Electronic Library of Scientific Literature



Rheumatologia



Volume IX / 1995 Number 1





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PROTILATKY PROTI HISTONOM PRI SYSTEMOVYCH CHOROBACH SPOJIVA. I. VZTAH K ANTI-DNP A DETEKCIA IMUNOBLOTOM



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ANTI-HISTONE ANTIBODIES IN CONNECTIVE TISSUE DISEASES. I. THEIR RELATIONSHIP TO ANTI-DNP AND DETECTION BY IMMUNOBLOTTING


L. CEBECAUER, L. LUKACOVICOVA, J. LUKAC, J. ROVENSKY

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: doc. MUDr. J. Rovensky, DrSc.

Suhrn
Protilatky proti histonom - AHA - su pritomne vo velkej casti ser chorych so systemovym lupus erythematosus a nezriedka aj v serach chorych s inymi systemovymi chorobami spojiva. V praci sa nadvazuje na predchadzajuci poznatok, podla ktoreho sa daju AHA urcit vo vacsine ser pozitivnych v teste anti-DNP-ELISA. Rozoberaju sa metodicke vyhody pouzitia DNP ako antigenu pri urcovani protilatok proti jednotlivym histonovym frakciam pomocou imunoblotu. Pritom je nespornou vyhodou DNP, ze neobsahuje ine interferujuce intracelularne antigeny, ale na druhej strane obsahuje nehistonove chromatinove proteiny (napr. HMG - high mobility group), ktore mozu reagovat s autoprotilatkami. Korelacia anti-DNP ELISA s AHA urcenymi imunoblotom naznacila, ze cast ser, najma od chorych s inymi chorobami ako SLE, v imunoblote nereaguje, aj ked reaguje nepochybne s DNP. Tato anomalia sa vysvetluje konformacnou podmienenostou reaktivity AHA. Imunoblot podla toho zachytava len cast AHA, ktorych heterogenita sa pokryje len sadou viacerych metod.

Klucove slova: protilatky proti histonom, imunoblot, ELISA, anti-DNP, SLE, systemove choroby spojiva, reumaticke choroby.

Summary
Anti-histone antibodies - AHA - are present in the great proportion of the sera of patients with systemic lupus erythematosus and not infrequently also in the sera of patients with other connective tissue diseases. The results presented are related to our previous finding according to which are AHA found in the great majority of anti-DNP-ELISA positive sera. Details of the methodology are discussed, when DNP is used as antigen in immunoblotting for the detection of antibodies to the individual histone fractions. One of the advantages in using DNP as an antigen is that it does not contain other intracellular antigens. On the other hand it contains nonhistone chromosomal proteins such as HMG etc. which may be important in connection to the related autoantibodies. Correlation with anti-DNP ELISA of immunoblotting analysis of AHA shows that part of the sera especially from patients with connective tissue diseases other than SLE do not react with histones in immunoblot even by undoubtful positivity of anti-DNP ELISA and absence of anti-DNA. This anomaly can be connected with conformational determinants on histones. Immunoblotting can determine only part of AHA.

Key words: antibodies against histones, immunoblotting, ELISA, anti-DNP, connective tissue diseases, rheumatic diseases.
pp. 3 - 6




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POUZITI ERYTROPOETINU V PRIPRAVE NEMOCNYCH REVMATOIDNI ARTRITIDOU K REVMATOCHIRURGICKEMU VYKONU



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THE USE OF ERYTHROPOIETIN IN PREPARATION OF RHEUMATOID ARTHRITIS PATIENTS TO THE RHEUMOSURGERY INTERVENTION


J. HRBA

Revmatologicky ustav, Praha
Reditel: doc. MUDr. K. Pavelka, CSc.

Souhrn
Revmatoidni artritis (RA) je ve 40-60 % provazena anemii. Anemie u RA ma vetsinou charakter tzv. ACD - anemie chronickych nemoci a je rezistentni na dosavadni způsoby leceni. Ucinnym lekem u tohoto typu anemie sa ukazal erytropoetin, nebot podstata tohoto typu anemie spociva hlavne v nedostatecne produkci tohoto hormonu, resp. v nedostatecne reakci kostni drene na nej.
Stale vice pacientů s revmatoidni artritidou je indikovano k nahradam velkych kloubů. Tyto operace vyzaduji zajisteni pacienta dostatecnym mnozstvim krve k transfuzi. Transfuze darcovske krve je spojena s radou problemů, ktere lze vyloucit pouzije-li se metody autotransfuze. Ale prave pacienti s RA a anemii nesplnuji kriteria k odberům krve pro ucely autotransfuze.
Autor provedl studii s 15 pacienty, kterym v predoperacni priprave aplikoval erytropoetin a zelezo. U vsech prokazal podstatny vzestup hemoglobinu a hematokritu, takze u 10 pacientů bylo mozno ziskat po dvou transfuznich jednotkach, u 3 po jedne jednotce krve a u vsech podstatneho zlepseni krevniho obrazu tesne pred terminem operace.

