Sikalo J. The melatonin and TNF-а levels in patients with rheumatoid arthritis: relationship with clinical, functional state and treatment effectiveness.

The dissertation is devoted to the study of daily fluctuations in levels of melatonin and TNF-а in patients with RA, establish pathogenesis links between immunological activity indices for rheumatoid process, clinical and laboratory features, functional and psychological status and impact of the paroxetine on main clinical and psychological manifestations of RA . Established that patients with RA inherent the violation of the circadian production of melatonin, which is manifested by increased morning and evening levels in two and three times, respectively, with a simultaneous decrease in the average range of individual variation in 1,8 times. Shown the existence of the close associative links between the production of melatonin and TNF-а (p <0.001), with activity index DAS 28 and CDAI (p <0.001), number of painful and swollen joints (p <0.01). Defined complex multifactorial influence melatonin generatuing function and cytokinemia in implementing typical psychological portrait response and insomnia in patients with RA. The obtained results indicate that a high level of melatonin in the blood is one of the predictors of resistance for RA treatment. The proposed scheme of treatment with paroxetine was effective both in terms of correction of sleep and emotional state of the patient and on the main manifestations of the disease.