[Role of obesity in the development of osteoarthrosis and concomitant diseases].

AIM: To specify the association between obesity and the frequency of concomitant states, fat metabolic disturbances, and progressive osteoarthrosis (OA) at various sites. SUBJECTS AND METHODS: The study included 298 patients with manifest knee and hip osteoarthrosis in whom the body mass index (BMI) and waist and hip circumferences were measured calculating the waist-hip index. The association of these indices with the severity of OA and the development of concomitant states was analyzed. RESULTS: Both women and men were found to have overweight and first-second-degree obesity at equal ratios - 61.6 and 59%, respectively. There was an evident rise in the prevalence of cardiovascular diseases (arterial hypertension, coronary heart disease) and diabetes mellitus with a higher BMI. Stages II-III gonarthrosis was predominant (97.1%) in the obesity group (BMI 30.0-35.0 or greater). With a BMI of > 40, X-ray stages III-IV OA were revealed in 83.3% of the patients. CONCLUSION: Our findings support the important role of obesity as a risk factor in the development of OA. Fat metabolic disturbances also make a considerable contribution in the development of concomitant states and in the progression of OA of both knee and hand joints.

[Statistics on rheumatic conditions in the Russian Federation in early 2000es].

The analysis of rheumatic disease morbidity in the Russian Federation in early XXI century is presented.

[Effect of metformin on the clinical course of gout and insulin resistance].

UNLABELLED: The aim of this prospective study was to evaluate results of metformin (MF) therapy during 1 year of uric acid (UA) metabolism and the clinical course of gout with insulin resistance (IR). The study included 30 patients (28 men and 2 women) of mean age 51 yr and duration of he disease 4-11 yr. IR was diagnosed based on the HOMA index. INCLUSION CRITERIA: the absence of anti-gout therapy, normal renal and hepatic function, abstinence. The patients were given 1500 mg MF/day. The measured parameters included anthropometric and clinical characteristics, 24 hour AP, plasma UA, glucose, insulin, urea, creatinine, ALT, AST, lipid spectrum at the first and subsequent visits. UA clearance and excreted UA fraction were calculated. UA level decreased from 569 +/- 109.5 to 442.8 +/-107.4 mcmol/l (p < 0.01) after 12 months of MF therapy. Normouricemia ( < 360 mcmol/l) was achieved in 11 patients. Fasting insulin level dropped by 35% (from 23.9 to 15.9 mcU/ml, p < 0.01), HOMA index from 6.5 to 3. 7(p < 0.01). Serum glucose, cholesterol, triglycerides, and LDL cholesterol decreased while HDL cholesterol increased. Parameters of renal UA regulation and anthropometry remained unaltered. MF therapy resulted in a decrease of serum UA, insulin, and the degree of IR. The hypouricemic effect of MF was unrelated to renal UA excretion, reduced AP and body weight. It is hypothesized that MF reduces production of UA in patients with gout due to inhibition of synthesis of free fatty acids.

[The analysis of chromosome lesions in lymphocytes of Hodgkin's lymphoma patients after chemotherapy and radiation therapy].

The analysis of chromosome lesions in peripheral blood lymphocytes of Hodgkin's lymphoma (HL) patients after chemotherapy and chemotherapy with the subsequent course of radiation therapy is carried out. Is shown, that the mean aberration frequency was significantly higher in HL patients after chemotherapy (7.20 +/- 0.58 per 100 metaphases) than in non-treated HL patients (4.80 +/- 0.54, p < 0.01). The subsequent carrying out of radiation therapy enlarges number of chromosome aberrations on 100 metaphases up to 46.7 +/- 10.7 (p < 0.05), of which chromosome-type aberrations (43.2 +/- 10.3 on 100 metaphases) averaged 92.5%. In lymphocytes of 37 out of 43 HL antitumoral treatment patients, we found, in addition to ordinary aberrant cells, a large number of multiaberrant (MA-cells) cells, i.e. metaphases carrying multiple (at least four) chromosome-type exchange aberrations. In 30 non-treated HL patients only one MA-cell was found. From 171 MA-cells which were in 43 HL patients after antitumoral treatment, 114 MA-cells were found at inspection of 9766 diploid metaphases, and the remaining 57 MA-cells were found at inspection of 196 polyploid metaphases. The carrying out after chemotherapy of radiation therapy enlarges in lymphocytes frequency of appearance of MA-cells. The analysis of MA-cells in diploid and polyploid metaphases shown, that the MA-cells could be formed both in vivo, and in vitro in absence of influence of clastogenic factors, and could survive at least two rounds of in vitro replication.

[Neutralisation of interferon gamma--a new trend in therapy of rheumatoid arthritis].

