The problem of invasive mycoses is becoming ever more urgent in modern rheumatology. The fact that physicians are unalert to mycoses in patients with systemic rheumatic diseases and that there are difficulties in their lifetime diagnosis and treatment is noteworthy. The significance of this problem substantially increases with the active clinical introduction of biologicals, primarily tumor necrosis factor а inhibitors (infliximab, adalimumab, etanercept), which goes on concurrently with the increasing risk for opportunistic infections. Part I presents information on different aspects of systemic aspergillosis, including the tactics of its diagnosis and rational therapy

Early rheumatoid arthritis (RA) is mainly presented as the signs of articular synovial membrane inflammation. Examination reveals the changed outline of joints, their dysfunction, and local palpatory tenderness. Juxta-articular osteoporosis is one of the earliest and characteristic X-ray manifestations of polyarthritis. Its most important X-ray symptoms should include joint space narrowing. It reflects articular cartilage destruction and it is taken into account in evaluating the progression of a pathological process. The most typical sign of RA is bone erosions that comparatively rarely occur at the onset of the disease and are a poor predictor.
Progression of RA leads to articular cartilage and bone destruction and ligament and tendon damage over time. Incompetence of the ligamentous apparatus may cause dorsal subluxation of the radius. In late RA, bone erosions are detectable in practically all patients. This is the most characteristic X-ray symptom of polyarthritis. Extensive and multiple destructive changes in the joints are accompanied by the development of their multiple subluxations, dislocations, and contractures. In addition to destructive changes in the joints, most deformities are associated with their tendinous and liga-mentous looseness and ruptures and with the rearrangement of normal muscle tension around one joint or more. Articular ankylosis occurs in late RA

This part considers the diagnosis and medical treatment for cervical and lumbar spinal lesions in rheumatoid arthritis (RA) and osteoarthritis (OA). The author has developed an original procedure for medical measures for patients with RA and OA with cervical spinal lesion and a modified procedure for the management of lower back pain (LBP). The help-himself principle is used to prevent recurrent LBP

Objective. To evaluate the efficiency of different intensive therapy (IT) regimens for rheumatoid arthritis (RA) in real clinical practice. Subjects and methods. The study enrolled 104 patients receiving different modalities of IT and 115 control patients having the standard basic therapy only. The time course of changes in the articular syndrome (Ritchie articular index, counts of tender and swollen joints, pain levels and global disease activity by the visual analogue scale, morning stiffness) was estimated in all the patients. Changes in the major laboratory parameters: erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and circulating immune complexes were studied in the comparable groups. The efficiency of IT was evaluated by the EULAR criteria from the changes in DAS 4 index and in ACR 20/ACR 50/ACR 70 response rates. Results. All IT modalities showed a rapid early clinical effect, the most evident changes in the major clinical and laboratory parameters being observed in the use of plasmapheresis synchronized with pulse glucocorticoid (GC) therapy. According to the EULAR criteria, improvement was achieved in 77,4% in the IT group versus 15,2% in the controls and, following 6 months, positive results remained in 60,6 and 26,8%, respectively. By the ACR criteria, 50% improvement was seen in 29,7% of cases after 3 months after IT and in 3.7% in the controls; after 6 months this persisted in 24,5 and 9,7%, respectively.
Conclusion. Addition of IT to the complex management of RA rapidly reduces the activity of RA and alleviates its systemic manifestations, the effect of IT persisting for 6 months on average. However, the application of programs for intensification of treatment with GC and cytostatics in high doses cannot retard the progression of erosive arthritis.

An open-labeled study of the efficiency and tolerability of the herbal preparation Urisan used for one month in 21 male gout patients has revealed that the agent has moderate antihyperurecemic activity, no adverse reactions, and excellent or good tolerability in the appraisal by physicians and patients.

Objective. To estimate the frequency and degree of osteopenia and osteoporosis (OP) in patients with rheumatoid arthritis (RA) versus those in patients with osteoarthrosis (OA).
Subjects and methods. The study included 150 patients aged above 18 years with the valid diagnosis of RA or OA, in whom the risk factors of OP were assessed. Bone mineral density (BMD) (the relative units were T test) of the lumbar spine in the frontal projection (LII-LIV) and the proximal femur (head, neck, WardXs region, and greater trochanter) were determined in all the patients by dichromatic X-ray absorption on a LUNAR DPX-NT densitometer.
Results. A high frequency of osteopenia and OP predominantly due to BMD loss in the WardXs region and lumbar spine was observed in post-menopausal patients with RA. In postmenopausal patients with OP, osteopenia was commonly detectable at the level of the hip or vertebral column and OP was more characteristic for the lumbar portion. Regression analysis showed that among the postmenopausal patients with RA, women over 60 years of age, with low body mass index in the greater trochanter, and high disease activity in the femoral neck were at the highest risk for OP in the femoral neck and lumbar spine.
Conclusion. The risk of osteopenia and OP is higher in RA than that in OA, low body mass index, old age, high disease activity, and a more severe disabling functional class RA being the most important risk factors

