Rheumatoid and other inflammatory arthritis (ankylosing spondylitis and psoriatic arthritis) have a high risk of cardiovascular disease (CVD). It is caused by the accelerated development of atherosclerosis associated with a chronic systemic inflammatory process. Nevertheless, traditional CVD risk factors (hypertension, smoking, dyslipidemia) are also important for patients with inflammatory arthritis. The greatest amount of data has been accumulated regarding the relationship between CVD and rheumatoid arthritis. Due to the difficulties in diagnosing coronary heart disease and other CVD, it is of great importance to identify patients at high and very high risk. The use of scales for assessing the total cardiovascular risk SCORE/SCORE 2 with a coefficient of 1.5 allows to identify patients who need measures to reduce their high risk of CVD. Control of the of the disease activity, lifestyle modification, therapy with statins and antihypertensive drugs in accordance with current guidelines, caution when prescribing non-steroidal anti-inflammatory drugs and minimizing the dose of glucocorticoids are the main components of the strategy for reducing the risk of CVD in patients with inflammatory arthritis.

Pain syndrome in the shoulder occurs in every 5th adult and is the 2nd most frequent reason for seeking primary medical care among all musculoskeletal disorders. Group of local causes of pain syndrome in the shoulder area. The starting point for differential search is patient’s age. For persons younger than 40, the most common causes are joint instability (dislocations / subluxations), as well as mild damage of the rotator cuff muscles due to injury. Patients older than 40 have an increased risk of severe chronic disorders of the above-mentioned muscles, adhesive capsulitis, and osteoarthritis of the shoulder joint. Treatment of shoulder joint and soft tissue pathology is nosological in nature and has to be justified by pathogenesis. Chondroreparants are a new class of pharmaceuticals based on hyaluronic acid modified by low molecular weight compounds using solid-phase stabilization. During physical stabilization (mechanosynthesis) of hyaluronic acid, chemical crosslinkers are not used, which leads to high tolerability and safety. Modified hyaluronic acid in Hyalrepair formulas has a number of structural features leading to its slower biodegradation in the tissues. Chondroreparant Hyalrepair-10 consists of hyaluronic acid, ascorbyl phosphate, zinc, cysteine, and glutathione; Hyalrepair- 2 consists of hyaluronic acid, ascorbyl phosphate, L-proline, L-lysine, and glycine. Use of intra-joint and periarticular injection of hyaluronic acid can be an effective approach in combination pathogenesis-directed therapy of the shoulder and soft tissues.

Back pain (BP), associated with the degenerative disc disease (DDD), poses a heavy social and economic burden due to early disability and indications to surgery, emerging in young adults. Pathophysiological basis of premature intervertebral disc (IVD) degeneration is being actively studied. The study was aimed to define the profiles of inflammatory cytokines in DDD, as well as their relationship to the structural spine diseases. The molecular genetic analysis of the mRNA gene abundance in patients with BP and herniated IVD after discectomy and healthy individuals was performed by the quantitative polymerase chain reaction method. High expression of TNFα, IL17 was revealed in the IVD tissues of the affected patients (p < 0.01); the levels of TNFα and IL1β correlated with the DDD severity (r = 0.301 and 0.37; p < 0.05). Elevated expression of IL1β, IL6 was found in peripheral white blood cells (p < 0.01); the levels of IL6 negatively correlated with Modic type 1 and 2 changes (r = –0.31; p < 0.05), and the levels of IL17 positively correlated with the IVD herniation in combination with erosions of the adjacent vertebral body endplates and Modic changes (r = 0.401; p < 0.05). The expression of VEGF-А in the IVD tissues and white blood cells negatively correlated with the DDD grades (r = –0.85; p < 0.001), indicating reduced vascularization in the terminal phase of the disease. The findings on DDD demonstrate the contribution of the local low-immune inflammation, coupled with the intense disc vascularization at the earlier stages, and associated with the reactive inflammation in vertebral bodies. The results are prerequisites for developing the anti-inflammatory and reparative therapy based on the DDD grade and the presence of Modic changes in young adults with BP.

