Radionuclide Diagnosis of Esophageal Dysmotility and Gastroesophageal Reflux in Patients with Systemic Sclerosis

Objective: to evaluate the possibilities of dynamic scintigraphy for the diagnosis of esophageal dysmotility (ED) and gastroesophageal reflux (GER) in patients with systemic sclerosis (SS).Material and methods. The study group included 77 patients with established SS of different disease duration (from several months to 30 years) who underwent Technephyt 99mTc dynamic esophageal scintigraphy using two-stage protocol. During the first stage, the esophageal transport function was evaluated; during the second stage, the presence and severity of GER were assessed. Scans were analyzed using visual assessment, quantitative estimation of time/activity curves, and a proposed three-point scale for evaluating ED and GER severity. The control group consisted of 19 practically healthy individuals who underwent a routine examination to exclude digestive system and gastrointestinal tract diseases, the algorithm of which included dynamic scintigraphy.Results. ED was found in 74 of 77 patients (96%). According to three-point scale, severe ED (3 points) was registrated in 41 (55%) patients, moderate ED (2 points) in 15 (21%), and mild ED in 18 (24%). GER was diagnosed in 35 of 77 cases (45%): mild GER in 13 (37%), moderate GER (2 points) in 22 (63%), and none of the patients was found to have severe GER (3 points). A significant relationship between the presence of GER and the severity of ED was not obtained, but a direct correlation was established between ED and GER severity.Conclusion. Most SS patients demonstrated ED of varying severity associated with mild and moderate GER in nearly 45% of the cases. The study results confirm the practical significance of dynamic scintigraphy for assessing the esophageal transport function and GER in SS patients

SURVIVAL RATES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: REGIONAL REGISTRY DATA

There has been an increase in the survival rates of patients with systemic lupus erythematosus (SLE) in recent decades.Objective: to determine the survival rates of SLE patients in the Republic of Tatarstan.Subjects and methods. The records of SLE inpatients treated at the Nephrology and Rheumatology Departments of the Republican Clinical Hospital in 2004 to 2018 were retrospectively analyzed. Demographic data (gender, age at onset of the first signs of the disease, age at diagnosis of SLE, its duration, labor activity, and disability), clinical manifestations of the disease (damage to the  musculoskeletal system, skin and mucous membranes, kidneys, as well as serositis, neuropsychological disorders), and 5-, 10- and 15-year survival rates were analyzed. A hierarchical cluster analysis was used to group patients on the basis of the similarity in the measured characteristics.Results and discussion. A total of 256 SLE patients (230 females and 26 males) were followed up. The median age at onset of the first symptoms of the disease for females and males was 29.0 [21.0; 38.0] and 25.5 [18.0; 37.0] years, respectively; the age at SLE diagnosis was 30.0 [23.0; 41.0] and 25.5 [18.0; 37.0] years. The main clinical manifestations of the disease were damages to the musculoskeletal system (n=199 (77%)), skin and mucous membranes (n=168 (66%)), and kidneys (n=155 (61%)), neurological disorders (n=39 (15%)) and serositis (n=83 (32%)). In the above period, 29 patients died in the study group; there are no data on 10 patients. The 5-, 10-, and 15-year survival rates of patients in our group were 93.7, 90.8, and 86.4%, respectively; those in patients with lupus nephritis (LN) were 90.4, 86.6, and 82.1%; those in hypertensive patients were 89.5, 84.6, and 79.3%. A cluster analysis identified four clusters. The most important criteria for grouping the patients into clusters were the presence of antiphospholipid syndrome (APS), LN, and hypertension. Cluster 1 included patients with LN and hypertension; Cluster 2 comprised those with APS, LN, and hypertension. Cluster 3 consisted of patients having hypertension only; Cluster 4 included those with LN only. In Cluster 2, the 10- and 15-year patient survival rates decreased to 77.9 and 70.1%, respectively.Conclusion. In our study, 5-, 10-, and 15-year patient survival rates were 93.7, 90.8, and 86.4%, respectively. Gender and age at SLE diagnosis did not affect death rates. The risk of death was significantly higher in patients with LN and hypertension