BackgroundTreatment of rheumatoid arthritis (RA) prior to “Treat to target” is difficult enough, forcing researchers around the world look for ways to improve the effectiveness of RA treatment.ObjectivesTo explore the possibilities of reducing RA activity on the disease activity score DAS28 CRP by adding pentoxifylline to the methotrexate treatment.MethodsThis study included women (n=101) with RA longer than 1 year in duration, have a seropositive rheumatoid factor, and DAS28 CRP activity score of 3.2–5.1. Middle aged – 45.04±5.24 years old. All patients received a 15.50±2.50 mg oral dose of methotrexate per week. Patients were divided into two groups - those who only had methotrexate (n=50) and those who were treated with an oral dose of methotrexate and 1200 mg of pentoxifylline per day (n=51).ResultsThe baseline for both groups of RA patients did not differ significantly in terms of the level on the DAS28 CRP (p=0.812). On 14th day of the group who were taking pentoxifylline, the DAS28 CRP disease activity score was significantly lower by 12.5% (p<0.001). After 28 days, the users had a DAS28 CRP disease activity score index difference. The difference between two groups is statistically significant. In the group that were treated with pentoxifylline in addition to methotrexate (p=0.001) the index was found to be 8.3% lower. For 28 days, the methotrexate group's disease activity according to the DAS28 CRP activity score significantly decreased by 14.3% from the baseline (p<0.001). For 28 days, the pentoxifylline + methotrexate group also achieved a statistically significant reduction in the index according to the DAS28 CRP activity score by 20.5% (p<0.001)The disease activity index for the two groups for 14 and 28 days is shown in the table.DAS28 CRP Index in the two groups of RA patientsGroups of patients and observation timeGroupGroupStatistical significant differences between the two groupsMethotrexate (n=50)Methotrexate + Pentoxifylline (n=51)Baseline3.11±0.053.13±0.05p=0.812For 14 days3.06±0.052.69±0.06p<0.001For 28 days2.71±0.042.48±0.06p=0.001ConclusionsThus, converting the monotherapy methotrexate to pentoxifylline will significantly reduce the activity of RA, while avoiding many of the adverse effects of the other combination therapies. This data requires further long-term research.Disclosure of InterestNone declared

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BackgroundThe treatment of patients with RA (rheumatoid arthritis) is a complicated task, because the achievement of remission and low level of activity often requires administration of 2–3 disease-modifying drugs. In such conditions we often face with the rise of treatment costs and with the increase of therapy side effects. That is why relevant is the search of the drugs increasing the effect of the “gold standard” of RA – therapy - methotrexate, and also frequently used sulphasalazine and leflunomid. Treatment of prior to “Treat to target” is difficult enough, forcing researchers around the world to look for the ways to improve the effectiveness of RA treatment.ObjectivesTo explore the possibilities of reducing RA activity on the disease activity score DAS28 CRP by adding pentoxifylline to the methotrexate, sulfasalazine and leflunomide treatment.MethodsThis study included women (n=131) with RA longer than 1 year in duration, having a seropositive rheumatoid factor, and DAS28 CRP activity score of 3.2–5.1. Middle aged – 46.44±3.24 years old. All patients received a 15.50±2.50 mg oral dose of methotrexate per week, 2000±500 mg oral dose of sulfasalazine per day, 20±5 mg oral dose of leflunomide per day. Patients were divided into two groups - those who only had disease-modifying drugs (DMARDs) (n=80) and those who were treated with an oral dose of methotrexate and 1200 mg of pentoxifylline per day (n=51).ResultsThe baseline for both groups of RA patients did not differ significantly in terms of the level on the DAS28 CRP (p=0.812). On 14th day of the group who were taking pentoxifylline, the DAS28 CRP disease activity score was significantly lower by 12.5% (p<0.001). After 28 days, the users had a DAS28 CRP disease activity score index difference. The difference between two groups is statistically significant. In the group that were treated with pentoxifylline in addition to DMARDs (p=0.001) the index was found to be 8.3% lower. For 28 days, the methotrexate group's disease activity according to the DAS28 CRP activity score significantly decreased by 14.3% from the baseline (p<0.001). For 28 days, the pentoxifylline + DMARDs group also achieved a statistically significant reduction in the index according to the DAS28 CRP activity score by 20.5% (p<0.001)The disease activity index for the two groups for 14 and 28 days is shown in the table.The DAS28 CRP Index in the two groups of RA patientsGroups of patients Observation timeGroup DMARDs (n=80)Group DMARDs + Pentoxifylline (n=51)Statistical significant differences between the two groups Baseline3.11±0.053.13±0.05p=0.812For 14 days3.06±0.052.69±0.06p<0.001For 28 days2.71±0.042.48±0.06p=0.001ConclusionsThus, converting the monotherapy DMARDs to pentoxifylline will significantly reduce the activity of RA, while avoiding many of the adverse effects of the other combination therapies. This data requires further long-term research.Disclosure of InterestNone declared

Авторами представлен случай редкого врожденного порока сердца -аномалии Эбштейна у взрослого пациента. Представлены некоторые особенности течения, возможности витальной рутинной диагностики и подходы к лечению, доступные на уровне врача участкового терапевта с раскрытием логистических схем курации на примере конкретного пациента из практики авторов. Приведенный клинический случай пациента с данной патологией -случай успешного оперативного лечения аномалии Эбштейна в зрелом возрасте с полной компенсацией пациента. Описание данного случая направлено на привлечение внимания врачей терапевтического профиля к дифференциальной диагностике аномалии Эбштейна, значимости раннего выявления симптомов, своевременности их устранения, тактике ведения пациентов после оперативного лечения на амбулаторно-поликлиническом этапе. Так как врожденные пороки сердца -редкое заболевание на терапевтическом амбулаторном приеме и внимание врача-терапевта в случае их обнаружения рассеивается посиндромно (синдром стенокардии, синдром недостаточности кровообращения), что затрудняет целостный взгляд на проблему и ее видение, назначение данной статьи -акцентировать врачей на диагностику бессимптомных пороков сердца, протекающих под маской коронарогенной патологии миокарда. Ключевые слова: врождённые пороки сердца, аномалия Эбштейна, трехстворчатый клапан, аномальное правое атриовентрикулярное отверстие. The authors presented a case of a rare congenital heart disease -an anomaly of Ebstein in an adult patient. Some features of the current, the possibility of vital routine diagnosis and approaches to treatment, available at the level of the physician with the disclosure of logistical schemes of supervision on the example of a particular patient from the practice of authors are presented. The resulted clinical case of the patient with this pathology is the case of successful surgical treatment of Ebstein's anomaly in adulthood with full compensation of the patient. The description of this case is aimed at attracting the attention of physicians of the therapeutic profile to the differential diagnosis of Ebstein's anomaly, the importance of early detection of symptoms, the timeliness of their elimination, the tactics of managing patients after surgical treatment at an polyclinic stage. Since congenital heart defects -are a rare disease in therapeutic outpatient care and the attention of a therapist in case of their detection is dissipated by syndrome (angina syndrome, circulatory insufficiency syndrome), which complicates the holistic view of the problem and its vision, the purpose of this article is to accent doctors on diagnosis of asymptomatic heart defects, that occur under the mask of coronary pathology of the myocardium. Keywords. congenital heart disorder, ebstein's anomaly, tricuspidal valve, anomality right atrio-ventricular foramen. EBSTEIN'S ANOMALYВрождённые пороки сердца (ВПС) относятся к числу распространённых заболеваний в детском возрасте. Общая рождаемость детей с указанными пороками, по данным мировой статистики, составляет 6-8 на ...