Klicova slova: erytropoetin, anemie pri revmatoidni artritis, autotransfuze.

Summary
Rheumatoid arthritis is accompanied in 40-60 % with anemia. The anemia in RA has mostly the character of so called ACD anemia of chronic diseases and is resistent to the so far applied ways of the treatment. A drug demonstrated to be efficient in this type of anemia was erythropoietin, because the essence of this type of anemia lies especially in an insufficient production of this hormone resp. in an insufficient reaction of bone marrow to it.
More and more rheumatoid arthritis (RA) patients are indicated to large joints replacements. These operations require providing a sufficient amount of blood for the patient for transfusion. The transfusion of the donor blood is connected with a number of problems, which can be excluded by using the method of autotransfusion. Buz the very patients with RA and anemia do not fulfil the criteria for the blood collection for autotransfusion purpose.
The author included in the study 15 patients to whom in the preoperative preparation erythropoietin and iron were administered. In all of them, a considerable increase of hemoglobin and hematocrit was manifested, so that in each of the 10 patients it was possible to obtain two transfusion units, in 3 one unit each in all a considerable improvemement of the blood count immediately before the term of the operation.

Key words: erythropoietin, rheumatoid arthritis with anemia, autotransfusion.
pp. 7 - 11




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ANALYZA ENDOSKOPICKYCH VYSETRENI HORNEHO GASTROINTESTINALNEHO TRAKTU U CHORYCH S REUMATICKYMI CHOROBAMI



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ANALYSIS OF ENDOSCOPIC EXAMINATIONS OF THE UPPER GASTROINTESTINAL TRACT IN PATIENTS WITH RHEUMATIC DISEASES


I. RYBAR, D. MICEKOVA*, D. ZLNAY*, M. ORLOVSKA*, J. LUKAC*

Subkatedra reumatologie IVZ, Piestany
Veduci: doc. MUDr. J. Rovensky, DrSc.
*Vyskumny ustav reumatickych chorob, Piestany
Riaditel: doc. MUDr. J. Rovensky, DrSc.

Suhrn
Pepticky vred sa poklada za heterogennu chorobu a gastropatia po nesteroidnych antireumatikach za jednu z podjednotiek. Cielom prace bola retrospektivna analyza 190 endoskopickych nalezov v hornom gastrointestinalnom trakte chorych liecenych nesteroidnymi antireumatikami. Gastropatia sa potvrdila u 137 z nich. 17 pacientov malo ulcus, 64 erozie a 56 loziska podsliznicovych hemoragii. Asymptomaticky priebeh sa zaznamenal u 38 % postihnutych. Frekvencia vyskytu dyspepsie stupala so zavaznostou endoskopickeho nalezu. Chori s erozivnou gastropatiou mali v anamneze castejsi vyskyt peptickeho vredu. Popri nesteroidnych antireumatikach boli castejsie lieceni glukokortikoidmi a mali vyssi priemerny vek, oba parametre vsak nedosiahli v porovnani s pacientmi s normalnym sliznicovym nalezom v hornom gastrointestinalnom trakte statisticky vyznamny rozdiel.

Klucove slova: nesteroidne antireumatika, gastroduodenopatia po nesteroidnych antireumatikach, neziaduce ucinky nesteroidnych antireumatik v traviacom trakte, gastrointestinalny trakt, pepticke lezie po nesteroidnych antireumatikach.

Summary
Peptic ulcer is considered a heterogenous disease and the gastropathy induced nonsteroidal antiinflammatory drugs one of subentities. The aim of the study was a retrospective analysis of 190 endoscopic findings in the upper gastrointestinal tract of patients treated with antiinflammatory drugs. Gastropathy was confirmed in 137 of them. Seventeen patients had ulcer, 64 erosions and 56 deposite of submucous hemorrhages. The asymptomatic course was found in 38 % of the affected patients. The frequency of dyspepsia increased with the severity of endoscopic finding. The patients with erosive gastropathy had a higher occurrence of peptic ulcer. In addition to nonsteroidal antirheumatics they were most frequently treated with glucocorticosteroids and had a higher average age, but the two parameters did not achieve statistically significant difference in comparison with the patients with normal mucosal finding in the upper gastrointestinal tract.

