Systemic lupus erythematosus (SLE) is characterized by a variability in clinical manifestations and laboratory abnormalities, which creates objective diagnostic difficulties.Objective: to investigate clinical and laboratory parameters in patients with definite and probable SLE.Patients and methods. The investigation enrolled 94 patients, 38 of whom were diagnosed with probable SLE. All the patients underwent immunological examination and unaffected skin biopsies, followed by an immunohistochemical study, the so-called lupus strip test (LST).Results and discussion. The group of patients with definite SLE showed a direct correlation between positive LST and disease activity (r=0.6), acute skin lesion (r=0.42), and elevated anti-double-stranded DNA antibody concentrations (r=0.37), and their inverse correlation with dry syndrome (r=-0.44). In patients with probable SLE, deposition of immunoreactants in the unaffected skin was detected in almost half of the cases, despite lower disease activity and specific antibody deficiency. Thus, LST that is quite easy to use and interpret its results can be used as an additional criterion for the differential diagnosis of SLE, especially in its early stages.
Распространенность системной красной волчанки (СКВ) существенно различается в разных регионах мира. Заболевание встречается в разных возрастных группах, однако наиболее часто развивается у молодых женщин и девочек-подростков (пик заболеваемости приходится на 15-25 лет). Известны семейные случаи СКВ. Отмечено, что течение СКВ у беременных характеризуется повышенным риском осложнений, а также особенностями фармакотерапии. Выделены факторы риска неблагоприятного прогноза вынашивания беременности у больных СКВ: высокая активность заболевания на момент зачатия, активный люпус-нефрит, наличие антифосфолипидных антител (АФЛ). Представлены предикторы антенатальной гибели плода: протеинурия, тромбоцитопения, наличие АФЛ и артериальная гипертензия. При сочетании СКВ и вторичного антифосфолипидного синдрома (АФС) вероятность неблагоприятного исхода беременности составляет 30%. Указано, что тактика ведения беременных с АФС, режим дозирования препаратов во многом зависят от данных анамнеза -наличия (отсутствия) неплацентарных тромбозов, количества спонтанных абортов, предшествующей терапии и др. Выделено четыре группы больных: 1) только с наличием антикардиолипиновых антител без предшествующей беременности или с одним эпизодом необъяснимого спонтанного аборта до 10 нед гестации, без тромбозов в анамнезе; 2) с АФС без неплацентарных тромбозов в анамнезе и с наличием антикардиолипиновых антител и ≥2 необъяснимыми спонтанными абортами (до 10 нед гестации) в анамнезе; 3) с АФС и неплацентарными тромбозами в анамнезе (получавшие варфарин до беременности); 4) с неэффективностью стандартной терапии в период следующей беременности. Представлены варианты терапии для каждой группы пациенток. Сделан вывод, что эффективная терапевтическая стратегия при СКВ, в том числе у беременных, подразумевает проведение мониторинга пациенток с целью длительного поддержания ремиссии (низкой активности) заболевания. Ключевые слова: системная красная волчанка; беременность; терапия. Контакты: Александр Михайлович Лила; amlila@mail.ru Для ссылки: Лила АМ, Трофимов ЕА, Лила ВА. Системная красная волчанка: особенности течения у беременных и варианты терапии. Современная ревматология. 2015;9(3):43-47.The prevalence of systemic lupus erythematosus (SLE) varies greatly in different regions of the world. The disease is encountered in different age groups; however it is most common in young and adolescent women (its peak incidence is in the range of 15-25 years). Familial SLE cases are known. The course of SLE in pregnant women is noted to have features due to an increased risk for complications and to pharmacotherapeutic peculiarities. Risk factors for poor pregnancy outcomes, such as high disease activity at the time of conception, active lupus nephritis, and the presence of antiphospholipid antibodies (APA), are identified in patients with SLE. The paper presents antenatal fetal death predictors: proteinuria, thrombocytopenia, APA, and hypertension. When SLE is concurrent with secondary antiphospholipid syndrome (APS), the risk of poor pregnancy outcome is 3...
The review presents the data available in the literature on the use of the lupus band test (LBT) for systemic lupus erythematosus (SLE). LBT is a direct immunofluorescence method used to detect immunoglobulins and complement factors in the dermoepidermal junction of skin biopsy specimens. LBT may be applied as one of the diagnostic tests for early diagnosis of SLE in patients without skin manifestations and in those of incomplete SLE. Like the results of other laboratory tests, those of LBT may be taken into account when establishing a final diagnosis only in conjunction with other clinical, immunological and instrumental data.
Objective: to evaluate the efficacy and safety of glycosaminoglycan-peptide complex (GPC, Rumalon) used in patients with knee osteoarthritis (OA) and comorbidities (hypertension and/or type 2 diabetes mellitus (T2DM).Patients and methods: A 10-month multicenter (13 centers from 10 subjects of the Russian Federation) prospective study included 179 patients with Stages II–III primary tibiofemoral knee OA and comorbidity, a walking pain intensity of ≥40 mm on a visual analogue scale (VAS), and a need for nonsteroidal anti-inflammatory drugs (for at least 30 days in the previous 3 months). The efficiency of treatment was evaluated from the changes in VAS scores for knee pain intensity during walking, the overall WOMAC score and scores of its individual indicators, laboratory parameters, and ultrasound data. All the patients received 2 cycles of GPC treatment with 25 injections, by following the manufacturer's instructions.Results and discussion. Even at 2 months after starting the treatment, there was a statistically significant reduction in pain during walking from 60 (50–69) to 40 (27–53.5) mm on the VAS (p< 0.05), which persisted during the follow-up period. A similar pattern was found when assessing the WOMAC index and its components. The drug demonstrated an anti-inflammatory effect: a decrease in the number of patients with synovitis from 55.7 to 39.2% (p=0.02), the level of high-sensitivity C-reactive protein (hsCRP) from 3.2 (1.3–6.2) to 2.6 (1.2–5.7) mg/l (p< 0.05). GPC was ascertained to have a safety profile.Conclusion. The data of this study confirm the good therapeutic effect and safety of GPC Rumalon in knee OA patients with hypertension and/or T2DM. The drug is shown to have a rapid analgesic and anti-inflammatory effect, as well as a positive influence on all clinical manifestations of OA.
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