Archive for November, 2008
Further consecutive activation of components With goes the same with formation complex causing cells [Miiller H., Eberhard D., 1983]. The basic physiological role With consists in participation in protection of an organism from an infection, however in the course of its activation the numerous biologically active substances possessing action damaging tissue in connection with their ability to strengthen a phagocytosis buy purchase cipro are formed, to raise activity, to render effect on capillary permeability, to strengthen a chemotaxis and aggregation of neutrophils, etc. At discussion of a role With in inflammation development at rheumatic diseases it is necessary to underline what activate system With on a classical way proteases, can IgG the Russian Federation and IgM the Russian Federation, and also DNA. On the other hand, activation With on an alternative way can be bound to action aggregated IgA and IgM, , proteases. As a result of the cascade of transformations of system of a complement various biologically active components are formed. By really, numerous researches the role With is shown at autoimmune and – and HARD CURRENCY, vasculites. With it is found out in the centre of fabric damage, rising of activity With and its components is established at HARD CURRENCY and , consumption of separate components of a complement With \, , With ^, Cs, C ^ and the factor of Century We already noticed, that in development rhematoid sinovi it With and its components they accept the most active participation expressed in their adjournment in the centres of damage in to a tissue, in neutrophils, along with Ig, in depression With in the liquids, correlating with activity of illness, etc.
Thus, activation With at inflammatory – one of the important factors of a chronic inflammation. enzymes of neutrophils and macrophages are also active mediators of an inflammation and destructive processes. Quality of true motive power of an inflammation is given to phagocytes. the enzymes concentrated in lysosomes of phagocytes, play the big role in the intracellular digestion defining, on I.I.Mechnikovu, function of protection of an organism from microbes. But the role of phagocytes as it has been shown, is not limited to digestion of microbes. They take part in degradation of products of the fabric disintegration, the damaged cells, etc. As a result of destruction of englobing cells or at processes of secretion during phagocytosis enzymes can get into extracellular space and have damaging an effect on tissues, and under certain conditions proinflammatory effect. By present time the extensive information on a role enzymes in development of a chronic destructive arthritis has collected. enzymes take part in damage of articulate tissues already in early stage when in to a cover infiltration prevails . During this period there is a local activation of phagocytes by immune complexes and at participation With, in particular Sza – and S^a-komponen , and is possible, and in the course of an alternative way of activation With there is a superfluous remission from phagocytes enzymes. At arthritis synchronisation by the main source enzymes there are clumps of monocytes and the fabric macrophages carrying on a surface receptors to Fc-fragment IgG. At activation About these fabric cells start to cosecrete the enzymes buy purchase rimonabant strengthening in turn damage of a tissue. Role vivid example enzymes at an acute inflammation in joints is the gouty arthritis developing owing to liberation from neutrophils of a considerable quantity of enzymes at destruction of these cells in the course of a phagocytosis of crystals of a monosodium lithate, whether and also because of rising of membranous permeability at contact to crystals. In processes of a destruction of a cartilage at the effect of a collagenase, elastase and the proteases participating in degradation of collagenic fibers and units PG of a cartilage is most obvious. At transformation of the last into soluble products they easily are exposed to endocytosis and leave from a cartilage. Thus, initial process of degradation of a matrix of a cartilage occurs at participation proteases, including neutral a protease of neutrophils, elastase and a cathepsine With or such neutral proteases, as a collagenase, etc.
November 30th, 2008
At interaction of Histaminum to N-receptors of endothelial cells there is a reduction of the last, between them there are ruptures that conducts to rising of permeability of vessels. Value of a serotonin in a rheumatic inflammation is to the full insufficiently clear, its participation together with Histaminum in vascular reactions, as a stimulator of synthesis of collagen and a monocytic chemotaxis is more obvious. System order purchase ultram online (the system of factor ) also participates in development of an inflammation and a fibrinolysis. To activity of a bradikinin bind such vascular components of an inflammation, as an edema, a pain and a hyperemia. Factor operating as the activator , promotes formation , causing a chemotaxis of cells of an inflammation. Value of this system becomes distinct at development of an acute attack of a gout and a pseudogout as a result of activation of factor by crystals of monosodium lithates and Pyrophosum calcium.