Key words: nonsteroidal antiinflammatory drugs, NSAIDs-gastropathy, adverse events by NSAIDs, peptic lesion by NSAIDs.
pp. 13 - 16




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CHLAMYDIOVE INFEKCIE A ICH VYZNAM V REUMATOLOGII. II. CHLAMYDIAMI INDUKOVANE ARTRITIDY - KLINICKA A LABORATORNA ANALYZA VLASTNEHO SUBORU PACIENTOV



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CHLAMYDIAL INFECTIONS AND THEIR SIGNIFICANCE IN RHEUMATOLOGY. II. CHLAMYDIA-INDUCED ARTHRITIDES - CLINICAL AND LABORATORY ASPECTS


F. MATEICKA, V. BOSAK

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: doc. MUDr. J. Rovensky, DrSc.

Suhrn
Chlamydiami indukovane artritidy (CIA) su neskorymi dosledkami inicialnej chlamydiovej infekcie organizmu (najcastejsie urogenitalnej).
Autori prinasaju klinicku a laboratornu prierezovu analyzu 23 pacientov (21 muzov a 2 zeny) s diagnozou istej alebo pravdepodobnej diagnozy CIA. Pri diagnostike pouzili aj vysledky serologickej analyzy protilatok proti chlamydiam, ako aj dokaz chlamydii vo vyteroch z uretry alebo spojivkoveho vaku.
Z hladiska klboveho postihnutia sa najcastejsie pozorovala asymetricka oligoartritida (69,6 %) a najcastejsie postihnutymi klbmi boli clenok (69,6 %) a koleno (56,5 %). Pozoruhodna bola znacna tendencia k chronickemu priebehu ochorenia. Z extraartikularnych prejavov sa najcastejsie pozorovali urogenitalne symptomy (60,9 %) a chronicka konjunktivitida (65,2 %). Kompletny Reiterov syndrom bol vyznaceny u 30,4 % pacientov. Priemerne u 70 % pacientov sa zistila asociacia ochorenia s antigenom HLA-B27. Priblizne u polovice pacientov boli pritomne evidentne alebo neurcite zapalove zmeny na krizovo-bedrovych klboch. Asi u stvrtiny pacientov boli znamky zvysenej humoralnej zapalovej aktivity ochorenia.
Autori porovnavaju zistene nalezy s dosial publikovanymi udajmi a upozornuju na osobitosti diagnostiky a diferencialnej diagnostiky CIA.

Klucove slova: chlamydiami indukovane artritidy, reaktivne artritidy, seronegativne spondylartritidy, diagnostika, diferencialna diagnostika.

Summary
Chlamydia induced arthritides (CIA) are late consequences of initial chlamydial infections of the organism (most frequently urogenital).
The authors present a clinical and laboratory analysis of 23 patients (21 men and 2 women) with diagnosis of certain or probable CIA. In the diagnostics were used also results of serologic analysis of antibodies against chlamydias as well as the evidence of chlamydias in the uretra or conjunctival sac swabs.
From the point of view of the joint involvement, most frequent was asymmetric oligoarthritis (69.6 %), the most frequently affected joints were the ankle (69.6 %) and the knee (56.5 %). Remarkable was a marked tendency to chronic course of the disease. Out of the extraarticular manifestations, urogenital symptomatology (60,9 %) and chronic conjunctivitis (65.2 %) were observed most frequently. A complete Reiter's syndrome was found in 30.4 % of patients. In some 70 % of the patients association of the disease with HLA-B27 antigen was found. In about a half of the patients evident or incertain inflammatory changes were found on the sacroiliac joints. In about a quarter of the patients there were signs of an increased humoral inflammatory activity of the disease.
The authors compare the findings obtained with the data published so far and point to the specificities of the diagnostics and differential diagnostics of CIA.

Key words: chlamydia induced arthritides, reactive arthritides, seronegative spondyloarthropathies, diagnostics, differential diagnostics.
pp. 17 - 22




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VYSETRENI HLADINY KERATANSULFATU, GLYKOSAMINOGLYKANU A STROMELYZINU V SYNOVIALNI TEKUTINE U NEKTERYCH ZANETLIVYCH REVMATICKYCH CHOROB



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EXAMINATION OF THE LEVEL OF KERATAN SULPHATE, GLYCOSAMINOGLYCANS AND STROMELYSIN IN SYNOVIAL FLUID IN SOME INFLAMMATORY RHEUMATIC DISEASES


J. KRAJICKOVA, V. PODRAZKY, B. SKRIVANKOVA, K. TRNAVSKY

Revmatologicky ustav, Praha
Reditel: doc. MUDr. K. Pavelka, CSc.

