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The purpose of the investigation was to study peculiarities of the functioning of neutrophile granulocytes in chronic rheumatic disease (CRD) complicated by cardiovascular pathology. The subjects of the study were 80 patients with CRD of the heart with valvular defects, accompanied by arterial hypertension (AH) and cardiac arrhythmias: 37 men (mean age 53.6 +/- 9.7 years) and 43 women (mean age 56.2 +/- 9.6 years). The control group consisted of 25 healthy donors. Isolated peripheral blood neutrophiles were cultivated during 6 hours. The level of nitric oxide (NO) production was measured. Functional cell activity was studied by chemoluminiscent assay. The degree of apoptotic readiness was studied by immunocytochemical method, determining bak marker expression on cell membrane surface. In CRD the processes of oxygen-dependent neutrophile metabolism were found to be intensified, which was accompanied by intensified reserve abilities and decreased NO synthesis and apoptotic activity. Functional cell activity in patients with a background of AH was characterized by lowered granulocyte NO production. Intensified production of active oxygen metabolites, observed in paroxysmal cardiac fibrillation, evidences the hyperactivity of the pro-oxidative system, leads to fast myocardial cell membrane lesion and the development of structural changes forming abnormal automatism and trigger activity. Neutrophiles isolated from patients with CRD were in a state of priming, the feature of which was high biocide cell potential. The lowering of apoptotic readiness evidences high mobilization abilities of neutrophiles. The synthesis of NO as one of autoregulation factors is a protective mechanism directed against the cytotoxic activity of phagocytes. The stimulation of granulocyte NO production can lower the oxidative stress intensity and leukocyte aggression and stabilize the course of the disease.

Screening of the population sample for articular pain and swelling.A screening questionnaire for detection of arthritides and arthralgias was filled in for each adult rural and urban citizen aged over 18 years from 15 RF regions. Rural population was covered with a complete examination, urban one was examined by formation of a representative sample from general population. The screening covered a total of 31424 persons, mean age of whom was 47.6 +/- 17.6 years. Among them 14001 lived in the cities and 17423 in the villages. 61% respondents were women.Prevalence of arthralgias in the population reaches 46%. While the symptoms alleviated with time in 8%, they became chronic in the rest. The articular complaints rate in the population is sex-related and depends on the age. In persons under 20 years arthralgia occurs in 9%. Urban citizens have articular pains more frequently than rural population--43 and 33%, respectively.Pilot results of the screening program demonstrate prevalence of arthralgias in Russia and the importance of joint pathology problem in Russia.

Clinical efficiency and safety of nimesil were studied in the multicenter open clinical trial of 52 patients with verified rheumatoid arthritis. Nimesil was given for 12 weeks in a daily dose 200-400 mg in addition to basic therapy. Clinical and laboratory parameters were assessed after 4 and 8 weeks of the treatment and after its end. The treatment produced a significant positive response of the articular syndrome. Marked improvement was registered in 11 (23.4%) patients, improvement--in 33 (79.2%) patients. Side effects were reversible and occurred in 8 (15.3%) patients. In 5 patients the drug was withdrawn. The conclusion is made on high efficiency and good tolerance of nimesil in rheumatoid arthritis patients.

The aim of this study was to examine the incidence of different renal lesions in rheumatoid arthritis (RA) and to determine their relationships with the type of previous drug therapy and with the specific features of immune disorders. Ninety four patients, 84 (89.9%) females and 10 (10.6%) males) with RA whose mean age was 45.2 +/- 11.9 years and duration of the disease 7.5 +/- 6.5 years were examined. Most of them had degrees 2 and 3 PA (62.7 and 24.4%, respectively). Systemic manifestations were encountered in 60 (63.8%) patients. Eighty one patients took nonsteroidal antiinflammatory drugs (NSAID) continuously: 18 patients for a year, 32 for 5 years, 14 for 6 to 10 years, and 17 for over 10 years. All the patients underwent clinical, laboratory, and instrumental study of partial functions of the kidney. Immunological study involved solid-phase immunoassay of IgA and IgM rheumatoid factor, von Willebrand factor antigens (WF:Ag), C-reactive protein. The serum concentrations were measured by the Mancini method. Changes in urinalysis and/or signs of decreased glomerular and tubular functions were found in 69 (73.%) patients, 25 (26.6%) had arterial hypertension. Tubular dysfunctions were more common [31 (32.9%) patients]. Signs of early renal failure were detected in 20 (21.2%) patients. There were no cases of acute renal failure. Amyloidosis, glomerulonephritis, pyelonephritis were diagnosed in 5 (5.3%), 16 (17%), and 13 (13.8%) patients, respectively. The above renal lesions were concurrent in some patients. Renal lesion correlated with the progression and severity of RA, the presence of systemic manifestations, and age. There was no relationship of both 5- and 10-year use of NSAID to the symptoms of renal disease. The use of these drugs for over 10 years was concurrent with the signs of chronic renal failure and arterial hypertension. Analyzing immunological disorders showed an association of increased erythrocytic sedimentation rates and WF:Ag with amyloidosis, that of higher IgA concentrations with proteinuria and tubular dysfunctions. It is concluded that renal lesion is common in RA, there is a predominance of tubular interstitial changes. In rare cases nephropathy is characterized by a benign course and fails to result in uremia. The symptoms of renal diseases are largely associated with RA progression and severity and the patients' age. Prolonged continuous use of NSAID may contribute to the development of renal failure. Different immune mechanisms are involved in the pathogenesis of glomerular and tubular nephropathy in RA.

