CC BY
17
UDK 61
Xolmatova Yo.N.
assistant Xolmirzayev A.L.
student
Fergana Public Health Medical Institute REACTIVE ARTHRITIS
Abstract: This article presents the results of studies on the features of the clinical course of reactive arthritis of post-enterocolitic and urogenital forms. The study was carried out in 120 patients with an established diagnosis of reactive arthritis.
Keywords: Reactive arthritis, Secondary osteoarthritis, Articular syndrome.
1. Introduction
Reactive arthritis (RA) is one of the diseases of spondylarthritis group, which is characterized by inflammatory lesion of joints, associated with trigger infection, as a rule, in genetically predisposed subjects. The pathology affects people from 20 to 40 years old, and mostly men [3]. About 85% of patients with RA are carriers of HLA-B27 antigen [4]. For a long time the term "Reuter's disease" was used for the definition of RA associated with urogenital infection. Recently the terms of RA and Reuter's disease are under discussion [2].It is known, that etiological structure of RA is heterogeneous. At the same time the greater spectrum of the agents responsible for the development of arthritis revealed annually. The most often determined is the interrelation of the disease with previous intestinal infections such as intestinal (postenyerocolitic RA: Yersinia enterocolitica, Yersinia pseudotuberculosis, Salmonella, Shigella, Klebsiella, Clostridium difficile, Campylobacter jejuni); urogenital (mostly linked with the infection conditioned by Chlamydia trachomatis, Ureaplasma) [8]. Pathogenetical aspects of RA are not studied well. Though the role of the infection in the development of the disease is commonly accepted, not only the agent but also the state of the macro organism is important. Immune pathological processes associated with the development of hyper immune response to infectious agent located inside a joint or extraarticulatory play a basic role in the RA pathogenesis [6]. Trigger factors can initiate cytotoxic T-cellular response leading to proliferation and activation of CD8+T-lymphocytes, causing lesion of synovial membrane and, consequently, development of arthritis.There is pathogenetic hypothesis of "antigen mimicry" of bacteria possessing common antigen determinants with HLA-system, providing cross-sectional reaction of produced antibodies not only with alien, but also with proper antigens. The role of HLA-B27 antigen in the development of RA can be
also explained by the theory of "arthritogenic peptide", the point of which is that HLA-B27 is arthritis-inducing peptide (a component of a cellular membrane of trigger micro organisms) cytotoxic to CD8+ population T-lymphocytes, triggering immune inflammatory response [8]. That is why in the modern time the possibility of autoimmune processes in the formation of articulate syndrome in RA, promoting chronization of the pathology, is under discussion. Due to heterogeneity of etiological structure and pathogenetic peculiarities RA diagnostics is associated with significant difficulties, conditioning the necessity of application of complex virologic, bacteriological, immunological, and sometimes morphological studies.Nevertheless, the basis of the diagnosis is a complex of clinical and history data, while the set of laboratory tests is often additional for the confirmation of the clinical diagnosis [4].RA, the clinical presentation of which is very heterogeneous and first of serves to be the reflection of etiological infectious factor, in some cases have complicated diagnosis. Existing clinical recommendations and clinical-laboratory approaches do not provide objective early diagnostics of the pathology. Only dynamic follow-up and testing provide correct verification of the diagnosis [1,4].Many problems of this pathology stay unsolved and that, first of all, is linked to the specificity of the disease, non-specific clinical manifestations [5,7], which are often similar to other rheumatic pathologies accompanied by arthritis with more unfavorable progression and prognosis.The objective of the work was to assess the peculiarities of modern progression of reactive arthritis.
2. Material and Research Methods
One hundred and twenty patients aged from 18 to 50 years old (36.9±8.3) diagnosed with RA (70 men and 50 women) and term of the disease 3.8 ±1.7 years were enrolled in the study.The age structure of the RA patients in the study was as follows: 12.5% were 18-20 years old, 16.7% were 21-30 years old, 45.8% were 31-40 years old, and 25% of the patients were 41-50 years old.In all patients we studied parameters characterizing inflammatory process (number of leukocytes, ESR, cialic acids, seromucoid, C-reactive protein). For the identification of "trigger" factors we used blood enzyme immunoassay, providing definition of IgM and IgG antibodies.Statistical processing of the results was performed with the help of M icrosoft Office and Statgraphics Plus 5.0 software packages. For the assessment of reliability of differences we applied Student's t-criterion. Critical level of significance for checking of statistical hypotheses in the comparison of the groups was considered to be equal to 0.05.
