Р е д а к ц и о н н а я с т а т ь я

BackgroundRheumatoid arthritis (RA) is a chronic immune inflammation of the joints, leading to early disability of patients at high risk of cardiovascular events and osteoporotic fractures. This problem is important today in men with RA, because, due to more frequent severe disease and increased mortality in the year after the fracture. Reduction of bone mineral density (BMD) and muscle mass are significant predictors of fractures, which leads to the high importance of studying the state of BMD and body composition.ObjectivesImproving the diagnosis of osteoporosis in patients with RA of the male gender with the regard of BMD and body composition.MethodsThe study involved 110 male patients with a documented diagnosis of RA at the age of 59 [53; 65] years. Depending on the taking of glucocorticosteroids (GCS) all patients was allocated two groups: I subgroup - 60 patients who are not taking GCS and subgroup II - 50 patients who are taking GCS. The control group consisted of 30 healthy men comparable by the age and body mass index.The study of BMD at the lumbar spine (L1-L4) and femoral bone was measured by dual-energy x-ray absorptiometry using a bone mineral density «STRATOS dR» (DMS, France). Assessment of body composition was carried out, using the «Whole body» («The whole body»). Sarcopenia was diagnosided as a decrease in lean mass index of less than 7,26 kg/m2.Results63,6% of patients with RA showed a reduction of BMD corresponding osteopenia/OP. OP was diagnosed in 28 (25,5%) patients with RA, and osteopenia - in 42 (38,2%). The detection rate of OP in the second subgroup was significantly higher (p<0,05), than in the first subgroup (48% and 5% respectively). The most significant decrease in BMD was observed in the neck of the femur in the main group as a whole and in individual subgroups. There was a negative correlation degree of activity of RA and indicators of BMD of the lumbar spine (r=-0,4, p<0,05) and proximal femur (r=-0,38, p<0,05). Assessment of body composition showed that patients of the main group were significant decrease in the total lean mass (LM) of the body, and the trunk and limbs of LM compared with patients of the control group (p<0,05). Sarcopenia detected in 66 (60%) of RA patients, whereas in the control group it was absent. In 44 (66,7%) male patients with RA with sarcopenia decreased BMD to the level of osteopenia (34,9%) and OP (31,8%). Obtained a negative correlation parameters LM and absolute 10 years risk of osteoporotic fractures (r=-0,302, p<0,05) on FRAX.Conclusion63,6% of men suffering from RA, there was a decrease in BMD, the corresponding OP/osteopenia with a primary reduction of BMD at the femoral neck. Decrease BMD in patients with RA was significantly associated with a high degree of disease activity (r=-0,4, p< 0,05). Taking GCS had no significant effect on BMD at the femoral neck. Analysis of body composition in 55% of patients with RA showed a reduction in the level of LM limbs sarcopenia. Obtained correlation lower BMD and LM limbs (p<0,05; r=0,28).Thus, in patients ...

Gout belongs to the group of microcrystalline arthritides and is a systemic tophus manifested by infl ammation of various tissues caused by deposition of monosodium urate crystals. Verifi cation of gout diagnosis in Russia takes on average four to eight years from the beginning of the disease. This period is suffi cient for the development of various complications (for example, gouty nephropathy) and disability of patient, and, therefore, it is necessary to revise the existing strategy for the diagnosis of this disease. One of the options for improving the provision of medical care can be attributed to the creation of a clinical decision support system (CDSS), which is based on the knowledge of experts, formalized as a knowledge base (KB).Aim. To develop a KB structure for CDSS for gout diagnosis.Material and Methods. Clinical information for gout diagnosis, presented as a nomenclature of medical concepts and logical schemes, which were collected on the basis of federal clinical recommendations, various literature sources and expert knowledge were used as materials. The ontological method was used as a method of knowledge structuring. Combined semantic network and frames were used as the methods of representation.Results. While developing KB structure, a combination of two methods of knowledge representation including semantic network and frames was used. An ontological approach was used in terms of knowledge structuring. The structure was built on the clinical knowledge collected in cooperation with experts in gout diagnosis. Compared with similar developments of diagnosing diseases based on knowledge engineering methods, the main feature of developed KB structure was the use of a separate type “Syndrome” concept as an aggregator accepted in medicine, signifi cantly reducing the volume of KB for diseases.Conclusion. The KB structure was developed comprising the use of seven types of concepts and 11 types of relationships. The structure involved the use of ontological approach and combination of two models of knowledge representation, namely: a semantic network and a frame model.

Gout is a chronic systemic disease characterized by the deposition of monosodium urate crystals in various tissues and inflammation. In Russia, time to diagnosis may be as long as 8 years. This leads to serious complications, such as urate nephropathy, and disability. Effective strategies are needed to improve the quality of medical care for gout patients. One of such strategies is creation of an expert system to aid the clinician in establishing the diagnosis and selecting adequate therapy. The cornerstone of an expert system is a knowledge base. The aim of this paper was to develop a medical nomenclature and algorithms for the diagnosis and treatment of gout that will be used to create an expert system in the future. A total of 1,174 entities were selected that laid the basis for 40 diagnostic and 50 treatment algorithms for gout patients. All informational models were verified by the expert panel.

The paper considers an update on the mechanisms for the development of adverse reactions of nonsteroidal anti-inflammatory drugs on the cardiovascular system.