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...

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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.

BackgroundChronic pain syndrome, immanent in the majority of immune-inflammatory processes, is one of the pathophysiological mechanisms of the development of emotional and affective disorders. It has been proven that high levels of “pro-inflammatory” mediators are predictors of depression, and increased anxiety leads to an imbalance in the autonomic nervous system (ANS). It is also known that the pain syndrome worsens the autonomic supply of the organism. However, this problem remains insufficiently studied today.ObjectivesTo assess the severity of anxiety and depression in patients with ankylosing spondilite, depending on the state of the ANS and pain syndrome.MethodsThe study included 75 patients with ankylosing spondylitis (AS), who studied the frequency of anxiety-depressive disorders and their severity on the Spielberger anxiety and Hamilton depression scales. The autonomic status was investigated according to the methods “Wayne-patient” - WP, filled by the patient (more than 15 points - possible autonomic dysfunction (AD)) and “Wayne-doctor” - WD, filled by a doctor (more than 25 points - confirms the presence of signs of AD); we evaluated the indicators of heart rate variability (HRV) - mode (Mo), mode amplitude (AMo), autonomic equilibrium index (AEI), regulatory systems tension index (TI), the standard deviation of the normal RR intervals (SDNN), the square root of the mean squares of the difference between successive RR intervals (RMSSD) and the balance ratio of the activity of the sympathetic and parasympathetic divisions of the ANS (LF/HF). Pain syndrome and the patient‘s own health index (POH) were assessed by a visual analogue scale (VAS) by patients, and by a physician - by counting the number of painful joints (NPJ), index BASDAI and ASDAS indices.ResultsIn 25.3% of patients with AS, a high situational anxiety was observed and in 36% of patients high personal anxiety (PA) was observed. Depressive disorders were found in 57 patients with AS (76%). The severity of pain in the joints and the spine influenced the increase in PA (F = 2.75, p = 0.047; F = 3.54, p = 0.037, respectively) and the level of depressive disorders (F = 3.28, p = 0.03; F = 3.44, p = 0.047, respectively), and the level of depression is also POH (F = 3.49, p = 0.048). 68% patients had an AD (according to WP and WD methods). They constituted the 1st group of observation, and the remaining 24 patients were included in the 2nd group. In group 1, signs of anxiety disorders were identified in 84.3% of cases, and in patients without AD in 45.8% of cases. Depressive disorders were observed in 94% patients with autonomic disorders (11 cases of psychotic, 37 - non-psychotic depression) and in 37.5% in patients without signs of AD - signs of non-psychotic depression.In both groups, there was a decrease in SDNN and RMSSD in comparison with normative ones, which indicates an increase in sympathetic regulation. In the 1 st group, there was a more significant increase in LF/HF (4.15 ± 0.64) and a decrease in SDNN (22.4 ± 5.6 ms) than in the 2nd ...