Souhrn
Ve skupine 22 nemocnych s reaktivni artritidou, 9 nemocnych s periferni formou ankylozujici spondylitidy, 3 nemocnych s dnavou artritidou a 6 nemocnych s psoriatickou artritidou byl vysetren v synovialni tekutine obsah glykozaminoglykanu, keratansulfatu a stromelyzinu. Ziskane hodnoty byly porovnany s nalezy u nemocnych s aktivni revmatoidni artritidou. Nejvyssi hladiny sledovanych ukazatelu byly nalezeny u nemocnych s ankylozujici spondylitidou. Keratansulfat a aktivita stromelyzinu byla vysoka u dnave artritidy. U dalsich vysetrovanych nemocnych se hodnoty sledovanych ukazatelů blizily hodnotam u aktivni revmatoidni artritidy. V zadnem pripade nekorelovaly s poctem bunek ve vypotku. Uvedene ukazatele maji omezeny vyznam pro diagnostiku, ale korelace s klinickym průbehem onemocneni by mohla byt prinosem pro monitorovani dynamiky kloubniho procesu.

Klicova slova: synovialni tekutina, zanetlive revmaticke choroby, glykozaminoglykany, stromelyzin, keratansulfat.

Summary
In a group of 22 reactive arthritis patients, 9 patients with peripheral form of ankylosing spondylitis, 3 patients with gouty arthritis and 6 patients with psoriatic arthritis, synovial fluid was examined for the content of sulphatized glycosaminoglycans, keratan sulphate and stromelysin. The values obtained were compared with the findings in patients with active rheumatoid arthritis. The highest levels of the studied markers were found in ankylosing spondylitis patients. Keratan sulphate and the activity of stromelysin were high in gouty arthritis. In further examined patients the values of the studied markers approached to those in active rheumatoid arthritis. They did not correlate in any case with the number of cells in the effusion. The mentioned markers have a limited significance for the diagnostics.

Key words: synovial fluid, inflammatory rheumatic diseases, glycosaminoglycans, stromelysin, keratan sulphate.
pp. 23 - 26




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KORELACIA MINERALIZACIE KOXY A LUMBALNEJ CHRBTICE U PACIENTOV S OSTEOPOROZOU (HODNOTENIE DEXA)



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CORRELATION OF THE HIP-JOINT AND LUMBAR SPINE MINERALIZATION IN PATIENTS WITH OSTEOPOROSIS (DEXA EVALUATION)


J. VOJTASSAK, K. RAUSOVA, A. SVEC, R. VOJTEK

I. ortopedicka klinika LFUK, Bratislava
Prednosta: prof. MUDr. F. Makai, DrSc.

Suhrn
Na zaklade 2-rocnych skusenosti s denzitometrickymi vysetreniami pristrojom LUNAR DPX-L pracujucom na baze dvojitej rontgenovej absorpciometrie autori udavaju korelaciu mineralizacie lumbalnej chrbtice a koxy v posterioanteriornej projekcii u 101 pacientok s osteoporozou. Najnizsiu mineralizaciu preukazoval stavec L1-BMD v pasme od 0,7 do 0,8 g/cm2, L2 stavec BMD v pasme od 0,8 do 0,9 g/cm2, vacsiu mineralizaciu preukazoval stavec L3-BMD od 0,9 do 1,0 g/cm2, najvacsiu denzitu mal stavec L4 v pasme od 0,9 do 1,0 g/cm2. Na proximalnom femure sa zistila mineralizacia na krcku v pasme BMD od 0,7 do 0,8, Wardov trojuholnik preukazoval denzitu BMD od 0,6 do 0,7 g/cm2. Trochanter mal denzitu od 0,6 do 0,7 g/cm2. Na zaklade nameranych vysledkov vidiet, ze osteoporozou u zien v postmenopauzalnom obdobi nie su rovnomerne postihnute vsetky kosti, ale osteoporoza nastupuje na L1 a postupne sa siri periferne. Len 52 % pacientok s osteoporozou lumbalnej chrbtice preukazovalo osteoporozu koxy. To, ze osteoporoza je najcastejsie na stavci L1, vysvetluju autori tym, ze postmenopauzalna osteoporoza sa zacina na vrchole kyfozy a progreduje postupne distalne. Na nepomere mineralizacie L1 a L4 sa zucastnuju aj osteochondroza, spondyloza a spondylartroza, co sa rontgenologicky a denzitometricky prejavuje zvysenou denzitou. Meranie denzity PA lumbalnej chrbtice je vhodne ako skriningove, pretoze tu nachadzame prve znamky osteoporozy, pricom mineralizacia koxy moze byt este v norme (prevencia fraktury coli femoris).

