[Use of anti-B-cell therapy in case of antisynthetase syndrome as the severest subtype of polymyositis/dermatomyositis].

Antisynthetase syndrome encompassing a symptom complex with severe interstitial lung disease is the severest subtype of polymyositis and dermatomyositis. The characteristic feature of antisynthetase syndrome is the insufficient efficiency of traditional therapy with glucocorticosteroids and cytostatics, which determines the prognosis of the disease and the need for new therapeutic approaches to treating these patients.

[Splenic perfusion in the combined treatment of patients with systemic lupus erythematosus]. / Splenoperfuziia v kompleksnom lechenii bol'nykh sistemnoi krasnoi volchankoi.

Twenty patients suffering from severe systemic lupus erythematosus (SLE) underwent 52 sessions of splenoperfusion (SP) by means of extracorporeal perfusion of the patient's blood through isolated porcine spleen. It got prepared directly before the perfusion. The organ was obtained from a healthy animal in sterile conditions, washed from the blood after cannulation of the artery and vein. The patient's blood was pumped from the peripheral vein to the spleen artery. After passing through the splenic vascular bed the blood outflew from the spleen vein into the opposite peripheral vein of the patient. SP was followed by positive clinical changes: normalization of body temperature, regression of skin symptoms and articular syndrome, reduction of lymphadenopathy, hepato- and splenomegaly. The tests indicated inhibition of SLE activity. Sp-related immunocorrective effect was also present as shown by depression of B-cell hyperreactivity and T-cell immunity stimulation. 1-4-year follow-up of 19 patients showed them to be in remission. The data obtained favour SP inclusion into intensive therapy of severe SLE.

[Effect of treatment with high doses of 6-methylprednisolone on the activity of anti-DNA antibodies and antiidiotypic activity in the sera of patients with systemic lupus erythematosus]. / Vliianie terapii udarnymi dozami 6-metilprednizolona na aktivnost' anti-DNK antitel i antiidiotipicheskuiu aktivnost' v syvorotkakh bol'nykh sistemnoi krasnoi volchankoi.

The effect of 6-methylprednisolone therapy at high doses on the time course of autoantibodies to DNA and anti-idiopathic (inhibitory) serum activity was studied in 22 patients suffering from SLE with a high clinicolaboratory activity. Pulse-therapy led to the improved status in 70% of the patients and rapid reduction of clinical and laboratory manifestations of disease (cerebrovasculitis, nephritis, skin involvement, etc.). Changes in clinicolaboratory findings well correlated with the time course of antibodies to DNA and the level of anti-idiopathic activity. This type of therapy was shown to result in a sharp reduction of antibodies to DNA and a parallel increase in idiopathic serum activity. Defining changes in idiopathic serum activity it is possible to determine therapeutic efficacy and to predict a further course of disease.

[Combined use of impact doses of 6-methylprednisolone and cyclophosphamide in patients with systemic lupus erythematosus]. / Kombinirovannoe primenenie udarnykh doz 6-metilprednizolona i tsiklofosfana u bol'nykh sistemnoi krasnoi volchankoi.

The priming doses of 6-methylprednisolone (6-MP) and cyclophosphamide (pulse therapy) were used for the treatment of 23 patients with SLE associated with primary involvement of the kidneys and pronounced immunologic disorders. The effect of combined therapy was evaluated on the extrarenal manifestations of SLE, proteinuria, hematuria, glomerular filtration, creatinine, antibodies to native DNA (anti-nDNA), complement, cryoprecipitins, antinuclear factor, and circulating immune complexes (CIC). The treatment efficacy was evaluated on day 4 since the beginning of the treatment and on the patients' discharge from hospital. The data obtained point to a significant increase of glomerular filtration and complement level, a reduction in CIC and anti-nDNA and cryoprecipitins within the first day after discontinuation of the treatment. The diminution of proteinuria and improvement of the urinary sediment were seen in over 50% of the patients. Variation of the laboratory findings correlated well with the improvement of the disease clinical picture. The combination of the priming doses of 6-MP and cyclophosphamide holds promise in the treatment of patients with associated SLE and grave renal involvement, marked immunologic disorders and generalized autoimmune vasculitis.