Bol' v spine (BS), associirovannaya s degenerativnoj bolezn'yu diska (DBD), — tyazheloe social'noe i ekonomicheskoe bremya vsledstvie rannej invalidizacii i vozniknoveniya pokazanij k operativnomu vmeshatel'stvu uzhe v molodom vozraste. Patofiziologicheskie osnovy prezhdevremennoj degeneracii mezhpozvonkovogo diska (MPD) nahodyatsya na stadii aktivnogo izucheniya. Cel'yu issledovaniya bylo opredelit' profil' vospalitel'nyh citokinov pri DBD i ih svyaz' so strukturnymi narusheniyami v pozvonochnike. U pacientov molodogo vozrasta s BS i gryzhej MPD, podvergshihsya diskektomii, i u zdorovyh lic provodili molekulyarno-geneticheskij analiz predstavlennosti genov mRNK metodom kolichestvennoj polimeraznoj cepnoj reakcii. U bol'nyh v tkani MPD vyyavlen vysokij uroven' ekspressii TNFα, IL17 (p < 0,01); urovni TNFα i IL1β korrelirovali s tyazhest'yu DBD (r = 0,301 i 0,37; p < 0,05). V lejkocitah perifericheskoj krovi obnaruzhena povyshennaya ekspressiya IL1β, IL6 (p < 0,01); uroven' IL6 otricatel'no korreliroval s I i II stadiyami Modic-izmenenij (r = –0,31; p < 0,05), IL17 pryamo korreliroval s gryzhej MPD v sochetanii s eroziej zamykatel'nyh plastin i Modic (r = 0,401; p < 0,05). Ekspressiya VEGF-A v tkani MPD i v lejkocitah krovi otricatel'no korrelirovala so stadiej DBD (r = –0,85; p < 0,001), ukazyvaya na snizhenie aktivnosti vaskulyarizacii v terminal'noj stadii. Dannye, vyyavlennye pri DBD, govoryat o vklade lokal'nogo nizkoimmunnogo vospaleniya, sopryazhennogo s aktivnoj vaskulyarizaciej diska na bolee rannih stadiyah i associirovannogo s reaktivnym vospaleniem tel pozvonkov. Poluchennye rezul'taty sluzhat predposylkoj k razrabotke protivovospalitel'noj i reparativnoj terapii v zavisimosti ot stadii DBD i nalichiya Modic-izmenenij u lic molodogo vozrasta s BS.

The problem of the association of infective endocarditis (IE) and oncological diseases has been discussed for more than 60 years, and is now becoming increasingly relevant because of observed increasing of number IE in elderly patients. The review of the literature presents both data on the incidence of oncological diseases diagnosed with IE and in the long-term follow-up of patients after IE, as well as current estimates of IE incidence in cancer patients, obtained in large population-based studies. The highest risk of IE development was found in patients with tumors of the colon and rectum, and the predominant etiological role of Streptococcus bovis/gallolyticus was proved in such cases. The frequency of concomitant oncological diseases is higher in elderly patients with IE. On the other hand, it is obvious that IE can be considered as a marker of latent oncological pathology, especially gastrointestinal tumors, malignant blood diseases and lymphoproliferative diseases that are most often detected during the period of active IE and in the first 1–2 years later. Therefore, mandatory colonoscopy is recommended for patients with IE caused by Streptococcus bovis/gallolyticus during the period of IE and annually in subsequent years, even if initially the colonoscopy did not reveal pathology. In elderly IE patients we should also be aware of the high likelihood of concomitant oncological pathology and carry out appropriate oncological search. Antimicrobial prophylaxis of IE in patients with gastrointestinal cancer remains unresolved.

У больных ревматоидным артритом (РА), различными формами ИБС и здоровых лиц разного возраста проводилось исследование колец реаранжировки альфа-цепи Т-клеточного рецептора (TREC) и фенотипа лимфоцитов с помощью проточной цитометрии, в том числе с применением метода магнитной сепарации с целью выявления признаком генотипической и фенотипической незрелости и определения количества клеток, несущих маркеры ранних тимических эмигрантов (РТЭ). В ходе исследования были выявлены отрицательная корреляция между уровнем TREC у доноров и больных инфарктом миокарда, у больных ревматоидным артритом подобной взаимосвязи не выявлено, что может говорить об изменении динамики тимической активности при данном заболевании. При исследовании фенотипа у больных было выявлено увеличение содержания клеток CD3 -4 + при высокой степени активности заболевания и внесуставных проявлениях. Метод магнитной сепарации лимфоцитов может быть использован для получения обогащенной суспензии клеток CD4 + и дальнейшего изучения еубпопуляции РТЭ.