To investigate clinical significance of tumor necrosis factor-alpha (TNF-alpha) and kidney damage in patients with rheumatoid arthritis (RA).94 patients (84 women and 10 men, mean age 45.2 +/- 11.9 years and the disease duration 7.5 +/- 6.5 years) with RA and 20 donors were examined. In 37(39.4%) and 57(60.6%) patients radiological stages I-II and III-IV, respectively, were determined. TNF-alpha and C-reactive protein (CRP) were measured by ELISA.Serum levels of TNF-alpha in patients with RA appeared significantly higher than in donors (10.9 +/- 22.1 pg/ml vs 0.6 +/- 2.0 pg/ml, p0.001). 33 (35.1%) of 94 patients had TNF-alpha levels above 6.6 pg/ml. High serum levels of TNF-alpha correlated significantly with the presence of nephrotic syndrome (r = 0.22, p = 0.03) caused by secondary amyloidosis. There were no correlations between high levels of TNF-alpha and sex, age, disease duration, stages and clinical activity in patients with RA. Positive correlation was found between high levels of TNF-alpha and ESR (r = 0.30, p = 0.003), CRP (r = 0.37, p = 0.0001).Thus, TNF-alpha may be involved in pathogenesis of amyloidosis in RA.

Rheumatoid arthritis is a systemic chronic inflammatory disease characterized by development of severe destruction of the joints caused by uncontrollable activation of cellular immunity. Activated T-lymphocytes synthesize interleukin-2 (IL-2) and specific membrane soluble receptors (sIL-2r) for this cytokine. The level of sIL-2r release is proportional to the number of molecules expressed on the membrane of activated immunocompetent cells. The data are provided for 59 patients with a significant RA diagnosis according to criteria of the American Rheumatology Board. Serum sIL-2r level was measured by enzyme immunoassay. It was found higher in RA patients than in controls (p0.001). Concentrations of sIL-2r increased with activation of RA. It is suggested that determination of sIL-2r extends potentialities of laboratory diagnosis of RA activity which is important for evaluating effectivity of the treatment and RA prognosis.

The hands of 45 RA patients were studied for vascular, neurological and functional characteristics. The patients underwent functional tests, dopplerography (to study regional arterial flow) and electroneuromyography (to study the peripheral nerves). Induration and defective elasticity of the vascular wall in the radial and ulnar arteries were disclosed in 74% of the cases. Digital arteries suffered occlusive lesion of degree III-IV in 46% of the examinees. One-third of the patients showed signs of polyneuropathy. Among functional defects, the upper grasp incompetence appeared the first. It is stated that parallel affections of the vascular, neurological and functional origin contribute to deficient functional performance of the hand in RA patients.

Radioimmunoassay was used to study the content of prostaglandins in blood plasma of patients suffering from rheumatoid arthritis (PGE in 133 and PGF2 alpha in 102 patients). It has been established that as compared to the control group subjects, it is appreciably elevated and reflects the degree of inflammatory process activity, being pronounced to a greater measure in persons not receiving glucocorticoids than in hormone-dependent patients. A relationship has been revealed between the content of PGE and PGF2 alpha and certain clinical and laboratory characteristics (disease standing, intensity of exudative component of inflammation, the presence of humoral and cellular immunity disorders, anemia, and some visceral lesions), which may be of definite importance in the assessment of the patient's status. The time-course of changes in blood plasma prostaglandins reflects on the whole the dynamics of the disease activity, being related to a greater degree to the application of nonsteroidal antiinflammatory agents than of glucocorticoids.

Short-term application of high doses of glucocorticoids removes the acuity of the generalized patterns of systemic rheumatic diseases. This is documented by the reported data and analysis of the authors' own 15 observations. The dose of glucocorticoids, duration of their application and administration routes are determined by the degree of the pathological process activity and by the organs concerned (kidneys, central nervous system). If the effect attained is doubtful, repeated courses of intensive treatment with glucocorticoids are indicated in some cases.