Klucove slova: osteoporoza, denzitometria, korelacia mineralizacie, DEXA, DPX.

Summary
On the basis of two-year experiences with densitometric examinations by the LUNAR DPX-L equipment working on the basis of x-ray absorptiometry, the authors present the correlation of lumbar spine and hip-joint mineralization in posterior projection in 101 female patients with osteoporosis. The lowest mineralization manifested the L1-BMD vertebra in the zone of 0.7 to 0.8 g/cm2, L2-BMD vertebra in the zone from 0.8 to 0.9 g/cm2, a higher mineralization was manifested by L3-BMD vertebra from 0.9 to 1.0 g/cm2, the highest density was found in the L4 vertebra in the zone from 0.9 to 1.0 g/cm2. On the proximal femur the mineralization was found on the collum in the BMD zone from 0.7 to 0.8, the Ward triangle manifested the BMD density from 0.6 to 0.7 g/cm2. The density of trochanter was from 0.6 to 0.7 g/cm2. On the basis of the measured results it can be seen that osteoporosis in women in postmenopausal period does not affect all the bones regularly, but osteoporosis starts on L1 and gradually spreads peripherally. Only 52 % of female patients with osteoporosis of the lumbar spine manifested hip-joint osteoporosis. The fact that osteoporosis is found most frequently on the L1 vertebra is explained by the start of postmenopausal osteoporosis on the peak of kyphosis and its gradual progressing distally. On the disproportion of L1 and L4 mineralization participate also osteochondrosis, spondylosis and spondylarthrosis, radiologically and densitometrically manifested by increased density. Measurement of density of PA lumbar spine is suitable as screening, as here are found the first signs of osteoporosis, while mineralization of the hip-joint can be still within norm (prevention of coli femoris fracture).

Key words: osteoporosis, densitometry, correlation of the mineralization, DEXA, DPX.
pp. 27 - 33




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NOVSIE MOZNOSTI STUDIA PSYCHOSOMATICKYCH VZTAHOV PRI REUMATICKYCH CHOROBACH



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SOME NOVEL POSSIBILITIES OF THE STUDY OF PSYCHOSOMATIC RELATIONS IN RHEUMATIC DISEASES


S. HERMANEK

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: doc. MUDr. J. Rovensky, DrSc.

Suhrn
V subore 60 chorych na ankylozujucu spondylitidu (38 muzov, 22 zien) a 68 chorych na psoriaticku artritidu (33 muzov, 35 zien) sa sledovala miera jedneho z novsich nosnych konstruktov psychosomatickeho vyskumu - alexitymie. Vyrazne alexitymicke charakteristiky prejavovalo 40 % chorych na ankylozujucu spondylitidu a 53 % chorych na psoriaticku artritidu. U dalsich 38 % chorych na ankylozujucu spondylitidu a 34 % chorych na psoriaticku artritidu bola charakteristika pre alexitymiu vyjadrena v mensej intenzite. Chori na psoriaticku artritidu mali signifikantne vyssie skore alexitymie oproti chorym na ankylozujucu spondylitidu, najma zasluhou zien, ktore mali skore preukazne vyssie ako muzi. Zeny oboch skupin spolu mali signifikantne vyssie skore ako muzi celeho suboru. V zhode s mierou alexitymie u sledovanych chorych bol aj stupen ich psychosomatickeho narusenia. Medzi alexitymickymi charakteristikami chorych a ich vekom, ako aj trvanim choroby sa nezistili nijake signifikantne korelacie. Pozoruhodne su vsak korelacie medzi alexitymiou a niektorymi osobnostnymi charakteristikami, emocnymi poruchami a niektorymi parametrami bolesti.

Klucove slova: ankylozujuca spondylitida, psoriaticka artritida, psychosomaticke vztahy, alexitymia.

