[State-of-the-art pharmacotherapy of juvenile arthritis].

The review of state-of-the-art stage of pharmacotherapy of juvenile arthritis is represented. Main principles and features of the use of antirheumatic remedies in children are given with the accent to age limitations. Detailed characteristic used drugs and treatment schemes and also recommendations for prevention and monitoring of collateral reactions are given. Special attention is devoted to differential approach to the therapy of juvenile arthritis various variants: systemic, polyarticular and oligoarticular. Schematic algorithms of therapeutical tactics are represented.

[Present-day classification and nomenclature of rheumatic fever]. / Sovremennaia klassifikatsiia i nomenklatura revmaticheskoi likhoradki.

The paper presents a new classification of rheumatic fever, which has been adopted by the Plenary Session of the Association of Rheumatologists of Russia in May 2003. This classification envisages the abandonment of the term "rheumatism" in its former interpretation. The term "acute rheumatic fever" (ARF) appears to be more justified since it makes a physician elucidate its association with Group A streptococcal infection of the throat and prescribe antibiotics for eradication of this infection in its acute period (primary prophylaxis) and for prevention of repeated attacks (secondary prophylaxis). The current interpretation of the clinical syndromes/symptoms and laboratory parameters that enter into diagnostic criteria for ARF is presented. There are 2 types of outcome of the disease. In case of recovery, we are dealing with the complete regression of the clinical symptomatology of ARF, normalized laboratory parameters and no residual changes. Chronic rheumatic diseases of the heart are considered to mean a disease characterized by a cardiac valvular lesion as postinflammatory marginal fibrosis of valvular leaflets or cardiac abnormality (failure and/or stenosis) developed after prior ARF. Emphasis is laid on the significance of evidence of Group A streptococcal infection that precedes the development of the disease. Examples of clinical diagnosis in accordance with the terminology of the International Classification of Diseases, the 10th edition, are given in the paper.

[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 current clinical and diagnostic aspects of juvenile ankylosing spondylarthritis]. / Sovremennye aspekty kliniki i diagnostiki iuvenil'nogo ankiloziruiushchego spondiloartrita.

The examination was performed of 700 children with juvenile arthritis diverse in nosology. Juvenile ankylosing spondylarthritis (JSA) was diagnosed in 60 patients. In 31 of them the diagnosis was accurate, 29 patients were suspected of having JSA by Garmisch-Partenkirchen criteria. 95% of the examinees were newly diagnosed. The study demonstrated polymorphism of clinical symptoms, variability of JSA course, articular syndrome characteristics, those of extraarticular manifestations, and the axial lesion.

[The use of interferon in the combined therapy of juvenile rheumatoid arthritis]. / Ispol'zovanie interferona v kompleksnoi terapii iuvenil'nogo revmatoidnogo artrita.

The efficacy of recombinant gene engineering alpha 2-interferon (reaferon) was studied and compared in 60 patients suffering from verified juvenile rheumatoid arthritis (JRA). Reaferon was shown to possess good tolerance and to produce an adequate therapeutic effect. The combined use of reaferon and methotrexate permits potentiating the therapeutic effect of interferon and avoiding side effects seen with methotrexate used alone. Besides, it makes it possible to reduce the incidence of respiratory infections which are often associated with exacerbation of the underlying disease when treated by conventional methods.

[Evolution of rheumatism in children during the past 30 years (1960-1989)]. / Evoliutsiia revmatizma u detei za 30 let (1960-1989).

The results of the anamnesis of more than 3000 case reports of patients with rheumatic fever treated at the pediatric hospital of the Institute of Rheumatology, USSR AMS during the recent 30 years have been presented. The authors established favourable tendencies of clinical evolution of rheumatism which found their reflection in a decreased markedness of carditis and extracardiac manifestations of the disease, considerable decrease in the number of relapses, development of cardiac defects and hospital lethality.

[The achievements and outlook in the study of the problem of reactive arthritis in children]. / Dostizheniia i perspektivy v izuchenii problemy reaktivnykh artritov u detei.

The paper is concerned with certain aspects of the problem of reactive arthritis (ReA) in children and with the data obtained by the author. The emphasis is laid on ReA related to intestinal and nasopharyngeal infections and viewed as an independent disease entity. Some controversial issues are discussed and approaches to further studies into such a complex problem are outlined.

