Comparison of the Endoscopic Picture in Case of Complications of the upper Gastrointestinal Tract Caused by the Use of Antithrombotic Agents and Non-Steroidal Anti-Inflammatory Drugs

Intaking antithrombotic funds (ATA) and non-steroidal anti-inflammatory drugs (NSAIDs) is one of the most frequent causes of pathology in gastrointestinal (GI) tract.The purpose of the study: comparison of pathological changes of the mucous membrane in the upper GI tract, that occur against the background of ATA and NSAIDs admission.Material and methods. Endoscopic data of two groups of patients taking ATA and NSAIDS have been compared. The first group of 448 patients from the 10th Gastrointestinal Department in N.N. Burdenko Main Military Clinical Hospital was on record from 2013 to 2017. The patients had erosive ulcerous changes of gastrointestinal mucosa, occurred against the background of the ATA admission. The second group comprised 6431 patients with rheumatic diseases. They were hospitalized in the clinic of V.A. Nasonova Research Institute of Rheumatology in the period from 2007 to 2016 and took NSAIDs regularly.Results. Duodenal and gastric ulcer changes in gastric mucosa and duodenal ulcers were identified in 168 (37.5 %) patients taking ATA and in 1691 (26.3 %) patient treated with NSAIDS. Structure of pathology varied. So, against the background of ATA and NSAIDS admission, the number of acute gastric ulceration amounted to 6.5 % and 15.5 % (p < 0.001); acute ulcers duodenal was 2.9 % and 4.9 %; combined ulcerative lesions of gastric and duodenal was 2.9 % and 2.0 %; multiple erosions of gastroduodenal mucosa were 52.4 % and 15.7 % (p < 0.001); single erosion was 35. 1% and 61.6 %. The factor of ulcer history and age ≥ 65 years old increased significantly the risk of duodenal and gastric ulcer changes in patients taking ATA and NSAIDs: OR 5.182 (95% CI 2.701–9.942) and 3.24 (95% CI 2.19–5.34), 4.537 (95% CI 2.036–10.11) and 2.016 (95% CI 1.230–2.917) respectively. Intaking of proton pump inhibitor (PPI) reduced significantly the risk of complications for both ATA and NSAIDs: OR 0.329 (95% CI 0.199–0.546) and 0.317 (95% CI 0.210–0.428) respectively.Conclusion. The structure of pathology of mucous in the upper gastrointestinal tract that arose against the backdrop of ATA and NSAIDs admission is different. The first is characterized by a multiple erosion, while the second one has single acute distal gastric ulcers. The ulcerative history and advanced age of patients increase significantly the risk of complications concerning the gastroduodenal mucosa when using ATA and NSAIDs. PPI is the effective means of preventing this pathology

Efficacy and tolerability of abatacept treatment: results of 12 months observation

Objectives: This article reports 1-year clinical outcomes of patients with rheumatoid arthritis (RA) receiving abatacept (ABA) therapy. Materials and methods: Patients (n=91) with high RA activity (DAS28 = 5.1 ± 1.0) and an inadequate response on synthetic DMARDs (mainly methotrexate, 70.3%) and biologics (mainly TNF-α inhibitors, 93%) were included in the study. The majority of patients were middle-aged (49 ± 13.5) womens, RF (72.5%) and ACPA (77%) positive, with moderate functional impairment - HAQ = 1.4 (0.9-2). ABA were administered IV, 10 mg/kg according to the standard scheme. The evaluation of the effectiveness of the therapy was carried out according to the EULAR / ACR 2011 criteria using SDAI, CDAI, HAQ and the intention to treat approach. Results: ABA led to a significant (

Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST–RA database

OBJECTIVE: To analyse associations between the clinical status of patients with rheumatoid arthritis (RA) and the gross domestic product (GDP) of their resident country. METHODS: The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 "high GDP" countries with GDP per capita greater than US$24,000 and 11 "low GDP" countries with GDP per capita less than US$11,000. RESULTS: Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = -0.78, 95% CI -0.56 to -0.90, r(2) = 61%). Disease activity levels differed substantially between "high GDP" and "low GDP" countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents. CONCLUSIONS: The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in "low GDP" than in "high GDP" countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries

