Background. EULAR experts include osteoscintigraphy of joints in the list of promising methods for the diagnosis of joint diseases. However, the method remains little used in rheumatology in our country.Aim of the study – to develop an algorithm for differential diagnosis for the most common arthropathies based on quantitative osteoscintigraphy.Materials and methods. 3 hours after the injection of pyrophosphate labeled with Tc-99m, scintigraphy of skeletal bones was performed according to the “whole body” program. The joint/adjacent bone uptake ratio was calculated. The CHAID algorithm was used for classification tree constructing.Results. The study included 266 patients aged 46.6±14.3 years, 134 men (50.4%). Axial spondyloarthritis (including ankylosing spondylitis) was diagnosed in 40 patients, peripheral spondyloarthritis (including reactive arthritis) – in 87, rheumatoid arthritis– in 45, osteoarthritis – in 68, psoriatic arthritis – in 26 people. A total of 2279 joints were included in the analysis. A classification tree algorithm for differential diagnosis of arthropathies was constructed. Key indicators for identifying subgroups in the algorithm were the intensity of radiopharmaceutical uptake in the wrist, knee and hip joints. The significance level of differences between the resulting groups at all points of the algorithm branching, taking into account the Bonferroni adjustment, was p=0.001 or less. In the training sample, 51.5% of the observations were correctly classified. According to results of the cross-validation, the expected rate of correct classifications in the actual application of the algorithm is 38.0%.Conclusions. An algorithm for differential diagnosis of the most common inflammatory diseases of the joints has been developed. It allows the use of quantitative osteoscintigraphy data in the diagnosis of arthritis.
In the present article, the authors provide detailed material on the 13-year observation of a patient with such a rare disease as Whipple’s disease. Pathophysiological aspects, in particular changes in immunity within the framework of this nosology, clinical picture are also described in detail, and the emphasis is placed on the interrelation of certain symptoms, their intensification and regression. Taking into account the absence of clear recommendations for the management of such patients, the article considers various options of therapeutic schemes, and also reflects the own results of treatment.
Результаты исследований последних лет позволяют говорить о наличии пандемии дефицита витамина D, обусловленной преимущественно недостаточной инсоляцией. Данные эпидемиологических исследований дают основания считать, что недостаточность витамина D, соответствующая уровню кальцидиола в крови менее 75 нмоль/л (30 нг/мл), сопровождается неблагоприятными последствиями для здоровья человека в виде возрастания риска сердечно-сосудистых осложнений, злокачественных новообразований, аутоиммунных и инфекционных заболеваний. Указанные риски возрастают с усугублением дефицита. Лица с экстремально выраженной недостаточностью витамина D — уровень кальцидиола менее 25 нмоль/л (менее 10 нг/мл) могут демонстрировать такие характерные проявления, как остеомаляция/рахит, распространенная мышечная боль, миодистрофия. В этой группе, по-видимому, имеет место и повышенный риск развития остеопороза. Доказано профилактическое действие восполнения дефицита витамина D в отношении снижения риска переломов, предупреждения злокачественных новообразований и некоторых инфекционных заболеваний. Вероятна также эффективность витаминопрофилактики в отношении сердечно-сосудистых, аутоиммунных заболеваний, сахарного диабета 1-го и 2-го типа. Ввиду нетоксичности витамина D в широком диапазоне доз оправдано его профилактическое назначение в самых разнообразных популяциях. Ключевые слова : витамин D, неклассические эффекты кальцитриола, профилактика
Results of recent studies give evidence of a pandemic of vitamin D deficiency due largely to insufficient exposure to sunlight. Epidemiological surveys demonstrated that vitamin B deficiency corresponding to blood calcidiol levels below 75 nmol/l or 30 ng/ml has negative effect on human health, increases the risk of cardiovascular disorders, malignant neoplasm, autoimmune and infectious diseases in proportion to the severity of deficit. Patients with extreme deficiency (calcidiol levels below 25 nmol/l or 10 ng/ ml) suffer osteomalation/rickets, diffuse muscular pain, myodystrophy, and enhanced risk of osteoporosis. Vitamin D replenishment reduces the risk of bone fracture, neoplastic growth, diabetes of both types, infectious, cardiovascular and autoimmune diseases. Being devoid of toxicity, vitamin D may be prescribed in a wide range of doses to patients from a variety of populations.
The authors describe a case of Whipple's disease (WD) in a 56-year-old male patient followed up for 2 years. The diagnosis was established on the evidence that there was a low-density retroperitoneal or mesenteric infiltrate at computed tomography and PAS-positive macrophages in the biopsy specimens of the duodenal retrobulbar mucosa. Arthropathy had developed within 10 years before the occurrence of intestinal symptoms, subsided with their progression, and recurred after their regression. On the basis of this observation and the data available in the literature, the authors discuss the relationships of arthropathy to the abdominal manifestations of WD.
The authors describe a case of Whipple's disease (WD) in a 56-year-old male patient followed up for 2 years. The diagnosis was established on the evidence that there was a low-density retroperitoneal or mesenteric infiltrate at computed tomography and PAS-positive macrophages in the biopsy specimens of the duodenal retrobulbar mucosa. Arthropathy had developed within 10 years before the occurrence of intestinal symptoms, subsided with their progression, and recurred after their regression. On the basis of this observation and the data available in the literature, the authors discuss the relationships of arthropathy to the abdominal manifestations of WD.
