[Heart defects in rheumatoid arthritis patients (the results of a multiyear prospective clinico-echocardiographic study)]. / Poroki serdtsa u bol'nykh revmatoidnym artritom (rezul'taty mnogoletnego prospektivnogo kliniko-ékhokardiograficheskogo issledovaniia).

The analysis of life-time diagnosis of valvular heart disease in rheumatoid arthritis (RA) patients has been made basing on a long-term clinico-echocardiographic investigation. Within 18-year follow-up valvular disease was revealed in 17 out of 214 RA patients (7.9%). Only 3 patients developed the disease in childhood prior to RA diagnosis. In 8 patients the diagnosis of valvular disease was established in the presence of RA, in 6 RA patients the disease was determined during the follow-up period. Mitral stenosis, aortal stenosis, combined mitral valve incompetence, combined aortal defect, mitral defect and tricuspid incompetence, combined mitral defect and pulmonary artery valvular incompetence were detected in 2, 2, 3, 1, 1, and 1 patients, respectively. Valvular disease occurs more frequently in progredient seropositive RA uncontrollable by on-going therapy. The authors emphasize the value of a prospective clinical echocardiographic examination of RA patients in early diagnosis of valvular disease in them. Frequent valvular lesions in RA patients dictate the need of persistent antirheumatic therapy to inhibit the activity and prevent progression of the disease.

[Drug-induced remission in the severe progressive variant of rheumatoid arthritis]. / Medikamentoznaia remissiia pri tiazhelom progressiruiushchem variante revmatoidnogo artrita.

Analysis of the remission incidence and duration has been made in 71 patients with severe progressive rheumatoid arthritis (RA) during the 10-20-year follow-up period, with special attention paid to the role of the disease-modifying drugs (DMARDs). Remission occurred only in those patients who received permanent long-term systematic treatment with DMARDs. Such a therapeutic approach resulted in remission lasting from 5 to 11 years for 32% of the patients. Otherwise the patients who received episodic non-regular DMARDs therapy or symptomatic treatment with nonsteroidal anti-inflammatory drugs or steroids had no remission at all. A detailed analysis of the cases of remission is presented. The authors are of the opinion that after the disappearance of the clinical signs of RA the maintenance basic therapy may be continued.

[The possibilities for a modifying influence of basic therapy on the long-term course of rheumatoid arthritis]. / Vozmozhnosti modifitsiruiushchego vliianiia bazisnoi terapii na dolgosrochnoe techenie progressiruiushchego revmatoidnogo artrita.

Analysis was made of the results of basic therapy carried out for 10-15 years in 71 patients suffering from rheumatoid arthritis (RA) bearing in mind the systematic nature of the treatment. The study included patients with the progressive disease variety and the onset of observation instituted within the first 5 years of RA. It is shown that only basic therapy carried out for many years and practically continuously during the observation period made it possible to control the disease. As a result of such treatment policy, 50% of the patients manifested for a long time (6-10 years) a pronounced decrease or complete suppression of RA activity followed by remission, which was accompanied by retardation and the ceasing of the progression of x-ray alterations and functional insufficiency of the joints. Nonsystematic basic treatment did not exert any material effect on RA. The results of such therapy in patients with the RA standing 10-20 years did not differ from those without the use of the basic drugs.

[The potentials of colchicine in the combined therapy of secondary amyloidosis in patients with rheumatoid arthritis]. / Vozmozhnosti kolkhitsina v kompleksnoi terapii vtorichnogo amiloidoza u bol'nykh revmatoidnym artritom.

The authors relate the results of prolonged treatment (up to 3.5 years) with colchicin of 22 patients suffering from rheumatoid arthritis (RA) complicated by morphologically verified secondary amyloidosis of the kidneys and/or of the gingival, rectal and hepatic mucosae. Colchicin prescribed as the only slowly acting agent turned out effective in 5 out of 11 patients and in all the 11 patients given the drug in combination with basic therapy by cytostatics or, rarely, by gold drugs and D-penicillamine. The treatment efficacy could be observed both in respect to the manifestations of rheumatoid disease proper and in respect to the manifestations of amyloidosis. The drug did not produce any side effects and could be administered for a long time. In the overwhelming majority of cases, the withdrawal of colchicin, even in basic therapy continuation caused the enhancement of the manifestations of RA and amyloid nephropathy.

[A comparative evaluation of parenteral and oral preparations of gold and D-penicillamine in the treatment of rheumatoid nephropathy]. / Sravnitel'naia otsenka parenteral'nykh i oral'nykh preparatov zolota i D-penitsillamina v lechenii revmatoidnoi nefropatii.

