[Clinico-immunologic analysis of sorption methods of treatment of rheumatoid arthritis and systemic lupus erythematosus]. / Klinicho-immunologicheskii analiz sorbtsionnykh metodov lecheniia revmatoidnogo artrita i sistemnoi krasnoi volchanki.

The paper is concerned with the results of the application of the sorption methods for the treatment of patients with rheumatoid arthritis and systemic lupus erythematosus. The authors show the advisability of the use of the above methods for different variants of the disease course, define the time of the treatment and complications common to the sorption methods of the treatment. The results of the treatment by hemoperfusion and enterosorption are compared with the results of the patients' treatment with immunodepressants. A study was made of the action of the sorption methods and immunodepressants on the blood content of the main autoantigens and autoantibodies capable of participation in the forming of the immune complexes. The concentration and the qualitative composition of the circulating immune complexes were studied in the course of the treatment.

[Various quantitative and qualitative characteristics of circulating immune complexes in rheumatic vasculitis]. / Nekotorye kolichestvennye i kachestvennye kharakteristiki tsirkuliruiushchikh immunnykh kompleksov pri revmaticheskom vaskulite.

Patients with rheumatoid arthritis and systemic lupus erythematosus associated with and without the clinical signs of the involvement of blood vessels were examined for the concentration of circulating immune complexes (CIC) and for the content of rheumatoid factor (RF), DNA and RNA as well as for the concentration of DNA, RNA and activity of acid nucleases in blood plasma. It was established that rheumatic vasculitis is coupled with a high concentration of CIC. In rheumatoid vasculitis, CIC contain a lot of rheumatoid factors which become far more activated after acidic dissociation of CIC. In patients with lupus vasculitis, CIC contain extremely much DNA. This is accompanied by dissociated interaction of DNA-DNase in blood plasma - activation of the enzyme is followed by the increased concentration of the substrate.

Arterial wall dysfunction in systemic lupus erythematosus.

Carotid-radial pulse wave velocity (PWV), aortic augmentation index (AIx) and endothelium-dependent flow-mediated dilatation (FMD) have been repeatedly showed to be related to premature atherosclerosis and cardiovascular diseases in different settings of population. The increased arterial stiffness and endothelium dysfunction may add to premature aging of the arteries in systemic lupus erythematosus (SLE) patients. Still data about arterial stiffness and endothelium function in inflammatory rheumatic diseases are not well described. The aim of this study was to determine the PWV, its derivate marker AIx and FMD and factors possibly influencing them in young SLE women without significant organ damage. Thirty women between 23 and 55 years with an established SLE diagnosis and 66 healthy women were consequently included in the study and both groups were comparable according to age, body mass index (BMI), serum lipid profile and creatinine. PWV was determined by measuring carotid-radial pulse wave transit time with the help of applanation tonometry and AIx, its derivate marker, was calculated as a difference between two waveform peaks expressed as a percentage of the pulse pressure. The FMD was performed by obtaining the repeated scans of the brachial artery at rest and during reactive hyperemia. In SLE women, PWV and AIx were significantly higher and FMD was not different from controls. In linear multiple stepwise regression analysis if patients and controls were both considered, PWV was weakly related to mean blood pressure (MBP), AIx was mostly predicted by age and MBP and FMD was predicted by the diameter of blood vessel, BMI, high density lipoproteins. If the sole SLE setting was analyzed, PWV was not related to any of the pending parameters, AIx turned out to be related to organ damage measured by Systemic Lupus International collaborative Clinics (SLICC) index and age, and FMD obtained strong and significant relation with vessel diameter, and BMI, and disease duration. Regardless of the small number of study group patients, we can state that controlling for MBP and taking measures towards organ damage prevention can partially slow down the process of early atherosclerosis in SLE patients.

The prevalence of systemic lupus erythematosus in Lithuania: the lowest rate in Northern Europe.

