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The development of subclinical atherosclerosis in patients with rheumatoid arthritis (RA) is associated with chronic inflammation, one of the key mechanisms of which may be abnormal activation of macrophages.Objective: To assess the characteristics of pro-inflammatory activation of circulating monocytes in patients with early RA depending on the presence of subclinical atherosclerosis of the carotid arteries.The study included 60 patients (42 women and 18 men) with early RA without signs of cardiovascular disease. Atherosclerotic vascular disease was diagnosed by identifying carotid atherosclerotic plaques. Basal and stimulated monocyte lipolysaccharide (LPS) secretion was studied in initial monocyte cultures obtained by immunomagnetic separation from blood. Quantification of the cytokines TNFα and IL-1β was obtained in the culture fluid by ELISA. Proinflammatory activation of monocytes was calculated as the ratio of LPSstimulated and basal secretion.Atherosclerotic plaques of the carotid arteries were found in a third of RA patients; they were detected more often in men (50%) than in women (26%, p < 0.05). The carotid thickness of the intima media complex correlated with the level of total cholesterol (R = 0.20; p = 0.001) and ESR (R = 0.31; p = 0.03). In RA patients and subclinical carotid atherosclerosis, cultured blood monocytes demonstrated higher basal TNFα secretion (294.6 (185.3-778.2) vs 146.1 (27.9-79.9) pg/mL, p < 0.01) and low activation of TNFα (9.5±2.1 vs 19.8±3.9, p < 0.001) and IL-1β (6.1±2.3 vs 9.5±1.8, p = 0.03) compared with patients without lesions of the carotid arteries. In RA patients with carotid atherosclerotic plaques, a relationship was found between LPS-stimulated IL-1β secretion and the level of total blood cholesterol (R = 0.36, p = 0.01).Data were obtained on a more powerful inflammatory potential of peripheral blood monocytes in patients with early rheumatoid arthritis in the case of detection of the subclinical carotid atherosclerosis.

Innate immune cells are important participants in inflammatory and fibrotic processes in systemic scleroderma (SSc). The pathogenesis of SSc involves immune cells, primarily macrophages, whose disorders are based on mitochondrial cell dysfunction. Mitochondrial DNA (mtDNA) copy number is used as a surrogate marker of mitochondrial cell dysfunction. The aim of the study was to evaluate the number of mtDNA copies in CD14+ monocytes and in all cell populations circulating in the blood in patients with SSc compared to healthy controls.The study included 25 patients with SSc (22 women and 3 men, median age 49 (43-57) years and disease duration 4.6 (1.0-9.6) years) and 25 people without autoimmune diseases or chronic inflammatory diseases matched by age and gender. The majority of patients (80%) had a limited form of SSc. All study participants did not receive antirheumatic therapy. DNA was isolated from CD14+ monocytes and whole blood. Absolute mtDNA copy number was measured using digital PCR. The number of mtDNA copies per cell used for analysis was calculated as the ratio of mtDNA and nDNA copies.It was found that in patients with SSc, the number of mtDNA copies in CD14+ monocytes was higher (108 (60-162) vs 72 (59-79), p = 0.01), and the indicator of all cell populations circulating in the blood did not differ in compared with the control group (109 (72-171) and 128 (85-227), p = 0.17). A negative relationship was found between the number of mtDNA copies and the duration of the disease, and a positive relationship with LPS-stimulated IL-6 secretion by cultured CD14+ monocytes.The study results suggest that increase of mtDNA copy number in CD14+ monocytes is a possible mechanism to maintain the reduced function of defective mitochondria in monocytes from patients with SSc associated with the development and progression of SSc.

Aim. To assess plaque burden according to peripheral artery ultrasound examination in patients with rheumatoid arthritis (RA) with low and moderate disease activity in comparison with the coronary artery condition.Material and methods. The study included 64 patients, of which 43 patients with an established diagnosis of RA and 21 patients with coronary artery disease (CAD) without RA (comparison group). All patients underwent a clinical and paraclinical examination to verify myocardial ischemia and/or CAD according to the 2020 national guidelines, as well as a carotid and femoral artery ultrasound (the latter, only for patients with RA) with determination of plaque burden.Results. In patients with RA in combination with CAD, plaque burden is higher than in patients with RA without coronary artery disease regarding the carotid plaque number 4,0 [4,0; 5,0]/2,0 [1,0; 3,5], proportion of maximum stenosis 35,0 [35,0; 45,0]/30,0 [25,0; 35,0] and the proportion of total stenosis 120,0 [110,0; 152,5]/85,0 [40,0; 110,0]. Three or more carotid plaques determine significant coronary atherosclerosis in RA. In RA patients with CAD, the combination of caro­tid and femoral plaques is associated with significant coronary atherosclerosis in 75% of cases. In a comparative analysis of patients with RA CAD+/RA CAD-, no significant differences were found in the main cardiovascular risk factors, lipid, and inflammatory parameters. When comparing the plaque burden indicators, the severity of coronary atherosclerosis was not revealed between RA patients with CAD+ and the comparison group.Conclusion. Determining the peripheral plaque burden parameters increases the clinical significance of ultrasound as a stage of non-invasive CAD diagnosis in RA.

The effect of an inhibitor of interleukin (IL) 6 receptors on the state of the cardiovascular system in patients with rheumatoid arthritis (RA) remains poorly understood, especially with its long-term use.The aim – to study the effect of therapy with the IL-6 receptor inhibitor tocilizumab (TCZ) on the dynamics of modifiable risk factors (RF), total cardiovascular risk (CVR), structural changes in the carotid arteries (CA) and the incidence of cardiovascular complications (CVC) in patients with rheumatoid arthritis during the 260-week follow-up period.Material and methods. The study included 37 patients with active RA (32 women and 5 men) with ineffectiveness and/or intolerance to disease modifying anti-rheumatic drugs (DMARDs); median age was 56 [48; 68] years, disease duration was 92 [49; 158] months; DAS28 (Disease Activity Score 28) – 6.2 [5.5; 6.7] points; all patients were seropositive for rheumatoid factor (RF), 86% – for antibodies to cyclic citrullinated peptide (ACCP). Patients received TCZ therapy 8 mg/kg intravenously every 4 weeks; after 192 [176; 210] weeks, 60% of patients switched to subcutaneous administration of the drug at a dose of 162 mg once a week. In 51% of patients with RA, TCZ monotherapy was performed, in 49% – combination therapy of TCZ with DMARDs. Statins were received by 17 (46%) patients, including 7 patients before and 10 after inclusion in the study. All patients underwent an assessment of traditional risk factors, the total cardiovascular risk was calculated using the mSCORE scale, atherosclerotic vascular lesions were assessed by the detection of atherosclerotic plaques (ASP) of CA. The observation period was 260.4 [251.5; 283.4] weeks.Results. After 260 weeks of TCZ therapy, RA remission was observed in 32 (86%) patients, low activity – in 5 (14%) patients. During the observation period, the frequency of modified RF and the total CVR did not change significantly, an increase in body mass index (BMI) by 11% was recorded, the number of patients with hypercholesterolemia and a reduced level of HDL cholesterol (C) decreased. In patients without statin therapy, there were no significant changes in the blood lipid spectrum. In the group of patients receiving statins, there was an increase in HDL-C by 43%, a decrease in cholesterol levels by 15%, atherogenic index (AI) by 56% (p

