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Osteoarthritis (OA) is one of the most common rheumatic diseases. Knee OA is particularly frequently encountered among all forms of OA, the prevalence of knee OA being about 25% in the general population. Despite multiple guidelines for the management of knee OA, which have been prepared by the European League Against Rheumatism (EULAR), the American College of Rheumatology (ACR), and the Osteoarthritis Research Society International (OARSI), many problems of its treatment policy remain to be solved. The same holds true for not only the symptomatic and disease-modifying effects of chondroprotectors, but also topical therapy options. Objective : to evaluate the clinical efficacy and safety of Carmolis gel in patients with knee OA. Subjects and methods. The trial included 280 patients with knee OA (a study group consisted of 190 patents; a control group comprised 90 patients). The mean age was 58.3±9.3 years in the study group and 59±10.5 years in the control group. The disease duration was 10.3±5.5 and 10.1±4.1 years, respectively. Carmolis gel was applied to the region of the most painful knee joint up to 4–5 times daily, followed by massage of this skin area. The treatment cycle lasted for 2 weeks. No therapy was performed in the control patients. The clinical efficacy was determined by the changes in joint pains at rest or on movement and palpation, according to a visual analogue scale (VAS), WOMAC questionnaire, the synovitis intensity (assessed by ultrasonography), patient and physician global assessments of disease activity (Likert scale), and the possibility of reducing the daily dosage of nonsteroidal anti-inflammatory drugs (NSAIDs). The onset the therapeutic effect of the gel and the duration of its action were recorded. Results and discussion. The topical application of Carmolis gel caused a statistically significant reduction in joint pain at rest and on movement from 57.7±6.8 to 12±1.8 mm (р < 0.01) and from 52±5.3 to 17±2.7 mm, respectively (р

Objective. To study the association between the clinical manifestations and work ability in patients with rheumatoid arthritis (RA) and to elaborate mathematical methods for predicting work productivity indicators according to the evaluation of the functional status of patients and disease activity. Material and Methods. A total of 185 RA patients were examined; 105 of them were employed. The mean age was 48.2±11.3 years; RA duration was 77.9±70.7 months; DAS28 4.68±1.53; visual analogue scale (VAS) score was 40.6±22.2; HAQ was 1.3±0.7. The employed patients in the test group had a longer duration but weaker activity of RA according to DAS28 as compared to those in the control group (p

Objective: to study the impact of the clinical characteristics of rheumatoid arthritis (RA) on work efficiency. Subjects and methods. One hundred and thirty-seven patients (116 women and 21 men) with RA were examined. Their mean age was 52.03+13.17 years; mean age at disease onset was 42.12+14.43 years. Median RA duration was 84 (range 24-174) months. DAS 28 for RA was moderate. The HAQ score was 1.42+0.82. Results. Fifty-nine (43%) of the 137 patients were in work. Absenteeism was 28.2%. It was equal to 0 in 28 of the 59 working subjects. The mean presenteeism was 42.3±27.9%. The reduction of overall work efficiency was 54.8±34.4%. The day-to-day activity determined in all the patients was reduced by 53.6±25.7%. Absenteeism turned out to be negatively related to RA duration (R = 0.26). DAS 28 scores were directly related to all WPAI indicators: absenteeism (R = 0.28), presenteeism (R = 0.63), lower overall work efficiency (R = 0.47), day-to-day activity (R = 0.64). The WPAI indicators (R >0.5), exclusive of absenteeism, were noted to have the strongest correlation with VAS pain intensity. The HAQ score was unassociated with absenteeism, but its association with presenteeism, lower overall work efficiency, and day-to-day activity proved to be high (R = 0.65; R = 0.43; R = 0.75, respectively). The correlation of the WPAI components with the transformed index of a patient's physical state (SF-36 PCS) was much higher than that with mental one (MCS). Conclusion. RA activity had a major influence on work efficiency. Presenteeism was much stronger related to the clinical characteristics of RA than with absenteeism. All WPAI scores were associated with activity, degree of functional defect, quality-of-life values, and fatigability. At the same time, absenteeism was least related to the clinical characteristics of RA.

