The course of gout in a patient with Cushing’s disease after successful surgical treatment

Endogenous  hypercortisolism  is a severe endocrine  disease characterized by prolonged  exposure to excessive amounts of glucocorticoid hormones, accompanied by a wide range of symptoms and complications, including immunosuppression. Timely surgical treatment in most cases allows to save the patient’s life, significantly improve its quality. However, restoration of the normal concentration of glucocorticoid  hormones can become a trigger factor in the development or exacerbation of autoimmune and auto-inflammatory diseases. We present a clinical case of atypical gout in a patient with hypercortisolism and a progressive increase in symptoms of the disease after successful surgical treatment for Cushing’s disease and achieving stable remission. The issues of diagnosis and treatment of this group of autoinflammatory diseases are highlighted, the leading clinical and radiological  symptoms are considered, the differential diagnosis  of microcrystalline (metabolic) arthritis is presented. Despite the widespread, the diagnosis and treatment of this group of diseases still cause difficulties for specialists. A competent choice of drug therapy allows to fully control diseases considered in the article, including when they are combined, and thereby improve the quality of life of the patient

Сочетание анкилозирующего спондилита и ревматоидного артрита: клинические наблюдения и обзор литературы

The article discusses one of the variants of overlap syndrome – a combination of symptoms of ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Three clinical cases are described, in these cases characteristic signs of both diseases were noted and the criteria of both diseases were met. The genetic factors and immunopathogenetic mechanisms underlying AS and RA are analyzed. A review of the literature on the combination of AS and RA is presented.В статье рассмотрен один из вариантов перекрестных (overlap) синдромов – сочетание симптоматики анкилозирующего спондилита (АС) и ревматоидного артрита (РА). Описаны три клинических наблюдения, в которых отмечались характерные признаки обоих заболеваний и соответствие критериям обоих диагнозов. Проанализированы генетические факторы и иммунопатогенетические механизмы, лежащие в основе АС и РА. Представлен обзор литературы, посвященной сочетанию АС и РА

Применение анакинры у пациентки с подагрой, длительно наблюдавшейся с диагнозом ревматоидного артрита

Gout is a chronic inflammatory arthropathy, caused by articular and periarticular sodium monourate (MUN) crystals deposition on the background of chronic hyperuricemia. Gout belongs to the group of autoinflammatory diseases characterized by activation of the innate immune system. In some cases, especially in women, with a long course of the disease and absence of adequate therapy, chronic arthritis is detected, which has little difference from that in rheumatoid arthritis (RA). At the same time, until recently, the combination of RA and gout was considered casuistry due to the inhibition of crystal formation by specific factors associated with RA, what is more mechanisms of inflammation development characteristic of these diseases are completely different. However, according to the latest data, the coexistence of these two diseases in one patient is possible, and the therapy of both, gout and RA (in some patients) can be successful when prescribing biological disease modifying antirheumatic drugs, in particular inhibitors of the interleukin 1 receptor (IL1r).The article presents a rare clinical case of chronic tophi gout in an elderly patient who was followed up for a long time with a diagnosis of RA, a significant improvement was achieved on therapy with the IL1r antagonist anakinra.Подагра является хронической воспалительной артропатией, которая вызвана отложением суставных и периартикулярных кристаллов моноурата натрия (МУН) в условиях хронической гиперурикемии и относится к группе аутовоспалительных заболеваний, характеризующихся активацией врожденного звена иммунитета. В ряде случаев, особенно у женщин, при длительном течении заболевания и отсутствии адекватной терапии выявляется хронический артрит, мало отличимый от такового при ревматоидном артрите (РА). При этом до недавнего времени сочетание РА и подагры считалось казуистикой ввиду ингибирования кристаллообразования специфическими факторами, ассоциированными с РА, а механизмы развития воспаления, свойственные этим заболеваниям, – абсолютно различными. Однако, по последним данным, возможно сосуществования этих двух заболеваний у одного пациента, а терапия как подагры, так и РА (у части пациентов) может быть успешной при назначении генно-инженерных биологических препаратов, в частности ингибиторов рецептора интерлейкина 1 (ИЛ1р).В статье представлен редкий клинический случай хронической тофусной подагры у пожилой пациентки, длительно наблюдавшейся с диагнозом РА, у которой достигнуто значимое улучшение при терапии антагонистом ИЛ1р анакинрой

