Vol 84, No 5 (2012)
- Year: 2012
- Articles: 15
- URL: https://journals.rcsi.science/0040-3660/issue/view/1763
Editorial
RHEUMATOID ARTHRITIS: PROBLEMS AND SIGNIFICANCE OF PERSONALIZED MEDICINE
Abstract
The last decade is prominent for significant progress in research in the field of mechanisms underlying development of rheumatoid arthritis (RA) opening new prospects in pathogenetic treatment of this disease. A great success of RA pharmacotherapy during the last 10 year period is design of novel genetically engineered biological medicines. Achievements of molecular biology, pharmacological genetics and biological information science promote an individual approach to treatment of RA patients within a new conception of individual medicine which considers personal aspects of genomic and proteomic sciences. This novel approach to treatment of RA patients can improve RA outcomes and noticeably reduce cost of the treatment.
Terapevticheskii arkhiv. 2012;84(5):5-9
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TOCILIZUMAB IMPACT ON BLOOD CHOLESTERINE TRANSPORT AND EARLY MANIFESTATION OF ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Abstract
Aim. To evaluate tocilizumab (TLZ) effects on blood lipids composition and severity of carotid arteries (CA) atherosclerosis in rheumatoid arthritis (RA) patients after 24 week TLZ treatment. Material and methods. Before and 24 weeks after TLZ treatment 43 RA patients (33 women and 10 men) were examined by DAS 28 index, for blood serum concentration of cholesterol, triglycerides (TG), LPHD and LPLD cholesterol. The drug was injected intravenously in drops in a dose 8 mg/kg each 4 weeks. Results. A 24 week TLZ treatment produced satisfactory and good anti-inflammatory effects in RA patients. Hypoalphalipoproteinemia incidence and atherogenicity index (AI) reduced 3 and 5 times, respectively (p < 0.05). Elevated levels of cholesterol, TG, LDPL cholesterol occurred with the same frequency before and after TLZ treatment. Cholesterol rose by 11.6%, LPHD cholesterol by 48.9%, TG lowered by 7%, AI by 31.9% (p<0.05). LDLP cholesterol decreased. Blood lipids composition shifts were associated with marked reduction in the disease activity: decreased concentration of C-reactive protein, IgM rheumatoid factor, DAS28 index, improvement of the patient’s functional status. Maximal thickness of the intima-media complex of CA increased by 8.2%. Atherosclerotic plaques were revealed before and after treatment in 17 (41,4 %) patients from 41, in 5 (12,2%) patients the plaques arose after 6 months and in 5 (12,2%) patients the number of plaques increased. Conclusion. Because of both positive and negative effects of IL-6 receptor inhibitors on blood lipids, combined treatment of RA must include statins for correction of dyslipidemia.
Terapevticheskii arkhiv. 2012;84(5):9-18
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FRAX-ASSISTED PREDICTION OF FRACTURES IN PATIENTS WITH RHEUMATOID ARTHRITIS
Abstract
Aim. To determine an absolute risk of fractures in patients with rheumatoid arthritis (RA) with the FRAX procedure (fracture risk assessment tool) for choice of further prophylactic, therapeutic and rehabilitative measures. Material and methods. The trial included 611 RA females over 49 years of age of 834 RA patients from 2004 data base RA entrees. All the patients were assessed for fracture risk with FRAX basing on clinical data without densitometry. Distribution into fracture risk groups was made by a graphic age-risk scheme. Results. High or moderate fracture risk was registered in 58.6 % RA examinees. These patients were older than those with a low fracture risk, they had lower body mass index, longer menopause, higher disease activity, more often had extra-articular manifestations of the disease. Therefore, duration of their glucocorticosteroid treatment was longer. Patients with high and moderate fracture risks more frequently had functional insufficiency of the third degree, fractures of skeletal bones in the past. Conclusion. The FRAX method for assessment of an absolute fracture risk in RA patients detects subjects with elevated risk of fractures. This facilitates timely and qualitative administration of medical care, lowers costs of examination, improves treatment and rehabilitation of patients with osteoporosis and its complications.
Terapevticheskii arkhiv. 2012;84(5):18-24
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SURVIVAL OF PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION, ASSOCIATED WITH SYSTEMIC SCLEROSIS
Abstract
Aim. To study survival of patients with a natural course of pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SS). Material and methods. Twenty SD patients with PAH and 71 SS patients free of PAH were followed up for 10 years (1998-2008) when therapy with specific pulmonary vasodilators was not available. Survival curves for both groups were plotted by Kaplan-Mayer method. Results. One-, 3and 5-year survival were 85, 25 and 5%, respectively, in the SS-PAH group and 99, 82 and 77% in the SS group, respectively. The differences were significant (р < 0,001). Survival median in the group SS-PAH was 32 months. Conclusion. The above evidence is comparable to the results obtained earlier and demonstrate a fatal outcome of the disease in the absence of therapy with specific pulmonary vasodilators.