The aim of this study was to explore the prevalence of systemic lupus erythematosus (SLE) in Lithuania (Vilnius). Two different studies were designed for SLE cases identification: registry-based SLE study and population-based SLE study. For the registry-based study patients were enrolled during the period of 1999-2004 and from two sources, including out-patient clinics of Vilnius and tertiary rheumatology center with interview during the year 2004. Only Vilnius residents who fulfilled the ACR 1982 revised criteria for the classification of SLE were counted in this study. Seventy-six living adult patients with SLE were interviewed and accounted for the prevalence of 16.2/100000 (0.016%) using the Vilnius adult population in January 2004 (a population of 470451). The population study of randomly selected 10,000 Vilnius inhabitants with beforehand validation of the survey was performed in the same year. The population-based study revealed two cases for 4017 respondents, but the low response rate may be important. Extrapolating the results to population of 10000 inhabitants, the point prevalence of SLE in the entire sample was at least 0.02%. Therefore, the prevalence of SLE in Lithuania is the lowest if compared to Northern European countries.

[Levels of the C 4 component of the complement, lactoferrin and leukocytic thermostabile alpha glycoprotein during the treatment of patients with systemic rheumatic diseases]. / Dinamika soderzhaniia C4-komponenta komplementa, laktoferrina i leikotsitarnogo termostabi'lnogo alpha-glikoproteina v protsesse lecheniia bo'lnykh revmaticheskimi zabolevaniiami.

The authors studied the dynamics of C4-component of complement (C4), lactoferrin (LF), leukocytic thermostable alpha-glycoprotein (LT alpha G) in the blood serum of 54 patients with rheumatoid arthritis, 32 patients with systemic lupus erythematosus, 8 patients with systemic vasculitis under the effect of hemosorption (HS), enterosorption (ES) and also immunosuppressants (IS). In severe forms of systemic rheumatic diseases the blood serum exhibits a decreased content of C4 but an elevated level of LF and LT alpha G. It has been established that HS is more active than ES or IS, and it influences the mechanisms of humoral immunity. This finds its expression in normalization of C4 level. The favourable clinical effect of HS correlates with a decrease in the level of LF and LT alpha G in the blood serum of patients during treatment.

Disease activity and health status in rheumatoid arthritis: a case-control comparison between Norway and Lithuania.

OBJECTIVE: To compare disease characteristics and health status in patients with rheumatoid arthritis (RA) from two countries, Norway and Lithuania. METHODS: Patients were recruited from the RA registers in Vilnius (Lithuania) and Oslo (Norway). For each patient from Vilnius, a patient matched for age and sex from the Oslo register was selected. Sociodemographic characteristics, disease process, and health status were compared between the patient groups. RESULTS: 201 Lithuanian patients and 201 Norwegian patients were included. Mean (SD) age in both groups was 55.9 (10.0) years, and 83% were women. Patients from Lithuania were less often employed (27% v 42%; p=0.001), had higher disease activity expressed by the disease activity score (DAS28; mean (SD) 5.3 (1.0) v 4.4 (1.4); p<0.001), had worse physical function by the modified Health Assessment Questionnaire (MHAQ; mean (SD) 2.3 (0.8) v 1.6 (0.5); p<0.001), had more often comorbidity (73% v 53%; p<0.001) and they reported worse general health measured by Short Form-36 Health Survey (SF-36; mean (SD) 23.2 (13.5) v 44.5 (21.3); p<0.001). The proportions of patients who had used disease modifying drugs were similar, but the pattern of use differed. CONCLUSION: Important differences in employment, disease activity, physical function, and self reported health status were observed in patients with RA from two northern European countries. Socioeconomic inequalities, differences in disease management, and access to specialised health care, as well as methodological issues regarding instruments and data collection are likely explanations. These data support the view that management of RA should be adapted to country-specific needs.

Different cytokine profiles in patients with chronic and acute reactive arthritis.