Factor is also a link between an inflammation and a chronic IDCS, practically obligatory sign of a chronic inflammation at . Metabolites of arachidonic acid () also are active mediators of an inflammation. – numerous group of biologically active substances which are cyclic fat acids with 20 atoms of Carboneum in a chain (eicosa in a Greek way – 20, from here and ). It is established, that they are formed in the course of transformation of arachidonic acid under the influence of two enzymes – cyclooxygenases and . On a cyclooxygenase way there is a synthesis is simple , and , on lipoxygenases of nomas – . It is established, that the trauma, an ischemia, reaction an antigen – an antibody can be stimulus to start transformation of arachidonic acid, etc. are found out in all tissues involved in pathological process, including in significant amounts at rhematoid and other kinds of an inflammation. The transformations of arachidonic acid formed in the course of a cyclooxygenase way Prostaglandinums, and about , possess a wide spectrum of biological activity, including proinflammatory effect. Prostaglandinums () – inflammation moderators – possess ability to render vasodilating effect. thus action of other active amines. With their vasodilating and raising permeability of capillaries action binds development at an inflammation of a local and general erythema; as pyrogens they cause a hyperthermia, the expressed inflammatory edema at interaction with nomas. 2 and 2 are powerful hyperalgesias, thus strengthening bradikinin action, promote development of a painful syndrome an inflammation. Value of role at inflammatory proves to be true their detection in a considerable quantity in liquids, in tissues, and also pharmacological effect which is powerful inhibitor . are formed in the course of a metabolism of arachidonic acid in the greatest quantity in thrombocytes, a lien and lungs. This group of mediators, especially a dignity, is extremely active as vasoconstrictors, stimulators of aggregation and degranulate of thrombocytes. In norm are in close correlation with (), especially which possesses opposite action. However at an inflammation this balance is broken towards concentration augmentation , that promotes hypercoagulation development. (LT), in particular the most active component LTB4 [Samuelson et al., 1980], possess expressed action concerning neutrophils, eosinocytes and monocytes, promote their attachment to to a wall and migration in the lesion centre, stimulate is vpxl successfull activity of neutrophils, rendering powerful about inflammatory effect. The combination of three – LTC4, LTE4 and LTD4 is slowly operating substance of an anaphylaxis – SRS-A (- English slow-reacting substance of anaphylaxis), formed at stimulation of mast cells. SRS-A possesses the most powerful effect to what intolerance by patients with , apparently, is bound, and a bronchial asthma. The complement system () represents group of the fibers consistently reacting with each other. Their activation occurs two ways – classical, usually bound to formation of a complex an antigen – an antibody, and alternative (), the caused influence of endotoxins, , , etc. On the scheme 3 differences in classical and alternative ways of activation are visible With The scheme 3. Activation ways * The first is characterised by consecutive activation 1- ^ – Sch-sz-sza-sz-components and complement subcomponents, and the second – immediate activation of the Sz-component with subsequent formation by means of including of “an intensifying loop» (a properdin (-factors D-).
November 30th, 2008
With development of an inflammation under the influence of infectious factors (a streptococcus And at rheumatic disease, microbes of intestinal group at reactive arthritises, etc.) in tissues and organs are taped its basic signs – pains, an edema, disturbances of function of joints and other amazed organs. By definition And. M.Chernuha (1979), the inflammation has arisen during evolution as reaction of living tissues to local damages. The inflammation consists of difficult stage-by-stage changes a circulatory buy order cipro bed, system of blood and a connecting tissue, which are referred finally on isolation and elimination of the damaging agent, and also restoration (or replacement) the damaged tissues. The inflammation at “submits” to the first part of definition. However uncertainty of in most cases damaging agent, impossibility owing to genetically caused imperfection of protective mechanisms completely to eliminate damaging factor, incompleteness for the same reasons of processes , and also development autoimmune and complex processes promote inflammation synchronisation at many . Microcirculation disturbance – one of early mechanisms of a rheumatic inflammation. It is caused by rising of permeability of a capillary wall and the disorders leading to development of a fabric edema and a hyperemia. In the subsequent there is a damage of capillary walls, capillary and stasises, rising stand concentration of various cells with aggregation of erythrocytes and thrombocytes, and also plasma factors of coagulation. The role of factors of a hypercoagulation (a chronic IDCS) especially accrues at a chronic rheumatic inflammation. The exudative phase of an inflammation is bound to active migration of leucocytes and macrophages from a vascular bed in the inflammation centre (in a connecting tissue), accumulation in it of cellular elements of blood, and also local mast cells and fibroblasts.