Objective. To specify the diagnosis of juvenile idiopathic arthritis (JIA) and to define the significance of pathogenetic changes, the authors have studied cellular and humoral immunological parameters, which are of the greatest informative value in this pathology: CD4+, CD4+/CD8+, CD8+, CD16+, CD95+ in the serum, as well as a spectrum of interleukins (IL): tumor necrosis factor-а, IL-6, IL-1, and IL-4. Subjects and methods. An optimal basic drug was selected for a specific form of JIA. Preference is given to cyclosporine and methorexate (MT) in its polyarticular form with the high activity of an inflammatory process, to MT, cyclosporine A, and auranofin in the disseminated form of oligoarthritis, and to auranofin and sulfasalazine in the persistent form.
Results. None of the basic drugs is superior while individually choosing a treatment and this or that drug has to be very frequently chosen empirically

Polymyositis (PM) and dermatomyositis (DM) are autoimmune skeletal muscle diseases of unknown etiology, which are referred to as systemic connective tissue diseases and united under the common term Tidiopathic inflammatory myopathiesy. The most severe subtype of PM/DM is the antisynthetase syndrome that is characterized by a certain sympathocomplex, including interstitial lung lesion that is one of the most common visceral changes. Of interest are the specific features of the antisynthetase syndrome, its onset, the course and pulmonary manifestations of fibrosing alveolitis, unlike the classical course of PM/DM. Two clinical cases of the antisynthetase syndrome are given.

Patients with systemic lupus erythematosus (SLE) form a high risk group osteoporosis (OP). Its main causes are autoimmune inflammation, concomitant pathology, and their treatment. When OP occurs in SLE, bone mass loss is shown to occur early and is associated with the use of glucocorticosteroids (GC). To prevent OP, all patients with SLE should modify their lifestyle. To verify bone changes, densitometry is performed in patients who have risk factors of OP and/or a menopause. Calcium preparations and vitamin D are used to prevent OP; bisphosphonates that significantly reduce the risk of fractures of the vertebral column and femoral neck are employed for therapy of OP. A SLE patient with gluco-corticoid-induced OP and a good effect of bisphophonate treatment is described.

Rheumatoid arthritis (RA) is one of the most common and severe chronic inflammatory diseases. The paper reviews the recent studies evaluating the efficacy of rituximab (MabThera®), chimeric anti-CD20 monoclonal antibodies in B cells, in patients with RA. It has been shown that Rituximab is an extremely effective and relatively safe drug for the treatment of RA and may be considered to be a prototype for a new line in the management of autoimmune diseases, the basis for which is B-cell immunity modulation.

Uveitis frequently develops in patients with ankylosing spondylitis (AS) and other autoimmune diseases. It is occasionally characterized by a severe recurrent course and untreatable with systemic glucocorticoids (GC) and standard immunosuppressive agents. The results of (mainly small) clinical trials, as well as some observations suggest that therapy with tumor necrosis factor-а (TNF-а) inhibitors is effective in such patients. There is the strongest evidence that they are beneficial in treating recurrent uveitis in patients with AS, infliximab having some efficacy advantages over etanercept and adalimumab. Accordingly, chronic uveitis in AS can be considered as an additional argument in favor of the use of TNF-а inhibitors. Furthermore, treatment with drugs of this group is warranted in severe uveitis refractory to GC and immunosuppressants. It is conceivable that in some forms of uveitis, for example, in patients with Behcet's disease, treatment with TNF-а inhibitors should be initiated at an earlier stage as the efficacy of standard immunosuppressants is generally limited

The paper presents the current views of the effects of nonsteroidal anti-inflammatory drugs on the mechanisms of development of inflammation in osteoarthrosis and their action on the metabolism of chondrocytes and extracellular substance of the articular cartilage. It also gives the results of numerous studies of the efficacy and safety of meloxicam in osteoarthrosis and the data supporting its chondroprotective properties