Summary
The study is focused especially on the finding of one of the novel carrying constructs of psychosomatic research - alexithymia. The study of this phenomenon was performed in a group of patients suffering from ankylosing spondylitis (38 men, 22 women) and psoriatic arthritis (33 men, 35 women). Alexithymia was studied by means of structured interview (6), set up on the basis of Toronto Alexithymia Scale (14). Marked alexithymic characteristics were found in 40 % of ankylosing spondylitis patients and 53 % of psoriatic arthritis patients. In further 38 % of ankylosing spondylitis patients and 34 % of psoriatic arthritis patients the characteristics for alexithymia was expressed in lesser intensity. The psoriatic arthritis patients had a significantly higher scores of alexithymia than the ankylosing spondylitis patients, especially due to the women scoring markedly higher than men. The women from both groups together had significantly higher scores than men from the group as a whole. The measure of alexithymia in the studied patients corresponded to the grade of their psychosomatic impairment. We have not found any significant correlations between the alexithymic characteristics of patients and their age, or duration of their disease. However, noteworthy correlations were found between alexithymia and some personal characteristics, emotional disorders and certain parameters of pain. The importance of the knowledge of the construct alexithymia for the clinical and particularly psychotherapeutic practice is discussed.

Key words: ankylosing spondylitis, psoriatic arthritis, psychosomatic relations, alexithymia.
pp. 35 - 39




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VLIV FLOBUFENU NA AKTIVITU PROTEINAZ DEGRADUJICICH CHRUPAVKOVOU MATRIX A POROVNANI S VLIVEM TETRACYKLINU, KYSELINY TIAPROFENOVE A ARTEPARONU



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INFLUENCE OF FLOBUFEN ON THE ACTIVITY OF PROTEINASES DEGRADING CARTILAGE MATRIX AND THE COMPARISON WITH THE INFLUENCE OF TETRACYCLINE, TIAPROFENIC ACID AND ARTEPARON


J. STOVICKOVA, M. STOL, K. TRNAVSKY

Revmatologicky ustav, Praha
Riaditel: doc. MUDr. K. Pavelka, CSc.

Souhrn
Afinitni chromatografii na perlove celuloze s kovalentne vazanou ostazinovou cerveni a naslednou permeacni chromatografii na Sephadexu G-75 byla ze zanetlive lidske synovialni tekutiny ziskana frakce proteolytickych enzymů. Tato frakce byla charakterizovana skupinove specifickymi inhibitory jako smes metaloproteinaz, serinovych proteinaz a cysteinovych proteinaz, s vyraznou prevahou metaloproteinaz. Byla studovana koncentracni zavislost ucinku noveho nesteroidniho antirevmatika flobufenu na kaseinolytickou aktivitu teto frakce a porovnana s koncentracnimi zavislostmi ucinku tetracyklinu, kyseliny tiaprofenove a Arteparonu. Inhibicni ucinek flobufenu byl v koncentracnim rozmezi jeho rozpustnosti vetsi nez inhibicni ucinek kyseliny tiaprofenove. Nejsilnejsi inhibicni ucinek mel tetracyklin, zatimco Arteparon kaseinolytickou aktivitu teto frakce nejenze neinhiboval, ale dokonce ji vyrazne zvysoval.

Klicova slova: afinitni chromatografie, proteolyticka frakce lidske synovialni tekutiny, nesteroidni antirevmatika.

Summary
Using the affinity chromatography on bead-cellulosis with covalent bound ostasin red and subsequent permeation chromatopraphy on Sephadex G-75, a fraction of proteolytic enzymes was obtained from the inflammatory human synovial fluid. This fraction was characterized by group-specific inhibitors as a mixture of metalloproteinases, serine proteinases and cysteine proteinases, with a marked predominance of metalloproteinases. The effect of various concentrations of the new non-steroidal antirheumatic flobufen on caseinolytic activity of this fraction was studied and compared with the effect of various concentrations of tetracycline, tiaprofenic acid and Arteparon. The inhibitory effect of flobufen in the concentration range of its sollubility was higher than that of tiaprofenic acid. The strongest inhibitory effect was produced by tetracyclin, whereas Arteparon did not inhibit the caseinolytic activity of this fraction, but, moreover, markedly increased it.

Key words: affinity chromatography, proteolytic fraction of the human synovial fluid, non-steroidal antirheumaticum.
pp. 41 - 44




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VPLYV BALNEOTERAPIE NA SEROVU HLADINU HYALURONANU A NA LEQUESNEOV ALGO-FUNKCNY INDEX U CHORYCH S KOXARTROZOU



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INFLUENCE OF BALNEOTHERAPY ON SERUM LEVEL OF HYALURONAN AND ON LEQUESNE ALGO-FUNCTIONAL INDEX IN PATIENTS WITH COXARTHROSIS


M. RISKA, M. STANCIKOVA*

Slovenske liecebne kupele, s.p., Piestany
Riaditel: Ing. J. Slafkovska
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.