Measurement of the cross-section and charge asymmetry of WW bosons produced in proton-proton collisions at s=8\sqrt{s}=8 TeV with the ATLAS detector

This paper presents measurements of the $W^+ \rightarrow \mu^+\nu$ and $W^- \rightarrow \mu^-\nu$ cross-sections and the associated charge asymmetry as a function of the absolute pseudorapidity of the decay muon. The data were collected in proton--proton collisions at a centre-of-mass energy of 8 TeV with the ATLAS experiment at the LHC and correspond to a total integrated luminosity of 20.2~\mbox{fb^{-1}}. The precision of the cross-section measurements varies between 0.8% to 1.5% as a function of the pseudorapidity, excluding the 1.9% uncertainty on the integrated luminosity. The charge asymmetry is measured with an uncertainty between 0.002 and 0.003. The results are compared with predictions based on next-to-next-to-leading-order calculations with various parton distribution functions and have the sensitivity to discriminate between them.Comment: 38 pages in total, author list starting page 22, 5 figures, 4 tables, submitted to EPJC. All figures including auxiliary figures are available at https://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/STDM-2017-13

Search for squarks and gluinos in events with isolated leptons, jets and missing transverse momentum at s√=8 TeV with the ATLAS detector

The results of a search for supersymmetry in final states containing at least one isolated lepton (electron or muon), jets and large missing transverse momentum with the ATLAS detector at the Large Hadron Collider are reported. The search is based on proton-proton collision data at a centre-of-mass energy s√=8 TeV collected in 2012, corresponding to an integrated luminosity of 20 fb−1. No significant excess above the Standard Model expectation is observed. Limits are set on supersymmetric particle masses for various supersymmetric models. Depending on the model, the search excludes gluino masses up to 1.32 TeV and squark masses up to 840 GeV. Limits are also set on the parameters of a minimal universal extra dimension model, excluding a compactification radius of 1/R c = 950 GeV for a cut-off scale times radius (ΛR c) of approximately 30

Evidence for the Higgs-boson Yukawa coupling to tau leptons with the ATLAS detector

Results of a search for H → τ τ decays are presented, based on the full set of proton-proton collision data recorded by the ATLAS experiment at the LHC during 2011 and 2012. The data correspond to integrated luminosities of 4.5 fb−1 and 20.3 fb−1 at centre-of-mass energies of √s = 7 TeV and √s = 8 TeV respectively. All combinations of leptonic (τ → `νν¯ with ` = e, µ) and hadronic (τ → hadrons ν) tau decays are considered. An excess of events over the expected background from other Standard Model processes is found with an observed (expected) significance of 4.5 (3.4) standard deviations. This excess provides evidence for the direct coupling of the recently discovered Higgs boson to fermions. The measured signal strength, normalised to the Standard Model expectation, of µ = 1.43 +0.43 −0.37 is consistent with the predicted Yukawa coupling strength in the Standard Model

Search for chargino-neutralino production with mass splittings near the electroweak scale in three-lepton final states in √s=13 TeV pp collisions with the ATLAS detector

A search for supersymmetry through the pair production of electroweakinos with mass splittings near the electroweak scale and decaying via on-shell W and Z bosons is presented for a three-lepton final state. The analyzed proton-proton collision data taken at a center-of-mass energy of √s=13  TeV were collected between 2015 and 2018 by the ATLAS experiment at the Large Hadron Collider, corresponding to an integrated luminosity of 139  fb−1. A search, emulating the recursive jigsaw reconstruction technique with easily reproducible laboratory-frame variables, is performed. The two excesses observed in the 2015–2016 data recursive jigsaw analysis in the low-mass three-lepton phase space are reproduced. Results with the full data set are in agreement with the Standard Model expectations. They are interpreted to set exclusion limits at the 95% confidence level on simplified models of chargino-neutralino pair production for masses up to 345 GeV

