ERGOTHERAPY IN RHEUMATOLOGY

The article reports one of the most affordable rehabilitation methods, i.e. occupational therapy. The issues related to the history of occupational therapy as a treatment method, its application in rheumatology and promising directions of development are covered

Early introduction of fish decreases the risk of eczema in infants

BACKGROUND: Atopic eczema in infants has increased in western societies. Environmental factors and the introduction of food may affect the risk of eczema. AIMS: To investigate the prevalence of eczema among infants in western Sweden, describe patterns of food introduction and assess risk factors for eczema at 1 year of age. METHODS: Data were obtained from a prospective, longitudinal cohort study of infants born in western Sweden in 2003; 8176 families were randomly selected and, 6 months after the infant\u27s birth, were invited to participate and received questionnaires. A second questionnaire was sent out when the infants were 12 months old. Both questionnaires were completed and medical birth register data were obtained for 4921 infants (60.2% of the selected population). RESULTS: At 1 year of age, 20.9% of the infants had previous or current eczema. Median age at onset was 4 months. In multivariable analysis, familial occurrence of eczema, especially in siblings (OR 1.87; 95% confidence interval (CI) 1.50 to 2.33) or the mother (OR 1.54; 95% CI 1.30 to 1.84), remained an independent risk factor. Introducing fish before 9 months of age (OR 0.76; 95% CI 0.62 to 0.94) and having a bird in the home (OR 0.35; 95% CI 0.17 to 0.75) were beneficial. CONCLUSIONS: One in five infants suffer from eczema during the first year of life. Familial eczema increased the risk, while early fish introduction and bird keeping decreased it. Breast feeding and time of milk and egg introduction did not affect the risk

PROBLEMS IN THE APPLICATION OF PRINCIPLES OF EVIDENCE-BASED MEDICINE TO THE MEDICAL REHABILITATION OF RHEUMATIC DISEASES

The paper analyzes the main problems associated with randomized controlled studies in medical rehabilitation: patient selection; use of simulation devices as placebo; standardization of methods; blinding procedure. It presents methodological considerations for improving the quality of studies

Cytokine profile in psoriatic arthritis: search for relationships with inflammation and blood rheological properties

Objective. To estimate the serum levels of interleukins (IL) 6 and 10, tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) in patients with psoriatic arthritis (PSA) and their relationship with the clinical and laboratory parameters of inflammation and with erythrocyte aggregation (EA). Material and methods. The authors measured the serum levels of C-reactive protein (CRP) by immunonephelometry (BN, ProSPEC, Siemens) and those of TNF-α, IL-6 and IL-10, and VEGF by X-MAP technology using a BioPlex-200 system (Panel Human 27-Plex Bio-Rad, USA) in 80 patients with PSA [45 women and 35 men; mean age 41.7±10.5 years, mean duration of PSA and psoriasis was 5.0 (2.0; 12,5) and 15 (4; 26) years, respectively; DAS 3.9 (3.09; 5.16)]. The blood samples from 16 healthy donors matched to the examinees for gender and age served as a control. The parameters of EA [Т1(с); Кt (arb. units); β (с-1), I2,5 (%)] were estimated, by recording the rate of back light scattering. The median (Me) and interquartile range [Q25; Q75], and mean and standard deviations (M±σ) were calculated; the indicators were compared by the Mann-Whitney test and Student's t test. Correlation analysis was made using the Spearman rank correlation coefficient (R); p < 0.05 was considered statistically significant. Results. There were significantly higher serum levels of IL-6 and IL-10, TNF-α, and VEGF in patients with PSA than in the controls, and impaired blood rheological properties. There were significant correlations of the level of most cytokines (IL-6 and IL-10, VEGF) with both the values of the clinical and laboratory activity of PSA (self-rated pain, the number of swollen and tender joints, a physician's assessment of disease activity, DAS, erythrocyte sedimentation rate, and fibrinogen) and most parameters of EA (Т1, Kt и I2.5). No significant relationships were found between VEGF and CRP. Conclusion. The enhanced clinical and laboratory activity of PSA is attended by the systemic activation of immunological mediators of inflammation and neoangiogenesis and by impaired blood rheological properties, which supports the interaction of these factors in the immunopathogenesis of the diseases

THE EFFECT OF AN ANTI-TUMOR NECROSIS FACTOR-? AGENT ON DISEASE ACTIVITY,BLOOD RHEOLOGICAL PROPERTIES, AND THE ARTERIAL WALL IN PSORIATIC ARTHRITIS