As a result in the inflammation centre the phagocytosis with remission in intercellular basic substance of a connecting tissue enzymes which, on the one hand, carry out degradation of products of fabric disintegration is activated, and at their superfluous activity cause a fabric destruction. There is also an activation of fibroblasts under the influence of peptides which are developed by inflammatory cells [Castor D., Lewin R. , 1975]. The cicatrical tissue is as a result formed. Feature of a chronic inflammation including at rheumatic illnesses, consists in primary migration of a blood channel – precursors of macrophages. The last possess phagocytic activity and liberate enzymes; besides, they transfer to lymphocytes the information on an antigen, promoting development of the immune answer referred on it. Inflammation synchronisation is buy acomplia aventis rimonabant sanofi accompanied by formation tissues, as, for example, at and other diseases with formation of huge cells. Accumulation in a zone of an inflammation of immunocompetent cells, including plasmatic, accompanies a proliferative phase of an inflammation which, as well as the general immunologic disturbances, autoimmune and processes, promotes synchronisation of an immune inflammation, characteristic for . It is necessary to note system, progressing, character of a chronic inflammation at . Inflammation mediators (biochemical bases). The vascular reactions listed above and cellular interactions in the course of an inflammation are carried out by means of numerous chemical mediators which or arrive in the centre of an inflammation from a blood channel, or produced immediately in the centre. Among them there are such mediators which are found out everywhere, and, on the contrary, physiologically active substances which are liberated only in the inflammation centre. Histaminum – biologically active amine possessing ability to cause rising of capillary permeability, and reduction of a smooth musculation. Histaminum, as well as other mediators, contains in the inactive form mainly in granules of mast cells and , in smaller quantity – other cells. At stimulation by any antigen the IgE-antibodies which are on a surface of mast cells, Histaminum is liberated in extracellular space.
November 29th, 2008
Despite the fact that what concrete mechanisms of predisposition to this or that illness bound to system HLA, are not opened yet to the full, the separate fact sheet has allowed to present some hypotheses. First of all it is the theory «molecular and», based on similarity a determinant of covers of HLA-antigens and microorganisms and loss by an ability organism to distinguish a foreign antigen, to develop against it antibodies and to delete an antigen from an organism that leads it and to development logic order buy ultram reactions. In particular, the antigenic generality (affinity) between B27 and Klebsiella aerogenes is supposed at Bekhterev’s illness. However it is not excluded, that there is a two-dimensional reaction at which antibodies on bacteriemic antigens can co-operate with antigens HLA B27. The similar effect is observed and at rheumatic disease.
According to the receptor theory, antigenic determinants HLA are receptors for viruses, that facilitates penetration of the last into a cell and development of pathological process, however a universal lesion of people a number of virus infections (for example, a flu) irrespective of a HLA-phenotype has a little shaken this theory, though for some virus infections (for example, slow) it can be actual. The hypothesis of possibility of including virus in a HLA-gene is close to this theory. It is rather attractive, though the hypothesis about existence in system of a HLA-gene of sensitivity to this or that illness which is in a condition of nonequilibrium coupling with other genes of system HLA is not proved. But the theory of a gene of the immune answer (Ir-gene) is most interesting, in ~ conformity with which Ir-genes are localised in Ir-area, or in a zone of locus D/DR, or is immediate in locus DK and are with system HLA in a condition of nonequilibrium coupling.a it is known, the Ir-gene is found out in mice at which it is linked to genes -2. The Ir-gene bound to the big complex , is shown at monkeys rhesuses. Appreciably prove this theory of feature of interrelation of HLA-antigens and illnesses. In particular, the majority of the taped associations concerns locuses In and D/DR, a diseases are characterised by a chronic inflammation and immunity disturbances. More often these illnesses associate with a carriage of antigens 8, Dw3 and DR3. HARD CURRENCIES concern diseases of this group syndrome and, probably. For such illnesses family accumulation, however relative risk of development is characteristic is insignificant (from 3 to 10), i.e. it is essential more low, than to combination 27 and Bekhterev’s illness. Attracts attention, that at illness antigens 8 and DR3 are more often observed. For accumulation of antigens HLA All, B12, 27, 35 and DR4 is characteristic at low relative risk of a case rate-from 1,9 to 2,57. Presence HLA DR4 in most cases associates with serious erosive seropositive . Sick the chronic arthritis had appeared polymorphic group concerning accumulation buy vpxl scam of separate HLA-antigens. So, at the beginning at boys of advanced age the association with HLA 27 is quite often observed. At serious seropositive accumulation DR4 that pulls together with adults on clinico-immunogeneticheskim associations is noticed. At development in patients of an iridocyclitis in a combination to the positive antinuclear factor () the strict association with DR6 and DR8 becomes perceptible, and at a cyclitis without – DR5. Accumulation 35 and DR8 becomes perceptible also at system beginning . The resulted materials allow to assume, that the genes supervising the immune answer, can be involved in a pathogenesis of some chronic inflammatory , but ways of realisation of this process are rather various. It is necessary to notice, that presence of this or that HLA-antigen are not an indicator of inevitability of development , but at corresponding influence of an environment can act as one of aetiologies. From this point of view presence of those or other HLA-antigens can be surveyed as etiological factors and risk factors. In summary it is necessary to underline, that, despite unconditional value of system HLA at , the diagnostic role for the individual patient of separate antigens is insignificant or is more likely problematic. At inspection of families data are important as risk factors of development of repeated cases in these families. Inflammation and immunity disturbance in a pathogenesis of rheumatic illnesses. Inflammation – one of the main mechanisms of development .
