BackgroundProgressive autonomic dysfunction syndrome development is a characteristic for the most of immune inflammatory processes. Pain syndrome chronization in patients with psoriatic arthritis (PsA) is one of the leading factors contributing to the development of psycho-emotional disorders. They, in turn, exacerbate the disorders of the autonomic nervous system.Objectivesto evaluate function of the autonomic in PsA patients and the presence of psycho-emotional disorders in themMethods73 patients with PsA (≥5 SJC and ≥5 TJC; CRP≥0,3 mg/dL) were examined by psycho-emotional testing using the Spielberger anxiety and Hamilton depression scales. Autonomic disorders were detected by “Vein-Patient”-VP method`s questionnaire, filled by the patient (when more than 15 points – autonomic dysfunction is possible (AD)) and “Vein-Doctor”-VD questionnaire, filled by the doctor (more than 25 points – confirmation of the presence of AD); studied the general indicators of heart rate variability (HRV) – mode (Mo), mode amplitude (AMo), autonomic equilibrium index (AEI), activity index of regulatory systems (AIRS); spectral characteristics – standard deviation of normal RR intervals (SDNN); square root of the mean of the sum of the squares of the differences between consecutive RR-intervals (RMSSD) and the ratio of balance between sympathetic and parasympathetic activities (LF/HF) of autonomic nervous system (ANS). All the patients received MTX in a stable dose for 6 months at least, prior the time of the study.Resultsin 39 PsA patients (53,4%) increased reactive anxiety (37,0±1,5 points) and personal anxiety (45,4±1,5 points) levels were determined as results of testing. They made up the 1st observation group, and the remaining 34 patients – the 2nd observation group. In the first group, according to the questionnaire VP and VD more significant excess of the norm was defined (19.79±0.54 points and 29.8±0.77 points respectively) than in the 2nd group (16,92±0,62 and 27,1±0,8 points). The decrease of the SDNN и RMSSD in comparison with norm was revealed in the both groups, that evidences an inhanced sympathetic regulation. However, more significant LF/HF growth (4,15±0,64) and SDNN decrease(22,4±5,6 ms) in the 1st group, than in the 2-nd (3,0±0,86; 29,1±8,4 ms, respectively) occurred. It indicates a link between the increase in the sympathetic level of regulation and the presence of signs of psycho-emotional disorders. And also the growth of AMO in the 1st group (47,9±8,4%) shows the strength of sympathetic mobilising influence and evidences an increased medullary vasomotor centre activation and growth of sympathetic regulation in PsA patients with depression.In general, the severity of changes in HRV in PsA patients can be due to a high content of pro-inflammatory cytokines, which induce the synthesis of free acid radicals and worsen ANS maintenance of the organisms` activity.ConclusionsEmotional disorders of the anxiety-depressive spectrum contribute to the regulatory mechanisms tension increase and adaptive capabilities decrease...
Background:The high incidence of ankylosing spondylite (AS) in people of working age, as well as the negative impact of the disease on the quality of life of patients, determine the need for adjuvants to reduce the severity of pain and thereby achieve the physical, psychological and emotional well-being of patients.Objectives:To study the effect of vitamin D (colecalciferol) on the quality of life and the severity of pain in patients with ankylosing spondylite.Methods:The study included 69 patients with AS, who studied the quality of life indicators according to the Medical Outcomes Study Short Form (SF-36); pain syndrome and stiffness in the spine were assessed by a visual analogue scale by patients, and by a physician - by counting the number of painful joints (NPJ), the disease activity index (BASDAI) and the Functional Index (BASFI). All patients were receiving a basic therapy in a stable dose for at least 10 months. They were divided into 2 groups, comparable in age, disease activity; Group 1 (n = 33) additionally received colecalciferol 1500 МЕ during 6 months of observation.Results:At the end of the observation period when evaluating data on SF-36: in the 1st group, the physical health component has improved - the increase in physical functioning (PF) and bodily pain (BP) by 51.4% and 37.8% from the baseline; vital activity, psychological health, and social functioning due to emotional state have also increased by 37.6%, 33.4% and 42.5%, respectively. In the 2nd group above mentioned parameters have not changed. In the 1st group the indexes of BASDAI and BASFI have decreased by 16% and 22% (p = 0.0079, p = 0.0022, respectively), and their dynamics in the 2nd group were less significant (p = 0.013, p = 0.017, respectively) Also, in patients of the 1st group have decreased the severity of morning stiffness and the pain in the spine a highly reliable (p < 