Terapevticheskii arkhiv. 2012;84(5):24-28
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IMMUNOLOGICAL DISORDERS AND CYTOKINE PROFILE IN SYSTEMIC AND LOCALIZED SCLEROSIS
Abstract
Aim. Comparative study of disorders in cellular immunity and cytokine profile in systemic and localized sclerosis (SS, LS). Material and methods. Parameters of cellular immunity and cytokine profile were examined in 58 systemic sclerosis patients (24 patients with SS, 34 patients with LS and 33 healthy donors). The examination protocol included assay of circulating immune complexes (CIC), serum cytokines (IL-1beta, IL-4, IL-6, TNF), DNA antibodies, assessment of oxygen-dependent and non-oxygen-dependent functions of circulating neutrophils and monocytes, identification of lymphocytic phenotype. Results. Elevated levels of CIC, proinflammatory cytokines in SS and LS, antibodies to native doublechain DNA in LS were found. Free radical oxidation of neutrophils in LS was higher only by one parameter, in SS by all spontaneous tests of neutrophils and monocytes. Non-oxygen-dependent metabolism of phagocytes was enhanced only in SS. Patients with LS and SS have subnormal count of lymphocytes CD3+, CD4+, CD11b+ in the presence of elevated count of lymphocytesCD8+, CD16+ as well as activation markers — CD19+, CD25+, CD95+ and HLA-DR+ cells. CD25+ lymphocytes count is higher in SS than in LS. Conclusion. The study of metabolism of circulating phagocytes, cytokine profile lymphocytic phenotype can be used for differential diagnosis of LS with SS.
Terapevticheskii arkhiv. 2012;84(5):28-31
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CARDIOVASCULAR COMPLICATIONS AND ENDOTHELIAL DYSFUNCTION IN PRIMARY VASCULITIS
Abstract
Russian and foreign data on development of atherosclerosis in patients with primary vasculitis are analysed. The discussion covers the role of risk factors, features of pathogenesis of atherosclerosis in primary vasculitis, diagnostic and therapeutic methods in this disease.
Terapevticheskii arkhiv. 2012;84(5):31-35
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HCV-ASSOCIATED CRYOGLOBULINEMIC VASCULITIS
Abstract
Aim. To analyze clinical and laboratory features of cryoglobulinemic vasculitis (CGEV) associated with HCV infection. Material and methods. We examined 61 patients with clinical manifestation of CGEV in 2006-2011. CGEV was associated with autoimmune diseases in 31 patients (51 %), with HCV infection in 21 patients (34,4 %), essential (idiopathic) cryoglobulinemia in 8 patients (13 %) and lymphoproliferative diseases in 1 patient (1,6 %). 21 patients with HCV-associated CGEV were studied for main clinical and laboratory manifestations of the disease. Kidney and liver involvement was confirmed morphologically and immunomorphologically. Electroneurophysiological investigation evaluated peripheral nervous system involvement. Biopsy of parotid, lacrimal glands, peripheral lymph nodes, splenectomy and bone marrow trephine biopsy with morphological study and immunohistochemistry were used to identify type of lymphoma. Characteristics of monoclonal secretion were assessed with high-resolution electrophoresis in agarose gel with subsequent immunofixation of sera and concentrated urine. Results. Liver involvement was detected in 66 % of patients with HCV-associated CGEV., 34% patients were chronic HCV carriers with persistently normal liver function tests. Common rheumatologic manifestations of HCV-associated CGEV were skin lesions (90%), arthralgia (85%), frequent peripheral nervous system involvement (52%) and glomerulonephritis (38%). Prevalent immunological markers of CGEV associated with HCV were mixed monoclonal cryoglobulinemia with rheumatoid factor activity (62%), rare polyclonal (34%) and olygoclonal (4%) cryoglobulinemia, low levels of С4 compliment fraction (80%). Patients with mixed monoclonal cryoglobulinemia often developed clinical manifestations of Sjögren s syndrome (23 %) and malignant lymphoproliferative diseases (14 %). CGEV is a prognostically adverse sign in HCV infected patients and caused death of 14% patients even in a short period of follow-up (1-2 years).