Vascular dysfunction and inflammation in psoriatic arthritis (PsA) share the same pathogenetic mechanism wherein the proinflammatory cytokine tumor necrosis factor- (TNF-) plays a key role. Treatment with anti-TNF- agents is effective in inhibiting inflammation in PsA; however, their effect on the wall of large arteries has not been studied. Objective. To evaluate the effect of Adalimumab (ADA) on the arterial wall and blood rheological properties in PsA. Subjects and methods. Eighteen patients with PsA [12 women and 6 men; mean age 43.1±10.2 years; disease activity scores (DAS), 4.78 (4.0; 5.45)] were subcutaneously injected ADA, 40 mg/every two weeks, for 12 weeks. The investigators assessed the vascular wall, by measuring the mean and maximum common carotid intima-media thickness (IMT) by ultrasound duplex scanning, and arterial rigidity (AR), by determining the refraction index (RI,%) and the rigidity index by digital volume photoplethysmography and Doppler study measuring the aortic pulse wave velocity (PWV) in the carotid-femoral segment (Micromedical, UK), before and after treatment. Erythrocyte aggregation (EA) parameters [Т1 (sec), Kt (c.u.); (sec-1), I2,5 (%)] were measured recording the rate of inverse light scattering and the levels of blood lipids [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)], and atherogenicity coefficient (AC) by routine methods on an automated Express plus analyzer (Bayer, Germany) at baseline, 4, and 12 weeks. The median and the interquartile range [Me (Q25; Q75)] were calculated; the changes in the parameters were estimated by the Wilcoxon test (Wt) and the Friedman test (Ft) for dependent samples;

Легионеллезная пневмония с формированием множественных абсцессов легких

A case of bilateral polysegmental destructive legionella pneumonia with the formation of multiple lung abscesses in an immunocompetent boy aged 15 years is presented.The child had symptoms of intoxication with febrile fever, myalgia, unproductive cough, respiratory failure, dull percussion sound and weakening of breathing on both sides in the lower sections. A computed tomography of the chest revealed multiple bilateral multifocal foci of pulmonary tissue with destruction. The diagnosis of legionella pneumonia was made on the basis of detection of IgM antibodies to L. pneumophila with an increase in titer in the dynamics and exclusion of other causes of lung damage. Levofloxacin turned out to be an effective antibacterial drug.It is necessary to take into account the ability of microorganisms of the genus Legionella to cause multiple abscess formation of lung tissue.Представлен случай двусторонней полисегментарной  деструктивной легионеллезной  пневмонии с формированием множественных абсцессов легких у иммунокомпетного мальчика в возрасте 15 лет.У ребенка отмечались  симптомы интоксикации с фебрильной лихорадкой, миалгии, малопродуктивный кашель, дыхательная недостаточность, притупление перкуторного звука и ослабление дыхания с обеих сторон в нижних отделах. При компьютерной томографии грудной клетки были выявлены множественные  билатеральные мультифокальные очаги уплотнения легочной ткани с деструкцией. Диагноз легионеллезной  пневмонии был поставлен на основании обнаружения антител класса IgМ к L. pneumophila с нарастанием титра в динамике и исключении других причин поражения легких. Эффективными антибактериальным препаратом оказался левофлоксацин.Таким образом, необходимо принимать во внимание способность микроорганизмов рода Legionella вызывать множественное абсцедирование легочной ткани

Clinical peculiarity of gout in South-Sakhalinsk residents

Objective. To study gout prevalence and clinical features in South-Sakhalinsk residents. Methods. Clinical picture of gout was analyzed in 120 pts (117 male and 3 female) followed up in South-Sakhalinsk city rheumatological center from 1990 till 1999. There are 7% of Koreans among the South-Sakhalinsk residents. The rest are Slavs. Results. Prevalence and some clinical features of gout depend on pts nationality. Gout prevalence among Koreans (280:100000) is 5,2 times higher than among Slavs (54:100000). All Koreans pts were male. Male/female ratio among Slavs was 26/1. Typical gouty attacks were recorded in 54% of Slavs and in 93% of Koreans. Attack duration in Slavs usually was 7-10 days and mean attack number per year 2 while in Koreans 3-5 days and 4-5 per year respectively. Tophuses were present in 3% of Koreans and in 17% of Slavs. There were also considerable differences between groups on frequency of gouty internal organs damage and concomitant diseases. Conclusion. Ethnic features of population can modify clinical course and prevalence of the disease