0.001), and in the 2nd group they were less significant (p = 0.043, p = 0.016, respectively). Positive dynamics of NPJ in the 1st group was more significant (p = 0.003) than it was in the 2nd group (p = 0.033).Conclusion:In the group of patients treated with colecalciferol was noted improvement in indicators of quality of life (the parameters of the physical component of health, vitality and social functioning) and also more significant decrease of the intensity of pain and of morning stiffness duration, of NPJ, than in not received to colecalciferol patients. Inclusion of vitamin D in the comprehensive AS therapy promotes not only reduction the severity of the chronic pain manifestations, but also improves the quality of life of patients with this pathology.Disclosure of Interests:None declared
BackgroundThe evaluation of early destruction markers in rheumatoid arthritis (RA) is of significant clinical importance for improving the patient`s life quality. One of the immunological markers of RA early diagnosis and of severe disease is antibodies to cyclic citrullinated peptide (ACCP). Instrumental methods for early diagnosis of RA include the ultrasound of joints. Vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) can stimulate the processes of angiogenesis and proliferation, which in turn can increase the infiltration and hyperplasia of synovia, the growth of pannus mass and contribute to the development of bone and cartilage erosions.Objectives: to establish the correlation of growth factor indicators with markers of the destructive course of rheumatoid arthritis.Methods194 patients with a diagnosis of RA were examined, among the examined patients women prevailed - 86.6%, the age was 47.7 ± 10.22 years. Positive by the presence of ACCP (> 20 U/ml) was 76.8%, and negative - 23.2%. The ELISA in the serum was determined by the concentration of CRP and TNF-α (Vector-Best, Russia), antibodies to cyclic citrulinated peptide (ACCP) (Euroimmun, Germany), VEGF and FGF (BCM Diagnostic, Canada). Ultrasound of the joints was performed by the device “ESAOTE MyLAB40” (Netherlands, 2011) with a linear sensor of 7.5 L 70 (frequency 7.5 MHz), semi-quantitative evaluation of indicators was used: effusion into the joint space (JS), synovial thickness, vascularization of the synovial membrane (SM), the presence of pannus and bone-cartilage erosion.ResultsDirect correlations with CRP and ACCP levels (p = 0.02; p = 0.01, respectively), TNFα and DAS28 (p <0.001) were established during analysis of the correlation links between VEGF and RA clinical course indicators. Analysis of the correlation of VEGF and ultrasound indices of the joints in the examined patients RA established strong direct links with the JS effusion parameters and the SM vascularization assessment (p <0.001, in all cases), and a direct interaction of weak force with the indicator of pannus (p = 0.04) was found. Regression analysis of the dependence of the variability of the SM vascularization assessment on the level of VEGF in the blood showed a sufficient value of the coefficient of determination (0.57), and the data of the normalized index DW = 2.09 reliably indicate the absence of autocorrelation (0.06).Direct correlations with Rö stage (p <0.001) and the rate of CRP (p = 0.02) were established during analysis of correlation links of FGF with the RA clinical course. Analysis of the correlation of FGF and ultrasound indices of the joints in the examined RA patients established strong direct correlations with the indicators of the thickness of SM, pannus, and bone-cartilage erosion (p <0.001, in all cases), the direct correlation of weak force (p = 0.04) was with the SM vascularization assessment index. Regression analysis of the dependence of the variability of the SM thickness indicator on the FGF blood level showed a sufficient v...
Today, regular physical activity is considered to be an important part of the treatment for many CVDs. Exercise tests are used to determine exercise tolerance and to assess cardiovascular risk. This review outlines the most common methods for assessing exercise tolerance (cycloergometric test and treadmill tests) that have a high diagnostic and prognostic value and allow the specialists to draw reliable conclusions about the patient’s physical activity. The results of stress tests are of great importance in determining further tactics of patient’s management with cardiovascular pathology. Attention is also paid to the issues of cardiopulmonary stress test, which is the most reliable research method, according to the latest international recommendations. However, it is associated with difficulties in conducting and interpreting the research results. The feasibility and effectiveness of tests with the exclusion of the pulmonary component in cardiac patients have been shown for widespread use. A systematic literature search was carried out in databases Medline, Scopus, Web of Science, and Elibrary.
