Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period.
Introduction. According to numerous studies, the prevalence of asymptomatic hyperuricemia has increased in most countries. Uric acid is an important biomarker of the cardiovascular system, and there are now quite a big number of sources indicating its role in the development of a some chronic metabolic conditions, cardiovascular disease and associated mortality. At present, there is no consensus on the need for urate-lowering therapy in patients with asymptomatic hyperuricemia. There is a limited number of studies examining the problem of asymptomatic hyperuricemia in patients with rheumatic diseases, the features of comorbidity in these conditions, the frequency and effectiveness of urate-lowering therapy. Purpose. To study the peculiarities of the course of rheumatoid arthritis and osteoarthritis with associated asymptomatic hyperuricemia and compare them with the ones associated with arthragra. Materials and methods. The analysis was performed on the basis of the data collected from the city register of the patients with arthragra and asymptomatic hyperuricemia in St. Petersburg. The data collected included the medical records of 1725 patients with arthragra, 433 patients with rheumatoid arthritis and hyperuricemia and 355 patients with osteoarthritis and hyperuricemia. Results. The patients with rheumatoid arthritis and hyperuricemia were more likely to have increased erythrocyte sedimentation rate and C-reactive protein, the highest medium level of erythrocyte sedimentation rate; acute myocardial infarction, chronic heart failure, gallstone disease and non-alcoholic fatty liver disease were more frequently detected. The patients with osteoarthritis and hyperuricemia were more likely to have high total cholesterol, at its highest medium level; stable angina, arrhythmia, varicosity, obesity, prediabetes and type 2 diabetes mellitus were more likely to be detected. Kidney damage was detected more frequently in the patients with arthragra. In the group of rheumatoid arthritis and hyperuricemia urate-lowering therapy was started in 30.95% of the patients, in the group of osteoarthritis and hyperuricemia in 36.06%. Conclusions. In rheumatic diseases, hyperuricemia is a common associated condition. Their combination leads to increased risk and frequency of cardiovascular, metabolic and gastroenterological comorbidity. The prescription of urate-lowering therapy to the patients with rheumatic diseases and asymptomatic hyperuricemia with high cardiovascular risk led to the target uric acid levels in 34.58% of the patients with rheumatoid arthritis and 52.08% of the patients with osteoarthritis.
By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices.
Background:Uric acid (UA) is well-known biomarker of cardiovascular risk and inflammation. However, the data about interrelations between asymptomatic hyperuricemia (AHU) and rheumatic diseases (RD) are limited and contradictory [1].Objectives:to identify the occurrence of AHU in pts with different RD and to evaluate the interrelations between the AHU and clinical features of the RD.Methods:The study included data from 822 pts with AHU and RD involved in the Saint-Petersburg Register of Pts with AHU in period from the 01jan2000 to the 01apr2020. The AHU was defined as the serum level of uric acid (UA) that exceeded 360 μmol/l without signs of gouty arthritis. Pts with the secondary reasons of AHU (an oncologic diseases, late stages of chronic kidney disease, ets), and inflammatory diseases another than RD were excluded from the study.Patient’s demographical characteristics, duration of AHU, level of UA, activity of RD, ESR, CRP, urate-lowering therapy (ULT) were analyzed. The study was approved by local ethic committee. Statistics was performed with SPSS17.Results:Characteristics of the Patients with the RD and AHU are present in Table 1. The duration of