Objective. To evaluate the functional state of rheumatoid arthritis (RA) patients receiving Infliximab therapy (IF) in real clinical practice and its efficiency. Subjects and methods. The analysis covered 225 patients receiving IF therapy, the follow-up duration in whom was 54 weeks. Disease activity was estimated by the DAS 28 index; functional status was assessed according to the Health Assessment Questionnaire (HAQ). The authors made an analysis of a Per-Protocol (PP) population (n = 154) at 54 weeks of treatment and an analysis that could consider the results of treatment (by the ACR and EULAR criteria) in patients who had been withdrawn before the control time - a LOCF (Last Observation Carried Forward analysis) population. Results. The mean age of the patients was 47.6±11.4 years; the duration of the disease was 7.8±6.4 years; DAS 28 activity scores were 6.6±1.1; the majority of patients had significant functional impairments (HAQ scores of 2.0±0.7), 86.7% of the patients had extraarticular manifestations; 79.6% were found to have rheumatoid factor (RF); the patients received an average of > 2 disease-modifying antirheumatic drugs (DMARDs). After 2 week-therapy, there was a reduction in RA activity by DAS 28 index in both the PP (from 6.7±1.1 to 4.0±1.4) and LOCF (6.6±1.1 and 4.2±1.4; p < 106) populations. Drug-induced remission (DAS 28 < 2.6) at 54 weeks was observed in 16.9 and 15.1% of the patients, respectively. Functional improvement was noted in the PP population: HAQ decreased from 2.0±0.7 to 1.7±0.7 scores by week 2; its reduction continued until week 14 (p < 0.05), by remaining stable later on. HAQ dropped from 2.0±0.7 to 1.2±0.7 scores in the LOCF population. At 54 weeks, normal population values of functional activity were achieved in 16.4%. Log regression analysis in the LOCF population indicated that the previous use of DMARDs and a short history of the disease were predictors of an ACR70 response to IF therapy [OR=1.61 (1.13-2.30), p = 0.008 and OR = 0.91 (0.84-0.98), p = 0.018, respectively]. RF seronegativity was a predictor for achievement of low RA activity [OR = 0.44 (0.23-0.84)]. The previous use of glucocorticoids failed to increase the probability of a good response to IF therapy and achievement of clinical remission [OR = 0.26 (0.11-0.60), p = 0.001]. Conclusion. Therapy with IF in combination with methotrexate or other DMARDs reduces RA activity and improves the functional capacities of patients with RA in real clinical practice.

Objective. To evaluate the functional status of patients with rheumatoid arthritis (RA) in Russia, to compare the distribution and associations between functional insufficiency (FI) and functional class (FC), as well as disability groups (DG), and to consider their impact of a number of the patients' demographic, social, and clinic characteristics. Methods. Rheumatologists from 27 cities and towns of Russia (a total of 30 centers) participated in the cross-sectional epidemiological study. The study included all patients with valid rheumatoid arthritis, who had consecutively turned to a polyclinic rheumatologist or who had been treated at hospital for 3 months. The demographic and social characteristics of a patient, his/her occupation, the onset and duration of RA, DG and a reason for its receiving, and the patient's clinicofunctional status at the study were recorded. Results. A total of 1504 patients, including 1271 women, were examined; their mean age was 53 years; the mean duration of the disease was 10.5 years; 80.4% were seropositive for rheumatoid factor; 94.3% patients had erosive arthritis (X-ray stages II-IV RA). High disease activity scores (DAS) were found; the mean DAS [Mean (SD)] was 5.44±1.18. Severe extraarticular manifestations were identified in 10% of cases. 63% of the RA patients were in FC III and IV; 67% had grades 2 and 3 FI, and 44.5% had DGs I and II. An association was found between FC and FI (r = 0.43; p < 0.0001), DG (r = -0.396; p