3. Results and Discussion
Among the patients with RA enrolled in the study more often there were people of 30-40 years old, and there were more men (23.3%) in this age group, while in the group of patients of 40-50 years old there were more women (55.8% of the total number of the age group). In the structure of RA there were reliably more (p<0.05) cases with long-lasting progression of the pathology,
which was equal to 55.8% of all cases; acute progression was observed in 26.7% and chronic one in 17.5% of the examined patients (Table 1). Long-lasting progression of RA among the patients of 40-50 years old was observed in 46.7% of the cases, which allows to classify that age group as a group of RA relapse risk.
Table 1. Distribution of RA patients according to etiological factor of reactive arthritis development (%)
As it is seen from Table 1, dependently on the trigger factor, the most often revealed one was Chlamydia trachomatis (68.3%). It should be noted, that men more often had urogenital arthritis (41.6%). At the same among postenteric forms of the disease we more often isolated Sinia enterocolitica (13.4%) and Campylobacter jejune (18.3%). Analysis of patients' distribution according to the trigger factor allowed us to reveal reliable differences in the prevalence of RA. Thus, it could be noted, that the prevalence of RA, caused by Campylobacter jejune among postenteric forms with acute progression is twice higher that with chronic one.Primary examination in cases of classic progression with arthritis lesions of eyes and urogenital tract were noted in 36.7% of the patients. Abortive form of RA with fast unnoticeable lesion of eyes and urogenital tract was noted in 69.2%. Obliterated clinical presentation like that certainly makes RA diagnosis complicated in the conditions of family polyclinic.We performed dynamic follow-up of the patients for two years, which provided clarification of the character of articulate pathology.
There were more patients with I—II activity stage of the process and II stage (55.8%) of articulate functional failure.Articulate dysfunction was more often conditioned by periarticular lesions, which caused pain syndrome, limitation of articulate mobility, and secondary osteoarthrosis (OA). As it is seen from Table 2, articulate syndrome was mostly observed in the joints of legs, prevailingly in ankle (85.8%) and knee joints (81.7%).Table 2. Articulate syndrome in patients with reactive arthritis Oligoarthritis (47.5%) was noted a little bit more often than polyarthritis. A quarter (23.3%) of patients had lesion of 3-4 joints. Polyartthritis often proceeded with asymmetric lesion of lower limbs with "spiral staircase" type and characteristic extra articulate manifestations. Patients with monoarthritis also in more than a half of the cases had involvement of ankle (69.3%), and less often knee joint (29.2%) into inflammatory process. In single cases there was notable pain in wrist and shoulder joints. In cases of mono and oligoarthritis all patients had swelling of joints and expressed limitation of their mobility. In cases of polyarthritis there was swelling of several joints, while others were just painful. The number of painful joints in the examined patients corresponded to 5.5±0.6, the number of swelling joints was 4.24±0.8, pain according to VAS in centimeters was equal to 8.1±0.7. Besides that, 90.8% of the patients with RA had clinical manifestations of enthesitis, most often pain in heel and metatarsal bones. As it is seen in the Figure 1, in 18.3% of the cases there were periostitis of calcaneal tubercle
("loose" heel spurs). It should be noted, that arthritis was asymmetric, seronegative, ADC negative, combined with urethritis and conjunctivitis. Clinical manifestations of sacroiliitis were noted in 25% of the patients, with I-II stage on x-ray. It should be noted, that in 66.7% of the cases there were x-ray symptoms of OA of hip joints (35.8%) and knee joints (64.2%). At the same time there was decrease in the height of articulate cartilage in arthrosonography with diminishing of the thickness of the cartilage in joints from 1.6±0.8 mm different from the group of patients (p>0.05), who had no OA. Figure 1. X-ray manifestations in patients with reactive arthritisIt is notable that, in 33.3% of the cases secondary OA developed in patients with RA within initial years (6-12 months) of the disease (fig. 2). Moreover, as it is seen from Figure 2, in 8.75% of the patients had III and IV stages of OA within the first year, and 13.5% within the second year, proving the necessity of endoprosthetics. In its turn from Table 3 it is seen, that OA was seen almost five times more often among the patients with RA with isolated Chlamydia trachomatis (72.5%), than with other trigger factors (p<0.05).Table 3. Distribution of patients with RA dependently on etiological factor of secondary osteoarthrosis development Figure 2. X-ray symptoms of secondary osteoarthrosis dependently on the term of disease in patients with reactive arthritisSymptoms of synovitis were identified in 100% of the patients; it was isolated and combined with periarthritis in the form of bursitis or tendinitis. Particularly, lesions of Achilles tendon such as ligamentitis and bursitis were noted in 27.5% of the patients.Besides articulate syndrome there were lesions of urogenital tract such as urethritis, prostatitis, balanoposthitis in men, and colpitis, adnexitis, urethritis, and oophoritis in women. Urethritis was registered both in men and women. There was often combination of various pathologies of urogenital tract. Dysuria was noted in 73 patients with RA (60.8%). At the same time cystitis was diagnosed in 13 of them (10.8%) and pyelonephritis in 38 (31.7%). Acute conjunctivitis was observed in 29 patients (24.2%). Fever, intoxication in the debut of the disease were observed in 1/3 of the cases. Dermal lesions included keratodermia in 32 patients (26.7%), dermatitis in 29 (24.2%), and onychodystrophy in 20 (16.7%).Iron deficiency anemia mild degree was noted in 21 patients (37.5%). Four patients had RA together with phenotypic signs of connective tissue dysplasia, fifteen patients with arterial hypertension, 43 with pathologies of thyroid gland, and 20 of them had hypothyroids, while four suffered autoimmune thyroiditis with euthyroiditis.
