[Aseptic necrosis of the head of the femur in patients with major rheumatic diseases of inflammatory and dystrophic genesis].

A total of 2392 patients treated at the Unit of Rheumatology, Tula Regional Hospital, in 2002 and 2003 were analyzed. Among them, there were 71 patients who were found to have aseptic necrosis of the head of the femur. A statistical analysis of clinical, laboratory, and X-ray data revealed a number of correlations. It was established that the risk factors of aseptic necrosis of the femoral heads were anemia concurrent with the high laboratory values in rheumatoid arthritis and elevated lipid levels and blood coagulative system activation in primary coxarthrosis.

Prevalence of rheumatoid arthritis in circumpolar native populations.

OBJECTIVE: To compare the prevalence of rheumatoid arthritis (RA) in related, but geographically separate, indigenous circumpolar populations. METHODS: Cases were identified by community survey in Russia and by examination of cases located through arthritis registries, a computerized patient information database, and query of local health care providers in Alaska. All possible cases were verified by examination and application of the American College of Rheumatology 1987 criteria. RESULTS: The prevalence rates of RA (age standardized to US population of 1980) varied from 0.62% in the Alaskan Yupik to 1.78% in the Alaskan Inupiat. The Russian Chukchi rate was 0.73% and that of the Siberian Eskimo was 1.42%. CONCLUSION: The Alaskan Yupik Eskimo and Chukchi natives had prevalence rates of RA within the usual range of North American Caucasian groups, in contrast to the Russian Siberian Eskimo and the Alaskan Inupiat Eskimo of the Barrow region, whose high rates approached those of unrelated North American native groups living in very different environments. The Alaskan Inupiat rate was significantly higher than that of the Alaskan Yupik (OR = 2.51, 95% CI 1.25-5.07; p = 0.013), but statistical inferences are limited in the Russian study populations by the small case numbers. The high prevalence rates probably have a genetic basis, although an environmental influence cannot be excluded.

[Methods for the instrumental diagnosis and verification of Lyme arthritis]. / Metody instrumental'noi diagnostiki i verifikatsii Laim-artrita.

We used instrumental methods to characterise Lyme arthropathy in 79 patients with joint involvement and history of Lyme borreliosis. All of them had arthralgia and 45 of them also had arthritis. Radiological examination has established subchondral bone sclerosis in sacroiliac joints in 68% and sacroiliitis in 29% of the examinees. Scintigraphy revealed polyarticular lesions in many cases. Ultrasound investigation has found inflammation and edema of periarticular tissues in the knee, shoulders and hips. The level of antibodies against the causative agent Borrelia (in EIA) was significantly higher in patients with marked signs of inflammation in ultrasound examination. Thus, the combined methods of examination in the diagnosis of Lyme arthritis provide the most complete information.

[An epidemiological study of sacroiliitis among the native inhabitants of Chukotka]. / Epidemiologicheskoe issledovanie sakroileita sredi korennykh zhitelei Chukotki.

For determination of sacroiliitis frequency among natives of Chukotka peninsula a cross-over epidemiological study was conducted. A total of 975 subjects aged 6 years and older were examined. 324 of them (33.2%) had low back pain. X-ray of the pelvis was made in 239 of 324 patients. It was found that sacroiliitis incidence in Chukotka natives makes up 11.3%. There were marked differences in sex distribution: in males 17.1%, in females 5.7%, RR = 3.9. Out of Chukotka natives with low back pain 2.5% had ankylosing spondylitis, of patients with sacroiliitis 30%. A prospective study of patients with sacroiliitis recorded development of ankylosing spondylitis in 17% of the cases 4 years after the disease onset.

Spondylarthropathic diseases in indigenous circumpolar populations of Russia and Alaska.

AIMS: To compare the nature and frequency of spondylarthropathy in geographically separated but genetically related populations with a high prevalence of HLA-B27. METHODS: Using a common questionnaire and disease criteria, cases were ascertained through cross-sectional community surveys in Russia and by examination and study of possible cases identified through rheumatic disease registries and the Native Health Service's computerized patient care data system in Alaska. RESULTS: Similar overall prevalences of spondyloarthropathy (2.0-3.4%) and a similar spectrum of disease were found, including reactive arthritis, ankylosing spondylitis and undifferentiated spondylarthropathy. Psoriatic arthritis was very rare. CONCLUSION: No predisposition to one particular form of spondyloarthropathy was observed; genetic and microbial settings for a spectrum of disease were present. Among adults positive for the presence of HLA-B27 the prevalence of all types of spondylarthropathies was estimated to be 4.5%, all populations combined, and the prevalence of AS was estimated to be 1.6%.

Spondyloarthropathies in circumpolar populations: II. Characterization of the populations.

For epidemiologic studies of spondyloarthropathy in circumpolar peoples of Chukotka, Russia and Alaska, we gathered demographic, physical and laboratory data to provide a background for evaluating and comparing factors that may influence susceptibility and clinical expression of disease. The study groups included the Chukchi and Siberian Eskimo of Russia and the Inupiat and Yupik Eskimo of Alaska. The 4 groups were remarkably similar in population structure, educational attainment, mean hemoglobin concentrations and frequency of the Class I histocompatibility antigen HLAB27. The Alaskan and Chukotkan groups were similar in mean height, but the Alaskans had higher body weights and significantly greater body mass indexes, probably a reflection of a shift away from traditional lifestyle and diet. Differences in the frequencies of ABO and MN blood group antigens were also apparent, with higher frequencies of blood group M in the Alaskan populations, particularly the Inupiat.