BackgroundNow it is proved that the leading reason for the decline in life expectancy in patients with rheumatoid arthritis (RA) are cardiovascular (CV) disease. The increase in CV risk in patients with RA is associated with increased progression of atherosclerotic vascular lesions. Autoimmune inflammatory process in RA affects the vascular endothelium contributes to the appearance of CV events and increased mortality of patients with RA. It is known that when SHTD increased levels of proinflammatory cytokines. Also, when there is an increase SHTD thickness complex intima-media (CIM)ObjectivesTo study the characteristics of ultrasound dopplerography in patients with RA with SHTDMethodsThe observation 139 patients with RA. The I group consisted of 91 patients with RA and SHTD, the II - 48 patients with RA without SHTD. Patients in group I and II did not differ significantly by age and duration of RA. Detection of endothelial dysfunction was performed using ultrasound dopplerography vessels in accordance with international guidelinesResultsIn the study of endothelial regulation of vascular tone in both groups of patients revealed the presence of disturbances, as determined signs of reduced endothelium-dependent vasodilation (EDVD) and endothelium-independent vasodilation (EIVD) compared with regulatory measures, which EDVD brachial artery (BA) is greater than or equal to 10% and EIVD BA - 15%. Defined EDVD significant decrease in group II, in contrast to the I (T=4.5, p<0.001), which amounted to 8.3±3.0% and, respectively 10.6±2.1%. EIVD figure was in group II 12.9±3.8%, and in the I – 15.4±1.5%, which also had significant differences (T=4.5, p<0.001) (Table 1).Table 1IndicatorsI group (n=48)II group (n=91)p D0, cm3.8 (3.7; 3.9)3.9 (3.7; 4.2)0.16D1, cm4.3 (4.1; 4.5)4.3 (4.0; 4.5)0.83D2, cm4.5 (4.3; 4.7)4.5 (4.2; 4.7)0.09V0, cm/s55.6 (52.6; 61.1)52.6 (44.2; 58.2)*0.002V1, cm/s76.1 (71.6; 79.6)70.8 (62.6; 76.6)*<0.001EDVD, %10.6±2.18.3±3.0*<0.001EIVD, %15.4±1.512.9±3.8*<0.001CIM, mm0.73 (0.71; 0.79)0.97 (0.95; 1.0)*<0.001C0.45 (0.34; 0.71)0.26 (0.18; 0.46)*0.002Note: * p<0.05.It is also a distinction between the two groups in terms of the thickness of the CIM (Z=9.7, p<0.001), exceeding in group II. Determined a significant decrease in the coefficient of sensitivity to endothelial shear stress (C) in patients with RA, who was in I group of 0.45 (0.34; 0.71), and in II - 0,26 (0.18; 0.46) that there was a statistical difference in this index between the groups of patients (Z=3.6, p<0.001) due to a significant reduction in patients of group II.The performed analysis of variance indicated that there SHTD influence on the development of disorders of vascular endothelial function in motor RA patients. The SHTD presence in group II patients significantly affected the reduction EDVD, EIVD, C (H=13.8, p<0.001; H=14.5, p<0.001; H=10.2, p=0.001).ConclusionsThe analysis indicated the presence of influence SHTD on the development of disorders of vascular-motor endothelial function in RA patients. These data show that the presenc...
BackgroundTo date, it has been established that anxiety-depressive spectrum disorders (ADSD) increase the perception of chronic pain. ADSD, as well as immuno-inflammatory diseases, in particular ankylosing spondylitis (AS), are caused by increased production of pro-inflammatory cytokines. Cytokines activate the hypothalamic-pituitary-adrenal system, and chronic stress factors provide a new release of cytokines with its subsequent sensitization, impairing the adaptive capabilities of the body, thereby exacerbating endocrine dysfunction that regulates stress and immune response in the body, which increases the level of proinflammatory cytokines, and is clinically manifested by a decrease in mood, chronic pain, fatigue, sleep disorders.ObjectivesTo study the features of pain syndrome in patients with ankylosing spondylitis with anxiety-depressive spectrum disorders.MethodsThe exploration involved 112 patients with AS, aged 25 to 58 years (43.7±7.9 years), the average duration of the disease was 9.5±4.4 years. 67 of them (group 1) showed signs of ADSD, established by the Spielberger anxiety and Hamilton depression scales. The remaining 45 patients without ADSD were included in the 2nd observation group. The patients in the groups did not differ in age (p=0.67), however, they differed in the duration of the disease (p=0.035) - in the 1st group 10.2±4.5, in the 2nd group 8.4±4.0 years. In addition, patients of the 1st and 2nd groups did not differ in the frequency of occurrence of chronic fatigue (p=0.2) and decreased mood (p=0.08). However, sleep disorders (difficulty falling asleep, shallow sleep, early awakening) were significantly more frequent in-group 1 (p=0.046). Quantitative indicators of pain syndrome (PS) were studied using the McGill Pain Questionnaire (MGPQ). The severity of pain in the spine, morning stiffness, the patient’s