November 29th, 2008
Unfortunately, at majority it is not possible to define «starting factor» which development of some the immune and autoimmune buy cheap cipro reactions defining the subsequent disease follows. Already there was an axiom a statement, that such as rheumatic disease, reactive arthritises and other illnesses with the established etiological factor, develop only under a condition family-geneti predispositions. Heredity. Achievements of last years have allowed to prove the important role of genetic factors at many . At the epidemiological researches spent in the various countries, it is revealed, that in families of patients some these illnesses meet more often, than in the general population. So, members of families of patients have more often at 2-10 time, and Bekhterev’s illness – in 2-6 times (when parents suffer these illnesses). The hyperuricemia is found out in 20 % of members of a family sick of a gout. The high case rate at twins , is noted Bekhterev’s by illness, a gout and some other rheumatic processes. Genetic conditionality matters in occurrence of metabolic arthropathies. It is proved, that genetically caused defect in system of the enzymes which are taking part in an urate exchange, conducts to development of metabolic type of a hyperuricemia and a primary gout.
Defect of enzyme conducts to occurrence of an ochronosis and arthropathies. The arthropathy, a “family” chondrocalcinosis concerns number of hereditary diseases . Assume, that one of the reasons of development of a primary deforming osteoarthrosis is genetically caused depression of resistance of an articulate cartilage to a usual physiological load to what the fact of existence of a family polyosteoarthrosis (illness ) testifies. Thus, the role of the genetic factor in development of many is conclusive, but not in all cases is still accurately proved. Immunogenetichesky and with to an aetiology and a pathogenesis of many last years are in the centre of attention of scientists. Without exaggeration it is possible to speak about information explosion on separate to markers, their communication with concrete illnesses buy rimonabant acomplia both separate clinical syndromes and symptoms. With workings out rational therapy and especially primary preventive maintenance based on formation of groups of risk, those uniting carriers or other antigens bind the decision of such important clinical problems, as early diagnostics. The association of illness of Bekhterev with HLA B27 became a classical example. HLA-antigenes (Human Leucocyte Antigene) are the superficial structural components of cells coded by corresponding genes. Now allocate three classes of antigens. HLA and, In and About locuses concern I class, they code antigens (), all present on a surface cells and thrombocytes. II class concern HLA D-antigenes (DR, DQ and DP), settling down on surface V-limfotsitov, the macrophages (monocytes) activated T-limfotsitov, dendritic cells, epithelial cells howl glands and of some specialised cells (for example, an osteal brain). Antigens , factor Bf are carried To III class and 4 (And,). Genes I and II classes are located in narrow area on a short shoulder of 6th chromosome (fig. 1). Each of these locuses contains set of genes , that testifies about systems HLA. So, in And 20 alleles, in a locus In – 42 , in locus -8 are identified, besides, 12 alleles are available in locus D and in locus DR. Thus each person has own , i.e. A set of alleles on one set from the father and mother and, thus, on 2, 2, 2, 2D and 2DR-aHTHreHaM. The listed groups of genes are characterised by various functions of regulation of the immune answer, the control of cellular cooperation, etc. HLA-genes and the antigens coded by them play the big role in processes of cellular recognition «» and “another’s”, define predisposition to diseases, especially with a pathogenesis, intensity of immune reaction to various stimuluses, correction of a homeostasis, etc. Now has collected enough given to give to system HLA a role of a regulator of the immune answer. The mutual relation between a carriage of separate antigens of system HLA and development of those or others speaks or direct including of HLA-antigens in a pathogenesis of these illnesses, as, for example, association B27 with Bekhterev’s illness, or existence of nonequilibrium coupling between alleles of an Ir-gene and sublocuses D and DR.