Objective: To study the severity of rheumatoid arthritis in a Russian patient population on the basis of the data of rheumatological care. Methods. Polyclinic and hospital rheumatologists from 27 cities and towns of Russia (a total of 30 centers) participated in the cross-sectional epidemiological study. The study included all patients with valid rheumatoid arthritis, who had consecutively turned to a polyclinic rheumatologist or who had been treated at hospital during the established 3-month period. The demographic and social characteristics of a patient, his/her occupation, comorbidity, the onset and duration of rheumatoid arthritis, clinicofunctional status at the study and antirheumatic therapy were recorded. Results. A total of 1504 patients, including 1271 women, were enrolled; their mean age at the study was 53 years; the mean duration of the disease (after the onset of its first symptoms) was 10.5 years. Most (66%) patients had a family. More than half of the examinees were professionals and specialists. More than 64% of patients were unemployed at the study. Mean disease activity scores were high: morning stiffness [Ме, range 25-75%] for mean 60.0 (30.0-180) min; number of tender (mean [SD] - 26.1±15.8), and swollen (13.4±11.4) joints; ESR, 29.45±15.5 mm/hr; pain, 58.1±22.6 mm (VAS); general health status, 57.4±20.6 mm (VAS). The mean DAS28 score (mean [SD]) was 5.44±1.18. The absolute majority (94%) of patients had erosive arthritis (Steinbrocker stages II-IV). Severe extraarticular manifestations were identified in 10%. The distribution of the patients by the ACR functional classes was as follows: Class I, 8%; Class II, 29%; Class III, 52%, and Class IV, 11%. Comorbidity was as high as 75%, there was a preponderance of cardiovascular diseases, diabetes mellitus, and chronic lung disease. The mean HAQ score in the examined patient cohort was 1.81±0.8. At the study, 89 and 43% of the patients received nonsteroidal anti-inflammatory drugs and systemic glucocorticoids, respectively. Methotrexate (62%) headed the list of basic anti-inflammatory drugs, sulfasalazine (8%), leflunomide (7%), and aminoquinolines (6%) were much less frequently used. Biologicals were given to 9% of the patients. Conclusion. The examined cohort of Russian patients with rheumatoid arthritis, which reflects experience in real clinical practice, is generally characterized by the severe course of the disease in both clinical and functional parameters.

Severity of hands and feet joint destruction is the most objective marker of rheumatoid arthritis (RA) progression determining functional disability. The main aim of RA treatment is suppression of joint destruction. Objective. To study dependence of joint erosions forming speed on disease modifying anti-rhcumatic drugs (DMARD) administration and RA activity. Material and methods. Retrospective analysis of 451 cases of RA treatment was performed. Erosions were counted according to modified Sharp method. Erosions forming speed was counted as ratio of erosion number increase to a year’s time space. Averaged disease activity was calculated as arithmetic mean for all DAS28 values obtained during disease course. Considering close relationship between disease activity and DMARD administration two-factor analysis was used. DMARD administration (>3 months) and mean activity of RA were considered as factors. Results. Variance analysis (ANOVA) with covariant showed that mean RA activity is a significant factor influencing erosions forming speed (F=12,5; p=4xl0 4). Character of DMARD, fact of its administration and disease duration did not significantly influence erosions forming speed considering disease activity covariant. Regression model with inclusion disease duration factor mean disease activity and DMARD administration at the moment of assessment allowed to explain 42% of dispersion (determination coefficient). Conclusion. Activity of RA is the main factor influencing erosions forming speed. Therapy not decreasing activity of RA does not change erosions forming speed

To standardize general quality of life (QL) questionnaire SF-36 scales and calculate population scale measures depending on respondents sex and age. Material and methods. Standardized QL measures of all SF-36 questionnaire scales were calculated in 3400 respondents of 5 centers of Russian Federation stratified according to sex and age. Results. Male population had better QL measures than female (p

Objective: to evaluate the efficacy and safety of immard in rheumatoid arthritis (RA) in outpatient practice. Subjects and methods. The open-labeled uncontrolled trial enrolled 30 patients with the reliable and valid diagnosis of RA of varying duration. Immard was used in patients with early RA or as an additive agent when a disease-modifying anti-rheumatic drug (mainly methotrexate) was ineffective. The effect of immard was evaluated 3 months of its intake of 400 mg from the number of swollen and tender joints, patients' and physicians' total ratings of disease activity on a visual analogue scale, from ESR values, C-reactive protein (CRP) levels, and DAS28 scores. Results. There was a significant decrease in the number of swollen joints and DAS28 scores in the patients receiving a combination of methotrexate and immard. No significant reduction in ERS and CRP levels was revealed during the follow-up period.