Peripheral neuropathy in inflammatory joint diseases

Background: For frequent extra-articular (systemic) manifestations of joints inflammatory diseases are various damage of the nervous system,2 and the presence and severity of peripheral neuropathy (PNP) have significance in the clinical course, which incidence among these patients is 5%–10%.1 Nevertheless, many clinical and pathogenic aspects of this peripheral neuropathy (PNP) remain obscure. Objectives: to evaluate the rate and clinical features of PNP in rheumatoid arthritis (RA), chlamydia urogenital reactive arthritis (ReA), psoriatic arthritis (PA) and ankylosing spondylitis (AS), to examine the issues of pathogenetic constructions such changes of the nervous system, define risk factors. Methods: The study included 416 patients with inflammatory joint diseases, among them 131 RA patients, 101 ReA, 76 PA and 108 AS. The average age of the examined was respectively 45, 32, 42 and 38 years, disease duration – 10, 4, 12 and 11 years, male to female ratio – 1:5, 1:1, 1:2 and 10:1

ASSOCIATION OF ADSORPTION-RHEOLOGICAL PROPERTIES OF URINE IN GLOMERULONEPHRITIS WITH MORPHOLOGICAL CHANGES OF RENAL STRUCTURES IN PATIENTS WITH HEMORRHAGIC VASCULITIS

The aim of the work: to assess adsorption-rheological state of urine in patients with hemorrhagic vasculitis (HV) with glomerulonephritis (GN), comparing the indicators with the nature of the morphological changes of the glomeruli, tubules, interstitium and vessels of the kidneys. Materials and methods. Microscopy of nephrobiopsy specimens was performed in 21 patients with HVwith GN, urinary syndrome and preserved renal function. Using computer tensiometers “MPT2-Lauda”, “ADSA-Toronto” and “PAT2-Sinterface” indicators of surface viscosity, surface elasticity, module of viscoelasticity, relaxation time (RT), dynamic surface tension (ST) of urine, inclination angle and phasic angle (FA) of tensiongrams were studied. Results and discussion. GN in HV is accompanied by a significant increase in (11%) the equilibrium ST of urine in 57% of patients on the background of decrease (21%) of FA. Adsorption-rheological condition of urine depends on the sex ofpatients and blood pressure level, the relative density of this biological fluid (RT, FA), its content ofprotein and non-protein nitrogen products, glomerular filtration rate and morphological class of GN (ST). The severity of the some renal structures lesion, the level of immune deposits in the mesangium, endothelium of glomerular capillary and podocytes, the degree of plasmatic impregnation arterioles and vascular endothelial proliferation significantly affect the integrated physical and chemical properties of urine. Prognostic significance in relation to the severity of morphological changes in the kidneys has an indicator of ST. Conclusions. Assessment of adsorption- rheological properties of urine is a diagnostic method of GN in HV, and variations of such physic-chemical parameters are determined by morphological class and the clinical course of renal pathology, correlated with the severity of glomerular, tubular, interstitium and vessels lesio

Types of Angiopathy in Experimental Autoimmune Disease in Rats

The purpose and objectives of this work were to study the nature of the heart, lungs and kidneys angiopathy in rats with a model of systemic autoimmune disease, carrying out comparisons of the results with extravasal morphological manifestations of the pathological process, the state of vascular endothelial function and activity of pro-inflammatory cytokines in the blood. The experiment was conducted on 40 non-linear rats. To simulate the disease animals were injected by complete Freund's adjuvant, a solution of splenic deoxyribonucleic acid cattle, mercaptopurine, methyluracilum and with food rats constantly received sulfate cadmium, lithium hydroxybutyrate and ammonium molybdate. Within two months from the start of the study animals were taken out of the experiment on the background of intraperitoneal nembutal anesthesia. Histological sections of the heart, lung and kidney tissue were stained with hematoxylin -eosin, alcian blue and by van-Gieson, becoming the PAS-reaction. In the animals with the proposed experimental model of systemic autoimmune disease observed morphological characteristics of lesions of the heart blood vessels, lungs and kidneys, the nature of the manifestations of which were interconnected with each other, which confirms the common pathogenetic angiopathy constructions at various diseases in clinical practice. In the genesis of cardiac, pulmonary and renal vessels lesions act the activation of pro-inflammatory cytokines and violation of vascular endothelial function, which has a certain practical significance. In clinical practice, not only purely systemic vasculitis, and other autoimmune diseases should be treated as angiopathy