November 28th, 2008
On the different developed countries close data are cited. In in 1981 among invalids of 8,9 % have been recognised by incapable to carry out professional work in connection with a locomotorium pathology. In Great order ultram without prescription Britain are the most frequent reason of physical inability, making 36 % from indicators of the general physical inability, the big specific gravity falls on chronic diseases of joints [Wood Ph. , 1978]. In our country the indicator of primary physical inability is rather insignificant and takes the seventh place among other reasons of physical inability, however, according to last years, more than half of workers and employees and more than 30 % of collective farmers already at the first survey have received II and I groups of physical inability. Thus from number for the first time recognised as invalids 45 years about 39 % of workers and employees and almost were younger than 25 % of collective farmers, i.e.
The people, suffering locomotorium diseases, long before a pension age lose professional activity. Besides the invalids who have received III group on disease of a locomotorium at the first survey, as a rule, the next years move in higher groups as it is shown A.J.Bolotinoj and co-workers. (1984). Studying of structure of physical inability has shown, that 15,6 % became invalids in connection with a rheumatic pathology. The injury put to the state RB, is defined also by that patients at young age. According to many authors, middle age of the invalids suffering PA, makes 52 years, Bekhterev’s illness – 44-47 years, rheumatic disease – 40-43 years, a gout – 51 year etc. Thus, the invalidism develops at patients who yet have not reached a pension age, and their professional conversion training is complicated because of mobility restriction [Altus R. , 1979]. It is necessary to consider also, that chronic diseases of joints are accompanied by serious physical, mental and social consequences, up to necessity of rendering assistance at movement. K.Sivere and co-workers. (1983) have shown, that 10 % of patients are not capable to move independently out of the house, and many of them require the elementary help as are deprived possibility to serve. 33 More % of patients experience serious difficulties out of a house situation. Thus, epidemiological researches show social and economic importance in connection with the big personal and state injury which is turning around for sick constant sufferings because of pains, restriction of their social activity and loss of professional working capacity in age. Therefore great value the actions warning of diseases and keeping working capacity of patients (get early recognition and adequate complex treatment, wide prophylactic medical examination, use of methods of aftertreatment). Experience shows possibility of conservation of professional working capacity even at such serious diseases, as rheumatic disease and .
Rheumatic illnesses represent the big group of separate nosological forms, various on the parentage and united mainly on the order vpxl online basis of localisation of the basic pathological process in a connecting tissue and such clinical implications, as articulate a syndrome. It is natural, that the reasons of occurrence and essence of these illnesses are extremely various. According to modern representations, it is possible to allocate some factors, undoubtedly, important in their development. Infectious factors play a part in occurrence of many , however their value at different processes unequally. In one cases the infectious agent (the microbe or a virus) has etiological value, as, for example, at rheumatic disease (Sokolsky – Bujo’s illness). As is known, connection of illness is established with (a 3-hemolitic streptococcus of group And, that is confirmed in practice by efficiency of treatment by Penicillinum of anginas and rheumatic disease relapses. Numerous infectious arthritises (tubercular, gonorrheal, syphilitic, septic, brucellous, etc.) Arise owing to direct penetration of the originator into tissues of a joint and then the microbe can be found out in joint tissues, however not so seldom reaction of articulate tissues develops in reply to the originator circulating in blood or its antigen (reactive arthritises).
November 28th, 2008
This difference remains at patients till 60 years, and in more advanced age disappears. The exception is made by Bekhterev’s illness, a gout and the system vasculites which are mainly illnesses of men. At the same time such illnesses, for example, as Bekhterev’s illness, are distinguished now at 12-15 % of women that is bound to deeper studying of clinic of illness and features of its current, and also buy generic cipro application of new methods of research, first of all HLA B27, a scintigraphy of ieosacral joints and a backbone. As to age aspects they have found reflexion in the name of some diseases, for example, and a senile kyphosis, an arthritis, senile , etc. the Age in which this or that illness begins, has not only practical value, but also theoretical as allows to understand a role of some the mechanisms inherent in the various age periods of human life. Well-known, that primary rheumatic disease – illness of children at the age of 7-15 years, on the contrary, a rheumatic polimialgija-pathology of people is more senior 55-60 years. J. Cassidy (1982) in a management on children’s rheumatology selective immunodeficiency IgA, an agammaglobulinemia results the classification adapted for children’s age in which along with an arthritis and a spondylarthritis the appreciable place gives to such purely children’s pathology, as combination with congenital conditions, congenital and hereditary syndromes, as syndrome – , . The appreciable place in children’s rheumatology is occupied with congenital and genetic disturbances of a metabolism of a connecting tissue, etc.