Suhrn
Sledovali sme subor pacientov s koxartrozou III. stadia, ktori absolvovali kupelnu liecbu v Slovenskych liecebnych kupeloch Piestany, s.p. Po 3-tyzdnovej intenzivnej balneoterapii dochadza k vyraznej zmene klinickych a funkcnych prejavov koxartrozy chorych, meranych Lequesneovym algo-funkcnym indexom. Celkovy pocet bodov klesol z 10,75#3,63 na 5,75#2,69 na hladine signifikantnosti p<0,01. Tento pokles odraza vyraznu zmenu v dvoch castiach Lequesneovho indexu tykajucich sa hodnotenia bolesti a moznosti chorych prekonat niektore vybrane cinnosti denneho zivota. Serova hladina hyaluronanu bola u chorych s koxartrozou v porovnani so zdravymi kontrolami pred balneoterapiou vyrazne vyssia (94,8#37,91 ug/L vs 50,6#21,62 ug/L). Po balneoterapii hladina seroveho hyaluronanu klesla u 9 z 20 chorych sledovaneho suboru. Pokles bodov podla Lequesneovho algo-funkcneho indexu je u tychto chorych takmer 2-nasobny z hladiska hodnotenia roznych typov bolesti a vybranych aktivit denneho zivota.
Praca prinasa originalne spojenie biochemickej metody s metodou funkcneho hodnotenia ucinku komplexnej balneoterapie u chorych s koxartrozou.

Klucove slova: koxartroza, balneoterapia, Lequesneov index, hyaluronan.

Summary
A group of patients with III grade coxarthrosis who underwent balneotherapy in the Slovak Health Spa in Piestany was studied. After three-week intensive balneotherapy, there was a marked change in clinical and functional manifestations of coxarthrosis, measured by Lesquesne algo-functional index. The total scores decreased from 10,75#3,63 to 5,75#2,69 on the level of significance p<0,01. This decrease reflects a marked change in two parts Lequesne index, related to the evaluation of the pain and the abilities of patients to overcome some selected activities of daily life. Serum level of hyaluronan in patients with coxarthrosis before balneotherapy in comparison with healthy controls was markedly higher (94,8#37,91 ug/L vs 50,6#21,62 ug/L). After balneotherapy serum hyaluronan level decreased in 9 out of 20 patients of the studied group. The decrease of the scores in these patients according to Lequesne algo-functional index is almost two-fold which applies to evaluation of various types of pain and the selected activities of the daily life.
The study presents an original combination of the biochemical method with the method of functional evaluation of the effect of complex balneotherapy in patients with coxarthrosis.

Key words: coxarthrosis, balneotherapy, Lequesne algo-functional index, hyaluronan.
pp. 45 - 48




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PRIMARNE IMUNODEFICIENTNE STAVY. II. IMUNODEFICIENCIE SEKUNDARNE K INEJ ZAKLADNEJ CHOROBE, DEFICIENCIE ZLOZIEK KOMPLEMENTU, PORUCHY FAGOCYTOZY



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PRIMARY IMMUNODEFICIENCIES. II.IMMUNODEFICIENCIES SECONDARY TO OTHER BASIC DISEASE, DEFICIENCY OF COMPLEMENT, PHAGOCYTIC DYSFUNCTIONS


M. BUC

Imunologicky ustav Lekarskej fakulty UK, Bratislava
Veduci: prof. MUDr. M. Buc, DrSc.

Suhrn
Roku 1952 Bruton opisal prvu imunodeficienciu. Postupne s pribudanim poznatkov o strukture, funkcii a genetickej determinacii imunitneho systemu sa pocet opisanych imunodeficientnych stavov zvysoval. Ich klasifikacia povodne vychadzala z delenia imunitneho systemu na nespecificku a specificku imunitu, takze sme rozlisovali imunodeficiencie nespecifickej imunity a deficiencie specifickej protilatkovej ci bunkovej imunity, resp. kombinovane imunodeficiencie. Toto rozdelenie sa postupom casu ukazalo ako uz nevyhovujuce stavu dnesnych poznatkov, a tak roku 1992 nomenklaturna komisia SZO prijala nove delenie a podala prehlad sucasneho stavu, ktory sme spristupnili nasim citatelom v predchadzajucom cisle a dokoncujeme v tomto cisle spolu so strucnou charakteristikou jednotlivych chorob.

Klucove slova: cytokiny a ich receptory, diferenciacne antigeny, fagocyty, HLA-antigeny, imunodeficiencia, protilatky, komplement, lymfocyty T a B, vyvoj imunitneho systemu.