The pathogenesis of immunoinflammatory rheumatic diseases (IRDs) is based on chronic inflammation, one of the key mechanisms of which may be abnormal activation of macrophages, leading to further disruption of the immune system.The aim – to evaluate the pro-inflammatory activation of circulating monocytes in patients with IRDs.Material and methods. The study included 149 participants: 53 patients with rheumatoid arthritis (RA), 45 – with systemic lupus erythematosus (SLE), 34 – with systemic scleroderma (SSc) and 17 participants without IRD, aged 30 to 65 years. Basal and lipolysaccharide (LPS)-stimulated secretion of monocytes was studied in a primary culture of monocytes obtained by immunomagnetic separation from blood. Quantitative assessment of the cytokines tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β) and the monocyte chemoattractant protein-1 (MCP-1) was carried out in the culture fluid by ELISA. Pro-inflammatory activation of monocytes was calculated as the ratio of LPS-stimulated and basal secretions.Results. It was shown that the basal secretion of all studied cytokines was significantly increased in all groups of patients with IRDs, except for the secretion of IL-1β in the SLE group, compared with the control. LPS-stimulated secretion of TNF-α was increased and MCP-1 was decreased in patients with IRDs compared to the control group; LPS-stimulated IL-1β secretion only in the SSc group was significantly different from the control group. In the RA group, monocyte activation was reduced for all cytokines compared to the control, in the SLE group – for TNF-α and MCP-1, in the SSc group – for MCP-1.Conclusion. The decrease in pro-inflammatory activation of monocytes in patients with IRDs is due to a high level of basal secretion of cytokines, which can lead to disruption of the adequate immune response in these diseases and is an important link in the pathogenesis of chronic inflammation.

Objective: assessment of the dynamics of T- and B-lymphocytes subpopulations in rheumatoid arthritis (RA) during therapy with synthetic disease-modifying antirheumatic drugs (sDMARDs) and biological disease-modifying antirheumatic drugs (bDMARDs): inhibitors of tumor necrosis factor α (iTNFα) and an inhibitor of interleukin 6 receptors (iIL6R ).Patients and methods. The study included 77 patients with RA who met the 2010 ACR/EULAR criteria (mean age 56 [44; 62] years). Group 1 included 30 (27 women and 3 men) patients with early RA who had not previously received therapy. Group 2 included 20 (14 women and 6 men) patients on sDMARD therapy who were prescribed iTNFα for the first time. The 3rd group is represented by retrospective data of 27 (23 women and 4 men) patients who previously used sDMARDs (MT – 85%, leflunomide – LEF – 15%), in whom iIL6R therapy was initiated for the first time. All study participants initially and 6 months later underwent immunophenotyping of T- and B-lymphocytes by flow cytofluorometry according to the standard method.Results and discussion. In all groups, there were no significant changes in the studied T-lymphocyte profile during 6 months of follow-up. When comparing the immunogram data of patients treated with sDMARDs and iTNFα, no significant differences in subpopulations of B-lymphocytes were found. At baseline, the iIL6R group had higher levels of naive B-lymphocytes and plasmablasts and low concentrations of «switched» B-cells. For all methods of treatment, the number of «switched» B-cells decreased, while plasmablasts and plasma cells increased.Conclusion. From the data obtained, it follows that the simultaneous decrease in the levels of memory B-cells and their «switched» forms, plasmablasts and plasma cells can be used as a marker for the early administration of drugs that disrupt the differentiation of B-lymphocytes, in particular, iIL6R.

Objective: to evaluate changes in T- and B-lymphocyte subpopulations at different stages of rheumatoid arthritis (RA).Patients and methods. The study included 53 patients with a definite RA diagnosis according to the 2010 ACR/EULAR criteria (mean age 54.2 [47; 62] years). Group 1 included 27 patients (25 women and 2 men) without history of synthetic disease modifying anti-rheumatic drugs (sDMARDs) intake, group 2 included 26 patients (22 women and 4 men) receiving sDMARDs (methotrexate or leflunomide). The control group consisted of 29 healthy volunteers (23 women and 6 men), the median age was 58.5 [53; 62] years. In all participants flow cytofluorometry according to the standard technique with immunophenotyping of T- and B-lymphocytes was performed.Results and discussion. Compared to controls, patients in group 1 who had not previously received sDMARDs showed a transient increase in "switched" memory B-cells, transient B-cells, and plasmablasts, which was not observed in patients of group 2 (on sDMARDs therapy). Patients with advanced RA showed a statistically significant decrease in the absolute and relative number of memory B-cells, the absolute and relative number of "switched" B-lymphocytes, as well as the number of plasmablasts and transient cells. In RA patients, a statistically significant rela tionship was established between the number of swollen joints and the level of plasmablasts (r=0.51), memory cells (r=0.54), and "switched" B-cells (r=0.41), p< 0,05 in all cases. There were no statistically significant changes in other subpopulations of B-lymphocytes and the profile of T-lymphocytes.Conclusion. Changes in the B-lymphocyte profile are characteristic of different stages of RA. At an early stage, there is an increase in the number of transient B-lymphocytes, plasmablasts and plasmocytes, and in the advanced stage, a decrease in the level of certain populations of B-lymphocytes, such as memory B-cells and "switched" B-lymphocytes. It can be assumed that the ineffectiveness of sDMARDs is associated with a change in the population composition of B-lymphocytes, which requires further study.