As a whole age aspects in rheumatology for the doctor with selective accumulation during the certain age periods – inflammatory at the age of 20-50 years and degenerate and gouts at the age of 55-65 years. Thus, both the floor, and age are certain risk factors of a course of a disease and its advance that should be considered at the organisation of the treatment-and-prophylactic help. As is known, the problem of the epidemiological researches referred on a statistical substantiation of a state of health of the population, along with diffusion of those or other diseases joins materials about a mortality from these illnesses and about that injury which they cause to a society in connection with a temporary invalidity and physical inability. The mortality in connection with constantly decreases. According to J. S. Lawrence (1977), the mortality from in 1938 in the Great Britain and the Wales made 153 on 1 million population, and in 1966 – only 43. This depression has occurred mainly at the expense of rheumatic disease. Constant depression of a mortality from rheumatic disease and in our country becomes perceptible. One of indicators of positive shifts in connection with organizational-preventive actions spent in the country is the age died of rheumatic disease. According to E.A.Kormiltsevoj and co-workers. (1984), 75 % have died aged is more senior 50 years (middle age 55,3). In developing countries the rheumatic disease still remains a principal cause of mors of children and teenagers among all diseases of cardiovascular system. Big social value is defined not only their prevalence, but also development in appreciable number of patients of time and proof invalidity. buy acomplia rimonabant The temporary invalidity at in all developed countries of the world is high enough, especially in connection with a lesion of osteomuscular system. In GDR invalidity owing to makes 13 % from the general invalidity [., , 1981]. In Germany of 24,6 % from number of all insured are invalid in connection with . The Temporary invalidity at in the Great Britain takes the third place among other diseases (the CART, 1979). In our country temporary invalidity indicators in connection with illnesses of osteomuscular system for last 5 years also were enlarged and take the fourth place on number of cases and the third place on number of days of a temporary invalidity. It is remarkable, that these indicators many times over exceed indicators at rheumatic disease. Physical inability at diseases of osteomuscular system draws to itself special attention for some reasons: 1) on relevancy of a specific gravity among all disabling diseases, 2) physical inability since the very first moment of its establishment becomes lifelong, proceeding tens years; 3) people young and middle age in 3-5 years from the illness beginning (for example, and Bekhterev’s illnesses) become invalids. According to data the CART, to 10 % from all invalids suffer .
November 27th, 2008
Worldwide be generalised the statistical data showing unconditional value in a state of health of the population of these countries as from 16 to 23 % of the population is more senior 15 years suffer those or other diseases of this group. According to the European region the CART (1978), among the patients daily visiting order ultram picture out-patient departments, sick 12-25 %, and among hospitalised in hospitals »- 5 % make. Data of later years confirm developed tendency. In Hungary [Balog Z. et al., 1983] in 1982 11,4 % of patients addressed to the doctor of the general profile concerning and at 19,5 %, treated concerning other diseases, complications of these illnesses in the form of the rheumatic syndromes demanding simultaneous treatment are taped. It means, that one third addressing for the help in out-patient departments requires treatment concerning locomotorium diseases. In Sweden [Bjelle A. Magi M „1983] 16-18 % addressing in medical institutions behind the help in 1978 suffered , thus 12 % were treated is out-patient and only 1 % required hospitalisation. At studying of data on appealability to out-patient departments (A.J.Bolotin) 39 from 1000 persons had various . Apparently from the resulted data on the different countries, number of patients observed in polyclinic establishments, various, however a specific gravity of this pathology among patients is high enough.