Morphological heart changes in animals with experimental systemic lupus erythematosus

Background: Heart pathology in systemic lupus erythematosus (SLE) refers to the most common manifestations of the disease and largely determines its prognosis..1 2 The pathogenetic constructions of myocardium, endocardium and coronary vessel lesions remain insufficiently studied..3 4 Histological evaluation of separate cardiac structures is performed on native models of SLE in linear mice. Objectives: to study in the experiment on animals (rats) with SLE model the degree of cardiomyocytes, myocardium, endocardium, valves and cardiac vessel damage, comparing the results with thymus and spleen tissues histological data. Methods: The SLE modelling was performed in 53 white non-breeding rats (34 females and 19 males) using full Freund’s adjuvant, splenic deoxyribonucleic acid of cattle, cyclophosphamide, azid and sodium deoxyribonucleate. Cadmium sulfate, lithium oxybutyrate and ammonium molybdate were added for feeding animals. Histological heart specimen were stained with hematoxylin and eosin, altsyon blue (pH=2.6), van Gieson. PAS-reaction was applied

Характер эндотелиальной дисфункции при анкилозирующем спондилите

In this research we evaluated the nature of endothelial dysfunction and vascular adsorption-rheological properties of serum in patients with ankylosing spondylitis, determined its characteristics in the presence of angiopathy and established communication with the clinical and instrumental parameters of vascular disease and the state of immunity. The study included 79 patients aged 15 to 66 years, among whom there were 95% of men and 5% of women. Endothelial vessels dysfunction occurs in each second patient with ankylosing spondylitis, which in the presence of clinical and instrumental vascular pathology accompanied by an increase in serum concentration of cyclic guanosine monophosphate and even greater reduction in prostacyclinemia parameters. The severity of disorders of vascular endothelial function in these patients is associated with disease duration, activity of the pathological process, the lesion of the peripheral nervous system, the severity of spondylopathies and sacroiliitis. В работе проведена оценка характера эндотелиальной дисфункции сосудов и адсорбционнореологических свойств крови у больных анкилозирующим спондилитом, определены ее особенности при наличии ангиопатии, установлена связь с клинико-инструментальными показателями сосудистой патологии и состоянием иммунитета. Под наблюдением находились 79 больных в возрасте от 15 до 66 лет, среди которых были 95% мужчин и 5% женщин. Эндотелиальная дисфункция сосудов развивается у каждого второго больного анкилозирующим спондилитом, которая при наличии клинико-инструментальной сосудистой патологии сопровождается нарастанием в крови концентрации циклического гуанозинмонофосфата и еще большим уменьшением параметров простациклинемии. Степень выраженности нарушений эндотелиальной функции сосудов у таких больных связана с длительностью заболевания, активностью патологического процесса, поражением периферической нервной системы, выраженностью спондилопатии и сакроилеита

Characteristics of articular syndrome in systemic vasculitis

The purpose of the study – investigation the separate joint lesion in systemic vasculitis, their X-ray sonographic characteristics, the correlation of the articular syndrome severity with extra-articular manifestations of the diseases, as well as aspects of the arthritis pathogenesis in this category of patients. The study included 525 patients in the ratio of the examined with Henoch-Schonlen purpura, microscopic polyangiitis, cryoglobulinemic vasculitis, polyarteritis nodosa, Takayasu’s arteritis, Wegener’s granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis Churg-Strauss as a 7:4:3:1:1:1:1. Joint’s damage in the form of arthritis or arthralgia observed in 32-67% different groups of patients, that depending on the disease duration, the degree of the pathological process’s activity, extraarticular signs severity, lung parenchyma involving and hemodynamic status in the pulmonary circulation. The frequency of the certain bone lesions, existence of tenosynovitis and enthesopathies, X-ray sonographic signs of articular syndrome in different kind of vasculitis has its own gender dimorphism. The immune system malfunction, the rheological properties of blood and endothelial function of vessels collaborate in pathogenetic constructions of arthropathy. What is more, the high value of rheumatoid factor in blood associates with severe course of joint damage. Joint syndrome at different variants of systemic vasculitis is progressing in 1/3-2/3 of cases, this syndrome has definite features of clinical course and pathogenesis

