[Development of studies on problem of infectious arthritis at the Institute of RHeumatology, Russian Academy of Medical Sciences in 1970 to 1990]. / Razvitie issledovanii po probleme sviazannykh s infektsiiami artritov v Institute Revmatologii RAMN v 70-90-kh godakh.

The paper presents information on the studies on the elucidation of the etiopathogenetic role of Chlamydia and Yersinia infections in reactive arthritis, which have been made at the Institute in the past decades. Among them it mentions the first experiments and subsequent findings of detection of both Chlamydia and DNA in joint tissues in urogenic arthritis, those of identification of altered minor forms of this microbe in chronic types, which mimic in vitro persistent Chlamydia infection. The clinical experience gained by the Institute in treating Chlamydia-induced urogenic arthritis with high-dose antibiotics is reported. In addition to detailed studies of the clinical manifestations and outcomes of Yersinia-induced arthritis, long-term follow-ups have examined an association of clinical and serological manifestations with HLA B27 carriage; it is suggested that there is a partial similarity between this antigen and Yersinia antigens. Pronounced changes have been found in the mucosa of the intestine and its microflora in enterogenous reactive arthritis and a treatment with bifidum-containing drugs proposed. A variety of clinical and serological manifestations of Lyme borreliasis detected in the endemic areas of Russia is described. The specific features of rheumatological manifestations of this disease are comparable with those observed in the USA and Europe.

[Morphology of psoriatic arthritis]. / Morfologiia psoriaticheskogo artrita.

Twenty-four biopsies of the synovial membrane, 8 biopsies of the cartilage and 8 samples of the synovial liquid from the knee joint were studied histologically, histochemically and by the immunofluorescent method. Proliferation, degeneration and desquamation of the synovial layer, localization of the inflammatory process in the superficial subsynovial layer, polynuclears in the inflammatory exudate, annular vascular sclerosis in the deep parts of the synovial villi are distinct features of psoriatic synovitis. The evidence for the involvement of humoral and cell immunity factors in the pathogenesis of the disease are obtained by means of immunological and immunofluorescent methods. On the basis of clinicomorphological data psoriatic arthritis is regarded as an independent nosological variety of the joint disease.

[Ankylosing spondylarthritis beginning in childhood]. / Ankiloziruiushchii spondiloartrit, nachavshiisia v detskom vozraste.

As many as 200 patients underwent comparative clinicoroentgenological and genetic examinations. The patients suffered from ankylosing spondylarthritis and were followed up for a long time. The patients were distributed into 2 groups depending on the age at which the disease commenced. Group I included 40 persons with the juvenile variant of the disease onset (under 16 years), group II comprised 160 subjects who fell ill at an age over 16 years. It has been shown that the patients who fell ill at an age under 16 years are prone to a more acute disease onset with involvement of the peripheral joints, to a slower and not so pronounced damage to the spine whereas the rate and the degree of injury to the iliosacral joints are practically the same in both the groups. On the contrary, adults are characterized by a gradual onset with earlier clinicoroentgenological signs of injury to the axial skeleton, which leads to rapid derangement of the posture in such patients.

[Cartilage-protective preparations in the therapy of osteoarthrosis]. / Khondroprotektivnye preparaty v terapii osteoartroza.

Based on an analysis of the current data on the pathogenesis of osteoarthrosis, the authors provide evidence for the importance of chondroprotective therapy. Present comparative experimental and clinical (tentative) data on the efficacy of chondroprotective drugs.

[The efficacy of bifidum-containing preparations in enterogenous reactive arthritis]. / Effektivnost' bifidumsoderzhashchikh preparatov pri énterogennykh reaktivnykh artritakh.

Analysis is made of the intestinal microflora in 43 patients suffering from reactive arthritides (ReA) that developed after intestinal infection. The overwhelming majority of the patients manifested a decrease of the level of the bifidoflora. The disorders of the intestinal microflora were related to the disease activity and standing. Bifidumbacterine was found to produce a significant beneficial effect on the course of ReA and to cause no serious side effects. According to the preliminary data, the efficacy of bifidumbacterin exceeded that of the known basic drug salazopyridazine, thus making it possible to apply the bifidum-containing drugs as basic agents in the treatment of ReA.

[Microcirculatory disorders in patients with psoriatic arthritis]. / Narusheniia mikrotsirkuliatsii u bol'nykh psoriaticheskim artritom.

As many as 39 patients with psoriatic arthritis were examined for hemorheology. Of these, 20 were examined at a time for the status of the microcirculatory bed in the skin and skeletal muscle by 133Xe clearance from the interstitial depot and by laser-Doppler flowmetry at the areas of the clinically intact skin. In 10 patients, the plasma blood viscosity was measured. All the test subjects manifested the clinical signs of damage to the vessels of the microcirculatory bed, namely capillaritis of the palmar surface of the hands and/or of the plantar surface of the feet, sensitivity to cold, numbness of the finger tips. A detailed analysis of the individual aggregation characteristics allowed two groups of patients to be revealed: with a decrease and enhancement of aggregation at a shift rate of 2.5 s-1. It should be noted that patients with severe hemorheological disorders showed both changes on the part of the microcirculatory bed (clinical and quantitative) and a rise of the blood plasma viscosity and hematocrit fall. The data obtained indicate that the microcirculatory and related rheological disorders may be implicated in the pathogenesis of psoriatic arthritis.