4. Conclusions
Thus, on the basis of the performed study of the patients with RA we determined, that most often the pathology had long-lasting character. Prevalence of urogenital arthritis (caused by Chlamydia trachomatis) was twice higher that in case of postenterocolytic. Patients with urogenital RA more often had characteristic development of secondary osteoarthrosis, developing within initial years of the disease progression, requiring further studies.
References:
[1] Asner T.V., Kalyagin A.N. Urogenic reactive arthritis: current aspects of diagnosis and treatment. Sovremennaya revmatologiya. 2010; (4): 11-15
[2] Bojovic J., Strelic N., Pavlica L. // Med. Pregl. - 2014. - Vol.67. - P.222-230.
[3] Eppinger S., Schmitt J., Meurer M. // Hautartzt. - 2006. - Vol.57 (4). -P.336-339.
[4] Hannu T. // Best Pract. Res. Clin. Rheumatol. - 2011. - Vol.25 (3). - P.347-357.
[5] Hannu T. // Best Pract. Res. Clin. Rheumatol. - 2011.- Vol.25 (3).- P.347-357.
[6] Moorthy L.N., Gaur S., Peterson M.G., Landa Y.F., Tandon M., Lehman T.J. Poststreptococcal reactive ar-thritis in children: a retrospective study // Clin Pediatr (Phila). - 2009. - Vol. 48, N 2. - P. 174-182.
[7] Tuuminen T., Lounamo K., Leirisalo-Repo M. // Front. Immunol. - 2013. -Vol.4. - P.400-418.
Xolmurodov I.
Termiz davlat universiteti magistratura bo'limi adabiyotshunoslikyo'nalishi
ikkinchi bosqich talabasi
OTASHNAFAS SHOIR HUVAYDO HAYOT YO'LIGA BIR NAZAR
Annotatsiya: Millatimiz tarixining XVII-XVIII asrida yashagan yetuk shoirlardan biri bo'lmish Xo'janazar Huvaydo Hazratlarining hayot yo'li haqida o'quvchilarda ta 'surot o'yg'otish, yangi ma'lumotlar bilan o 'quvchilarni tanishtirish.
Kalit so'zlar: Huvaydo, "Rohati dil", O'sh va Chimyon. Nosihiy, Boborahim Mashrab, Beg'ali Qosimov, Qodirqul Ro'zmatzoda maqolalari.
Kholmurodov I.
2nd year graduate student department of literary studies Termez State University
A LOOK AT THE LIFE WAY OF THE FIRM POET HUWAIDO
Annotation: To acquaint students with the life of Hazrat Khojanazar Huwaido, one of the leading poets of the 17th-18th centuries in the history of our people, to acquaint students with new information.
Keywords: Huwaido, Rohati Dil, Osh and Chimgan. Nosikhiya, Boborahima Mashrab, Begali Kasimov, articles by Kadyrkul Rozmatzoda.