Terapevticheskii arkhiv. 2012;84(5):35-42
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KNEE JOINT OSTEOARTHROSIS: RISK FACTORS OF RAPID PROGRESSION
Abstract
Aim. To study risk factors of knee joint osteoarthrosis (KJO) progression within 5 years since the disease onset. Material and methods. We examined 158 females with primary KJO (by ACR criteria). Each patient’s record contained demographic and disease history information, pain score in the knee joints by visual analog scale and joint status. All the patients have undergone standard rhoentgenography of the knee joints in two projections and two-energy x-ray densitometry of the lumbar spine, the neck of the femur (NF), subchondral condyles of the femur and of the tibia. Results. We found factors promoting rapid progression of gonarthrosis within the first 5 years of the disease: high body mass index and mineral bone density (MBD) in subchondral parts of the tibia, low MBD in NF and bone marrow edema in the tibia. Conclusion. We revealed factors contributing to rapid progression of gonarthrosis in initial disease. MBD of the axial skeleton and subchondral MBD among them. Using established variables it is possible to distinguish a cohort of patients with initial signs of OA who need earlier treatment. This is of practical importance and can improve the disease prognosis.
Terapevticheskii arkhiv. 2012;84(5):42-45
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SURVIVAL OF GOUT PATIENTS
Abstract
Aim. To assess survival and lethal outcome risk factors in gout patients. Material and methods. The study included 286 gout patients (246 males, 86% and 49 females, 14%) treated for gout in the Research Institute of Rheumatology from 2001 to 2006. From 2010 to May 2011 a telephone survey was made to obtain information about death of the above examinees. After the survey clinical condition of the dead patients was compared to that of survivors. Results. Of 286 participants of the trial, 38 did not response. By information from the relatives, there were 31 (12.5%) lethal outcomes of 248 patients. A cause of death in 20 patients, irrespective of age, were cardiovascular complications, 6 patients died of cancer, one patient of chronic renal failure, one of infection, one of trauma and 2 of unknown cause. Median of age at death was 62,1 years, median of gout duration 12,8 years. 65% of the deceased patients had risk factors of cardiovascular complications (type 2 diabetes mellitus, coronary heart disease, acute myocardial infarction, stroke, chronic cardiac failure). Median of time since examination in the clinic to death was 4.3 years. Conclusion. Gout patients’ mortality is high. 7-year survival was 85% in high overall mortality. 2/3 patients died of cardiovascular diseases. Survival of gout patients with normuricemia is the same of those with hyperuricemia. A high level of highly sensitive CRP is a factor of poor prognosis (death) for gout patients.
Terapevticheskii arkhiv. 2012;84(5):45-50
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THE LEVELS OF PLASMINOGEN AND INHIBITOR OF PLASMINOGEN ACTIVATORS OF TYPE 1 IN ANTIPHOSPHOLIPID SYNDROME
Abstract
Aim. To estimate the levels of of plasminogen (Pg) and inhibitor of plasminogen activators of type 1 (IPA-1) in patients with antiphospholipid syndrome (APS) and to reveal correlations between their content and clinical-laboratory characteristics of APS. Material and methods. A Pg level was measured in 78 APS patients: 35 of them had systemic lupus erythematosus (SLE), 43 had primary APS and 19 with idiopathic thrombosis (IT). IPA-1 was detected in 63 APS patients: in 26, 37 and 18 patients, respectively. The control group consisted of 10 subjects free of autoimmune disease and thrombosis. The patients were matched by age. Pg and IPA-1 levels were estimated kinetically. The Pg level was stratified: normal (1.5-2.0 mcM, high (above 2.0 mcМ), low (under 1.5 mcM). Thromboses in the past occurred in 67 patients: arterial (n=32), venous (n=53), of combined localization (n=14). Results. Of 78 APS patients, Pg level was normal in 34 (44%), high in 20 (25%), low — in 24 (31%). Of 43 primary APS patients, low Pg was in 8 (19%), of 35 patients with SLE+APS — in 16 (46%) patients. A Pg concentration (1.59 [1.4; 1.98] mcM) was significantly less in APS patients with thrombosis than in patients with IT (2.4 [1.74; 2.99] mcM). Pg tended to lower levels than in the controls (1.95 [1.63; 2.26] mcM). IPA-1 varied in primary APS from 0.45 to > 1 nM, in SLE+APS from 0.44 to >1 nM, in IT —from 0.65 to 0.81 nM. The levels of active IPA-1 in all the patients with APS and IT were higher than in healthy donors and varied from 0.44 to >1 nM. Most of APS patients had high level of IPA-1 — 52 (83%) (IPA-1 from 0,1 to 1), of them 22 (85%) patients with SLE+APS and 30 (73%) — with primary APS. 11 (17%) APS patients had high IPA-1 ( >1), of them 4 (15%) with SLE+APS and 7 (27%) with primary APS. All IT patients had moderately high IPA-1 level. Conclusion. A low level of Pg in APS patients was seen significantly more frequently than in IT patients and controls and was associated with thrombosis, primarily arterial. Moderate high IPA-1 occurred in 83% of 63 APS patients, high in 17%. IT patients had moderately high IPA-1. High IPA-1 was associated in APS with thrombosis, primarily arterial.
