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The publication is summarizing application of biological DMARDs in autoimmune inflammatory rheumatic diseases.Up to now conventional therapy, which for example in rheumatoid arthritis was application of methotrexate (MTx) in combination with glucocorticoids, was effective, but the remission as a target was achieved in small proportion of patients and also there was little effect on structural progression of diseases. Biological therapy was great advance because response was achieved in ¾ patients who failed MTx. At present time 8 biological drugs are available. 5 are inhibitors of TNFα and 3 have different move of action. In psoriatic arthritis are beside TNF blockers available blocker of IL 17 (secukinumab, ustekinumab, apremilast). For ankylosing spondylitis is registered secukinumab.Anti-TNF therapy is relative safe but rarely serious adverse events can occur. The most important are serious infections, opportunistic infections and tuberculosis. Other adverse event includes allergic reactions and local intolerance. Increase incidence of lymphomas was not confirmed. There is probably minimal increased risk of skin melanoma and non-melanoma tumors. Benefit/risk ratio is still very positive.National registry of biological therapy ATTRA was founded 15 years ago and includes patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis. In June 2016 over all 6800 patients with those diagnoses was included and actually 5194 have been treated. In registry patients are regularly followed for activity, efficacy of the drug and other events. Results of registry are sent payers for evaluations of pharmacologic parameters.

An overview of pharmacological and surgical approaches aiming to preserve the articular cartilage and prevent progression of degeneration during osteoarthrosis (OA) is given. From the pharmacological approaches the most promising appears to be glucosaminosulphate from the SYSADOA group. Also preparations affecting the bone metabolism as calcitonin and biosulphates are tested. Along with it some biological curatives blocking the activity of IL-1, TNF-alpha, MMP, and NO are experimentally used. They have been parenterally administered, however, the gene therapy enabling transfer of the genetic information by means of retroviruses directly into the joint and synthesis of the target proteins in situ becomes clinically tested. From the surgical approaches aimed to preserve the articular cartilage several methods are currently tested: joint debridment, transplantation of the soft components, transplantation of the cartilage grafts and some experimental methods.

The authors present the description of a family comprising father (his mother had died middle-aged from renal failure) and his two children aged 15 and 17 years who developed is young age (already in the second decade) gouty arthritis and primary interstitial nephritis. Based on the laboratory finding of hyperuricaemia with disproportionately low urate excretion and excretion of excessive uric acid formation, an enzyme defect and other renal disease the authors diagnosed familial gouty juvenile nephropathy. This diagnosis was confirmed also by histological examination of renal biopsy in the youngest member of the family. It is a disease which belongs into the group of hereditary types of nephritis. In the literature worldwide some nine families were described, in the Czech Republic it is the first description of this condition.

In the Rheumatological Institute in Prague the authors made a retrospective investigation in patients with ankylosing spondylitis affecting the hip joints where one or two endoprostheses of the hip joints were made. In all these patients they evaluated the subjective complaints of the operated extremity, they made a clinical examination of the extent of mobility and evaluated X-ray pictures. The group of 20 patients was examined in this retrospective investigation approximately five years after operation. From the total of 32 endoprostheses 20 were cemented and 12 were without cement. From the total number of patients only four reported slight pain in the area of the operated hip joint without signs of loosening on the X-ray picture. The extent of mobility of all endoprostheses was very satisfactory, the mean abduction in men was 27.6 degrees, in women 30.7 degrees, flexion 84 degrees in men and 97 degrees in women. As revealed by X-ray, the hip joints were affected most frequently by coxitis, osteoplastic changes were detected in six patients. Enthesopathies of a small or medium extent were found in almost all patients. Heteroplastic bone was evaluated according to Brooker's criteria, in the investigated group only type I was found. It may be stated that the submitted group of results of endoprostheses in ankylosing spondylitis is a very satisfactory solution which improves the patient's mobility and thus restores the quality of life.

The authors implemented a prospective double blind, controlled study where they administered to a group of 34 patients with active rheumatoid arthritis either three pulses a 1000 mg methyl prednisolone in a small infusion or an infusion with placebo. They proved a very favourable effect--after five days a marked diminution of morning stiffness was recorded, as well as a diminution of pain during locomotion and rest and general improvement of the patient's condition. After two weeks the effect declines but even after 8 weeks the difference, as compared with the initial value, was still significant, while this was not the case after placebo. The sedimentation rate increased after the initial decline to the baseline level. A number of immunological indicators (decline of immunoglobulins, IgG rheumatoid factor, rise of C3 and C4 complement levels and rise of T lymphocytes) suggest an anti-inflammatory and immunosuppressive action persisting for several weeks although the mentioned results were not statistically significant (the majority at the very borderline of significance, probably significant in a larger number of patients). The authors confirm the reactive safety of this treatment, emphasize the necessity to investigate contraindications of treatment (diabetes mellitus) and the necessity to follow up patients in inpatient facilities.

The authors assessed, using the method of sandwich enzyme immunoassay (ELISA), the soluble receptor for interleukin-2 (s-r IL-2). In patients with rheumatoid arthritis mean values of 620.5 = 500.0 u./ml were recorded which was significantly higher than in patients with osteoarthritis (p less than 0.001) (313.3 +/- 155 n./ml) and in healthy controls (181.7 +/- 159.6 n./ml). In patients with rheumatoid arthritis a correlation was found between the activity of the disease expressed by means of Lansbury's index (r = 0.61, p less than 0.01). There was no correlation between s-r IL-2 and the sedimentation rate (r = 0.32, p = n. s.). The author reviews the literature and discusses the hypothesis that s-r IL-2 acts as a competitive inhibitor for interleukin-2.

The authors submit a review on the influence of non-steroid anti-rheumatic drugs on the articular cartilage. First they review the general literature and then discuss the effect of different NSA on cartilage, taking into account their classification into six groups with regard to their chemical composition. Experience is based practically only on laboratory and experimental work and the results therefore cannot be mechanically applied in clinical medicine. However, NSA which do not have a negative impact on the cartilage of experimental animals are probably also safer in clinical practice. In this country the following NSA are available: diclofenac, piroxicam and thia profenic acid.

In a double blind study with hydroxychloroquine sulphate used for treatment of rheumatoid arthritis the correlation of six X-ray criteria of progression of RA, based on calculation of the narrowing of the articular spaces and erosions (Sharp and Amos) and 23 clinical and laboratory criteria was assessed. Before treatment a satisfactory correlation of the majority of clinical and laboratory criteria with X-ray criteria was found. As after one-year treatment the majority of clinical criteria improved significantly and X-ray criteria did not differ significantly before and after treatment, the authors found very few correlations between changes of clinical and X-ray criteria, in particular after a dose of 20 mg/day. The X-ray criteria recommended by Sharp and Amos are not sensitive enough to be used for the evaluation of changes of the X-ray picture after one-year treatment with anti-rheumatic drugs which modify the course of RA. This applies in particular to more advanced cases.