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AIM: To assess leflunomide efficacy and tolerance in patients with rheumatoid arthritis (RA) during the first four months of the treatment. MATERIAL AND METHODS: The study included 200 RA patients treated in four Moscow clinical centers. Leflunomide was given in a dose of 100 mg/day for 3 days, then 20 mg/day for 16 weeks. The activity of the disease according to the criterion DAS 28 was assessed before the treatment and 4, 8, 12 and 16 weeks after the treatment start. RESULTS: RA activity diminished considerably after one month of leflunomide treatment. Later, the articular syndrome continued to improve. A significant improvement by DAS 28 was observed after 16 weeks of the treatment in 65% (129 of 200) patients, high RA activity persisted only in 17 of 90 patients. CONCLUSION: Leflunomide reduces articular inflammation and raises RA patients' quality of life at early stages of the treatment. This reduction continued for 4 months of the study. Therefore, adequate assessment of leflunomide efficacy should be made only after 4-6 months of therapy.

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AIM: To study immune status of patients with rheumatoid arthritis (RA) to improve immunodiagnosis at early stage of the disease. MATERIALS AND METHODS: Immunological examination covered 28 patients with rheumatoid arthritis (RA) aged 16 to 72 years. The duration of RA varied from 1.5 months to 1.5 years. Lymphocyte population and T-lymphocyte subpopulation were measured using monoclonal antibodies. Serum Ig were measured in Reafarm plates. RESULTS: Patients with stage II articular function insufficiency (AFI) demonstrated a significant lowering of the absolute number of lymphocytes, natural killers, elevated concentration of IgA compared to patients with less severe AFI. Patients with systemic symptoms had significantly decreased percentage of T-lymphocytes vs patients with isolated articular syndrome. Natural killers' levels were elevated in all the patients in early RA. A significant rise in the percentage of B-lymphocytes and serum IgG concentrations were also seen. In T-lymphopenia, relative amount of T-helpers and T-suppressors was significantly elevated while the ratio T-helpers/T-suppressors was reduced. CONCLUSION: Changes found in the immune status allows diagnosis of early RA, characterize immune disorders, help to select adequate immunomodulating therapy supporting function of the suppressor cells.

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The parameters of cholesterol (CS) metabolism in the epidermis, blood plasma lipoproteins, and red cell membranes were assessed in patients with psoriasis. The levels of free and total CS in extracts from the surface of epidermis, in plasma lipoproteins, and in plasma triglycerides were measured, and the molar ratio CS/ phospholipids (CS/PL index) in red cell membranes assessed in 194 patients with psoriasis of different severity. The levels of free and total CS in the epidermis were found to increase as the psoriatic process grew in severity. These shifts manifested even in apparently intact skin sites, which indicated the primary nature of total-system disorders. As for the plasma lipids, statistically reliable changes were observed only for the relative level of free cholesterol of the plasma and, most of all, high-density lipoproteins. These values for the mean parameters in the five groups of examinees correlated (r from 0.71 to 0.92) with the levels of total and free CS in the epidermis. Contrary to it, the levels of total CS and triglycerides in the plasma had a tendency to decrease as the severity of the psoriatic process augmented. Such a trend was statistically reliable for the CS/PL index, which increased in all the patients except the most grave, this increase being the more, the less grave the disease was; this was manifested in an inverse correlation (r = 0.9, on average) with the epidermal CS. The detected uncommon relationship between CS values in the epidermis, plasma lipoproteins, and biological membranes indicates heretofore unknown features of metabolic disorders in psoriasis.

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The levels of epidermal total, free and esterified cholesterol were studied in psoriatic patients. Lipids were isolated from the areas of psoriatic lesions and from the normally appearing epidermis by the authors' non-invasive surface extractive method. The quantity of cholesterol was given in microgram per square centimeter. Fifty six and 11 healthy persons were examined. The skin cholesterol levels were twice-four-fold higher in the patients than in the healthy subjects. The same levels were noted from the areas of lesion and from normally appearing epidermis. The proportion of an esterified fraction decreased mainly in the normally appearing epidermis areas, especially in severe psoriasis. The role of the findings was also discussed.

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A noninvasive method for cholesterol extraction from the surface layers of the epidermis is suggested. Levels of cholesterol and its fractions were measured in extracts obtained from the foci of psoriasis and apparently intact skin of 105 patients with psoriasis. Cholesterol levels were found noticeably increased, mainly at the expense of its free fraction in involved foci and in apparently intact skin. A conclusion is made on the good informative value of the suggested method.

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An attempt was made to study the incidence of gout and hyperuricemia among the workers of the Moscow meat-packing plant exposed to high food purine loads. Using extensive clinical material (535 men and 1121 women) the authors established that gout was diagnosed 33 times more often in men of this plant than in the muscular population of other towns of the country. Moderate hyperuricemia was revealed in every second of the examinees. Marked hyperuricemia was noted 1.8 times more often, it being 3.4 times more often in men working at this plant as compared to the whole muscular population of the country. There was a direct dependence of the level of hyperuricemia in men working in this industry on their service record. The levels of moderate hyperuricemia in all groups of men and in some groups of women directly depended on the amount of daily purine loads. Marked hyperuricemia among the examined men is a factor of risk in the development of load and among the examined women an indicator of risk (i. e. warning) of possible metabolic changes which require an adequate dietetic and therapeutic correction.

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