Эффективность и пути оптимизации эндоваскулярной лазерной коагуляции при варикозном расширении вен нижних конечностей

The purpose of the work is to assess the efficiency of endovascular laser coagulation (EVLC) of varicose vein disease of lower limb and to define the ways of optimization of such treatment. Material and methods. Out of 263 patients isolated EVLC was performed in 33.8% of the cases, with crossectomy and chemical sclerotherapy by sclerovein or fibro-vein – in 8.0%, with sclerotherapy without crossectomy – in 58.2%. EVLC was carried out by means of the device “Fotonika-Lika-Surgeon” (Ukraine). Results. In a month, a considerable improvement was noted in 39.9% of patients after EVLC, and later in a half a year – at 93.9%, at the same time the risk factors of the lower efficiency of the operation were the male and advanced age of the patients, high arterial blood pressure, the narrowing of the femoral arteries and the presence of comorbide gonarthrosis, within the first 4 weeks from the time of the operation the results of the treatment were closely connected with the changes of initial superficial adsorptive and rheological viscose properties of venous blood, whereas later on they depend on the condition of endothelial function of the vessels (the indicators of superficial viscosity, thromboxane-A2 and prostacyclin can have the predictive value), and the best effect is reached after holding of sclerotherapy conjoint with EVLC and the prescription of rivaroxaban within the first two weeks, besides, low-molecular heparins and cyclo-3-fort.Цель работы – оценить эффективность эндоваскулярной лазерной коагуляции (ЭВЛК) при варикозном расширении вен нижних конечностей и определить пути оптимизации такого лечения. Материал и методы. Среди 263 больных изолированная ЭВЛК выполнена в 33,8% случаев, с кроссэктомией и химической склеротерапией склеровейном или фибровейном – в 8,0%, со склеротерапией без кроссэктомии – в 58,2%. ЭВЛК осуществляли с помощью аппарата ≪Фотоніка-Ліка-Хірург≫ (Украина). Результаты. Значительное улучшение через месяц после ЭВЛК отмечено в 39,9% случаев, а спустя полгода – в 93,9%, при этом факторами риска более низкой эффективности операции являлись мужской пол и пожилой возраст больных, высокое артериальное давление, сужение бедренных артерий и наличие коморбидного гонартроза, причем в течение первых 4 недель от времени оперативного вмешательства результаты лечения были тесно связаны с изменени- ями исходных поверхностных адсорбционно-реологических вязких свойств венозной крови, тогда как в последующем зависели от состояния эндотелиальной функции сосудов (показате- ли поверхностной вязкости, тромбоксана-А2 и простациклина могут обладать прогностичес- кой значимостью), а наилучший эффект достигался после проведения совместной с ЭВЛК склеротерапии и применения ривароксабана, в течение первых двух недель – низкомолекулярных гепаринов и цикло-3-форта

Metals, included in the prosthetic knee joints, in the patients’ body with gonarthrosis

The purpose of the research – to determine blood and hair levels of metals included in the composition of prosthetic knee joints in patients with gonarthrosis, to evaluate the clinical and pathogenetic significance of this microelementosis in different variants of disease course. Materials and methods. Were examined 87 patients with gonarthrosis (45% men and 55% women with an average age of 53 years). Atomic absorption spectrometer "SolAAr-Mk2-MOZe" with electrographite atomizer (UK) were used to study the existence of metals in the organism. Results. Microelementhosis in blood of patients with gonarthrosis observed in 41% of cases, while in the hair - 23%, which is accompanied by increased levels of Ti and V in serum on the background of reducing the concentration of Fe, and the hair changes of metals are related to the increasing content of Al, Fe and Ti with decreasing parameters of Co, Cr and Mo. It depends on the radiographic stage of the disease, the presence of synovitis, the prevalence and severity of articular syndrome, involving in the pathogenesis of meniscus lesions, bursitis, trabecular oedema in the patella, forming osteophytes, osteocytes and intraarticular Shtydy bodies, which is correlated with osteoporosis. Conclusions. Gonarthrosis courses with changing levels of metals in blood and hair (Al, Co, Cr, Fe, Mo, Ti, V) contained in the prosthetic knee joints, which depends on the clinical course of the disease, determines the pathogenetic compositions of articular degenerative inflammatory lesions