The effect of an inhibitor of interleukin-6 (IL-6) receptors on the state of the cardiovascular system in patients with rheumatoid arthritis remains poorly understood.Objective: to study the effect of therapy with an inhibitor of IL-6 receptors, tocilizumab (TCZ), on the dynamics of modifiable risk factors, total cardiovascular risk, and structural changes in the carotid arteries in patients with rheumatoid arthritis during a 12-month follow-up period.Material and methods. The study included 40 patients with active rheumatoid arthritis (33 women and 7 men) with ineffectiveness and/or intolerance to basic anti-inflammatory drugs (DMARDs); the median age was 55 (49; 64) years, the duration of the disease – 102 (48; 162) months; DAS28 – 6.2 (5.5; 6.7) points; all patients were seropositive for rheumatoid factor, 80% – for antibodies to cyclic citrullinated peptide. Patients received TCZ 8 mg/kg therapy every 4 weeks: 52% received TCZ monotherapy, 48% received combined TCZ therapy with DMARDs. All patients underwent an assessment of traditional risk factors, the total cardiovascular risk was calculated using the mSCORE, and atherosclerotic vascular damage was assessed by the detection of atherosclerotic plaques.Results. After 12 months of TCZ therapy, a decrease in disease activity was noted: remission was observed in 25 patients (64%) with rheumatoid arthritis, low disease activity – in 12 (31%); DAS28, HAQ, CRP and ESR concentrations decreased significantly. А high frequency of traditional risk factors was found in rheumatoid arthritis patients: dyslipidemia – 67%, arterial hypertension – 65%, overweight – 55%, burdened heredity for cardiovascular diseases (CVD) – 35%, smoking – 15%. Every third patient had a combination of three or more traditional risk factors. After 12 months of TCZ therapy, the frequency of traditional risk factors did not significantly change, there was an increase in BMI by 2%, an increase in the concentration of HDL-C in serum by 27%, a decrease in the atherogenic index by 28% (p

Cardiovascular risk (CVR) in patients with calcium pyrophosphate crystal deposition disease (CPPD) has not been studied, and the optimal method for assessing it has not been established yet.Objective: Evaluation of CVR and comparison of results using Adult Treatment Panel III (ATP III) and Reynolds Risk Score (RRS) scales in patients with CPPD, gout, rheumatoid arthritis (RA) and in the control group.Materials and methods: Cross-sectional, single-center study performed by case-control method. There are 42 patients with CPPD in main group, 42 patients with gout and RA in the comparison groups are, 42 healthy volunteers in the control group. The survey included measurements of anthropometric measures, blood pressure (BP), serum glucose, creatinine, cholesterol (TC), high density lipoproteins (HDL), low density lipoproteins (LDL), C-reactive protein (CRP). CVR was assessed on ATP III and RRS scales, comparison of its evaluation results was carried out between groups and between scales within groups.Results and discussion: Most of the parameters in the compared groups did not differ. However, HDL CS levels were significantly higher in patients with CPPD and in the control group than in RA and gout (p0.05). The CRP > 5 mg/L in CPPD and in the control group was greater than in RA (p

The paper presents three cohorts of patients with early rheumatoid arthritis (RA) who fell ill at 50 years or older and had a disease duration of 1.5 months to 1 year. To establish its diagnosis, the investigators used classification criteria for each cohort of its period: 1) the 1958 American Rheumatism Association (ARA) criteria; 2) the 1987 ARA criteria, and 3) the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. Along with a change in the criteria, diagnostic methods were improved in this period. Many qualitative laboratory parameters were replaced with their quantitative equivalent; new disease markers (including anti-cyclic citrullinated peptide antibodies) emerged; imaging methods were improved; treatment policies were changed, and targeted biological agents and numerous analogs of the original drugs appeared.Conflicting opinions about the course of RA in older age groups have repeatedly been published in the literature. In the period when the 1958 classification criteria were applied, the opinion that RA has a relatively favorable course was prevalent. Later on, when a more rigid approach to diagnosing RA was applied, there were more and more specialists who considered it to be a severe disease. In this study, the authors try to answer the question of whether the course of the disease changed in the older age groups at the earliest possible date after its onset, by comparing the three cohorts of patients. The findings are discussed.

The question about the peculiarities of the course of rheumatoid arthritis in different age periods was raised in the literature repeatedly and the answer depended on the period of development of rheumatology and was not unambiguous. The course of age-specific features of the initial stages of disease development has also been studied (although less frequently). At the same time, the issues of age-related features of as yet untreated early rheumatoid arthritis have not been previously presented in the literature studied by the authors. This article gives a brief overview of the problem and discusses the findings.The aim of the present study was the comparative study of the characteristics of untreated early rheumatoid arthritis with early (18–49 years) and late (50 years and older) onset.The material was represented by 292 patients with rheumatoid arthritis with disease duration from 1 to 12 months from the disease onset, entered into the All-Russian Register of Patients with Inflammatory Arthritis “OREL” in the period from January 01, 2012 to December 31, 2018 with the results of examination at the time of the first examination. All patients were naïve to treatment with basal (synthetic, biological or other targeted) drugs and systemic glucocorticoid therapy. In 141 patients, the disease started at a younger age, group 1 (18–49 years), and in 151, at an older age (50 years or older), group 2.Methods. Disease activity (according to DAS-28 index), radiological stage – (according to Steinbroker, modified), functional disorders – according to functional class, immunological characteristic and additional immunological characteristic (rheumatoid factor, cyclic citrullinated peptide antibodies) and other parameters were estimated in accordance to requirements of current national rheumatoid arthritis classification. The results of the study indicate that the disease in older age is characterized by more pronounced inflammatory, destructive changes in relation to the joint apparatus and functional disorders than the onset of rheumatoid arthritis at a young age.