[The comparative efficacy of slow-acting (basic) preparations in psoriatic arthritis]. / Sravnitel'naia éffektivnost' medlenno deistvuiushchikh preparatov pri psoriaticheskom artrite.

Overall 126 patients with verified and clinically active psoriatic arthritis (PA) were subjected to a randomized study of the efficacy of chrisanolum (Chr), sulfasalicylic drugs (SSD) (sulfasalazine and salazopyridazine) and methotrexate (MT) as compared to nonsteroidal anti-inflammatory drugs (NSAID). The treatment that lasted for a year was completed by 77 patients: in the group on NSAID, by 31, on Chr by 15, on SSD by 15, and on MT by 16. In the remainder, the treatment was discontinued because of side effects. The best clinical effect was recorded in patients on Chr. The improvement was observed in 73% of the patients, with a significant effect being attained in 60%. In the groups on SSD and MT, the improvement was observed in 80 and 69%, respectively. However, noticeable improvement was only recorded in 20 and 19%. SSD turned out more effective than MT. in the group on NAID, the improvement was ascertained but in 35% of the patients, with noticeable one being attained in 6%. According to Pearson's criterion chi 2, the results of the treatment with NAID alone were less potent than in the group given Chr (p < 0.001) and SSD (p < 0.05). The differences between the effect of the treatment with NAID and MT appeared nonsignificant (p > 0.1). Therefore, according to the diminution of the clinical efficacy in PA, the basic drugs may be distributed in the following way: Chr, SSD, MT. The side-effects in the group on NAID were. recorded in 37% of cases, in the group on Chr in 53%, on SSD in 33%, and on MT in 55%. This means that SSD were tolerated best of all.

[The clinico-genetic characteristics of combined forms of seronegative spondylarthritis]. / Kliniko-geneticheskie osobennosti sochetannykh form seronegativnykh spondiloartritov.

The authors present the results of clinico-genetic investigations made in 124 patients with combined forms of seronegative spondylarthritis. The combined and isolated forms are compared clinically. HLA-typing results are analysed.

[The development and testing of diagnostic criteria in psoriatic arthritis]. / Razrabotka i aprobatsiia diagnosticheskikh kriteriev psoriaticheskogo artrita.

The paper is concerned with diagnostic criteria of psoriatic arthritis developed by the expert method. The criteria include 14 signs with the aid of which one can diagnose classical, definite and probable psoriatic arthritis. The sensitivity of the developed diagnostic criteria tried in 108 patients afflicted with psoriatic arthritis constitutes 99.2%, whereas the specificity tested in patients suffering from related diseases (reactive arthritides, ankylosing spondyloarthritis, seronegative rheumatoid arthritis) amounts up to 77.8%.

[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.

[Various aspects of the chronic course of Reiter's disease]. / Nekotorye aspekty khronicheskogo techeniia bolezni Reitera.

A comparative clinicolaboratory study of followed-up patients with a chronic (38 patients), acute and lingering (137 patients) course of Reiter's disease was conducted. The role of a persisting focus of infection in the genitourinary organs and genetic predisposition (HLA-B27 was detected in 100% of the cases) in the formation of a chronic variant of disease was shown. Sacroileitis, amyotrophy, bursitis and enthesitis developed more frequently in a chronic than in an acute variant; erosion in the joints was detected in over 40% of the patients. Morphological investigation of the synovial bioptates revealed a picture of chronic synovitis with superficial localization of an inflammatory process.

[Microbiocenosis and the status of the intestinal mucosa in alkylosing spondyloarthritis]. / Mikrobiotsenoz i sostoianie slizistoi obolochki kishechnika pri ankiloziruiushchem spondiloartrite.

Intestinal microbiocenosis was examined in 53 patients with ankylosing spondyloarthritis (AS). Of these, 23 had the central and 30 presented with the peripheral form. 34 patients underwent endoscopic examinations (rectoromanoscopy, ileocolonoscopy). As a result, in 74% of cases with the central form of AS and in 80% of cases with the peripheral form of AS, alterations in the intestinal microflora were revealed, which can be regarded as intestinal dysbacteriosis (ID), with dysbacteriosis being more pronounced in patients with the peripheral form. In such patients it manifested by a considerable decrease of the amount of bifido- and lactoflora, which promoted the increment of the amount of opportunistic microorganisms, particularly Klebsiella. Macroscopic signs of nonspecific inflammation of the small and large intestines were identified in 63% of patients with the central and in 67% of those with the peripheral form of AS. Mean-while histomorphological study of biopsy specimens of the intestinal mucosa showed that all the examinees had chronic inflammation of varying degree.

[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.

[Immunoglobulin E in ankylosing spondylarthritis]. / Immunoglobulin E pri ankiloziruiushchem spondiloartrite.

Ankylosing spondylarthritis (AS) patients (n-95) were examined for IgE concentrations using radioimmunoassay (commercial kits "Pharmacia"). Elevated IgE concentrations (greater than 100 Ku/l) were recorded in 16% out of 45 patients with central AS and in 40% out of 50 patients with peripheral AS (p less than 0.05). High IgE levels showed frequent association with a CIC rise and extraarticular manifestations (uveitis, focal nephritis). It is suggested that AS extraarticular signs arise in response to vascular affection due to IgE overproduction and formation of IgE-containing immune complexes.