A STRUCTURED TRAINING PROGRAM FOR PATIENTS WITH RHEUMATOID ARTHRITIS TO SELF-MONITOR DISEASE ACTIVITY

Objective. To develop a structured training program for patients with rheumatoid arthritis (RA) to self-monitor disease activity and to assess effectiveness of this program.Material and Methods. The study included 60 patients with definite diagnosis of RA according to the ACR/EULAR 2010 diagnostic criteria (52 females and 8 males, mean age 58.8 ± 10.4 years, the median duration of RA was 5 [2.75; 12] years). Patients were trained using the original method Structured Program of Training Patients with RA to Self-Monitor Disease Activity during the first visit and one month later (second visit). Skill acquisition was controlled by estimating the number of painful (NPJ) and swollen (NSJ) joints in parallel by a physician and the patient during the second visit and 2 months after the first visit (the third visit). Statistical significance was analyzed using the McNemar’s test (differences are considered to be significant when p <0.05).Results. Absolute coincidence of NSJ as assessed in parallel by a physician and the patient was observed in 26 (43%) cases during the second visit and 41 (68%) cases during the third visit (p = 0.018). Results of NPJ assessment by a physician and the patient coincided in 20 (33%) cases during the second visit and 36 (60%) cases during the third visit (p = 0.003).Conclusion. The structured program allows RA patients to correctly determine the painfullness of joints in 60% of cases and joint swelling in 68 % of cases, which is important for self-control of the disease activity

A STRUCTURED TRAINING PROGRAM FOR PATIENTS WITH RHEUMATOID ARTHRITIS TO SELF-MONITOR DISEASE ACTIVITY

Objective. To develop a structured training program for patients with rheumatoid arthritis (RA) to self-monitor disease activity and to assess effectiveness of this program.Material and Methods. The study included 60 patients with definite diagnosis of RA according to the ACR/EULAR 2010 diagnostic criteria (52 females and 8 males, mean age 58.8 ± 10.4 years, the median duration of RA was 5 [2.75; 12] years). Patients were trained using the original method Structured Program of Training Patients with RA to Self-Monitor Disease Activity during the first visit and one month later (second visit). Skill acquisition was controlled by estimating the number of painful (NPJ) and swollen (NSJ) joints in parallel by a physician and the patient during the second visit and 2 months after the first visit (the third visit). Statistical significance was analyzed using the McNemar’s test (differences are considered to be significant when p <0.05).Results. Absolute coincidence of NSJ as assessed in parallel by a physician and the patient was observed in 26 (43%) cases during the second visit and 41 (68%) cases during the third visit (p = 0.018). Results of NPJ assessment by a physician and the patient coincided in 20 (33%) cases during the second visit and 36 (60%) cases during the third visit (p = 0.003).Conclusion. The structured program allows RA patients to correctly determine the painfullness of joints in 60% of cases and joint swelling in 68 % of cases, which is important for self-control of the disease activity

METHODS FOR RHEUMATOID ARTHRITIS ACTIVITY SELF-ASSESSMENT: PROS AND CONS

The paper analyzes the foreign and Russian literature devoted to teaching patients how to control rheumatoid arthritis (RA) disease activity. It shows the historical development of this matter. The paper also describes currently known methods for the self-assessment of RA disease activity. The factors that affect the correctness of both a patient's selfassessment and a rheumatologist's evaluation are indicated. The results of studies, which prove the practical importance of self-control of RA activity, are presented. The paper demonstrates the ambiguity of rheumatologists' opinions on whether self-control can be applied

THE ASSESSMENT OF EFFICACY AND OF SAFETY USING SELF-MONITORING OF DISEASE ACTIVITY VIA INTERNET PORTAL IN THE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

