[Evaluation of methotrexate effect on the acute-phase response in rheumatoid arthritis after 12-week treatment].

UNLABELLED: DAS28 index calculated with regard for ESR, the number of swollen/painful joints and evaluation of the patient's condition by VAS is universally used to estimate activity of rheumatoid arthritis (RA). There is a variant of calculation using C-reactive protein (CRP) instead of ESR. Our experience indicates that ESR decreases more slowly than CRP during treatment and better reflects dynamics of patients' condition. From the practical standpoint it is important to estimate activity of RA because therapeutic modalities are chosen based on the DAS28 value. AIM: To study the influence of pharmaceutical form of methotrexate on the acute-phase response in rheumatoid arthritis. MATERIALS AND METHODS: The study included 32 patients (24 women, 8 men) aged 19-76 (mean 47.5 +/- 28.5) yr with active RA (DAS28 > 3.2) 4-30 months (11.5 +/- 7.4, median 8) in duration. Diagnosis was made using AXR criteria (1987), none of the patients previously received methotrexate injections. Inclusion criteria: initially high ESR (Westegren, mm/hr) and/or CRP (mg/l measured by a highly sensitive method). All patients were given methotrexate subcutaneously for 12 weeks as monotherapy (initial dose 10 mg, maximum one 25 mg/week). The cumulative dose was 211.36 +/- 17.2 mg. RESULTS: Side effects did not require withdrawal of methotrexate. CRP level decreased faster than ERS: a 70% decrease of CRP by week 12 was recorded more frequently than that of ESR. Slow dynamics of the number of swollen joints compared with CRP may be due to the low cumulative dose of methotrexate. Duration of the disease had no effect on dynamics of acute phase characteristics. CONCLUSION: Methotrexate injections resulted in markedly delayed development of clinical signs of improvement compared with laboratory values. CFP levels fell down much faster than ESR, Remission or low activity of RA (estimated from DAS28) occurred only in 38% of the cases after 3 month monotherapy by methotrexate injections. It is concluded that efficacy of this drug should be estimated no sooner than 4 months after the onset of the treatment.

[Standardization of methotrexate administration in routine rheumatological practice].

The review is devoted to administration of methotrexate--a basic anti-inflammatory drug--in rheumatoid arthritis. Some issues of practical use of this drug are still disputable. Recommendations of international experts and information on standardization for patients are considered.

[The peculiarities of pulmonary pathology in rheumatoid arthritis].

The review covers the problems of terminology, pathogenesis, morphology, clinical manifestations, and diagnostics of pulmonary pathology in patients with rheumatoid arthritis (RA). The main variants of pulmonary and pleural changes in RA are presented. The article covers possibilities provided by modern technologies, which make it possible to widen and objective diagnostic methods, including those directed towards revealing specific changes in respiratory organs in RA patients. The authors give preference to non-invasive radiodiagnostic methods, among which the leading role is played by high-resolution computed tomography due to its high information value in the imaging of pulmonary pathology, compared with conventional chest radiograms. The article also covers the issue of the complex application of non-invasive methods, such as functional (including methods of diffusing lung capacity evaluation), radiological and radionuclid ones, and invasive methods including fibrobronchoscopy, bronchoalveolar lavage, and lung biopsy, in diagnostics of interstitial pulmonary lesion, especially its subclinical variants.

[Drug disease: is it iatrogeny?].

AIM: To draw attention of medical professionals to the problem of side effects of medication. MATERIAL AND METHODS: Analysis of evolution of views on unwanted effects of the drugs. RESULTS: The authors hold that the problem of side effects of many drugs is underestimated in Russia as relevant information is scare. CONCLUSION: Detection of side effects of the drugs allows conduction of prophylactic measures.

[Antibodies to Yersinia enterocolitica and Proteus mirabilis in blood sera of rheumatoid arthritis patients]. / Antitela k Yersinia enterocolitica i Proteus mirabilis v syvorotkakh bol'nykh revmatoidnym artritom.

Data on specific antibodies to the bacterial antigens of Yersinia enterocolitica (serovars 03, 09) and Proteus mirabilis in rheumatoid arthritis (RA) patients are presented. According to the data of some researchers, these organisms play some role in the pathogenesis of RA. The highest level of IgG antibodies to Y. enterocolitica antigens of both serovars was noted. The activity of specific IgG antibodies to serovar 03 was higher than that to serovar 09. In the sera of RA patients with P. mirabilis antgens the activity of IgM antibodies was higher.