Transformations of organ lesions in hemorrhagic vasculitis

Background. Hemorrhagic vasculitis or Henoch-Schönlein purpura (HSP) is the most common variant of systemic vasculitis in childhood, and peculiarities of the further transformation of the pathological process in adult patients remain unexplored. Objective. To explore the transformation of juvenile HSP, comparing the nature of skin lesions, joints and kidneys of patients in childhood and adulthood. Material and methods. The study included 92 patients (61 men and 31 women on the average age of 27 years, and at the onset of the disease in 11 years). I degree of the activity of the pathological process is determined in 40% of cases, II - in 35%, III – in 25%. Seropositivity by hyperimmunoglobulinemia A occurred in 27% of cases, by the presence of rheumatoid factor – in 21%. At the time of the survey cutaneous syndrome was diagnosed in 55% of patients, the joint – in 45%, kidney – in 71%. There were performed renal biopsy in 15 cases. Results. The cutaneous, joint-cutaneous-abdominal and cutaneous -abdominallyrenal forms of the disease, lesions of the skin, gastrointestinal tract, wrist, ankle and knee joints become more rarely in the course of evolution of juvenile HSP, but exceptionally renal variant of the pathological process, the change of skeletal muscle, liver, spleen are revealed more often. Chronic kidney disease with the kidney failure progression is developed in 12% of patients (in 17% of cases of nephropathy). Sacroiliitis, spondylopathy, tendovaginitis, enthesopathies, epiphyseal osteoporosis, meniscitis of knee joints are arisen. II, III, VI and IV morphological classes of Henoch glomerulonephritis are formed in a ratio of 8:4:2:1 with tubulointerstitial component in all cases. And lymphohistiocytic infiltration of the vascular wall is the unfavorable sign for the prognosis of the disease. Conclusions: In cases of transfer of juvenile HSP in chronic adult form disease often obtain progressive course as regards, first of all, the pathology of the joints and kidneys

Disturbance of the muscoloskeletal system in juvenile ankylosing spondylitis and disease developed in the adulthood (involvement of spine and sacroiliac joints).

Background. Two forms of ankylosing spondylitis (AS) are distinguished: juvenile and adult, depending on debut age of the disease. The diagnosis of juvenile AS (JAS) is one of the most urgent problems in a pediatric rheumatology. The peculiarities of AS course that onsets in childhood and adulthood are manifested by differences in the nature of a spinal column disturbance. At the same time, the evolution of JAS in adulthood remains unexplored. The goals and objectives of research: to study clinical and X-ray symptoms of spondylopathy and sacroiliitis course, to assess their characteristics in the disease that onset in childhood and adulthood. Material and methods. 217 patients with AS (193 men and 24 women) with an average age of 38 years were examined. The fast-progressing course of the disease was detected in 21% of cases, moderate and high degree of activity – in 79% of cases, the ІІ-ІІІ stage in 82%, and polyarthritis – in 65%. JAS was detected in 16% of cases (all boys), among them the third stage occurred twice more likely than among the other patients. Results. The clinical and radiologic signs of spondylopathy and sacroiliitis are observed in 95% and 97% of the total number of AS cases, respectively, among all patients with JAS lumbago was detected 4,3 times more frequently, sciatic muscles hypotrophy – 7,8 times, "the string symptom" - 2,9 times", the calcification of the spinal cord - 2,3 times, whereas the prevalence of spinal column injury, the severity of cervico-spondylopathy and sacroiliitis among patients with the disease debut in the adulthood is significantly greater, and the involvement in the process of the lumbar and thoracic spine are detected correspondingly twice as often and by 19%, occurrence of dorsalgia is 4 times as often, the limitation of body lateral bendover by 59%, while there are ambiguous dispersion-correlation links with extraarticular (systemic) manifestations of the disease, and the high prevalence of a peripheral articular syndrome regarding spondylopathy in JAS is a negative prognosis sign, and for the remaining patients there are indices of the Lansbury index and the index of arthro­pathy progression. Conclusion: the onset of AS in adulthood is a risk factor for the severe course of spondylopathy