AIM: To evaluate objectively therapeutic potentialities of a novel method of biological therapy--blocking interferon gamma (IF-gamma)--by means of a comparative analysis of using antibodies to IF-g (anti-IF-gamma) and tumor necrosis factor alpha (anti-TNF-alpha) in resistant rheumatoid arthritis (RA). MATERIAL AND METHODS: A double blind trial included 55 patients with resistant RA. They received 5 intramuscular injections of anti-IF-gamma (n = 20), anti-TNF-alpha (n = 20) and placebo (15 patients). The results were assessed on the treatment day 7 and 28. RESULTS: 16 patients withdrew because of the treatment uneffectiveness (2 from the group on anti-IF-g, 3--on anti-TNF-alpha, 11--on placebo). To the treatment day 28 the patients given anticytokines achieved significant improvement of all clinical indices while placebo group had no improvement. The highest response was observed in the group on anti-IF-gamma (ACR 70). As shown by ultrasound investigation, a significant reduction of the synovial membrane thickness took place also in administration of anti-IF-gamma. Most frequent side effect of the anticytokine therapy was mild dermatitis at injection site on treatment day 8-11. CONCLUSION: Therapeutic efficacy of anti-IF-gamma was comparable with efficacy of anti- TNF-alpha and even was superior in some aspects. The block of IF-gamma holds much promise in the treatment of RA.

[Development and relapse of gastroduodenal ulcer in patients taking nonsteroid anti-inflammatory drugs: effects of standard risk factors].

AIM: To investigate incidence and recurrence rate of endoscopic ulcers in patients with rheumatic diseases (RD) taking NSAID in respect to factors of NSAID gastropathy risk. MATERIAL AND METHODS: Endoscopic findings in the gastrointestinal tract were analysed for 6103 patients (age 50.1 +/- 14.6 years, 83.1% females) with RD taking NSAID regularly, 1642 of them took also glucocorticoids (GC). Control RD patients (n = 504) matched by age and sex took no NSAID, GC and low dose aspirin a month and more before the trial. RESULTS: Gastric or duodenal ulcers were detected in 763 (12.5%) RD patients treated with NSAID, in 20 (4.0%) in the control group, p < 0.0001. Ulcers were more frequent in older patients (65 years of age and older) with ulcer history treated with nonselective NSAID in combination with low aspirin doses (15.1 and 12.0, p < 0.05; 27.3 and 9.7%, p < 0.001; 13.1 and 9.8%, p < 0.001; 19.1 and 12.2%, p < 0.001; respectively). No significant difference in ulcer occurrence was observed in patients given NSAID+GC and NSAID only (11.3 and 12.9%, respectively; p = 0.041). The recurrence rate was assessed in 407 patients with NSAID-induced ulcer 12 months later. Control consisted of 1640 patients having no ulcer, multiple erosions after 12 months of regular intake of NSAID. Ulcer recurrence rose in 163 of 407 patients (40%) while only in 107 f 1640 controls (6.5%, p < 0.0001). Old age and GC administration had no impact on the recurrence rate. Recurrences were less frequent in patients taking nonselective NSAID than those taking nonselective ones (23.4 and 46.5%, respectively; p < 0.001) and in patients treated with NSAID in combination with proton pump inhibitors (24.6 and 42.6%, respectively; p < 0.001). Prophylactic intake of H-2 blockers did not reduce recurrence rate. CONCLUSION: Old age, ulcer history and intake of nonselective NSAID increased the risk of endoscopic GI ulcer. Combined use of NSAID and GC did not increase the risk of ulcer development or recurrence. In a year or later of NSAID continuation recurerences arose in 40% patients with NSAID-induced ulcers. Recurrence risk was reduced by selective NSAID and proton pump inhibitors.

[The analysis of genomic mutations and structural chromosome aberrations in irradiated human lymphocytes].

The lymphocytes of healthy donors were exposed to 60Co gamma-rays in doses ranging 0.5 to 6.0 Gy, and were incubated with PHA and 5-bromodeoxyuridine at 37 degrees C for 72 h. In the course of five consecutive in vitro divisions of cultured lymphocytes, the frequency of polyploid metaphases were determined, and chromosome structural aberrations in polyploid and diploid metaphases were analyzed. Dose dependence of polyploid formation was investigated, and patterns of polyploid cells were analyzed at various DNA replication cycles post exposure and 5-bromodeoxyuridine addition. Radiation is most effective induces of polyploid metaphase of the second and of the third mitotic divisions. In metaphases of the fourth mitotic divisions radiation does not enlarge authentically frequency of polyploid cells. In metaphases of the fifth divisions was not retrieved of polyploid cells. Was shown, that 84.8% of polyploid metaphases compound of tetraploids, while of octoploids and the cells with endoreduplicated chromosomes compound, accordingly, 8.4 and 6.8%. The analysis of chromosome aberrations have shown that the percentage of aberrant cells was higher in polyploid metaphases than in diploids, which indicated that chromosome lesions were involved in formation of polyploid metaphases.