We found that the level of CD3+4+8+T-cells was normal in peripheral blood of RA patients. Otherwise an amount of CD3+4-8-, CD3-4+ and CD3-8+ subpopulations was increased in 10 patients and level of CD10+ cells (24%) in 2. We found also significant imbalance of CD3+4+8- and CD3+4-8+ mature T-cells in all RA patients The level of CD3+4+5-40-fold exceeded the level of CD3+8+. The 24-hour incubation of RA patient's lymphocytes with human TEC culture and TEC supernatant could influence upon T-cell receptor phenotype. We found tendency to increase of CD3 after the incubation in all patients. Otherwise the dynamic of CD4 and CD8 was different. In 4 cases we saw the moderate decrease of CD4 expression and increase of CD8. But in 9 cases the imbalance of CD3+4+ and CD3+8+ subpopulations increased after cultivation due to progressive CD8 expression diminution. The above mentioned facts allowed us to suppose the heterogeneity of T-cell selection disturbances in RA

AIM To specify the course and outcomes of arthritides associated with streptococcal infection (AASI). MATERIAL AND METHODS The trial comprised 60 patients with arthritis (mean age 26.8 +/- 14.0). The patients met the following criteria: arthritis, elevated (< 500 U) titers of antistreptolisin-0 in the absence of heart disorders detected at Doppler-echocardiography (2D-echoCG), urogenital infection, Yersinia infection, psoriasis. In addition to routine clinical tests, the following investigations were made: tests for alloantigen of B-lymphocytes D8/17 and antigen HLA-B27, antibodies to polysaccharide of streptococcus of group A, bacteriological test of laryngeal smears for streptococcal infection, prospective follow-up (mean 31.2 +/- 19.6 mon) with 2D-echoCG. RESULTS Rheumatic arthritis was rejected in 33.3% patients. Other diseases were diagnosed: early rheumatoid arthritis (10%), seronegative spondylarthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, Still's disease, Konig's disease, sarcoidosis, gout, arthritis on the background of streptococcal nodular erythema. Acute rheumatoid fever (ARF) was diagnosed in 56.7% patients, poststreptococcal arthritis (PSA) in 10%. PSA differed from ARF by onset at the age of 36.0 +/- 10.2 years, short latent period (11.2 +/- 1.3 days), a significantly longer course of arthritis (95.0 +/- 3.9 days), recurrences. Alloantigen of B-lymphocytes was detected in 52.8% AASI patients (the difference from the control is highly significant (p < 0.001). Arthritis development was not associated with carriage of HLA-B27 carriage. CONCLUSION In examination of AASI patients for diagnosis of ARV and PSA it is necessary to reject other diseases among which early RA (10%) is most frequent. It is recommended to make diagnosis of ARF in AASI patients with definition of risk factors (age 7-15 years, family history of rheumatic fever, carriage of alloantigen d8/17), 2.5-year and longer follow-up with 2D-echoCG. Diagnosis of PSA is made in rejection of ARF and in the presence of the following characteristics: development of the disease at the age 30-40 years, a short latent period of the infection, long-term persistent course of arthritis, insufficient effect of nonsteroid anti-inflammatory drugs, frequent affection of sacroiliac joints, recurrence, entezopathy.

We studied the phenotype of peripheral blood lymphocytes and serum immunoglobulin concentration in patients with early rheumatoid arthritis and rheumatoid arthritis of more than 12 months duration. Subpopulations of CDIgM+, CD25+, and HLA-DR+ lymphocytes and IgA concentration differed in these groups of patients with rheumatoid arthritis. The count of lymphocytes carrying CDIgM+ and HLA-DR+ receptors correlated with activity of rheumatoid arthritis.