Melatonin influence on clinical and endocrine measures in early rheumatoid arthritis

Objective. To assess melatonin (ML) efficacy for correction of sleep disturbances, its influence on clinical symptoms and laboratory activity measures as well as cortisol level in pts with rheumatoid arthritis (RA) Material and methods. Blind randomized placebo controlled study was performed. 38 women with RA fulfilling ACR criteria and disease duration not exceeding a year were included. Pts of the main group (n=19) received melatonin (Melaxen, Unifarm, USA) 3 mg I hour before sleep, control group pts (n= 19) received placebo. All pts received nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs. Clinico-laboratory measures of inflammatory activity, sleepless symptoms score, plasma cortisol and urine 6-sulphotoximelanotonin (6-STM) levels with immuno-enzyme assay were evaluated. Results. To the end of study sleep quality improved and morning stiffness significantly decreased in the main group pts in comparison with placebo group. 20% decrease of morning stiffness was achieved in 90% of ML group and 44% of placebo group pts. Other clinical features of RA including DAS28 changes did not significantly differ between groups. Treatment with ML also induced endocrine status changes in RA pts: decrease of plasma cortisol and significant increase of urine 6-STM levels. Endocrine measures did not change in placebo group. Conclusion. ML efficacy in the treatment of sleep disturbances in pts with RA was confirmed. Decrease of cortisol blood level in such pts probably connected with shift of its peak to earlier hours providing decrease of morning stiffness

Melatonin influence on clinical and endocrine measures in early rheumatoid arthritis

Objective. To assess melatonin (ML) efficacy for correction of sleep disturbances, its influence on clinical symptoms and laboratory activity measures as well as cortisol level in pts with rheumatoid arthritis (RA) Material and methods. Blind randomized placebo controlled study was performed. 38 women with RA fulfilling ACR criteria and disease duration not exceeding a year were included. Pts of the main group (n=19) received melatonin (Melaxen, Unifarm, USA) 3 mg I hour before sleep, control group pts (n= 19) received placebo. All pts received nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs. Clinico-laboratory measures of inflammatory activity, sleepless symptoms score, plasma cortisol and urine 6-sulphotoximelanotonin (6-STM) levels with immuno-enzyme assay were evaluated. Results. To the end of study sleep quality improved and morning stiffness significantly decreased in the main group pts in comparison with placebo group. 20% decrease of morning stiffness was achieved in 90% of ML group and 44% of placebo group pts. Other clinical features of RA including DAS28 changes did not significantly differ between groups. Treatment with ML also induced endocrine status changes in RA pts: decrease of plasma cortisol and significant increase of urine 6-STM levels. Endocrine measures did not change in placebo group. Conclusion. ML efficacy in the treatment of sleep disturbances in pts with RA was confirmed. Decrease of cortisol blood level in such pts probably connected with shift of its peak to earlier hours providing decrease of morning stiffness

Clinical and endoscopic assessment of gastric state in systemic lupus erythematosus and antiphospholipid syndrome

Objective. To characterize gastric mucosa (GM) state in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Material and methods. Gastroscopy (GS) with GM biopsy and histological examination was performed in 85 pts (65 with SLE and 20 with primary APS). 26 from 65 pts with SLE had secondary APS. 21 SLE pt before inclusion did not receive glucocorticoids (GC). H. pylory and its cytotoxicity gen CagA, HSV-I, CMV were examined in GM samples with PCR. Results. The most frequent GS-feature in pts with SLE and ARS was antral gastritis (82%). In 25% of pts erosions and in 8% - hemorrhages of GM were present. Erosions localized mostly in stomach (25%), in 7% of cases they were present in duodenum. In APS pts epigastric pain and GM erosions were more frequent than in SLE without APS. H.pylory in GM was revealed in 70-81%. In 42% of pts it was present in combination with HSV-1 and/or CMV. In more than half of pts with antral gastritis and GM erosions revealed H. pylory was CagA-positive. GC therapy did not influence frequency of GM erosions and hemorrhages formation. Conclusion. The most frequent GS-features in pts with SLE and ARS were antral gastritis and GM erosions. Epigastric pain and GM erosions were more frequent in pts with APS