[Nosological diagnosis and outcomes of arthritis associated with streptococcal infection].

AIM: To specify the course and outcomes of arthritides associated with streptococcal infection (AASI). MATERIAL AND METHODS: The trial comprised 60 patients with arthritis (mean age 26.8 +/- 14.0). The patients met the following criteria: arthritis, elevated (< 500 U) titers of antistreptolisin-0 in the absence of heart disorders detected at Doppler-echocardiography (2D-echoCG), urogenital infection, Yersinia infection, psoriasis. In addition to routine clinical tests, the following investigations were made: tests for alloantigen of B-lymphocytes D8/17 and antigen HLA-B27, antibodies to polysaccharide of streptococcus of group A, bacteriological test of laryngeal smears for streptococcal infection, prospective follow-up (mean 31.2 +/- 19.6 mon) with 2D-echoCG. RESULTS: Rheumatic arthritis was rejected in 33.3% patients. Other diseases were diagnosed: early rheumatoid arthritis (10%), seronegative spondylarthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, Still's disease, Konig's disease, sarcoidosis, gout, arthritis on the background of streptococcal nodular erythema. Acute rheumatoid fever (ARF) was diagnosed in 56.7% patients, poststreptococcal arthritis (PSA) in 10%. PSA differed from ARF by onset at the age of 36.0 +/- 10.2 years, short latent period (11.2 +/- 1.3 days), a significantly longer course of arthritis (95.0 +/- 3.9 days), recurrences. Alloantigen of B-lymphocytes was detected in 52.8% AASI patients (the difference from the control is highly significant (p < 0.001). Arthritis development was not associated with carriage of HLA-B27 carriage. CONCLUSION: In examination of AASI patients for diagnosis of ARV and PSA it is necessary to reject other diseases among which early RA (10%) is most frequent. It is recommended to make diagnosis of ARF in AASI patients with definition of risk factors (age 7-15 years, family history of rheumatic fever, carriage of alloantigen d8/17), 2.5-year and longer follow-up with 2D-echoCG. Diagnosis of PSA is made in rejection of ARF and in the presence of the following characteristics: development of the disease at the age 30-40 years, a short latent period of the infection, long-term persistent course of arthritis, insufficient effect of nonsteroid anti-inflammatory drugs, frequent affection of sacroiliac joints, recurrence, entezopathy.

Phenotype of peripheral blood lymphocytes and serum immunoglobulin concentration in patients with early rheumatoid arthritis.

We studied the phenotype of peripheral blood lymphocytes and serum immunoglobulin concentration in patients with early rheumatoid arthritis and rheumatoid arthritis of more than 12 months duration. Subpopulations of CDIgM+, CD25+, and HLA-DR+ lymphocytes and IgA concentration differed in these groups of patients with rheumatoid arthritis. The count of lymphocytes carrying CDIgM+ and HLA-DR+ receptors correlated with activity of rheumatoid arthritis.

[Crystotomy with use of surgical ultrasonic instruments]. / Kristotomiia s ispol'zovaniem khirurgicheskikh ul'trazvukovykh instrumentov.

The authors propose to make crystotomy using energy of low-frequency ultrasound (the device URSK 7N 22, frequency - 26.5-30 kHz, amplitude - 40-50 mcm). The working part of the waveguide was designed in specific geometric shape. Indications to ultrasonic crystotomy and surgical techniques are outlined. A total of 29 patients were operated on. Good results were achieved in 25 patients, satisfactory results in 4 patients.

[Immunological aspects of early stage rheumatoid arthritis diagnosis]. / Immunologicheskie aspekty diagnostiki rannei stadii revmatoidnogo artita.

AIM: To study immune status of patients with rheumatoid arthritis (RA) to improve immunodiagnosis at early stage of the disease. MATERIALS AND METHODS: Immunological examination covered 28 patients with rheumatoid arthritis (RA) aged 16 to 72 years. The duration of RA varied from 1.5 months to 1.5 years. Lymphocyte population and T-lymphocyte subpopulation were measured using monoclonal antibodies. Serum Ig were measured in Reafarm plates. RESULTS: Patients with stage II articular function insufficiency (AFI) demonstrated a significant lowering of the absolute number of lymphocytes, natural killers, elevated concentration of IgA compared to patients with less severe AFI. Patients with systemic symptoms had significantly decreased percentage of T-lymphocytes vs patients with isolated articular syndrome. Natural killers' levels were elevated in all the patients in early RA. A significant rise in the percentage of B-lymphocytes and serum IgG concentrations were also seen. In T-lymphopenia, relative amount of T-helpers and T-suppressors was significantly elevated while the ratio T-helpers/T-suppressors was reduced. CONCLUSION: Changes found in the immune status allows diagnosis of early RA, characterize immune disorders, help to select adequate immunomodulating therapy supporting function of the suppressor cells.

[Analysis of immune disorders in patients with rheumatoid arthritis and heart involvement]. / Analiz immunnykh narushenii u bol'nykh revmatoidnym artritom s porazheniem serdtsa.

Examinations of 121 patients with rheumatoid arthritis (RA) included immunological testing for antinuclear antibodies (ANA), lymphocyte blastogenesis test, and leukocyte migration inhibition test and functional cardiological examinations (ECG and EchoCG). RA patients with positive ANA test (n = 43) more often developed immune disorders: the titer of rheumatoid factor was higher and antibodies to type I collagen were more often detected; this was paralleled by decreased cellular immunity and macrophage formation in spontaneous lymphocyte blastogenesis test. The same group more often had ECG and EchoCG deviations. A conclusion is made about a probable role of immune disorders in the development of cardiac disease.

[Functional disturbances of the immune system in rheumatic diseases and their dynamics in the context of pathogenetic therapy]. / Funktsional'nye narusheniia v immunnoi sisteme pri revmaticheskikh zabolevaniiakh i ikh dinamika na fone patogeneticheskoi terapii.

Immunological investigations in patients with rheumatic diseases (rheumatoid arthritis, Reiter's disease, infectious endocarditis, rheumatic heart disease) evidence that the time of onset of different immunologic pathogenetic mechanisms was the same. Immunological rehabilitation was achieved by different therapeutic methods: drugs, plasmapheresis, hemosorption, electrophoresis, ultrasound. In experiments it was beta-1-trophoblastic glycoprotein.

[The immunologic aspects of inflammatory complications in combined maxillofacial and craniocerebral trauma]. / Immunologicheskie aspekty vospalitel'nykh oslozhnenii pri sochetannoi cheliustno-litsevoi i cherepno-mozgovoi travme.

In 56 patients with combined maxillofacial and craniocerebral trauma the indices of cellular and humoral immunity were investigated in the course of acute post-trauma period and related to trauma severity. Investigated was also the influence of ACTH and corticosteroid hormones on the mechanisms of secondary transitory immune deficiency and related complications. It was established that in combined craniocerebral and maxillofacial trauma the late complications developed against the background of a considerable catabolic activation (increased levels of ACTH and cortisol), and suppression of cellular immunity. These were indications to goal-directed immune correction as a part in combined therapeutic intervention at the early stages of traumatic disease.