AHU in pts with the RD was 3.4±3.4 [0.08-18] years, mean duration of follow-up 2.7±4.0 years, mean number of visits during the period of follow-up was 3,2 [min 1; max 7], ESR 26.0±14.1 mm / h, CRP 19.6±21.0 mg/l.Table 1.Characteristics of the Patients with the Rheumatic diseases and asymptomatic hyperuricemia.Age, years(Mean±SD)Male, %**Serum UA, μmol/l(Mean±SD)Normalization of UA during the follow-up, n (%)RD, n=82256.7±14.540.27493.3±98.5242 (29.44) ##RA, n=32964.2±12.13.74504.8±107.5#99 (30.09) ##PsA, n= 14956.6±12.953.69531.5±94.9#32 (21.48) ##SpA, n= 10745.6±15.1*33.43520.8±86.5#18 (16.82)##SLE, n=13750.3±14.1*20.44451.6±91.457 (41.61)SSc, n= 5761.0±12.422.81456.2±99.520 (35.09)SD, n= 4362.0±10.716.28442.4±107.516 (37.21)RD – rheumatic disease; RA –– rheumatoid arthritis; PsA –– psoriatic arthritis; SpA –– spondyloarthritis; SLE –– systemic lupus erythematosus; SSc –– systemic sclerosis; SD –– Sjogren’s disease; * –– p<0.001 for the differences with RD, RA, PsA, SSc, SD; ** –– p < 0.01 for all intergroup differences; # –– p < 0.01 for the differences with RD, RA, SSc, SD; ##–– p < 0.01 for the differences with RA, SSc, SD.Were revealed the interrelations between the level of UA and ESR (Spearmen’s R=0.1, p=0.01), and UA and CRP (Spearmen’s R =0.12, p=0.001).The level of UA in male pts was 507.0 [361-940], in female pts 450.0 [361-1010] μmol /l (p<0.0001), in SLE pts with elevated anti-nuclear factor (ANF) UA was 429 [361-940] and with normal 494 [361-973] (p<0.0001). In pts with high and low RD activity UA was 490 [361-940] and 454 [363-1010]) μmol /l respectively, (p<0.0001). The higher UA level was found in any RD as compared with UA in low activity of the same RD (p<0.0001 for all the differences).Normalization of UA was found in 243 (29.6 %) pts, lack of normalization of UA in 434 (52.8 %) of cases, n = 677, Table 1. ULT received 219 (26.6 %) pts. Normalization of UA without ULT was registered in 16 (1.9 %) of the pts.Conclusion:UA level is higher and normalize less often in patients with SpA and PsA as compered with RA, SLA, SSc and SD pts. In any of analyzed rheumatic diseases the level of UA is higher in male pts and in pts with high disease activity.References:[1]K.Bosmansky, M. Ondrasik. Ter Arkh.1987;59(4):22-5.Disclosure of Interests:None declared.
Исследования эффективности терапии базисными противовоспалительными препаратами (БПВП), а также генно-инженерными биологическими препаратами (ГИБП) у пациентов с ранним ревматоидным артритом (рРА) в рамках стратегии «Лечение до достижения цели» немногочисленны. Цель настоящей работы-изучить влияние БПВП и ГИБП в комбинации с метотрексатом (МТ) на клиническое течение, качество жизни (КЖ) и эволюцию суставных эрозий и синовита у больных РА. Пациенты и методы. В исследование включен 151 больной рРА. На первом этапе пациенты получали БПВП. На втором этапе 101 пациенту с сохраняющейся умеренной и высокой степенью активности был назначен МТ 25 мг/нед, либо 20 мг/нед в комбинации с инфликсимабом (ИНФ), либо 20 мг/нед в комбинации с ритуксимабом (РТМ). На третьем этапе 20 пациентов с сохраняющейся высокой активностью заболевания были переведены на терапию тоцилизумабом (ТЦЗ). Результаты и обсуждение. К 12 мес лечения БПВП клиническая ремиссия чаще достигалась в группе МТ. Назначение ИНФ или РТМ приводило к значимому улучшению КЖ пациентов. Применение ТЦЗ как препарата второй и третьей линии способствовало достоверному снижению DAS28 СРБ. Выводы. Между группами больных, получавших терапию ИНФ и РТМ, не выявлено статистически значимых различий в динамике СРБ, СОЭ, циркулирующих иммунных комплексов и показателей рентгенологического прогрессирования, что подтверждает возможность «переключения» с первого ГИБП на препараты последующих линий при нарастании активности. ТЦЗ может быть препаратом второй и третьей линии при ускользании эффекта от терапии другими ГИБП.
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