Objective: to investigate the impact of therapy with the interleukin-6 receptor inhibitor tocilizumab (TCZ) on the time course of changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with rheumatoid arthritis (RA) during a 12-month follow-up period.Subjects and methods. 31 RA patients (26 women and 5 men) with an inadequate response and/or intolerance to disease-modifying antirheumatic drugs (DMARDs) were included. Their median age was 54 [45; 61] years; the disease duration – 110 [62; 168] months; DAS28 – 6.2 [5.1; 7.1]; SDAI – 35.0 [23.9; 51.0], and CDAI – 30.0 [21.0; 42.0]. All the patients were seropositive for rheumatoid factor (RF), 84% – for anti-cyclic citrulinated peptide (anti-CCP) antibodies. Extra-articular manifestations were found in 54% of patients. Patients with chronic heart failure were notincluded. The RA patients were found to have a high frequency of traditional risk factors for cardiovascular diseases (CVD): hypertension (75%), dyslipidemia (61%), smoking (17%), overweight (61%), a family history of CVD (36%), and hypodynamia (68%). Coronary heart disease was diagnosed in 11% of patients. The inefficacy of three or more NSAIDs was noted in 45% of cases; intolerance to previous therapy with NSAIDs was observed in 55%. The patients received TCZ at a dose of 8 mg/kg every 4 weeks: 39% received TCZ alone; 61% – in combination with methotrexate (MTX), the MTX median dose was 20 [18; 25] mg/week. The level of NT-proBNP was measured before and 12 months after TCZ therapy.Results and discussion. After 12 months of treatment with TCZ 54% of patients had disease remission (DAS28

Objective: to analyze therapy with rituximab (RTM) in real clinical practice according to the data available in OREL registry of patients with active rheumatoid arthritis (RA).Subjects and methods. The analysis included 349 patients. All the patients received RTM: 340 – the original drug (MabThera®) and 9 – the biosimilar Acellbia®. 263 patients (75.4%) received RTM in combination with disease-modifying anti-rheumatic drugs (DMARDs) and 86 (24.6%) – RTM as monotherapy.Results and discussion. Of the 349 patients included in the analysis, 272 (77.9%) patients received RTM as the first biologic agent (BA) (263 patients were treated with the original drug and 9 – with the biosimilar) and 77 (22.1%) patients had previously used the BA. The majority of patients (n=205 (58.7%)) received three or more; 109 (31.2%) patients – one, and 35 (10%) – two RTM courses of RTM therapy. RTM caused a significant reduction in disease activity just after the first therapy course and in the levels of acute-phase reactants (C-reactive protein (CRP) and ESR); after the fifth therapy course, median CRP concentration decreased by 1.4 times and amounted to 7 [1.2; 17.9] mg/l and that of ESR reduced by 1.8 times and was 10 [5; 20] mm/hr (p

The high prognostic significance of the concentration of the N-terminal - pro-B-type natriuretic peptide (NT-proBNP) in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) and general populations. Aim: to investigate the significance of NT-proBNP level in patients (pts) with RA with the ineffectiveness and/or intolerance of basic anti - inflammatory therapy; compare the level of NT-proBNP with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers. Materials and methods. The investigation enrolled 28 pts (24women/4men) with the lack of efficacy/resistance and/or intolerance of basic anti - inflammatory drugs (DMARDs); median age was 55 [46; 61] years, median disease duration 114 [60; 168] month; DAS28 6,2 [5.1; 7.0]; SDAI 35.0[23.9; 51.0], CDAI 30.0[21.0; 42.0], serum positivity for rheumatoid factor (RF) (100%)/anti - cyclic citrullinated peptide antibodies (ACCP) (86%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension - in 75%, dyslipidemia - 61%, smoking - 17%, overweight - 61%, family history of cardiovascular diseases - 36%, hypodynamia - 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs - in 54% pts. 47% were receiving methotrexate (20 [18; 25] mg/week), 11% - leflunomide, 7% - sulfasalazine, 46% - glucocorticoids, 75% - non - steroidal anti - inflammatory drugs. The control group consisted of 20 healthy donors, comparable to pts by age and sex. Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). The determination of the intima - media thickness (IMT) BCA were assessed from duplex scanning. Atherosclerotic lesion of BCA was assessed by the presence of atherosclerotic plaque (IMT ≥1.2 mm). Results. NT-proBNP concentrations in RA pts proved to be higher (78.7 [41.4; 101.3] pg/ml) than those in the control group (55.3 [36.6; 67.3] pg/ml, p100 pg/ml - 1 group (n=6) and ≤100 pg/ml - 2 group (n=22). Groups of RA pts did not differ in gender, age, activity of RA, frequency of detection of traditional risk factors. Atherosclerotic lesion of the BCA was detected in 3 (50%) pts of the 1 group and in 8 (36%) pts of the 2 group (p>0.05). In RA pts the level of NT-proBNP correlated with age (r=0.39; p

The clinical efficacy and safety of interleukin-6 (IL-6) receptor blockade have been well studied, but the data on the impact of therapeutic inhibition of IL-6 on B cells are scarce and contradictory. Preliminary reports have shown that B cell function and a humoral immune response may be modulated by an IL-6 receptor inhibitor.Objective: to assess the effect of 12-month tocilizumab (TCZ) therapy on B-cell phenotype and gene expression in RA and to analyze the association between B-cell subsets and RA activity.Subjects and methods. Examinations were made in 24 active RA patients (20 women and 4 men) (median age, 55 [49; 64] years; disease duration, 72 [24; 108] months; DAS28 5.8 [5.3; 6.3]; the patients were seropositive for rheumatoid factor (RF) (100%) and for anti-cyclic citrullinated peptide antibodies (87.3%). The patients received TCZ 8 mg/kg every 4 weeks. After 12 months of therapy, 54% of patients were categorized as good responders, 46% as moderate responders according to the EULAR response criteria. A control group consisted of 29 volunteers (21 women and 8 men; median age, 58.5 [53.0; 62.0] years). Peripheral blood lymphocytes were immunophenotyped at the time of enrollment and after 12 months. The absolute and relative counts of CD19+B lymphocytes, memory B cells (CD19+CD27+), non-switched memory B cells (CD19+IgD+CD27+), switched memory B cells (CD19+IgDCD27+), naive (CD19+IgD+CD27-), double-negative (CD19+IgD-CD27-), transitional (CD19+IgD+CD10+CD38++CD27) B cells, plasma cells (CD19+СD38+), and plasmablasts (CD19+СD38+++IgD-CD27+CD20-) were estimated using multicolor flow cytometry. Results and discussion. The relative and absolute counts of memory B cells (CD19+CD27+) (1.3 [0.9; 1.7]%, 0015 [0.001; 0.003]•109/l), switched memory B cells (CD19+IgD-CD27+) (6.8 [3.6; 11.6]%, 0.01 [0.005; 0.02]•109/l), and the absolute number of transitional B cells (CD19+CD38++CD10+IgD+CD27-) (0.00009 [0; 0.00028]•109/l) were found to be lower in RA patients than in donors: 2.2 [1.1; 3.0]%, 0.003 [0.001; 0.007]•109/l; 12.8 [9.3; 17.0]%, 0.02 [0.01; 0.04]•109/l; 0.0001 [0; 0.0003]•109/l, respectively (p

