Antiprothrombin antibodies (aPT), a new serologic marker of antiphospholipid syndrome, were studied in 46 patients randomly selected from 73 with Sneddon's syndrome and 20 matched normal controls. aPT were elevated in 26 patients (57%) and were not found in any of the controls. The addition of aPT data increased the proportion of Sneddon's syndrome patients with at least one type of antiphospholipid syndrome marker from 65 to 78%. The finding that aPT are common in Sneddon's syndrome supports the hypothesis that Sneddon's syndrome is a form of antiphospholipid syndrome.

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...

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.

BackgroundThe ability of melatonin to reduce the activity of the sympathetic nervous system tone and of pituitary-adrenal system ensures its anti-stress properties. It can be used to reduce psycho-emotional manifestations of chronic pain in patients with psoriatic arthritis (PsA).ObjectivesTo evaluate the effect of combined therapy with the use of melatonin on the expression of psycho-emotional disorders, and pain in patients with PsA.MethodsHigh levels of anxiety and depressive disorders were established in the survey on Spielberger Anxiety Scale and on Hamilton Rating Scale for Depression (HRDS) in 43 patients with PsA (≥5 SJC and ≥5 TJC; CRP ≥0.3 mg/dL). The quality of life was studied by questionnaire Medical Outcomes Study Short Form (SF-36); the severity of morning stiffness, pain, patient's health status (EWS) - using the 100-mm visual analog scale (VAS). All patients were receiving a stable dose of MTX for at least 6 months. They were divided into two groups; 1 group (n=22) additionally received 3 mg of melatonin at bedtime for 2 months of observationResultsAt the end of the observation period the frequency and the level of severity of depression by HRDS (p=0.0098), and the index of personal anxiety (P=0.009) in group 1 decreased. In the 2nd group above mentioned parameters have not changed. On the 1 group data of SF-36 evaluation: the physical health component has improved - the increase of RP and BP 57.4% and 37.8% from the baseline; vital activity and role functioning due to emotional state, have also increased by 35.6% and 43.5%, respectively. In the 2nd group (n=22) investigated parameters have not undergone significant changes in dynamics. In the 1 receiving melatonin group TJC and SJC have decreased by 15% and 22% (p=0.0079, p=0.0022, respectively) and their dynamics in the 2nd group was less significant (p=0.013 and p=0.017, respectively). Also, patients in group 1 have highly significant (p<0.001) reduction in the severity of morning stiffness and joint pain, and in the 2nd group the changes were less significant (respectively, p=0.043, p=0.016). Positive dynamics of CRP in group 1 was more significant (p=0.003), than it was in 2 patients` group (p=0.033).ConclusionsIn the group of patients treated with melatonin was noted improvement in general condition (a significant improvement in the parameters of the physical components of health, reduction of depressive and psycho-vegetative disorders) and also more significant decrease of the intensity of pain and of morning stiffness duration, of TJC and SJC, than in not treated with melatonin patients. Inclusion of Melatonin in the comprehensive PsA therapy promotes not only reduction of depression symptoms and sleep disorders, but also reduces the severity of the chronic pain manifestations and, consequently, improves the quality of life of patients with this diseaseDisclosure of InterestNone declared

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