The epidemiological researches spent in the various countries, testify that prevalence grows. According to K.Sivere and co-workers. (1983), in Finland prevalence of all in 1976 in comparison with 1964 was enlarged by 69 % (13,3 and 8,8 % accordingly), mainly at the expense of a backbone lesion (7,1 and 3,6 % accordingly) and (3,2 and 0,7 %). At the same time prevalence practically has not changed (1,2 and 1,1 % accordingly). As a whole worldwide it is taped at 1 % of persons among all population. Registration on appealability shows, that annually in the USA primary case rate makes 0,75 on 1000 persons to what steady indicators of its prevalence – nearby 1 %, apparently, are bound. The impression about rising of detectability of HARD CURRENCY is made. So, in New York in 1950 5-10 new patients on 1 million population a year, and after 1965 – 75 on 1 million annually were registered. Probably, that it not true growth of a case rate, and diagnostics improvement, however the resulted fact sheet should draw to itself attention of doctors. Among numerous forms on the first place on prevalence there are degenerate diseases of joints and with which suffer from 8 to 12 % of the population of the various countries. In our country RB also are among rather extended. So, according to I.I.Zhadenova (1979), among urban population of some districts RSFSR reach 10,3 %. However the epidemiological data received at continuous inspection of the population with use of strict criteria of diagnostics are most authentic. To such data belong , received in a course the research spent by Institute of rheumatology buy vpxl review the USSR [Benevolensky L. , etc., 1985). It is established, that 8,5 % of the population of the country suffer five the most widespread - rheumatic disease (1,4 %), (0,42 %), Bekhterev's illness (0,05 %), a gout (0,1 %) and (6,4 %). These data show, that at least each 8-9th person among inhabitants of the country suffers any rheumatic disease. Despite essential depression of a primary case rate by rheumatic disease - in 2,7 times by 1977 in comparison with 1965 [Safonov A. G, 1979], prevalence of rheumatic heart diseases still remains high. At epidemiological researches dependence of a case rate on a sex, age that is important for a concrete definition of risk factors and the organisation of the treatment-and-prophylactic help is especially accurately taped. In the Great Britain of men of 28 % and 36 % of women suffer various chronic [Lawrence J. S., 1977]. Similar data result J. Hernander and co-workers. (1984) on a number of the countries of Latin America where the number of women among patients reached 75-83 %.
November 27th, 2008
According to classification (1985), all forms are distributed on 14 headings. Apparently from the resulted classification, in first eight sections are carried inflammatory character, a part from which are united on the general etiological (the arthritises bound to an infection) or pathogenetic (, system you ) to a sign; separate buy cipro online most significant illnesses (rheumatic disease, ) are allocated in independent sections. Degenerate diseases of joints and a backbone are carried in section. Nosological forms of the diseases having admixed is inflammatory-degenerate character (microcrystallic arthritises and , bound to other diseases), enter in IX and XII sections. In separate headings illnesses of extraarticular soft tissues (section XIII) and those illnesses of bones with which the rheumatologist (section XIV) should be familiar are allocated. Group DBST is essentially dilated at the expense of including of a diffusive fasciitis, rheumatic , a polychondritis and a relapsing panniculitis at which, according to modern data, the systemic lesion of a connecting tissue with immune disturbances becomes perceptible.
This group also includes the admixed disease of a connecting tissue allocated and studied in last years at which separate signs of a system scleroderma are combined, and (or) a system lupus erythematosus (HARD CURRENCY). The group of system vasculites (section III) has close or similar with pathogenetic mechanisms and therapeutic approaches, but differs mainly a lesion of vessels (an angiitis, an arteritis) and a treatment principle. The diseases having the general genetic basis are included in section VII (association with HLA B27) at which are amazed not only peripheric joints, but also ieosacral joints and a backbone as ankylosing . The arthritises bound to an infection (section VIII), are sectioned on two basic subgroups: infectious, caused to straight lines . the causal agent in articulate tissues, and reactive – the arthritises developing as a result of logic reactions to a previous infection at which, however, the infectious agent is not found out in a joint cavity. Besides known illnesses, in this heading some diseases are included also, which infectious nature is proved only recently (illnesses of the Whipple, an arthritis), and also recently described in our country an infection proceeding with an articulate syndrome (the Karelian fever). The new disease bound to abaissement in a cavity of a joint of crystals which is shown by an acute articulate syndrome ( an arthropathy) is carried to group of microcrystallic arthritises (section IX). In section XI various diseases of joints of an obscure genesis, and also a tumour and tumorous processes in joints are united. « at other diseases» as shows the name, are secondary in relation to the basic illnesses listed in section XII which are diagnosed and treated by experts of a corresponding profile at participation a roar , carrying out only diagnostics and treatment of a secondary articulate syndrome. However the rheumatologist faces quite often for the first time such patient and should define buy rimonabant online diagnostic and therapeutic tactics correctly. Illnesses of bones (section XIV), entering into the competence a roar , are allocated in special group and united with chondropathies (, or aseptic, a bone necrosis) as the basic implications of the last is formation of an osteal sequester. Thus, in the present classification have found reflexion the basic groups of rheumatic illnesses and the place of each of nosological forms that will facilitate orientation at diagnostics and treatment of rheumatic diseases is defined, will raise professional level of the rheumatologist and will improve the specialised help to the population. The uniform classification approach will promote perfection of the statistical account, and consequently, and our knowledge of prevalence of illnesses. RHEUMATIC ILLNESSES For last two decades have drawn to itself attention everywhere – in developing countries because of high statistics of a primary case rate rheumatic disease and mortalities from heart diseases, and in developed – owing to diffusion of chronic diseases of joints and a backbone, accompanied time and proof disability. According to the generalised data the CART (1979) more than in 30 % of cases a temporary invalidity and in 10 % the general physical inability are caused .
