 patients the drug was withdrawn. The conclusion is made on high efficiency and good tolerance of nimesil in rheumatoid arthritis patients.