Одна из актуальных и развивающихся проблем современной медицинской науки – поражение сердечно-сосудистой системы, обусловленное атеросклеротическим поражением сосудов, у больных с иммуновоспалительными ревматическими заболеваниями (РЗ). Ревматоидный артрит (РА) – заболевание с известно высоким кардиоваскулярным риском. Установлено, что основная причина высокой преждевременной смертности при РА связана с сердечно-сосудистыми осложнениями, обусловленными ускоренным прогрессированием атеросклероза. Распространенность субклинических и клинических проявлений атеросклероза при РА составляет 35–59%. Наиболее часто ССО развиваются у больных РА с низким или умеренным кардиоваскулярным риском, но с высокой клинико-иммунологической активностью болезни. Привлекает внимание схожесть механизмов иммунопатогенеза классических РЗ и хронического low-grade воспаления при атеросклерозе. По современным представлениям, хроническое воспаление, развитие которого связывают с неконтролируемой активацией как врожденного, так и приобретенного иммунитета, играет фундаментальную роль на всех стадиях аутоиммунных РЗ и атеросклеротического процесса. Среди многочисленных «иммунных» клеток и медиаторов, участвующих в иммунопатогенезе как РА, так и атеросклероза, важное место занимают моноциты-макрофаги и цитокины, продуцируемые ими. Дисбаланс между M1- и M2-фенотипами макрофагов рассматривается в качестве одной из причин развития РА. Определена важная роль М1-макрофагов, продуцирующих два основных «провоспалительных» цитокина – интерлейкин 6 (ИЛ6) и ИЛ23, – в поддержании ревматоидного воспаления. Проводятся поиски возможных механизмов возникновения дизрегуляции М1/М2-макрофагов при воспалении. Изучение ключевого патогенетического фактора в развитии аутоиммунного и атеросклеротического воспаления – активированных моноцитов-макрофагов – не только углубит знания о патогенезе хронического воспаления, но и позволит расширить представления о патогенетическом и предиктивном значении «клеточных» маркеров и перевести на качественно новый уровень раннюю диагностику атеросклеротического поражения при РА.

Objective: to determine frequency and grade of the coronary artery (CA) damage using coronary angiography data in patients with rheumatoid arthritis (RA) and suspected coronary artery disease (CAD); to evaluate the association of its progress with traditional risk factors (TRF), inflammatory markers and antirheumatic therapy. Subjects and methods. 25 male and 38 female RA patients with suspected or verified CAD, (median age was 58 [52; 63] years, RA duration – 10,5 [7; 23] years), were included in the study. 85% of patients were seropositive for IgM rheumatoid factor, 69% – for cyclic citrullinated peptide (CCP) antibodies. DAS28 median was 4,7 [3,3; 5,8]. CA stenosis was diagnosed if hemodynamically significant narrowing of the artery lumen (≥50%) was present. Results and discussion. CA stenosis was diagnosed in 22 (35%) patients (group I), 15 (68%) of them had single vessel damage, 7 (32%) – three-vessel involvement; the damage of two vessels was not diagnosed in any RA case. 41 (65%) patients had no lesions in CA (group II). The frequency of CA stenosis was higher in male patients (15 out of 25; 60%) than in female (7 out of 38; 18%; p0,05). The multiple regression analysis did not revealed any direct relationship of CA stenosis development with age, gender, DAS28, erythrocyte sedimentation rate, C-reactive protein level, concentration of cholesterol, low density lipoprotein cholesterol, HDLC, and consumption of anti-rheumatic drugs. The prediction of CA stenosis development was not possible with parameters used in this study. However, differences in age were the closest to statistical significance (OR=0,85; 95% CI [0,72–1,0], p=0,05). Other parameters, including HDLC level< 1,2 mmol/L for women and< 1,0 for men (OR 0,82; 95% CI [0,64–0,90], p=0,09) had less predictive power. Conclusion: CA stenosis was diagnosed in every third patient with RA and suspected CAD or verified CAD. Male gender and low level of HDLC may increase the risk of CA stenosis.

Increased arterial stiffness is one of the additional risk factors (RFs) for cardiovascular diseases along with traditional RFs, such as male gender, age, dyslipidemia, hypertension, and smoking. In rheumatoid arthritis (RA), the risk of cardiovascular events, including coronary heart disease (CHD), is significantly higher than that in the general population, which may be associated with the characteristics of the underlying disease or the prevalence of traditional RFs.Subjects and methods. The results of investigating the arterial stiffness in 56 patients including 46 with RA and 10 with CHD without inflammatory joint disease (a control group) were analyzed. Arterial stiffness was assessed by carotidfemoral pulse wave velocity (cfPWV) in the area from the carotid artery to the femoral one, which was determined by applanation tonometry, as well as by CAVI that was calculated according to the data of volume sphygmography.Results and discussion. According to the investigation encompassing exercise tests and coronary angiography, the group of patients with RA was divided into two subgroups, depending on the presence or absence of coronary artery disease caused by atherosclerosis. The patients' age was 38 to 77 years (mean age 60.3±7.2 years); the male proportion was 34.8%.Conclusion. The presence of RA with and without CHD is associated with a significant rise in arterial stiffness compared to isolated CHD (cfPWV, 13.6 and 8.6 m/sec, respectively). The increase in cfPWV and CAVI compared with the age norm was revealed in the majority of RA patients both with and without CHD.

Представлен случай одномоментной хирургической коррекции эндокардитического поражения аортального клапана при инфекционном поражении функционирующего открытого артериального протока у взрослого пациента в подострую стадию инфекционного процесса.Поступила в редакцию 7 сентября 2016 г. Принята к печати 31 октября 2016 г.Финансирование Исследование не имело финансовой поддержки.Конфликт интересовАвторы заявляют об отсутствии конфликта интересов.

Abnormalities in the blood cholesterol transport system play a leading role in the development of atherosclerotic vascular lesions in rheumatoid arthritis (RA). The article analyzes the lipid profile in patients with untreated RA. It gives data on the impact of inflammation on proatherogenic lipid and lipoprotein metabolic disturbances and defines the need to explore high-density lipoprotein subfractions and their functions, namely, reverse cholesterol transport in patients with RA as a more promising method for assessing cardiovascular risk.

The article presents the data of international registries and cohort studies of systemic lupus erythematosus (SLE). It justifies the purpose and objectives of the international registry of SLE patients, a Eurasian cohort (RENAISSANCE), which was launched in 2012 and amalgamated the leading rheumatology centers of the Russian Federation (V.A. Nasonova Research Institute of Rheumatology; Department of Rheumatology, Pacific State Medical University), Kazakhstan (Department of Rheumatology, S.D. Asfendiyarov Kazakh National Medical University), and Kyrgyzstan (Academician M. Mirrakhimov National Center for Cardiology and Therapy), which mainly concentrate patients with the acute course of this disease. The first data of the registry are given.