Terapevticheskii arkhiv. 2012;84(5):50-57
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MULTISLICE COMPUTED TOMOANGIOGRAPHY IN ASSESSMENT OF CORONARY STENT LUMEN
Abstract
The treatment of coronary artery stenosis has progressively shifted over the past decades from surgical (bypasses) to percutaneous (stenting). Recent introduction of drug-eluting stents further reduced the occurrence of in-stent re-stenosis (ISR). However, a non-negligible number of patients need imaging tests when symptoms recur. Multi-Slice computed Coronary Angiography (CT-CA) is a clinical reality for evaluation of coronary artery stenosis, but still under evaluation in the follow-up of coronary stents. Several factors may impair proper depiction of in-stent lumen even with the most recent CT equipments. In highly selected populations CT-CA may play a clinical role even though the performance requirements both from the technical standpoint (i.e., CT scanner) and from the training (i.e., operators’ experience) are still very demanding. In the meantime CT technology should improve towards higher contrast, spatial and temporal resolution in order to achieve the results that may be proper for clinical implementation.
Terapevticheskii arkhiv. 2012;84(5):57-60
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POSTPRANDIAL ANGINA PECTORIS
Abstract
The article present literature and original data on rare cases of postprandial angina which is a symptom of postprandial syndrome. The latter is characterized with dyslipidemia, endothelial dysfunction, proinflammatory and prothrombogenic shifts in the blood.
Terapevticheskii arkhiv. 2012;84(5):61-64
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ANEMIA IN PATIENTS WITH RHEUMATOID ARTHRITIS
Abstract
Anemia is characterized by a reduced count of red blood cells and/or low hemoglobin content in blood. The article reviews basic information on pathogenesis, differential diagnosis and treatment of anemia in patients with rheumatoid arthritis (RA). Anemia in this case is characterized as anemia of a chronic disease. Strong evidence is presented on effective treatment of anemia in RA patients with tocilizumab both in combination with methotrexate and other basic anti-inflammatory drugs and monotherapy in a dose 8 mg/kg.
Terapevticheskii arkhiv. 2012;84(5):64-68
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CURRENT TRENDS IN CLASSIFICATION AND TREATMENT OF SYSTEMIC VASCULITIS ASSOCIATED WITH ANTI-NEUTROPHILIC CYTOPLASMIC ANTIBODIES: RESULTS OF 2011
Abstract
Systemic vasculitis (SV) pathogenetically associated with anti-neutrophilic cytoplasmic antibodies (ANCA) is the subject of intensive research in present-day rheumatology. There were noticeable changes in ANCA-associated SV (ANCA-SV) nomenclature in 2011 as well as mid-term success was achieved in the study of biological anti-B-cell therapy in this disease. European recommendations on rituximab administration in ANCA-SV have been developed. Russian Register of ANCA-SV patients on rituximab treatment is presented. State-of-the art in ANCA-SV research is reviewed.
Terapevticheskii arkhiv. 2012;84(5):68-74
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ENTEROPATHY INDUCED BY NONSTEROID ANTI-INFLAMMATORY DRUGS: PATHOGENESIS, DIAGNOSIS, TREATMENT
Abstract
Nonsteroid anti-inflammatory drugs (nSAD) are among most often used medicines. Development of complications in patients taking NSAD is still an important problem. Negative NSAD influence on the upper part of the gastrointestinal tract is well-known as it is responsible for frequent complications. NSAD impact on a distal part of the gastrointestinal tract is studied much less, especially small bowel lesions. The article presents literature data about pathogenesis, diagnosis, treatment and prevention of NSAD-induced enteropathy. The article is addressed to a wide range of readers to attract attention to NSAD enteropathy problem.
Terapevticheskii arkhiv. 2012;84(5):74-79
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