Analysis is made of the results of the treatment with parenteral (crysanol and myochrysine) and oral (ridaura) gold drugs as well as with small doses of D-penicillamine (DP) of patients suffering from rheumatoid arthritis with the signs of nephropathy. The latter ones were identified, respectively, in 18 out of 80 patients who began receiving treatment, in 17 out of 72, and in 16 out of 61 patients. The clinical, laboratory, instrumental and morphological manifestations of nephropathy are described and analysis of their dynamics under the treatment impact is provided. It is noted that these types of basic therapy produce a beneficial effect on the manifestations of rheumatoid nephropathy. That referred to a greater measure to the gold drugs than to the small doses of DP. The degree of counteracting the symptoms of renal pathology agreed well with a good clinical effect in respect to the articular syndrome and inflammatory responses of blood. Among patients receiving crysanol, iatrogenic nephropathy was recorded in 8.75% of cases, among those on ridaura, in 2.8%, and those on DP, in 8.2% of cases. The authors provide evidence for the use of gold drugs and DP in patients suffering from rheumatoid nephropathy.

[Roentgeno-morphological comparisons in rheumatoid arthritis based on data of a long-term prospective study]. / Rentgenomorfologicheskie sopostavleniia pri revmatoidnom artrite po dannym dlitel'nogo prospektivnogo nabliudeniia.

During a prospective observation lasting 6 years 68 patients with rheumatic arthritis (RA) were repeatedly examined (up to 8 times) roentgenologically with parallel puncture biopsy of the synovial fluid of the knee joint made with an atraumatic needle, and numerical evaluation of markedness of 25 morphological signs of synovitis. A comparative analysis of the markedness of morphological signs of synovitis in relation to the degree and dynamics of destructive changes in the knee joint was made on the basis of the findings of 254 puncture biopsies and the same amount of roentgenograms. There is a close relationship between the activity of synovitis and the progress of destructive arthritis except for the morphological signs characterizing the reaction of hypersensitivity of an immediate type that may serve the purpose of prognostication of further articular destruction and of the choice of an early adequate therapy.

[A comparative evaluation of the efficacy and tolerance of gold and D-penicillamine preparations in patients with rheumatoid arthritis. II. The effect on the morphological indices of rheumatoid synovitis]. / Sravnitel'naia otsenka éffektivnosti i perenosimosti preparatov zolota i D-penitsillamina u bol'nykh revmatoidnym artritom. Soobshchenie II. Vliianie na morfologicheskie priznaki revmatoidnogo sinovita.

Morphological signs of rheumatoid synovitis have been analysed on the basis of 130 puncture biopsies taken from 46 patients prior to the beginning and during parenteral therapy with auric preparations (crysanolom and myocrysin) and peroral administration of an auric preparation rhidaura and small doses of D-penicillamine. The most marked morphological effect was reached in 1.5 years. With a favourable clinical effect all the preparations exhibited capacity for suppressing the following basic signs of rheumatoid synovitis: proliferative changes in the layer of synoviocytes, reaction of blast cells.

[Kidney involvement in patients with rheumatoid arthritis]. / Porazhenie pochek u bol'nykh revmatoidnym artritom.

Renal pathology was revealed in 284 out of 498 patients with rheumatoid arthritis (RA) subjected to the 15 years' prospective controlled follow-up and given individualized pharmacotherapy. Biopsy specimens of the kidney were examined in 90 cases. Of these, in 14 patients, they were examined repeatedly. On morphology the following alterations were detected in renal tissue: minimum morphological alterations (18 cases), glomerulonephritis (32 cases), amyloidosis (53 cases), interstitial nephritis (4 cases), and arteriosclerotic nephrosclerosis (1 case). In patients with nephropathy, no pathology nas revealed on morphology (5 cases). Chronic pyelonephritis was diagnosed in 137, nephroptosis in 47, nephrolithiasis in 17, papillary necrosis in 3, and drug nephropathy in 33 patients. Many patients had concomitant renal pathology. Repeated morphological examinations of renal tissue point to dynamic morphological alterations occurring during treatment and disease. Chlorbutin was found to exert a beneficial effect not only on the manifestations of arthritis but also on renal tissue. It could be seen in patients with a primary morphological diagnosis of mesangioproliferative nephritis and minimum morphological alterations in renal tissue. In some cases the clinical and morphological data did not agree, which provides evidence in favour of making renal biopsy in RA patients with a purpose of early diagnosis and specification of renal pathology, choice of the treatment policy.

[The healing of the bone erosions during therapy with gold preparations and D-penicillamine in rheumatoid arthritis patients]. / Zazhivlenie kostnykh érozii na fone terapii preparatami zolota i D-penitsillaminom u bol'nykh revmatoidnym artritom.

The paper is concerned with the data obtained during 17-year prospective follow-up of over 500 patients with rheumatoid arthritis (RA) who received individualized treatment mainly with basic drugs. Cases of repair of bone erosions in small joints of the hands and feet are described as are cases of complete or partial repair of osteolysis in 8 patients with significant RA treated for a long time with parenteral or oral gold drugs, or D-penicillamine in different daily doses.

[Glomerulonephritis in rheumatoid arthritis]. / Glomerulonefrit pri revmatoidnom artrite.

Results of a light optics morphological study of kidney biopsy material in 20 patients with rheumatoid glomerulonephritis supplemented by the data of immunofluorescent and electron microscopic diagnosis have been presented. All-round morphological investigation of biopsy material is the only proof for the presence of a renal lesion in 1/4 of the patients.