November 26th, 2008
These examples show importance of unification of the nomenclature which in turn reflects level of knowledge of essence of illnesses. That is why at revisions of classifications nomenclature revision, as a rule, is simultaneously spent. Practically there were a curiosity terms «collagenic illnesses», “collagenoses” in connection with finding-out, that not only the collagen pathology defines essence of illnesses of a connecting tissue order ultram tramadol hci tablet , but also involving in process of all its components, i.e. Its diffusive lesion. Therefore more modern rubrication – «diffusive illnesses of a connecting tissue» () is entered also. However it is necessary to underline, that the term «collagenic illness» has kept the historical value as a certain stage of development of rheumatology. The term «saline arthropathies», based on the concept of adjournment of salts occurring in the past in articulate structures as the pathology reasons mismatches modern level of knowledge.
With specification of structure of microcrystals which can really be postponed in various articulate tissues at a gout (lithates), a chondrocalcinosis ( you), more proved became the name «microcrystallic arthropathies». The term “pseudorheumatism” has strongly replaced the term «an infectious nonspecific polyarthritis» that corresponds also to such widely applied designations as «the rhematoid factor», «a rhematoid carditis», etc. Unfortunately, the term «» is not supported by opening of etiological essence of illness. Terminology is not unified yet. In effect it only a variant the chronic arthritis, close to adults, and, apparently, for such illnesses in a larger measure is justified the name use «chronic an arthritis». Term application « a tsionno-allergic polyarthritis» as it did not stimulate searches of concrete etiological factors is not justified. Allocation of group of reactive arthritises that provides necessity of finding-out of concrete aetiologies has appeared more progressive. The listed remarks do not settle at all the information on the modern nomenclature in rheumatology, and the attention of the reader is only drawn to this very important question.
The nomenclature and classification – closely bound two concepts as the first is necessary for the most correct designation, and the second – for the most proved grouping of illnesses. First domestic classifications have been order vpxl pill framed in 1928-1930 by All-Union antirheumatic committee according to which allocated three groups of illnesses – a rheumatic fever, illnesses of joints and «muscular rheumatic disease». In 1971 Working classification of diseases of joints and extraarticular soft tissues of a locomotorium »has been accepted«. The Primary goal consisted in paying attention of rheumatologists to illnesses of joints in which they practically were not engaged until the rheumatic disease problem has been solved. This classification has been based on a clinico-pathogenetic principle according to which all illnesses of joints have been parted on four groups: 1) independent forms of diseases (arthritises and arthroses); 2) secondary articulate syndromes; 3) traumatic damages; 4) diseases soft tissues. Classification, certainly, has played a positive role, having allowed practical doctors to receive representation about all range of rheumatic diseases of joints. For the last years much in rheumatology has changed, new forms are described, out-of-date concepts are reconsidered. That is why at III All-Union congress of rheumatologists (1985) the project of new classification in which basis principles of clinical grouping of diseases are put has been approved, and the etiological orientation has found reflexion only at association infectious (bacteriemic, virus) and reactive (postinfectious) arthritises. By preparation of this classification already existing national classifications (-1983, Germany-1979) have been considered, that has allowed to unify views to a certain extent. The primary goals of working classification and nomenclature (, 1985) consisted, first, in that it is as much as possible full, according to modern representations to generalise all forms of diseases, and, secondly, to facilitate to the doctor diagnostic, differentsialno-diagnostic process, a choice of optimum ways of treatment and whenever possible a forecast estimation. In classification the modern nomenclature is reflected: an arthritis for a designation not only , but also other diseases of children’s and youthful age, for illnesses of peripheric ligaments and muscles, etc.
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