The paper presents the materials of the Russian Arthritis Registry (OREL) that includes 3276 patients from 11 Russian Federation's largest research-and-practical centers situated in Moscow, Saint Petersburg, Novosibirsk, Kazan, Tula, Yaroslavl, Tyumen. It discusses the main goals of setting up registries, compares the results of an analysis of the data available in the Russian Registry OREL and registries of European countries and the USA. The findings suggest that there is non-uniform information on clinical, laboratory, and instrumental parameters in the national registers of a number of European countries and the USA. According to its basic characteristics, the Russian Registry OREL compares favorably with a number of other registries in the completeness of data collection, which allows a general idea of rheumatoidarthritis (RA) patients in Russia. For further development of the OREL Registry, it is necessary to concentrate our attention on the following main areas: to improve the quality of filling out documents; to follow-up patients receiving different RA therapy regimens according to the guidelines of the Association of Rheumatologists of Russia for the treatment of RA; to conduct in-depth studies of comorbidity, primarily depressive disorders; to analyze adverse reactions that make RA therapy difficult; to actively use modules for patients' self-rating of their condition; to develop nursing care, etc.

Objective: to reveal irreversible organ damages and to establish factors that influence their development in a RENAISSANCE cohort of patients with systemic lupus erythematosus (SLE) admitted to the clinic of the V.A. Nasonova Research Institute of Rheumatology in the period 2012 to 2014.Subjects and methods. The investigation enrolled 231 young (mean age, 34.91±11.10 years) patients (209 women and 22 men) with a mean SLE duration of 107.65±97.36 months. On admission of the patients, the investigators collected history data (disease duration, the number of exacerbations and hospitalizations during the follow-up period), assessed current disease activity by SLEDAI-2K, irreversible organ damages by SLICC damage index (DI), and the therapy performed.Results and discussion. Irreversible organ damages were absent in 95 (41%) patients; one or more damages associated with both disease itself and the therapy were observed in the other (59%) patients. There were low (1), mean (2–4), and high (>4) SLICC DI values in 64 (28%), 62 (27%), and 11 (5%) patients, respectively. Ocular lesions were most common (35%); a significant proportion of patients were found to have damages to the cardiovascular (22%), musculoskeletal (19%), and nervous (10%) systems. Lung disease, diabetes mellitus, and cancer were less prevalent (6.0, 3.4, and 1.3%, respectively). The patients with damages were significantly older (p = 0.02), had a longer disease duration (p = 0.0005) and more frequent SLE exacerbations and hospitalizations (p = 0.0003 and p = 0.001, respectively). The patients with DI ≥1 received glucocorticoids (GCs) longer (p = 0.001). At the onset of SLE they had significantly higher doses of GCs (mean 44.06±18.97 mg) than those without damages (35.91±20.12 mg; р = 0.002). DI correlated with GC doses at the onset of the disease, duration of GC use, number of hospitalizations and exacerbations. There was also a statistically significant correlation of overall SLICC DI with the duration of disease (r = 0.23) and the total dose of cyclophosphamide (CP) (r = 0.19).Conclusion. Irreversible organ damages are present in 59 patients in the RENAISSANCE cohort. Older individuals develop a larger number of damages, with higher frequency of exacerbations and hospitalizations, longer use of GCs, and higher cumulative dose of CP. DI correlates with the dose of GC and does not depend on the activity and clinical manifestations of SLE at its onset.

The article presents 3 cohorts with early rheumatoid arthritis in patients aged 50 years and older with a disease duration from 1.5 months to 1 year. To establish a diagnosis, the classification criteria of its period were applied to each of the cohorts: to the 1st - the 1958 ARA criteria, to the 2nd – the 1987 ARA criteria, to the 3rd - the 2010 ACR / EULAR criteria. Along with changes in the criteria diagnostic methods improved, many qualitative laboratory indicators were replaced by a quantitative equivalent; new disease markers (including ACPA), improved imaging methods, changed treatment strategies, genetically engineered drugs, numerous analogues of the original drugs appeared. Сonflicting opinions about the course of RA in older age periods have been published in the literature consistently. During application of the 1958 classification criteria, the prevailing opinion was that these patients had a more favorable course; as a more hardline approach to RA diagnosing appeared, a growing number of supporters of its more severe course appeared. In the research the author tries to answer the question whether the course of the disease in the older age groups has changed at the earliest time from its beginning by comparing three cohorts of different time periods. The data obtained are discussed.

The paper presents the materials of the Russian Arthritis Registry (OREL) that includes 3276 patients from 11 Russian Federation's largest research-and-practical centers situated in Moscow, Saint Petersburg, Novosibirsk, Kazan, Tula, Yaroslavl, Tyumen. It discusses the main goals of setting up registries, compares the results of an analysis of the data available in the Russian Registry OREL and registries of European countries and the USA. The findings suggest that there is non-uniform information on clinical, laboratory, and instrumental parameters in the national registers of a numberof European countries and the USA. According to its basic characteristics, the Russian Registry OREL compares favorably with a number of other registries in the completeness of data collection, which allows a general idea of rheumatoid arthritis (RA) patients in Russia. For further development of the OREL Registry, it is necessary to concentrate our attention on the following main areas: to improve the quality of filling out documents; to follow-up patients receiving different RA therapy regimens according to the guidelines of the Association of Rheumatologists of Russia for the treatment of RA; to conduct in-depth studies of comorbidity, primarily depressive disorders; to analyze adverse reactions that make RA therapy difficult; to actively use modules for patients' self-rating of their condition; to develop nursing care, etc.

The start of the new millennium is marked by a substantial progress in the development of rheumatology: pathogenesis of many rheumatic diseases (RDs) was more deeply studied; their diagnostic criteria validated; disease activity indices worked out; the concepts of remission and exacerbation introduced; much attention has been given to the investigations of quality of life in patients. The possibility of pharmacotherapy for immunoinflammatory RDs was extended by the advent of biological agents (BA). The treatment strategy for RDs was also changed. The treat-to-target concept was put forth for rheumatoid arthritis in 2010 and for ankylosing spondylitis later. The project of treat-to-target concept in systemic lupus erythematous (SLE) was launched on the initiative of the world’s leading rheumatologists in January 2013. The result of their work is the treat-to-target-in-SLE recommendations published in 2014 and formulated as 4 basic principles and 11 general recommendations. The purpose of this publication is to provide general characteristics of the basic provisions of the principles and recommendations with commentaries of leading experts discussing characteristics of SLE in the Russian Federation and some debatable and unsolved problems.

