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The objective of the present study was to develop the program for combined step-by-step rehabilitation of the patients presenting with early-onset rheumatoid arthritis (RA); the secondary objective was to estimate the effectiveness of this program. A total of 34 patients were recruited for the participation in the study. They received medicamental therapy in combination with the rehabilitative treatment during 6 months. The hospital-based treatment included therapeutic exercises for large joints under the supervision of a specialist (45 min), occupational therapy (45 min), local aerial cryotherapy of wrist, knee, and ankle joints (10 sessions 15 min each at a temperature of -60 degrees C), ortheses, and the educational program (4 daily studies 90 min each). The outpatient and home-based treatment included therapeutic exercises for large joints (45 min), wrist exercises (45 min) three times every week, ortheses. 26 patients received only medicamental therapy (control group). The following characteristics were measured: the average power of extension of knee joints and of flexion of ankle joints (by means of En-TreeM analysis of movements), wrist grip strength, articular pain (100 mm VAS, DAS28, HAQ, RAPID3 indices). The rehabilitative program ensured excellent compliance with basal therapy, reduced requirements for symptomatic medicines, and improved adherence to the methods for the formation of the correct movement patterns, orthesis wearing, and regular therapeutic exercises. The rehabilitative treatment resulted in the relief of articular pain by 70.4% (p < 0.01), decrease of DAS28 by 31.9% (p < 0.05), HAQ by 75.8% (p < 0.01), and RAPID3 by 60.1% (p < 0.01). The grip strength of the more seriously injured wrist increased by 44.9% (p < 0.05) and that of the less damaged one by 31.3% (p < 0.05). The average extension power of the weaker knee joint increased by 88.7% (p < 0.01) and that of the stronger joint by 67.7% (p < 0.01). The average flexion power of the more seriously injured ankle joint increased by 81.6% (p < 0.01) and that of the less damaged one by 70.2% (p < 0.01). The two groups were significantly different in terms of the majority of characteristics evaluated. It is concluded that the combined rehabilitative treatment helps to control the activity of the disease, enhances the functional abilities, improves the locomotor activity and quality of life of the patients with early-onset rheumatoid arthritis.

A hundred and two patients (18 males, 84 females; mean age, 50.3 +/- 12.3 years) diagnosed as having early rheumatoid arthritis (RA) were examined. A control group consisted of 189 patients with various rheumatic diseases and 30 healthy donors. The serum concentrations of antibodies to modified citrullinized vimentin (MCVA) and to cyclic citrullinized peptide2 (CCTP2A) were measured by enzyme immunoassay (EIA); rheumatoid factor (RF) IgM was determined by nephelometric immunoassay. In early RA, the level of MCVA (median, 49.6 U/ml; interquartile range, 0.9-249.3) was significantly higher than in the control group 1.65 U/ml; 0.3-19.7). There was a direct significant correlation between the levels of MCVA and CCTP2A (p = 0.9), as well as RF IgM (p = 0.6). The diagnostic efficiency of MCVA (area under the curve, 0.705; 95% confidence interval, 0.607-0.803) was higher than that of CCTP, (0.590; 0.467-0.714), but lower than that of RF IgM (0.813; 0.736-0.889). MCVA was comparable with CCTP, and RF IgM in sensitivity; however, it ranked below them in specificity (71%). Choice of the optimum upper normal range (30 U/ml) permits up to an 88% increase in MCVA specificity and the concurrent consideration of results of testing MCVA, CCTP2A, and RF IgM is attended by up to a 78% increase in sensitivity. EIA of MCVA is a sensitive and specific serological test for the diagnosis of early RA.

The paper deals with problems of rehabilitation of patients with rheumatoid arthritis, osteoarthrosis and systemic lupus erythematosus. These problems are rather topical in view of high prevalence of rheumatic diseases, their severe course and a high rate of invalidization at the most productive age. Relevant multifactorial therapeutic measures should be staged, aimed at lowering and stabilization of the disease activity. The role of updated medication, joint surgery, diet therapy, etc. is shown.