[Efficacy of antihelicobacter therapy in NSAID-induced gastropathies]. / Effektivnost' antikhelikobakternoi terapii pri NPVP-indutsirovannykh gastropatiiakh.

The aim was to evaluate antihelicobacter therapy in the treatment and prophylaxis of NSAID-induced gastropathy recurrences in patients with rheumatic diseases (RD). 66 patients with RD (58 females and 8 males, mean age 53.6 +/- 12.6 years) participated in the study. They met the following criteria: the presence of ulcers or multiple (more than 10) erosions of gastric or duodenal erosions, administration of nonsteroid anti-inflammatory drugs, Helicobacter pylori (HP) in gastric mucosa biopsies. The patients were randomized into two groups matched by sex, features of RD, antirheumatic therapy, history of ulcer, GIT disease. All the patients received omeprazol in a dose 40 mg/day. Patients of group 1 took also amoxicillin (1 g/day) and klarythromycin (0.5 g/day) for 10 days. Group 2 was control. EGDS was conducted 2, 4 weeks and 6 months after the treatment. HP eradication and dynamics of morphological changes were examined in biopsies of the antral gastric mucosa and mucosa of gastric body. The efficacy of 4-week treatment (ulcer scarring and epithelization of erosions), rate of ulcer recurrences and erosions 6 months after treatment were compared. The efficacy of the treatment was 88 and 95% in group 1 and 2, respectively. HP eradication was achieved in 88% of patients of group 1. In 6 months, recurrences arose in 50 and 48.3% of patients of groups 1 and 2, HP was detected in 22% of patients of group 1. Morphological changes in group 1 patients was characterized by alleviation of chronic active gastritis. HP eradication does not raise the efficacy of the treatment and does not lower the risk of recurrences in patients with NSAID-induced gastropathies. Active chronic gastritis is not the background for recurrences of NSAID-induced gastropathy.

[Omeprazole and misoprostol for NSAID-induced gastropathies: comparative efficiency of their short-term treatment]. / Omeprazol i mozoprostol pri NPVTS-indutsirovannykh gastropatiiakh: sravnitel'naia éffektivnost' korotkogo kursa lecheniia.

It is rather difficult to choose a drug to treat nonsteroidal anti-inflammatory drug (NSAID)-induced gastropathies in patients with rheumatic diseases, which primarily makes it necessary to use antiulcerous treatment as part of continuous NSAID therapy. Detecting upper gastric ulcers or erosions in many patients admitted to a rheumatology hospital for exacerbation of the underlying disease cannot cause NSAID to be discontinued even temporarily as this may lead to a significant deterioration and progression of the joint syndrome. The aim of the study was to evaluate the efficiency of 2-week treatment with misoprostol (Cytotec), 800 micrograms/day, and omeprasole (Omez), 40 mg/day, for NSAID-induced gastropathy in 63 patients with rheumatic diseases. The study has indicated that the use of Omez seems to be more advisable than that of Cytotec in the treatment of NSAID-induced gastropathy if it is necessary to continue to treat the patient with a whole range of antirheumatic drugs. Equally effective in healing ulcers and erosions, Omez is much better tolerated and able to rapidly relieve gastralgias and dyspepsia. It seems that the use of Cytotec for NSAID-induced gastropathy with a great deal of side effects and relatively less efficiency borne in mind may be limited because of cases of inefficiency of proton pump inhibitors.

[Intake of non-steroid preparation and risk of developing cancer of the upper gastrointestinal tract]. / Priem nesteroidnykh protivovospaletel'nykh preparatov i risk razvitiia zlokachestvennykh opukholei verkhnikh otdelov zheludochno-kishechnogo trakta.

AIM: To compare occurrence of upper gastrointestinal tract (UGT) cancer in rheumatic patients taking long courses of nonsteroid antiinflammatory drugs (NSAD) and in non-rheumatic patients who have not received NSAD. MATERIAL AND METHODS: The study group of 1271 rheumatic patients on NSAD for at least 12 months. Control group of 654 patients free of rheumatic diseases and having no history of regular NSAD intake. The groups did not differ by the mean age, erosion and ulcer incidence. RESULTS: Esophagogastroduodenoscopy detected and histology confirmed adenocarcinoma in 2 patients of the study and 10 patients of the control group (0.16 and 1.5%, respectively, p < 0.001). CONCLUSION: Long-term treatment with NSAD lowers the risk of UGT tumors.

[Approaches to prediction of gastropathy development risk due to non-steroidal antiinflammatory drugs]. / Podkhody k prognozirovaniiu riska vozniknoveniia gastropatii, vyzvannykh nesteroidnymi protivovospalitel'nymi preparatami.