Search for direct stau production in events with two hadronic tau-leptons in root s=13 TeV pp collisions with the ATLAS detector

A search for the direct production of the supersymmetric partners ofτ-leptons (staus) in final stateswith two hadronically decayingτ-leptons is presented. The analysis uses a dataset of pp collisions corresponding to an integrated luminosity of139fb−1, recorded with the ATLAS detector at the LargeHadron Collider at a center-of-mass energy of 13 TeV. No significant deviation from the expected StandardModel background is observed. Limits are derived in scenarios of direct production of stau pairs with eachstau decaying into the stable lightest neutralino and oneτ-lepton in simplified models where the two staumass eigenstates are degenerate. Stau masses from 120 GeV to 390 GeV are excluded at 95% confidencelevel for a massless lightest neutralino

Search for new phenomena in final states with an energetic jet and large missing transverse momentum in pp collisions at √ s = 8 TeV with the ATLAS detector

Results of a search for new phenomena in final states with an energetic jet and large missing transverse momentum are reported. The search uses 20.3 fb−1 of √ s = 8 TeV data collected in 2012 with the ATLAS detector at the LHC. Events are required to have at least one jet with pT > 120 GeV and no leptons. Nine signal regions are considered with increasing missing transverse momentum requirements between Emiss T > 150 GeV and Emiss T > 700 GeV. Good agreement is observed between the number of events in data and Standard Model expectations. The results are translated into exclusion limits on models with either large extra spatial dimensions, pair production of weakly interacting dark matter candidates, or production of very light gravitinos in a gauge-mediated supersymmetric model. In addition, limits on the production of an invisibly decaying Higgs-like boson leading to similar topologies in the final state are presente

Влияние терапии колхицином, метотрексатом и гидроксихлорохином на сердечно-сосудистые исходы у пациентов с болезнью депонирования кристаллов пирофосфата кальция