Summary
In 1952 O. Bruton described the first known immunodeficiency. Since then the number of immunodeficiency diseases raised substantially. Their classification was first based on a general division of the immune system; we therefore recognized immunodeficiencies of unspecific and specific immunity. This division, however, does not any more reflect our contemporary knowledge about immunodeficiencies. In 1992 the nomenclature commitee of WHO has therefore adopted a new division of immunodeficiency disorders. We describe it, together with a short characteristic of any immunodeficiency disease, in two articles. In the previous article we described the primary specific immunodeficiencies; in the present article we continue by writing about immunodeficiencies secondary to other basic disease, deficiencies of complement, and phagocytic dysfunctions.

Key words: cytokines and their receptors, differentiated antigens, phagocytes, HLA antigens, immunodeficiency, antibodies, complement, lymphocytes T and B, development of immune system.
pp. 49 - 55




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KLINICKO-EKONOMICKA ANALYZA NAKLADOV NA LIECBU REUMATICKYCH CHOROB Z POHLADU REUMATOLOGA



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CLINICAL-ECONOMIC ANALYSIS FROM THE RHEUMATOLOGIST'S POINT OF VIEW


P. MASARYK

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.

Suhrn
Autor podava prehlad o klinicko-ekonomickej analyze reumatickych chorob ako o trojdimenzionalnom probleme (dimenzia analyzy nakladov, dimenzia druhu nakladov, dimenzia subjektu nakladov).
Reumaticke choroby patria v populacii k chorobam s najvacsim podielom na chorobnosti a praceneschopnosti. Zavinuju 10 % pripadov kratkodobej praceneschopnosti (druhe miesto po chorobach dychacieho traktu). Svojim 30 % podielom su na 1. mieste v dlhodobej praceneschopnosti. Ako celok maju teda obrovske ekonomicke dosledky a vyzaduju komplexnu klinicko-ekonomicku analyzu. Kedze ich prevalencia vekom narasta, so starnutim populacie rastu aj celkove naklady na ne. To sa prejavuje najma pri osteoartroze a osteoporoze, hlavne v oblasti fraktur femuru. Celozivotne naklady na reumatoidnu artritidu predstavuju 4. miesto za nadormi, mozgovymi prihodami a ischemickou chorobou srdca.

Klucove slova: klinicko-ekonomicka analyza, reumaticke choroby.

Summary
The author makes a survey of the clinical-economic analysis of the rheumatic diseases as a three-dimensional problem (cost analysis dimension, type of costs dimension, subject of cost dimension).
The rheumatic diseases belong in the population to those having the highest share of a sickness figure and sick leave. They represent 10 % of the short-term sick leave cases (second place after the respiratory tract diseases). With their share of 30 % they are in the 1st place of a long-term sick leave. In the whole they have accordingly a huge economic consequences and require a complex clinical-economic analysis. In view of the fact their prevalence increases with the age, with population growing older the total expended costs increase as well. This evident above all with the osteoarthritis and the osteoporosis, mainly in the area of the femoral fractures. The lifelong costs for the rheumatoid arthritis represent the 4th place after tumours, cerebral accident and the ischemic heart disease.

Key words: clinical-economic analysis, rheumatic diseases.
pp. 57 - 60




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TRANSPORT KYSELINY MOCOVEJ OBLICKAMI U ZDRAVYCH OSOB A U PACIENTOV S DNOU



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TRANSPORT OF URIC ACID BY KIDNEYS IN HEALTHY PERSONS AND IN PATIENTS WITH GOUT


M. KOVALANCIK

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.

Suhrn
V prehladnom referate sa opisuje mechanizmus exkrecie kyseliny mocovej oblickami na zaklade dnes akceptovaneho stvorzlozkoveho modelu, ktory tvori: glomerularna filtracia (takmer 100 %), proximalna tubularna reabsorpcia (99,3 %), tubularna sekrecia (50 %) a postsekrecna reabsorpcia (40 %). Rozoberaju sa vplyvy, ktore maju v exkrecii kyseliny mocovej rozhodujuci vyznam a uvadzaju sa vysledky farmakologickych pokusov, ktore spresnuju objasnenie transportneho mechanizmu uratov u zdravych a u pacientov s dnou.

Klucove slova: renalny transport uratov, kyselina mocova, dna.

Summary
The mechanism of uric acid excretion by kidneys is described on the basis of today accepted four-component model, including: glomerular filtration (almost 100 %), proximal tubular reabsorption (99,3 %), tubular secretion (50 %) and postsecretion reabsorption (40 %). The influences which are of a decisive significance in uric acid excretion are discussed and the results of pharmacological experiments are presented defining more precisely the urate transport mechanism in healthy persons and in patients with gout.

Key words: uric acid excretion by kidneys, uric acid, gout.
pp. 61 - 65
pp. 61 - 65