OBJECTIVE: Analysis of cytokine production in patients with acute and chronic reactive arthritis (AcReA/ChrReA) in order to search for new treatment possibilities. METHODS: Cytokine production by peripheral blood and synovial fluid mononuclear cells (PBMCs/SFMCs) of 28 patients with AcReA, 27 patients with ChrReA, 26 patients with rheumatoid arthritis (RA) and 31 healthy controls was analysed by enzyme-linked immunosorbent assay (ELISA) and flow-cytometry. Production of tumour necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and interleukin (IL)-10 was measured by ELISA, while the percentages of TNF-alpha-, IFN-gamma- and IL-4-positive CD3+ cells were determined in the same groups of patients and healthy subjects using flow cytometry. RESULTS: Spontaneous TNF-alpha production observed in PBMCs of ChrReA, but not of AcReA, patients was significantly higher (P<0.001) than in healthy controls. The percentages of TNF-alpha-positive CD3+ blood cells in ChrReA exceeded that of RA patients and healthy controls (P<0.05 and P<0.001, respectively). Also, the percentages of IFN-gamma-positive CD3+ cells were significantly higher in peripheral blood and synovial fluid of ChrReA patients (P<0.05 and P<0.05, respectively) as compared with AcReA. In ChrReA spontaneous IL-10 production in PBMCs was similar to that observed in healthy controls, while in RA and AcReA the production of IL-10 was significantly increased (P<0.05 and P<0.05, respectively). IL-4 production was low in all study groups with no significant differences detected. CONCLUSIONS: High production of TNF-alpha and IFN-gamma detected in ChrReA supports the possible use of anti-TNF-alpha treatment in ChrReA.

Evaluation of vaginal introital sampling as an alternative approach for the detection of genital Chlamydia trachomatis infection in women.

BACKGROUND: Genital Chlamydia trachomatis infections in women are traditionally detected by testing cervical and urethral samples. This sampling approach is not acceptable in some, e.g. screening situations. We evaluate an alternative approach, i.e. use of vaginal self-collected specimen for testing by polymerase chain reaction. METHODS: The sensitivity of self-collected vaginal (introital) samples to diagnose genital infections by Chlamydia trachomatis using Roche AMPLICOR CT/NG PCR was compared with the cervical- and first-voided urine samples from women consulting with- (Group 1; n=123) and without (Group 0; n=160) genital symptoms. Women were interviewed regarding genital hygiene. Genital symptoms and signs were noted. RESULTS: C. trachomatis DNA was detected in 13.0% of women from Group 1 and in 5.0% of women from Group 0, i.e. in urine of 6.5% vs. 1.9%, in the cervical swab in 9.8% vs. 5.0% and in vaginal swab in 11.4% vs. 3.8% of women, respectively. The vaginal sample was the most sensitive specimen for detecting C. trachomatis in the Group 1 women. It had sensitivity of 87.5% vs. 75% for cervical- and 50% for urine specimens. In Group 0, the cervical sample was 100% sensitive, while the vaginal introital sample and urine had a sensitivity of 75% and 37.5%, respectively. C. trachomatis was less often detected in urine of women who routinely practised genital washing. CONCLUSIONS: Vaginal sampling performed by the woman herself is a sensitive approach and might serve as an important stimulus for screening for C. trachomatis infections in young women at risk.

EULAR randomised controlled trial of pulse cyclophosphamide and methylprednisolone versus continuous cyclophosphamide and prednisolone followed by azathioprine and prednisolone in lupus nephritis.

OBJECTIVE: To compare the efficacy and side effects of intermittent pulse cyclophosphamide plus methylprednisolone with continuous oral cyclophosphamide plus prednisolone, followed by azathioprine, in patients with proliferative glomerulonephritis caused by systemic lupus erythematosus (SLE). METHODS: A multicentre randomised controlled trial was conducted between June 1992 and May 1996 involving eight European centres. All patients satisfied the American College of Rheumatology criteria for SLE and had biopsy proven proliferative lupus nephritis. All received corticosteroids in addition to cytotoxic drugs, as defined in the protocol, for two years. The trial was terminated after four years as recruitment was disappointing. RESULTS: 32 SLE patients with lupus nephritis were recruited: 16 were randomised to intermittent pulse cyclophosphamide and 16 to continuous cyclophosphamide plus azathioprine. Mean duration of follow up was 3.7 years in the continuous group (range 0 to 5.6) and 3.3 years in the pulse group (range 0.25 to 6). Three patients were excluded from the pulse therapy group as they were later found to have pure mesangial glomerulonephritis. Two patients in the continuous therapy group developed end stage renal failure requiring dialysis, but none in the intermittent pulse therapy (p = 0.488; NS). There were similar numbers of side effects and withdrawals from treatment in both groups. There were three deaths: two in the intermittent pulse therapy group and one in the continuous therapy group. CONCLUSIONS: There was no statistically significant difference in efficacy and side effects between the two regimens. Infectious complications occurred commonly, so careful monitoring is required during treatment.