Objectives: Maximally quickly identify the exacerbation of the disease and timely strengthen the therapy, for more rapid achievement of remission or low disease activity.Methods: The authors created an interactive web portal for self-monitoring of RA activity. The patient management model using this method is that a patient conducts a monthly self-evaluation of the disease activity and transmits this information to his treating doctor in a remote manner via the web portal. In case of worsening and in the absence of any dynamics, according to the patient, he was invited to the center, where this information was verified by a doctor. If, in the patient’s opinion, there was an improvement, he did not come to clinic, but continued therapy. Currently, 30 women with RA, age 57 (38; 71), who completed the 6-month treatment period, are included in the study. 20 women included in the control group, average age 60.5(40; 77).Results: During 6 months, there was a positive dynamic of the course of the disease, the activity of the RA by DAS 28 decreased. Initially, 5 patients (16.7%) had high DAS activity, 24 — moderate (80%), 1low (3.3%). After 6 months of treatment 8 patients (26.7%) had low activity, 22 (73.3%) achieved remission. The mean value of the DAS 28 index at the time of inclusion was 3.99 (2.46; 5.78) and after 6 months of management 2.175 (0.79; 4.31), a statistically significant decrease (Wilcoxon T-test = 5). The DAS 28 index at the time of control group was 4,1 (2.46; 5.78) and after 6 months of management 3,9 (0.79; 4.31), a statistically significant decrease (Wilcoxon T-test = 5). Analysis of clinical and laboratory parameters did not reveal statistically significant deviations.Conclusions: The 6-month period of patient management via the Internet portal for self-monitoring of rheumatoid arthritis activity proved the possibility of achieving remission and low disease activity in all patients

Adverse cardiovascular outcomes and their relationship with risk factors according to the prospective study MERIDIAN-RO

Aim. To assess the incidence of adverse outcomes and the role of main risk factors in their development.Material and methods. Prospective, long-term study was conducted with observation period of 36 months. The sample in the MERIDIAN-RO study was formed from the urban and rural population. It included 1622 people aged 25-64 years. The response to the study was 86,1%. Observation and screening of endpoints continued for 36 months. The endpoints were: all-cause death, ischemic stroke, myocardial infarction, coronary artery revascularization.Results. When studying the relationship between various risk factors and outcomes, it was found that they had a significant impact on the combined endpoint (all-cause death + nonfatal ischemic stroke + nonfatal myocardial infarction): risk SCORE >5% (odds ratio (OR) 5,80, 95% confidence interval (CI) 2,31-14,58, p=0,0001, Wald — 23,040), excessive alcohol consumption (OR 714, 95% CI 1,41-36,31, p=0,018, Wald — 2,908), arterial hypertension (OR 4,77 95% CI 1,91-11,90, p=0,01, Wald — 9,000), combination of coronary artery disease/myocardial infarction/stroke in history (OR 11,16, 95% CI 3,98-31,31, p=0,0001, Wald — 22,607) and an apolipoprotein B increase more than 180 mg/dL (OR 28,57 95% CI 732-111,42, p=0,0001, Wald — 24,509).Conclusion. The most significant effect on the combined endpoint (all-cause death + nonfatal myocardial infarction + nonfatal stroke) made: SCORE risk >5%, excessive alcohol consumption, hypertension, combination of coronary artery disease/myocardial infarction/stroke in history and an apolipoprotein B increase more than 180 mg/dL. That should be considered when choosing aims and preventive strategies

Molecular machines governing exocytosis of synaptic vesicles.

Calcium-dependent exocytosis of synaptic vesicles mediates the release of neurotransmitters. Important proteins in this process have been identified such as the SNAREs, synaptotagmins, complexins, Munc18 and Munc13. Structural and functional studies have yielded a wealth of information about the physiological role of these proteins. However, it has been surprisingly difficult to arrive at a unified picture of the molecular sequence of events from vesicle docking to calcium-triggered membrane fusion. Using mainly a biochemical and biophysical perspective, we briefly survey the molecular mechanisms in an attempt to functionally integrate the key proteins into the emerging picture of the neuronal fusion machine