Synovial membrane in the early stage of rheumatoid arthritis: clinico-morphological comparisons

AIM: To evaluate implications of pathomorphological alterations of synovial membrane at an early stage of rheumatoid synovitis (RS) for further course of rheumatoid arthritis (RA) and prognosis of the disease. MATERIAL AND METHODS: 92 new cases of RA (22 males, 70 females, mean age 31.1 +/- 10.5 years, mean duration of RA 5.99 +/- 3.27) subjected to puncture biopsy of the synovial membrane of the knee joint in 1967-1983. At admission to hospital 54.3, 45.7 and 29.3% patients had polyarthritis, mono- and oligoarthritis, rheumatoid factor, respectively. The RA diagnosis was confirmed in 68 (73.9%) patients, 26 (28.3%) of them were observed for 1-2 years, 42 (45.6%)--for 11.8 +/- 8.8 years, on the average. In 9 (9.8%) patients the diagnosis was changed for Bechterew's disease (n = 6), polymyositis (n = 1), rheumatism (n = 1), reactive arthritis (n = 1), 15 (16.3%) patients with seronegative oligoarthritis of large joints were lost for follow-up. Now (the beginning of 2002) synovial biopsies were investigated in "blind" mode by one morphologist (using the semiquantitative method) and compared to clinical and x-ray evidence. RESULTS: The most frequent changes were the following: proliferation of lining synovial cells (82.6%), lymphoid infiltration (64.1%), angiomatosis (60.9%), fibrinoid changes (60.9%). Accumulation of large amounts of macrophages and lymphocytes in the infiltrate was detected in RA significantly more often than in non-RA patients. Among 68 patients with definite RA morphological picture in biopsies obtained from the knee joints with manifest synovitis (69.1%) and from clinically intact joints (30.9%) was practically the same. The most important morphological sign was angiomatosis associated with early polyarticular involvement, early development of joint erosions and early disability (patients with marked angiomatosis were disabled after 4 years of illness, on the average, without angiomatosis--after 11 years). Statistically significant associations of parameters of RA development with other histological signs of synovitis were not detected. CONCLUSION: Angiomatosis in the synovial membrane occurs at early (including preclinical) stages of RA and, as a manifestation of angiogenesis, is an unfavorable prognostic factor of early polyarticular involvement, early development of joint erosions and early disability. Synovial biopsy at an early stage of arthritis is of differential-diagnostic value and helps to define a long-term outcome. Therefore, synovial biopsy of the knee joint must be in the list of standard examinations of patients with early RA.     

Nimesil treatment of gouty arthritis

AIM: To evaluate efficacy and safety of nimesil, a selective inhibitor of cyclooxigenase-2, in gouty arthritis (GA). MATERIAL AND METHODS: Nimesil was given to 20 male patients with GA (mean age 53.8 years, mean duration of the disease 8.1 years) in a dose 100 mg twice a day for 14 or 21 days depending on positive clinical changes (13 and 6 patients, respectively). The articular swelling index, supraarticular skin hyperemia, the articular index, pain in rest and movement were estimated on the treatment day 1, 5, 14 and 21. Arterial pressure was controlled in all the patients. ESR, uric acid, seromucoid, ALT, AST, gamma-GTP, glucose levels were measured before and after the treatment. RESULTS: Nimesil relieved pain and inflammation (ESR and seromucoid level lowered significantly). Effects on the other estimates were not registered. One patient developed generalized urticaria on the treatment day 5. The drug was discontinued in him. CONCLUSION: Nimesil can be used as monotherapy of an acute attack of gout. In a dose 200 mg/day nimesil provides an effective and fast treatment of gout, is well tolerated and safe.     

New methods of prevention and treatment of the stress-related disorders in children with burn disease

An assessment of the key pathogenesis chains involved in triggering the vital complications was based on a prospective randomized controllable retrospective study of a burn-disease clinical course in 473 children. As a result of it, a standardized system was worked out, within a large industrial region, designed to render the medical care to children with severe thermal lesion; such system cut the therapy time by 12 days in the intensive care unit and by 2.6 time--in hospital; it also contributed to reducing the purulent-and-septic complications from 73.9% to 21% and the lethality rate--from 3% to 0.8%.     

Regional peptic acid activity in gastroduodenal ulcers

The acid peptic activity in different parts of the gastroduodenal area using an original method was investigated in 25 patients with duodenal ulcer, 39 patients with gastric ulcer and 14 controls. Acidity and proteolytic activity in the gastroduodenal area were different and correlated with morphofunctional peculiarities of the mucosa. The acid peptic activity in the zone of ulceration in mediogastric and anthropyloric ulcers did not exceed that in persons without gastroduodenal pathology. The acid peptic activity in the proximal part of the duodenum was higher in the patients with duodenal ulcer than in the controls.