Proinflammatory cytokines involved in the pathogenesis of rheumatoid arthritis (RA) are able to inhibit the production of insulin and to cause insulin resistance in peripheral tissues. Conceivably RA increases the risk of developing carbohydrate metabolic disturbances (CMDs), such as diabetes mellitus (DM), fasting hyperglycemia (FH), and impaired glucose tolerance. Patients with a concurrence of RA and DM belong to a category of the most critically ill patients with a poor prognosis of macro- and microvascular complications.Objective: to estimate the rate of CMDs (DM and FH) in a cohort of patients with RA and their possible impact on the course of arthritis.Subjects and methods. The investigation enrolled 165 patients (28 men and 137 women) aged 55 [47; 61] years who were diagnosed with RA and followed up at the V.A. Nasonova Research Institute of Rheumatology. The patients who were seropositive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies were 86.3 and 78.8%, respectively. RA activity was low in 29.1% of the patients, moderate in 48.5%, and high in 22.4%. Glucocorticoids (GC) were taken at a mean dose of 5 [5; 7.5] mg/day by 40.6% of the patients; methotrexate, leflunomide, and genetically engineered biological agents were used by 72.7, 8.5, and 23.7%, respectively. A survey was conducted among the patients to find out their awareness of the presence of CMDs and fasting venous plasma glucose levels were determined to screen for hyperglycemia. Height and weight were measured and body mass index (BMI) was calculated.Results. CMDs were present in 21 (12.7%) of the 165 patients with RA. Only 11 (6.7%) of the 165 patients were aware of having DM (2 cases with type 1 DM and 9 with type 2 DM); laboratory tests revealed CMDs in the remaining 10 patients (8 cases with FH and 2 with type 2 DM). The patients with DM and FH had a large number of tender joints (TJN) and high scores of general health survey (GHS) and DAS28 than those with normal blood glycose levels, but did not differ in RA duration, acute-phase indicators (erythrocyte sedimentation rate, C-reactive protein), and the number of swollen joints. Fifty-seven (34.5%) patients were overweight and 39 (23.6%) were obese. In the patients who took GC, glucose levels were lower (5.1 [4.7; 5.5]) than in those who did not (5.4 [5.0; 5.9] mmol/l; p = 0.001) and correlated with BMI ((r = 0.3; p = 0.01).Conclusion. The investigation demonstrated the high rate of DM and FH in RA, but low patient awareness of these conditions, as well as the relationship of CMDs to arthritis activity mainly due to the changes of subjective indices (GHS and TJN). The intake of GC and BMI may affect blood glucose levels in RA.

Rheumatoid arthritis (RA) is a proven high cardiovascular risk disease. High heart rate (HR), lower heart rate variabil- ity (HRV), and increased QT interval are considered as predictors of cardiovascular events in patients with coronary heart disease, chronic heart failure, and diabetes mellitus. In RA, there is a pronounced rise in HR, a reduction in HRV, and an increase in QT interval mainly due to the factors reflecting the severity of the disease. Rituximab (RTM) is successfully used to treat patients with high RA activity. At the same time there are only a few pieces of evidence for the effect of the drug on the cardiovascular system. Objective: to study changes in HR, HRV, and QT interval values obtained during electrocardiography (ECG) Holter monitoring (ECG HM) in RTM-treated women during a 6-month follow-up. Subjects and methods: The investigation enrolled 55 women (mean age 50 years) with a definite diagnosis of RA and its high activity. The patients were examined 6 months after administration of RTM. The latter was infused intra- venously twice (500 and 1000 mg in 22% and 78% of the patients, respectively) during therapy with disease-modifying antirheumatic and non-steroidal anti-inflammatory drugs and glucocorticoids. The RA patients were divided into two groups: 1) a satisfactory/good effect of RTM according to the EULAR criteria (n = 41); 2) no effect (n = 14). Analysis of 24-hour ECG HM yielded the values of HR and mean duration of corrected QT interval (QTc). The tim- ing HRV values obtained at ECG HM were standardized from age and mean HR (SDNNn, RMSSDn, and pNN50n). Results. The baseline HRmin and HRmean values were higher and SDNNn was lower in the RA patients in Group 1 than those in Group 2 (p < 0.05). In Group 1, RTM therapy was accompanied by a reduction in HRmean and HRmin by 8% and by an increase in SDNNn by 3%, RMSSDn by 26%, and pNN50n by 33% whereas no significant changes in HR and HRV were found in Group 2. The RTM therapy-induced HRmean decrease was associated with the reductions of C-reactive protein concentration and HAQ disability index (p < 0.01), the increases of rMSSDn and pNN50n associated with lower HAQ index, ERS, and DAS28 (p < 0.01). There were no differences in QTc in Groups 1 and 2 during 6 months after RTM therapy. Thus, effective RTM therapy is attended by reduced HR and improved HRV values.

The peak onset of rheumatoid arthritis (RA) is at 30-55 years of age. At this age, the patients have also other concomi- tant diseases (comorbidities) that affect the course and prognosis of RA, the choice of its treatment policy, quality of life of the patients. Objective: to identify the most important and common comorbidities in patients with RA. Subjects and methods. Two hundred patients (median age 55 [46; 61] years) were enrolled; there was a preponderance of women (82.5%) with median disease duration 5 [1; 10] years, seropositive for IgM rheumatoid factor (83.0%) and anti-cyclic citrullinated peptide antibodies (81.6%) with moderate and high disease activity (median DAS28 value 3.9 [3.1; 4.9]). Varying degrees of destructive changes in hand and foot joints were radiologically detected in 71.2% of the patients; 64.5% of the patients had Functional Class II. Methotrexate was given to 69.5% of the patients; therapy with biological agents was used in 21.0% of the cases. 15.5% of the patients did not receive DMARD or biologics. 43.0% of the patients with RA received glucocorticoids. Results. Comorbidities were present in 72.0% of the patients with RA. The most common diseases were hypertension (60.0%), dyslipidemia (45.0%), fractures at various sites (29.5%), and coronary heart disease (21.0%). Myocardial infarction and stroke were observed in 1.5 and 1.0% of cases, respectively. There was diabetes mellitus (DM) in 7.5% of the cases and osteoporosis in 15.5% of the patients. 81.7% of the patients with RA and hypertension and 80.0% of those with RA and DM received antihypertensive and sugar-lowering therapy, respectively. At the same time the RA patients with dyslipidemia and osteoporosis received specific drugs far less frequently (30.0 and 29.0%, respectively). Conclusion. Comorbidities are frequently encountered in RA. By taking into account the fact that cardiovascular dis- eases are a main cause of death in RA; it is necessary to adequately and timely modify traditional risk factors (hyper- tension, dyslipidemia, and diabetes mellitus). Treatment patients with RA requires an interdisciplinary approach and an interaction between physicians of different specialties.