Anti-inflammatory therapy, such as colchicine (COL), has been suggested to affect the incidence of cardiovascular events in patients with calcium pyrophosphate crystal deposition disease (CPPD).Objective: to study the effect of anti-inflammatory therapy with COL, hydroxychloroquine (HC), and methotrexate (MT) on cardiovascular outcomes in patients with CPPD.Patients and methods. The study included 305 patients with CPPD, the majority (62.30%) were women. The average follow-up period was 3.9±2.7 years. Among factors influencing cardiovascular outcome were considered: gender; age; smoking; alcohol intake >20 conventional doses per week; arterial hypertension; a history of cardiovascular diseases (CVD), in particular ischemic heart disease, acute myocardial infarction, acute cerebrovascular accident, chronic heart failure >III stage according to NYHA, as well as type 2 diabetes mellitus (DM); body mass index >25 kg/m2 and >30 kg/m2; cholesterol level (CHOL) >5.1 mmol/l; glomerular filtration rate (GFR) < 60 ml/min/1.73 m2; serum uric acid level >360 μmol/l; hypercalcemia (serum calcium level >2.62 mmol/L); CRP level >2 mg/l; the presence of hyperparathyroidism (parathyroid hormone level >65 pg/ml); CPPD phenotypes (asymptomatic, osteoarthritis with calcium pyrophosphate crystals, chronic arthritis, acute arthritis); intake of COL, HC, MT, glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs).Results and discussion. 264 patients were under dynamic observation. Any of the studied cardiovascular events were registered in 79 (29.9%) patients. During the observation period, 46 (17.4%) patients died, in 76.1% of cases the cause of death was CVD. Death from other causes was diagnosed in 11 (23.9%) patients. Non-fatal cardiovascular events were reported in 44 (16.7%) cases. The risk of cardiovascular events was higher in patients over 65 years of age (odds ratio, OR 5.97; 95% confidence interval, CI 3.33–10.71), with serum cholesterol levels ≥5.1 mmol/L (OR 1,95; 95% CI 1.04–3.65), GFR <60 ml/min/1.73 m2 (OR 2.78; 95% CI 1.32–5.56), history of CVD (OR 2,32; 95% CI 1.22–4.44). COL therapy reduced the risk of cardiovascular events (OR 0.20; 95% CI 0.11–0.39).Conclusion. Poor CVD outcomes in CPPD are associated with age, hypercholesterolemia, chronic kidney disease, and a history of CVD. The use of COL, in contrast to MT and HC, was accompanied by a decrease in cardiovascular risk.Предполагается, что противовоспалительная терапия, в частности прием колхицина (КОЛХ), влияет на частоту сердечно-сосудистых событий у пациентов с болезнью депонирования кристаллов пирофосфата кальция (БДПК).Цель исследования – изучить влияние противовоспалительной терапии колхицином (КОЛХ), гидроксихлорохином (ГКХ) и метотрексатом (МТ) на сердечно-сосудистые исходы у пациентов с БДПК.Пациенты и методы. В исследование включено 305 пациентов с БДПК, большинство (62,30%) из которых составляли женщины.Средний период наблюдения – 3,9±2,7 года. Были рассмотрены факторы, влияющие на сердечно-сосудистый исход: пол; возраст; курение; прием алкоголя >20 условных доз в неделю; артериальная гипертензия; наличие в анамнезе сердечно-сосудистых заболеваний (ССЗ), в частности ишемической болезни сердца, острого инфаркта миокарда, острой недостаточности мозгового кровообращения, хронической сердечной недостаточности >III стадии по NYHA, а также сахарного диабета (СД) 2-го типа; индекс массы тела >25 кг/м2 и >30 кг/м2; уровень холестерина (ХС) >5,1 ммоль/л; скорость клубочковой фильтрации (СКФ) <60 мл/мин/1,73 м2; уровень мочевой кислоты сыворотки крови >360 мкмоль/л; гиперкальциемия (уровень кальция сыворотки >2,62 ммоль/л); уровень СРБ >2 мг/л; наличие гиперпаратиреоза (уровень паратгормона >65 пг/мл); фенотипы БДПК (бессимптомный, остеоартрит с кристаллами пирофосфата кальция, хронический артрит, острый артрит); прием КОЛХ, ГКХ, МТ, глюкокортикоидов и нестероидных противовоспалительных препаратов (НПВП).Результаты и обсуждение. Под динамическим наблюдением находились 264 пациента. Любые из исследуемых сердечно-сосудистых событий были зарегистрированы у 79 (29,9%) пациентов. За время наблюдения умерли 46 (17,4%) пациентов, в 76,1% случаев причиной смерти были ССЗ. Смерть по другим причинам констатирована у 11 (23,9%) пациентов. Нефатальные сердечно-сосудистые события отмечены в 44 (16,7%) случаях. Риск сердечно-сосудистых событий был выше у пациентов старше 65 лет (отношение шансов, ОШ 5,97; 95% доверительный интервал, ДИ 3,33–10,71) с сывороточным уровнем ХС ≥5,1 ммоль/л (ОШ 1,95; 95% ДИ 1,04–3,65), СКФ <60 мл/мин/1,73 м2 (ОШ 2,78; 95% ДИ 1,32–5,56), наличием ССЗ в анамнезе (ОШ 2,32; 95% ДИ 1,22–4,44). Терапия КОЛХ снижала риск сердечно-сосудистых событий (ОШ 0,20; 95% ДИ 0,11–0,39).Заключение. Неблагоприятные исходы ССЗ при БДПК ассоциируются с возрастом, гиперхолистеринемией, хронической болезнью почек, а также с наличием ССЗ в анамнезе. Применение КОЛХ, в отличие от МТ и ГКХ, сопровождалось снижением сердечно-сосудистого риска