AIM: Examination of gastric secretion in rheumatoid arthritis (RA) patients and its response to sodium diclophenak and indomethacine. MATERIALS AND METHODS: 46 RA patients entered the study. All of them have been long on nonsteroid antiinflammatory drugs (NAID). Two groups of patients were analysed: group 1--free of NAID gastropathy, group 2--with NAID gastropathy. pH was followed by Gastroscan system. RESULTS: The analysis of 24-h pH-grams in both groups when NAID were not taken showed that in NAID gastropathy acid-forming gastric function is not affected while the alkalizing function markedly declines. Indomethacine is more aggressive to upper gastrointestinal tract mucosa than sodium diclophenak. CONCLUSION: Dynamic intragastric pH-metry can prognosticate the risk of NAID gastropathy.

[The assessment of the effect of glucocorticosteroid and nonsteroidal anti-inflammatory preparations on the development of an erosive-ulcerative lesion of the gastrointestinal tract in patients with rheumatic diseases]. / Otsenka vliianiia gliukokortikosteroidnykh i nesteroidnykh protivovospalitel'nykh preparatov na razvitie érozivno-iazvennogo porazheniia zheludochno-kishechnogo trakta u bol'nykh s revmaticheskimi zabolevaniiami.

AIM: A comparative evaluation of the frequency and severity of upper gastrointestinal mucosal lesions in patients taking nonsteroid anti-inflammatory drugs (NSAID) and glucocorticosteroids (GCS). MATERIALS AND METHODS: The trial entered 1086 rheumatic patients examined endoscopically. To compare the effects of their medicines, the patients were divided into 3 groups: 726 patients on NSAID alone (group 1); 238 patients on NSAID and GCS (group 2); 122 patients on GCS only (group 3). RESULTS: Gastropathies were diagnosed in 38.2, 32.4, 12.5% of group 1, 2 and 3 patients, respectively (the difference is significant). More serious diseases prevailed in group 1: multiple erosions and gastroduodenal ulcers. Group 2 and 3 patients had erosions only. CONCLUSION: GCS are safer for gastrointestinal mucosa than NSAID. Combination of NSAID with GCS does not increase the risk of gastropathy onset compared to NSAID alone.

[Can local therapy of joint syndrome with Dolgit cream be used as an alternative to systemic nonsteroid antiinflammatory drugs in rheumatic diseases?]. / Iavliaetsia li lokal'naia terapiia sustavnogo sindroma kremom "Dolgit" pri revmaticheskikh zabolevaniiakh al'ternativoi sistemnomu naznacheniiu nesteroidnykh protivovospalitel'nykh preparatov?.

AIM: The trial of therapeutic effect of local therapy with dolgit cream of the joint syndrome in rheumatoid arthritis (RA), osteoarthrosis (OA) and juvenile chronic arthritis (JCA). MATERIALS AND METHODS: Cream dolgit was used locally with assessment of its effect by pains at rest, movement, palpation, swelling in 169, 98 and 102 patients with RA, OA and JCA, respectively. RESULTS: Subjective improvement was recorded in 75.6% of RA and 90% of OA patients, objective--in 80.9 and 87.2%, respectively. The cream enables a 30-50% reduction in daily dose of nonsteroid antiinflammatory drugs in 1/3 and 1/4 OA and RA patients, respectively. In JCA patients dolgit relieved symptoms of local inflammation. The response was growing in combination of dolgit with dimexide or magnetotherapy. Some of the OA patients experienced local skin itch which was not registered in children. No other side effects arose. CONCLUSION: Cream dolgit is effective in the treatment of joint syndrome in rheumatic patients, is well tolerated and may replace systemic nonsteroid antiinflammatory drugs in some patients.

[The endoscopic assessment of the effect of ranitidine and pirenzepine on the manifestations of the gastropathy induced by nonsteroidal anti-inflammatory preparations]. / Endoskopicheskaia otsenka vliianiia ranitidina i pirenzepina na gastropatii, vyzvannoi nesteroidnymi protivovospalitel'nymi preparatami.

Two antiulcer drugs, ranitidine and pirenzepine belonging to blockers of H2-receptors and selective M-cholinoblockers, respectively, were compared by efficacy against erosive and ulcer lesions in the upper gastrointestinal mucosa. A total of 62 rheumatics were examined. In patients treated by nonsteroid antiinflammatory drugs irrespectively of the mode of their administration the highest response was shown by ranitidine while pirenzepine efficacy proved poor.