state of health (PSH) were studied using visual analog scales (VAS); BASDAI and BASFI indices, ESR and CRP indices were also recorded.ResultsPatients in the groups did not differ in BASDAI indices - in group 1, 4.04±1.24, in group 2, 3.83±0.98 and BASFI - 4.21±0.99 and 4.24±0.84, respectively; there were also no differences in the level of CRP and ESR. Spinal pain in group 1 (67.8±17.5 mm) was significantly stronger (p=0.02) than in group 2 (60.2±15.9 mm), morning stiffness was also significantly (p=0.028) more pronounced in group 1 (67.4±15.9 mm) than in group 2 (60.3±17.2 mm). According to the indicator of SPP, a more negative tendency to its increase should be noted in the 1st group (68.7±15.2 mm) than in the 2nd (63.7±14.4 mm), but without significant differences (p=0.084). All quantitative indicators of BS according to the ICD in the groups had significant differences (p<0.05), reaching maximum significance for the sensory and affective components of pain, the index of the number of selected descriptors (INSD). Namely: in group 1, the number of sensory and affective class descriptors was 5.9±0.8 and 4.5±0.7, the evaluative component of pain was 2.9±0.5, INSD was 11.9±1.4 points, the pain rank index (PRI) was 26.3±5.5 points; in group 2, the number of sensory and affective descriptors was 5.0±0.9 and 3.75±0.6, evaluative - 2.6±0.6, INSD - 10.3±1.5, RIB - 21.2±5.1 points. A higher number of affective class descriptors and ICPD in group 1 indicates the emotional lability of patients with ADSD and to a certain extent explains the significantly more significant negative indicators of BS recorded during the survey using VAS.ConclusionSignificantly higher quantitative indicators of BS in patients with AS with ADSD confirm the presence in this category of patients of a pronounced emotional-affective component of pain, which has a central origin, and contributes to the growth of its somatic perception.Disclosure of InterestsNone declared
BackgroundThe ability of melatonin to reduce the activity of the sympathetic nervous system tone and of pituitary-adrenal system ensures its anti-stress properties. It can be used to reduce psycho-emotional manifestations of chronic pain in patients with psoriatic arthritis (PsA).ObjectivesTo evaluate the effect of combined therapy with the use of melatonin on the expression of psycho-emotional disorders, and pain in patients with PsA.MethodsHigh levels of anxiety and depressive disorders were established in the survey on Spielberger Anxiety Scale and on Hamilton Rating Scale for Depression (HRDS) in 43 patients with PsA (≥5 SJC and ≥5 TJC; CRP ≥0.3 mg/dL). The quality of life was studied by questionnaire Medical Outcomes Study Short Form (SF-36); the severity of morning stiffness, pain, patient's health status (EWS) - using the 100-mm visual analog scale (VAS). All patients were receiving a stable dose of MTX for at least 6 months. They were divided into two groups; 1 group (n=22) additionally received 3 mg of melatonin at bedtime for 2 months of observationResultsAt the end of the observation period the frequency and the level of severity of depression by HRDS (p=0.0098), and the index of personal anxiety (P=0.009) in group 1 decreased. In the 2nd group above mentioned parameters have not changed. On the 1 group data of SF-36 evaluation: the physical health component has improved - the increase of RP and BP 57.4% and 37.8% from the baseline; vital activity and role functioning due to emotional state, have also increased by 35.6% and 43.5%, respectively. In the 2nd group (n=22) investigated parameters have not undergone significant changes in dynamics. In the 1 receiving melatonin group TJC and SJC have decreased by 15% and 22% (p=0.0079, p=0.0022, respectively) and their dynamics in the 2nd group was less significant (p=0.013 and p=0.017, respectively). Also, patients in group 1 have highly significant (p<0.001) reduction in the severity of morning stiffness and joint pain, and in the 2nd group the changes were less significant (respectively, p=0.043, p=0.016). Positive dynamics of CRP in group 1 was more significant (p=0.003), than it was in 2 patients` group (p=0.033).ConclusionsIn the group of patients treated with melatonin was noted improvement in general condition (a significant improvement in the parameters of the physical components of health, reduction of depressive and psycho-vegetative disorders) and also more significant decrease of the intensity of pain and of morning stiffness duration, of TJC and SJC, than in not treated with melatonin patients. Inclusion of Melatonin in the comprehensive PsA therapy promotes not only reduction of depression symptoms and sleep disorders, but also reduces the severity of the chronic pain manifestations and, consequently, improves the quality of life of patients with this diseaseDisclosure of InterestNone declared
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