Spondyloarthropathies in circumpolar populations: I. Design and methods of United States and Russian studies.

Parallel epidemiologic studies of spondyloarthropathy in aboriginal circumpolar populations were carried out by U.S. and Russian investigators. These complementary studies used the same data collection instrument and disease criteria to facilitate comparisons. During three expeditions to Siberia, Russian investigators collected cross-sectional data from four settlements of Eskimos and Chukchi Indians on the Chukotka peninsula for a study of disease prevalence. U.S. researchers collected cross-sectional data from Eskimos in four Alaskan regions for studies of prevalence and longitudinal data for studies of clinical manifestations, natural history, disease impact, and health care utilization. The aims of these studies were to describe the spectrum of spondyloarthropathy in these populations, and to lay the groundwork for investigations of the role of specific genetic and environmental factors in the pathogenesis and expression of disease. These studies were carried out with a minimum disruption to the native people.

Spondyloarthropathies in circumpolar populations of Chukotka (Eskimos and Chukchi): epidemiology and clinical characteristics.

OBJECTIVE: We sought to determine the prevalence of HLA-B27 and the prevalence and nature of spondyloarthropathies in the native residents of Eastern Chukotka, Siberia, Russia. METHODS: We conducted a cross sectional study with medical examination and interview of 464 of 640 (72.5%) native residents of 2 Eastern Chukotka settlements, Sireniki and Novo-Chaplino. RESULTS: Among them were 212 Eskimos, 98 Chukchi and 154 subjects of mixed race. There were 2 subjects (0.4%) with ankylosing spondylitis, 2 with Reiter's syndrome, 2 with undifferentiated spondyloarthropathy and 1 with late onset pauciarticular juvenile arthritis consistent with spondyloarthropathy. Four of the subjects were Eskimos, 2 were of mixed race, and 1 was Chukchi. We found a high percentage of HLA-B27 antigen in the population, 32% in the native population overall, and 40% among the Eskimos. CONCLUSION: Our data complement other studies of circumpolar populations and reinforce the reported high prevalence of spondyloarthropathy and HLA-B27 among those people.

[The epidemiology of spondylarthropathies among the native inhabitants of Chukotka (Eskimos and Chukchi). 1. The prevalence of spondylarthropathies among the Eskimos and the coast Chukchi]. / Epidemiologiia spondiloartropatii sredi korennykh zhitelei Chukotki (éskimosov i chukhei). Soobshchenie 1. Rasprostranennost' spondiloartropatii sredi éskimosov i beregovykh chukchei.

To establish the prevalence of spondyloarthropathies among the indigenous population of Chukot Peninsula, a one-stage cross-sectional study was made with a direct medical examination of the natives of the two settlements of Eastern Chukot Peninsula: Sireniki and Novo-Chaplino where the main part of Eskimos live. During expedition, 640 natives aged over 6 years lived in both settlements (382 and 258 respectively). 464 persons (72.5%) were examined. Of these, 7 persons (1.5%) were diagnosed to suffer from diseases belonging to the group of spondyloarthropathies: 2 persons (0.4%) had ankylosing spondyloarthritis, 2 (0.4%) Reiter's syndrome, 2 undifferentiated spondyloarthropathies, and 1 juvenile chronic arthritis. Of the 7 patients, 4 were Eskimos, 2 half-breeds and 1 was a Chukchi man. The incidence of ankylosing spondyloarthritis among Eskimos amounted to 0.9%, Reiter's syndrome to 0.5%, and undifferentiated spondyloarthropathies to 0.5%. Thus the one-stage expedition examination of the indigenous population of Chukotka Peninsula (Eskimos and Chukchi) has shown that diseases belonging to the group of spondyloarthropathies are widely prevalent among Eskimos.

[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%.

[Stomatological manifestations in Sjögren's disease and syndrome]. / Stomatologicheskie proiavleniia bolezni i sindroma Shegrena.

For diagnosis of SS and SD and the detection of early stages of disease one should necessarily take into account the symptom complex of "major" (salivary gland enlargement, xerostomia, exacerbation of parotitis) and "minor" stomatological signs (multiple cervical caries, dry lips, perlèche, mycotic and herpetic stomatitis, lymphadenopathy). The initial, marked and late stages were defined according to a degree of expression of stomatological manifestations. The initial stage prevailed in SS, the late stage in SD. The chief method of examination were sialometry, sialography and minor salivary gland biopsy. Sialography was widely used as a less traumatic diagnostic procedure. In addition to common signs with SD, salivary gland involvement was characterized by changes typical of SS combined with rheumatic disease (sclerosis in sclerodermia, vasculitis in RA and SLE, nuclear pathology in SLE).

[Clinical x-ray and scintigraphic evaluation of the state of the sacroiliac joints in patients with chronic monarthritis]. / Kliniko-rentgenologicheskaia i stsintigraficheskaia otsenka sostoianiia kresttsovo-podvzdoshnykh sochlenenii u bol'nykh s khronicheskimi monartritami.

The paper is concerned with some comparative data on the frequency of the detection of sacroileitis using clinicoroentgenological and scintigraphic studies in 57 patients with chronic monarthritis of the knee joint of different genesis. On clinical examination 14 patients (24.7%) only had indirect signs of the affected sacroiliac joints, in 30 patients (52.6%) sacroileitis was diagnosed by x-ray. Scintigraphy with 99mTc-pyrophosphate proved to be most effective for the detection of early signs of sacroileitis because lesions in the sacroiliac joints were found in 35 patients (61.4%).