AIM: To compare the prevalence of risk factors, clinical and subclinical manifestations of cardiovascular diseases (CVD) and their complications in methotrexate (MT)-treated and untreated patients with rheumatoid arthritis/MATERIAL AND METHODS: The investigation enrolled 193 patients (168 women and 25 men) less than 60 years of age (mean age 49 [44; 53] years) with RA. The patients were divided into 2 groups: 1) 69 patients who received MT in a dose of 15.1 [10.2; 21] mg/week for at least 12 months (mean disease duration 25 [18; 48] months); 2) 124 patients who did not take MT. The patient groups were matched for age, gender, disease duration, RA activity, and the rate of rheumatoid factor (RF) seropositivity and extraarticular manifestations/RESULTS: Dyslipidemia was significantly less frequently identified in MT-treated patients (35/69 or 51%) than in MT-untreated ones (85/124 or 69%; p=0.01). The serum from the patients treated with MT exhibited higher high-density lipoprotein cholesterol concentrations ((1.8 [0.9; 2.0] mmol/l) than in those untreated with MT (1.2 [1.0; 1.6] mmol/l; р=0,047). In Group 1, hypertension (49%) and diabetes mellitus (3%) were slightly rare than in Group 2 (62 and 13%, respectively; p>0.05). Carotid atherosclerotic plaques were found in 19 and 16% and intima-media thickness (IMT) enlargement was seen in 53 and 56% of the patients in Groups 1 and 2, respectively. Silent myocardial ischemia was diagnosed in every 10 patients; heart disease (exertional angina, myocardial infarction) was in every 5 patients in both groups. Aortocoronary bypass surgery was performed in 2 (3%) patients from those who received MT and had experienced MI and in one (1.6%) patient from the MT-untreated group/CONCLUSION: Long-term MT therapy was associated with the lower rate of dyslipidemia, but it failed to affect the incidence of CVD in patients with RA.

Aim. To compare 10-year risk of cardiovascular complications (CVC) assessed by Adult Treatment Panel III (ATP III) and Reynolds Risk Score (RRS); to specify contribution of C-reactive protein (CRP) to development of CVC in patients with rheumatoid arthritis (RA). Material and methods. The trial included 116 RA patients (100 females and 16 males) and 85 healthy subjects (63 females and 22 males) under 55 years of age free of clinical symptoms of cardiovascular diseases. RA duration and activity were the same in men and women. The patients and controls were matched by age, incidence of standard risk factors (RF). The 10-year risk of CVC development was estimated by two scales - ATP III and RRS. Total cholesterin, HDLP cholesterin were measured with standard enzyme tests, concentration of CRP was assessed by highly sensitive immune nephelometry. Results. The 10-year risk of CVC was higher in RA patients both by ATP III (1.8 - 1;10%) and RRS (2.6 - 2; 7)% compared to the controls (1 - 1;3)% and (1.2 - 1;4)% (p < 0.05). In male RA patients RRS is higher than in females - 7 (3.5; 12)% and 2 (1;2)%, respectively (p < 0.001). Re-calculation from the scale ATP III to RRS has changed the risk in 17 (17%) females and 7 (44%) males with RA. As a result, the number of RA patients with a low CVC risk decreased, with a moderate risk rose 2 times, with a high risk was the same. RRS dependence on the disease duration, RA activity (DAS28) was not registered. RA patients showed a positive correlation of RRS with thickness of the intima-media complex of the carotid arteries (r = 0.44; p < 0.001). Conclusion. Introduction of a new prognostic scale RRS allows isolation of groups of patients with moderate and high CVC risk and timely medication of such patients.

Objective. To characterize metabolic syndrome (M S) in pts wit h systemic lupus erythematosus (SLE) and determine contribution of immune inflammation to the development of MS. Material and methods. 156 females with SLE (mean age 35 years, mean disease duration 99 months) were included. Control group consisted of 69 people of comparable age without rheumatic diseases. MS was diagnosed according to ATP III criteria, \fascular atherosclerotic damage was assessed by carotid sonographic evaluation. Serum cholesterol (CS), triglycerides (TG) and high-density lipoprotein (HDLP) CS concentration was assessed with colorimetric and photometric methods, hs CRP level — with nephelometric immunoassay. Results. MS was revealed in 29 from 154 (19%) pts with SLE and in 5 from 69 (7%) controls (p=0,02). MS components (hypertension, TG elevation and a lipoprotein decrease) in SLE were significantly more frequent than in control group. TG, HDLP CS and CRP levels in SLE were higher than in control. Thickness of carotid intima-media complex did not differ in SLE and control. Frequency of atherosclerotic plaques (15%) and coronary heart disease (14%) in SLE was higher than in control (4% and 2% respectively), p=0,01. Pts with SLE and MS were older, had higher disease activity and maximal glucocorticoid dose during disease period (p

Patients surviving non-ST-segment-elevation acute coronary syndrome constitute a group of high coronary risk and sudden death risk and are therefore in particular need of adequate and proper rehabilitation and secondary prevention including physical training. 122 patients surviving non-Q-wave myocardial infarction or an episode of unstable angina have been studied, with mild to moderate arterial hypertension (mean age 52. 26± 0. 56 years), in the period of stabilization 3-8 weeks following the onset of the acute period. The main group (80 subjects) underwent controlled systematic physical training of moderate intensity for 3 months, leading to improved central hemodynamical parameters, left ventricle diastolic function, increased tolerance to physical stress, promoting blood pressure decrease, which, in overall, improved the clinical course of the disease and led to early restoration of working capacity, decreased invalidation, decreased the risk of cardiovascular complications.

Objective. To study relation of SLE pts blood serum atherogenicity to disease activity and corticosteroids (CS) administration. Methods. 40 young women with SLE were included. 20 of them did not received CS (group 1) and 20 were treated with small doses of CS (