[Early diagnosis of rheumatoid arthritis in modern clinical practice (results of a follow-up of a Moscow cohort of early arthritis patients participating in the program RADICAL)].

AIM: To estimate potentialities of early diagnosis of rheumatoid arthritis (RA) diagnosis in clinical practice in the course of the RADICAL program. MATERIAL AND METHODS: Of 366 patients participating in the trial 61 (16.7%) were males and 305 (83.3%) were females at the age of 47.76 +/- 14.1 years. The longest duration of the symptoms before consulting a doctor was 51 weeks, mean duration--5.7 weeks, 55% patients had the symptoms for 3 weeks. All the patients have undergone laboratory examination including leukocyte count, platelet count, estimation of ESR, concentration of C-reactive protein (CRP), rheumatoid factor (RF) and antibodies to a cyclic citrullated peptide (ACCP); roentgenography of the wrists and feet. On demand, antinuclear factor (ANF) and HLA-B27 were investigated. RA was diagnosed on the basis of ACR classification criteria. If the criteria were not complete at the moment of the study, the patient was referred to the group of "undifferentiated arthritis" (UA). The patients were examined before the treatment, 6 and 12 months later. The treatment was made according to Russian clinical recommendations. RESULTS: Prior to admission to hospital, 58% patients were suspected for RA, 18.3%--osteoarthrosis (OA), 14%--reactive arthritis. 18.9% were not diagnosed, other diagnoses were considered in 12.6% patients. At primary examination RA was diagnosed in 212 (57.9%) patients, UA was in 133 (36.3%) patients, 21 (5.7%) patients had other diagnoses. Twelve months later RA, UA and other diseases were diagnosed in 256 (69.9%), 70 (19.1%) and 40 (10.9%) patients, respectively. CONCLUSION: A 3-stage algorithm of early RA diagnosis is proposed. At the stage of the first contact with the patient in an outpatient clinic a valid RA suspition with consideration of modified EULAR criteria must be formulated. At the second stage a district rheumatologist must examine the patient outpatiently with determination of ACR classification criteria. In diagnosis verification the treatment must be started according to APP and EULAR clinical recommendations. If RA diagnosis can not be verified or rejected, the patient must be refered to hospital (stage 3). If verification of RA diagnosis is impossible, the diagnosis should be formulated as UA.

[Antibodies to cyclic citrullinized peptide in rheumatoid arthritis]. / Antitela k tsiklicheskomu tsitrullinirovannomy peptidu pri revmatoidnom artrite.

AIM: To estimate a diagnostic value of antibodies to cyclic citrullinized peptide (CCP) in rheumatoid arthritis (RA). MATERIAL AND METHODS: The study was made of 85 RA patients. Of them, 48 patients had early RA, i.e. of 8 month and less duration. The control group consisted of 35 patients with non-differentiated arthritis (NDA) and 8 healthy donors. Concentrations of CCP antibodies, rheumatoid factor (RF) IgM and RF IgA were measured with enzyme immunoassay (EIA). RESULTS: The level of CCP antibodies in RA patients (76.3 +/- 43.8; median 100.0 U/ml) was significantly higher than in NDA patients (25.1 +/- 43.9; median 0.8 U/ml; p < 0.05) or in donors (0.38 +/- 0.36; median 0.2 U/ml; p < 0.05). A correlation was found between the CCP antibodies level and that of RF IgM (chi2 = 15.4; p = 0.001) and RF IgA (chi2 = 10.3; p = 0.001). Sensitivity (82%) and specificity (90%) of CCP antibodies in RA diagnosis was higher than these parameters for RF IgM and IgA (78%, 86% and 72%, 83%, respectively). Simultaneous tests for CCP antibodies, RF IgM and RF IgA led to a 93% specificity. CCP antibodies were detected in 50% patients seronegative by RF IgM and in 62% patients seronegative by IgA. Detection of CCP antibodies was closely associated with early RA (chi2 = 30.8; p = 0.0001). CONCLUSION: The EIA for CCP antibodies is a sensitive and specific serological test for early RA diagnosis.

[Role of carbohydrate-protein recognition in the process of Bdellovibrio attaching to bacterial host cells]. / Rol' uglevod-belkovogo uznavaniia v protsesse prikrepleniia Bdellovibrio k kletkam bakterii-khoziaev.

The authors discuss the role of carbohydrates in the surface layer of the cell wall in the process of Bdellovibrio attachment to host-bacteria cells. The paper presents the results of inhibitory analysis using sugars conducted with two model systems as well as the data about the effectiveness of the interaction between parasite cells and host cells after the modification of their surface polysaccharide layer with concanavalin A and sodium periodate.

[Effect of a deficiency of carbon, nitrogen, phosphorus and magnesium in the growth medium on the mechanical properties of Escherichia coli cell walls]. / Vliianie defitsita ugleroda, azota, fosfora i magniia v srede vyrashchivaniia na mekhanicheskie svoistva kletochnykh stenok Escherichia coli.

Values of modulus of elasticity of cell walls and strength level of cells Escherichia coli cultivated in the carbon, nitrogen and phosphorus deficient media or incubated in the magnesium-free medium were determined. Elastic modulus of cells grown in the magnesium-free medium was by two order of magnitude lower than that of the control cells. Elastic modulus of cells cultivated in the nitrogen and carbon deficient media was by one and two orders of magnitude lower than in the control cells whereas strength level was by 1.15 and 1.39 times higher, respectively. Elastic modulus of cells grown in the phosphorus deficient medium remained undetermined and strength level of those cells proved to be the lowest (0.9 of the control).

[Results of measuring the modulus of elasticity of microorganism cell walls]. / O rezul'tatakh izmereniia modulia uprugosti u kletochnykh stenok mikroorganizmov.

The elasticity modulus of Escherichia coli cell walls was found to change in the course of growth of the culture. It decreased in the middle of the exponential phase, apparently as a result of intensification of biosynthetic and related to them transport processes at this period. If the cells were treated with EDTA, their elasticity modulus was lower, by an order of magnitude, than that of the control cell walls. If the cells were treated with lysozyme, the elasticity modulus of their walls decreased by three orders of magnitude. The elasticity modulus of cell walls was less in gram-positive rods than in E. coli. The elasticity modulus of spherical cells cannot be determined using this technique.