Aim: To perform of clinical trial of alisate--a garlic preparation produced in Russia., Materials and Methods: An open controlled trial of alisate enrolled 30 patients with rheumatoid arthritis (RA). 15 patients with RA of varying clinical form, stage and activity were given alisate in a dose 300 mg (1 tablet) twice a day for 4-6 weeks. 15 control RA patients received conventional antirheumatic therapy., Results: The alisate group achieved a good and partial response in 86.5% of cases. The drug was well tolerated and had no side effects. In control group, some parameters changed for the worse., Conclusion: Alisate can be recommended for treatment of RA patients in combined and monotherapy.

93 patients with rheumatoid arthritis (RA) were given diet therapy and unloading diets (ULD). Adjuvant diets appeared beneficial for RA patients, allowed reduction in antirheumatic drug dosages. ULD are recommended as an alternative treatment of RA dependent on the process activity and pattern.

As many as 200 patients with acute rheumatic fever were examined. Impairment of the joints in the form of classic migrating polyarthritic was detected in 96% of the cases. The knee (in 80%), talocrural (in 72%), slightly rare radiocarpal (in 21%), and elbow joints were mostly damaged. In addition to the above-indicated damage to the joints, one could see slightly atypical injuries in the form of monoarthritis (in 4%), arthritis of small articulations of the feet and hands (in 6%), and of the sternoclavicular articulations (in 3.5%). According to the cytological, biochemical and immunological findings, synovial fluid obtained from 11 patients suffering from acute rheumatic fever did not differ, significantly from synovial fluid of patients with reactive arthritis.

The main requirements for the dietotherapy of rheumatoid arthritis (RA) patients have been formulated, and for the first time a pathogenetically balanced diet has been developed that produces antiinflammatory and immunocorrective effects. The effectiveness of the dietotherapy included into the combined treatment was studied in 41 patients with classic and proved RA. The authors have studied the influence of the dietotherapy on the clinical signs characterizing the activity of inflammation in the joints, and laboratory immunological parameters (IgG, IgM, IgA, IgD, the complement components: C1-inhibitor, C3, C4, C5, C9; haptoglobin, orrhozomucoid, transferrin, ceruloplasmin, alpha 1-antitrypsin, alpha 2-macroglobulin, prealbumin). The results of the study have shown that the dietotherapy is not only conducive to the improvement of the clinical picture of the disease, that permits diminishing the amount of nonsteroid antiinflammatory drugs used, but also produces a favourable effect on the RA patients' immunological state. It has been concluded that inclusion of the dietotherapy into the combined treatment of RA patients is advisable.

The authors studied the effect of the Soviet-made immunoglobulin drug intended for intramuscular administration on the clinico-immunological indices of 15 patients with rheumatoid arthritis (RA). The drug was administered in a dose of 1500-1800 mg for 7 days running of each month. The control group included 15 patients with RA who received the drug in extremely low doses in accordance with the same pattern. Significant positive changes in the majority of the clinico-laboratory indices were noted in the main group. Individual assessment of the drug efficacy allowed one to note improvement in 8 patients (out of 14) in one month, in 7 (out of 12) in 3 months, in 4 (out of 7) in 6 months. One patient exhibited considerable improvement of her state and one developed fever due to which the treatment was discontinued. The results of the therapy correlated with deexpression of Ia-antigens under the effect of the drug on the peripheral blood lymphocytes.

ELISA quantitation of antibodies to Klebsiella pneumonia, Proteus mirabilis, and Yersinia enterocolitica was conducted in 75 ankylosing spondylitis (AS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) probands and in 262 of their first-degree relatives. The control group comprised 28 healthy donors. Sixteen (64 per cent) AS probands (12 with B27+) and 26 (30.2 per cent) their relatives (14 with B27+) were found to have high titres of antibodies to Klebsiella pneumonia. In 18 (60 per cent) active RA probands and 27 (23.7 per cent) relatives, antibodies to Proteus mirabilis were found. The obtained results suggest the presence of genetic determinants of the increased immune response to various infectious agents, at least in the AS cases. The possibility of Enterobacteriaceae acting as polyclonal stimulators is not excluded.