[Comparative evaluation of the effectiveness of gold preparations and D-penicillamine and their tolerance in rheumatoid arthritis. I. The effect on the indicators of their activity and tolerance]. / Sravnitel'naia otsenka éffektivnosti pri revmatoidnom artrite preparatov zolota i D-penitsillamina i ikh perenosimost'. I. Vliianie na pokazateli aktivnosti i perenosimost'.

In the period of 5 years the authors observed 213 patients with RA. Of this number 80 patients got Au parenteral preparations and 61--D-penicillamin in the average daily dose of 450 mg. The efficacy of the drugs was assessed by its effect of the indices of the activity (quantitative assessment of clinical manifestations of vascular syndrome) which had been determined by the time of treatment and on the 3, 6, 12, and 18th month of subsequent therapy.

[The potentials of a peroral gold preparation (Ridaura) in treating rheumatoid arthritis based on prospective observation data]. / Vozmozhnosti peroral'nogo preparata zolota (ridaury) v lechenii revmatoidnogo artrita po dannym prospektivnogo nabliudeniia.

Ridaura was given to 72 patients with true rheumatoid arthritis (RA) in the period of 6 mos to 2 yrs. Patients with I-II degree of activity and II-III x-ray stage of RA prevailed. Extraarticular RA manifestations were detected in 79% of the patients. The efficacy of Ridaura was assessed by its effect on the indices of activity (clinical manifestations of the articular syndrome, ESR, morphological signs of rheumatoid synovitis) and progression (the rates of erosive arthritis development in the hand and foot joints, the time course of the level of the serum rheumatoid factor and RA systemic manifestations). The drug efficacy was assessed with relation to the preceding variant of a RA course by the onset of treatment and after 3, 6, 12 and 18 mos. The results obtained indicated a high clinical efficacy of the drug and the presence of its basal activity which manifested itself in a good clinical effect by a decrease in the rates of x-ray progression, a serum RF level, the expression of morphological signs of synovitis and extraarticular RA manifestations, in particular myocarditis, diffuse interstitial pulmonary fibrosis, fever, and Aschoff's nodules. The therapeutic effect of the drug was on an increase in the period over 1 year. The highest efficacy of the drug was noted in RA with persistent activity of I-II degree or with activation up to II degree. Side-effects were revealed in 19% of the patients. Good tolerance of the drug was observed in 63% of the patients with a previous history of intolerance to parenteral gold drugs.

[Amyloidosis in patients with rheumatoid arthritis]. / Amiloidoz u bol'nykh revmatoidnym artritom.

Of 467 patients followed-up for 15 yrs, rheumatoid arthritis was complicated by amyloidosis in 47 (10%). The relationship of amyloidosis development with a high or constantly moderate activity and expression of rheumatoid arthritis and its severity was brought to light. The results of biopsies of the mucosa, kidneys and liver, autopsy and clinical findings were analyzed and correlated. An increase in the frequency of amyloidosis development was noted in patients treated with glucocorticoids whereas in patients receiving cytostatics there was not such an increase.

[Chlorbutin, azathioprine, D-penicillamine and levamisole (decaris) in the treatment of patients with rheumatoid arthritis. IV. Comparative evaluation of their effects on systemic (extra-articular) manifestations of the disease]. / Khlorbutin, azatioprin, D-penitsillamin i levamizol (dekaris) v lechenii bol'nykh revmatoidnym artritom. IV. Sravnitel'naia otsenka vliianiia na sistemnye (vnesustavnye) proiavleniia zabolevaniia.

The authors studied and compared the action of chlorbutin, azathioprin, of large and mean doses of D-penicillamine and levamisole with that of nonsteroidal antiinflammatory drugs (NAID) on rheumatoid arthritis systemic manifestations in 186 patients treated with these drugs for more than 3 months. It was shown that the basic drug compared very favourably with NAID. The cytostatics and levamisole were discovered to be highly efficacious. The authors believe that if the patients are afflicted with alveolitis and rheumatoid nephropathy, this should be regarded as indication for use of chlorbutin and levamisole.

[Clinico-morphological comparisons in variants of rheumatoid arthritis (based on the data of puncture biopsy of synovial membrane)]. / Kliniko-morfologicheskie sopostavleniia pri razlichnykh variantakh revmatoidnogo artrita (po dannym punktsionnykh biopsii sinovial'noi obolochki).

Altogether 564 successive puncture biopsies withdrawn from patients with different versions of RA were subjected to morphological study with the aid of a statistical analysis of the intensity of 25 signs of synovitis evaluated according to the 5-score system. The differences in the structure of synovitis were recognized: predominance of the signs of the humoral immunity (particularly plasma cell infiltration) in patients with a mild (with a favourable evolution) version of RA and predominance of the signs of the cell-mediated immunity (macrophagal and T-lymphocyte infiltration, cytolysis, proliferation and mesenchymal transformation of fibroblasts) in a grave (incurable, invalidism-producing) version. The disease of medium gravity (running a progressive course but relatively eliminated by therapy) was characterized by the combination of and undulatory time course of the signs indicated. The greatest involution of the majority of the synovitis signs as influenced by the treatment was observed in a mild, whereas the least in the grave version of RA. It is suggested that local antibody genesis may play a protective role in RA.