[Comparison of the time to analgetic and anti-inflammatory effect in the treatment of gouty arthritis with nimesulide and sodium diclofenac].

AIM: To compare the time to presentation of the analgetic and anti-inflammatory effects of granulated and tablet nimesulide and sodium diclofenac since the start of therapy for gouty arthritis (GA). MATERIAL AND METHODS: Ninety males with gout were randomized into 3 equal groups. The patients were included in the study by the following criteria: a documented diagnosis of gout (Wallace S. criteria), age over 18 years, acute arthritis for less than 3 weeks, affection of 4 and more joints. For 7 days patients of group 1 received nimesil (200 mg/day), those of group 2--aponil (200 mg/day), group 3 --sodium diclofenac (150 mg/day). Swelling, articular, pain indices were estimated daily for 7 days. RESULTS: Patients of group 1 (nimesil) experienced pain relief on min 20; patients taking nimesulide (aponil) experienced pain attenuation within the first hour. Pain (at rest and movement) and the indices declined faster in group 1 than in group 2 as well as in groups 1 and 2 compared to group 3. Arthritis was arrested in 24 (80%) patients of group 1, 11 (36%) of group 2 and 4 (13%) of group 3. CONCLUSION: Efficacy of nimesulide for arrest of an acute gout attack exceeds that of sodium diclofenac. Granulated nimesulide has advantages over tablets.

[Action of mixed gamma-neutron radiation with various dose rates on the number of cells in thymus and chromosomes of mice bone marrow and human lymphocytes].

The irradiation with mixed gamma-neutron radiation was carried out at the pulse nuclear reactor on fast neutrons BARS-6 in a regimen of one pulse (100 micros) and in a regimen of continuous irradiation during 60 minutes. Was shown, that the irradiation of mice with pulse radiation was 1.3-1.8 times more effective in the induction of the chromosome aberrations in bone marrow cells in comparison with the continuous regimen of irradiation. At the same time, other biological tests (yield of chromosome aberrations in human lymphocytes, decreasing the number of cells in thymus) demonstrated that pulsed and continuous regimens have almost equal biological effectiveness.

[The genome instability in the descendants of the Chinese hamster of the cells, irradiated by the low dose and by various intensities of gamma-radiation].

The V-79 Chinese hamster cells were irradiated by gamma-rays in dose of 0.5 Gy at powers of doses 0.48 Gy/min (an acute irradiation) and 0.0485 MGy/min (a prolonged irradiation). The acute and prolonged irradiation in a dose of 0.5 Gy enlarges frequency of the appearance of micronucleus (MN). Subsequent cultivation of the irradiated cells during 20 generations enlarges frequency of MN, and for prolonged an irradiation the boosted frequency of MN, is saved during 40-60 generations. After an acute irradiation the number of MN starts to reduce after 20 doublings.

[Severity of a female gout course].

AIM: Comparison of a gout course in males and females. MATERIAL AND METHODS: The trial enrolled 34 patients (17 females and 17 males). The patients were matched by age and the disease duration. Severity of a gout course was assessed by the disease history, articular syndrome, concomitant diseases, blood biochemistry. Statistical processing was made with a computer program "Statistica 6.0". RESULTS: Events predisposing to purin metabolism disturbances and, therefore, to development of gout occur more frequently in females than in males. For the most part this concerns arterial hypertension and intake of diuretics. Women often have endocrine pathology (artificial menopause, dysmenorrhea, euthyroid goiter). In women gout runs a more severe course manifesting in early chronization, polyarticularity, lingering arthritis, rapid formation of tophuses. Both groups demonstrated marked polymorbidity with accumulation of the diseases related to atherosclerosis. Distinct group differences by content of uric acid seem to arise from early onset of chronic renal failure in women. CONCLUSION: In the absence of sex- and age-related differences, a more severe course of gout is observed in women. This may be due to hyperuricemia and a trend to the disease chronization, high prevalence of arterial hypertension and renal failure.

[Radioprotective and antistressful properties of nitric oxide production modulators].

The radioprotective and antistressful activities of L-arginine and the "Pronumol" preparation, in which L-arginine is contained in the complex of proteins with nucleic acids, were studied. In mice repeated peroral intake of L-arginine and "Pronumol" partially prevented radiation-induced and stress-induced lipid peroxidation and DNA degradation in thymus, increased hemopoietic stem cell survival, and prevented an increase in chromosome aberration frequency in bone marrow cells of irradiated mice. When repeatedly administered per os before irradiation, "Pronumol" increased survival of intestinal stem cells in irradiated mice and prevented thymus cell devastation induced by radiation and stress.

[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.