[The evaluation of the therapeutic efficacy of auranofin in juvenile rheumatoid arthritis (the results of Soviet-American research)]. / Otsenka terapevticheskoi éffektivnosti auranofina pri iuvenil'nom revmatoidnom artrite (rezul'taty sovetsko-amerikanskogo issledovaniia).

The authors describe the results of prospective multicenter Soviet-American placebo-controlled 6-month investigations concerned with assessment of the therapeutic efficacy of auranofin in juvenile rheumatoid arthritis (JRA). 231 patients with JRA were placed under observation. Auranofin was found to be slightly superior to placebo. The drug was tolerated well. It is noted that in the treatment of JRA, of importance are long (6-month) courses of non-steroidal anti-inflammatory drugs.

[Heterogeneity of the immune response to antigens of the muscular and interstitial connective tissue of the heart in patients with rheumatic diseases. I. Age factors and specificity to alpha-galactose]. / Geterogennost' immunnogo otveta na antigeny myshechnoi i interstitsial'noi soedinitel'noi tkani serdtsa u bol'nykh revmaticheskimi zabolevaniiami. I. Vozrastnye osobennosti, spetsifichnost' k al'fa-galaktoze.

Antibodies (Ab) reacting with the myocardial sarcolemma (SL) and interstitial connective tissue (ICT) were determined in 1333 rheumatic disease (RD) patients and in 286 healthy subjects of various age using indirect immunofluorescence technique. The age-related levels of SL and ICT Ab are responsible for the heterogeneous immune response to SL and ICT antigens. The presence of SL Ab is characteristic for young patients, of ICT Ab, for older patients. Children are found to have ICT Ab more infrequently, Sl Ab are more common in rheumatism than in other rheumatic diseases. The higher inflammatory process activity is associated with a more frequent presence of SL Ab and rare ICT Ab in each age group. In RD patients, SL Ab are considered to be risk factor of cardiac disease development. The ICT antigen is found to incorporate alpha-galactose. The reasons for the absence of ICT Ab in the healthy young and in patients with maximum inflammation are discussed.

[A working classification and nomenclature of rheumatic diseases (pediatric aspects)]. / Rabochaia klassifikatsiia i nomenklatura revmaticheskikh boleznei (pediatricheskie aspekty).

The authors provide the working classification of rheumatic diseases prepared by a large group of scientists under the aegis of the All-Union Society of Rheumatologists and under the guidance of V. A. Nasonova, Academician of the USSR AMS. In preparing the final variant of the classification use was made of the experience gained by therapists in cooperation with pediatricians.

[The state of humoral immunity to enterobacterial antigens in juvenile rheumatoid arthritis and reactive arthritis in children]. / Sostoianie gumoral'nogo immuniteta k bakterial'nym antigenam kishechnoi gruppy pri iuvenil'nom revmatoidnom artrite i reaktivnykh artritakh u detei.

Investigation findings are generalized based on quantitation of antibodies against the antigens of intestinal microorganisms of Enterobacteriaceae family conducted in 66 children with various joint disease using the enzyme-linked immunoassay (ELISA) methodology. High antibody titres were revealed in 77.1% juvenile rheumatoid arthritis cases and in 80% cases with chronic juvenile arthritis which was not defined nosologically. All the patients with reactive arthritis associated with intestinal infection showed high tension of immunity to all tested enterobacteriaceae antigens with cross reactions to them. Patients with reactive arthritis associated with oral infection, with Reiter's disease and other disorders exhibited high antibody titres at the same rate as in the control.

[Sjögren's syndrome in children]. / Sindrom Shegrena u detei.

The authors summed up the results of a many-year study of 13 children with Sjogren's diseases and syndrome, presented clinical characterization of patients, a course of this childhood pathology, some therapeutic problems and catamnestic data. An excerpt from a case history of a child with Sjogren's syndrome was given. Characteristic features of this childhood pathology were defined in comparison with adult patients.

[Reiter's disease in children]. / Bolezn' Reitera u detei.

The paper is concerned with the results of a long-term study of 16 children with a verified diagnosis of Reiter's syndrome. Preceding factors, the clinical symptom complex, laboratory findings and the evolution of the disease were described. Emphasis was placed on the necessity of early diagnosis and adequate therapy including antiinflammatory drugs and antibiotics to prevent serious complications, especially of the eyes.