Millatimiz ta'rixiga nazar tashlar ekanmiz, ming yillar davomida xalqimiz qon qoniga singib ketgan Islom dinining qadriyatlari, ahkomlari o'z o'zidan adabiyotimizga ham o'z ta'sirini ko'rsatgan. Qarib ming yillar davomida xalqimiz muqaddas kitobimiz bo'lmish Qur'oni karim va hadisi sharifga tayangan holda yashab kelganlar. E'tiborli jihati shundaki, ko'p xollarda yetuk din ulamolari bir vaqtning o'zida shoir, faylasuf, mutafakkir, hatto, ba'zi xollarda qomusiy olim kishilar bo'lishgan, yetuk shoirlar esa dinni puxta bilgan, yoshligidan Quroni karimni yod olgan murattab qori bo'lgan, shariat ahkomlarini o'zlashtirgan kishilar bo'lishgan. Bunday ulug' siymolarga Abu Nasr Farobiy, Al- Xorazmiy Abdurahmon Jomiy, Alisher Navoiy kabi ulug' mutafakkirlarni misol qilib keltirishimiz mumkin. Asrlar davomida din va adabiyot birlashib, dinning yetuk falsafasi bilan adabiyotning nodir so'z sanati vujudga keldi. Natijada islom diyorida ko'plab mutasavvuf shoirlar yetishib chiqdilar. Bu xolat XVIII asrda ham o'z aksini ko'rsatgan jumladan So'fi Olloyor, Boborahim Mashrab kabi mutasavvuf shoirlar ham din arbobi, ham yetuk shoir ham edilar. Biz ijodini o'rganmoqchi bo'lgan bir vaqtning o'zida ham ilmda piri murshidi komi, ham ijodda yetuk mutasavvuf shoir Ho'janazar
Huvaydo hazratlari ham shunday buyuk zodlardan edilar. Ham din peshvosi piri murshid, ham mohir so'z ustasi bo'lgan Huvaydo hazratlari o'z she'rlatida din falsafasini va qarashlarini aks ettirgan. Xo'janazar G'oyibnazar o'g'li Huvaydo 1704 — Chimyon shahrida tavallud topgan. Shu o'rinda shoirning tavallud topgan shahri haqida adabiyotshunoslikda bir qancha baxsli munozaralar mavjud ekanligini ham ta'kidlab o'tishimiz lozim. Jumladan adabiyotshunos olim Beg'ali Qosimov maqolasida shunday yozadi: "Huvaydo (taxallusi; asl nomi Xo'janazar G'oyibnazar o'g'li) (1704 — O'sh shahri — 1780/81, Farg'ona viloyati Chimyon qishlog'i) — shoir, tasavvuf she'riyatining yirik vakili. Qo'qon madrasalarida o'qigan. Qishlog'ida maktab ochib, uzoq vaqt maktabdorlik qilgan, kosiblik bilan ham shug'ullangan." Ammo olimning Xo'janazar Huvaydo hazratlarining O'sh shahrida tug'ilganligi haqidagi mulohazalarini Farg'ona davlat universiteti dotsenti Qodirqul Ro'zmatzoda o'zining "Sharq Yulduzi" jurnalida chiqqargan maqolasida tanqid ostiga oladi. Adabiyotshunos olim Nusratullo Jumaxo'ja ham Beg'ali Qosimovning yuqoridagi fikrlariga qo'shilmaydi va Xo'janazar Huvaydoning hayoti hamda ijodiga bag'ishlangan ilmiy maqolasida shunday yozadi: " Huvaydoning otasi G'oyibnazar Ernazar o'g'li 1104 hijriy yillarda bir guruh marg'ilonlik qarindoshlari bilan Chimyonga ko'chib kelgan. Huvaydo shu oilada, shu maskanda tavallud topgan." Biz bu holatda shoirning "Rohati dil" dostonida o'z i yozgan ma'lumotga tayanishni lozim topdik. Shoir "Rohati dil" dostonida shunday yozadi:
Kaminaning oti Xojamnazardur,
Atosinging oti G'oyibnazardur.
Nasabda O'shiyu mavludi Chimyon
G'aribu xoksoru dil parishon
Bundan ko'rinadiki, shoir asl nasabi o'shlik bo'lsada, Chimyon shahrida tavallud topgan. Otasi G'oyibnazar dastlab O'sh shahrida yashagan va keyinchalik Chimyonga ko'chib o'tgan. Qodirqul Ro'zmatzoda maqolasida bir vaqtning o'zida Tasavvufshunos Ikromiddin Ostonaqulovning ham qarashlariga qarshi chiqadi. Olim Huvaydo haqida shunday yozadi: "Kunlardan bir kun Ofoqxo'ja (rahmatullohi alayhi) o'z muridiga "Sen farzand ko'rsang. Otini Xo'janazar qo'y, mening nazarim andadur" deb xushxabar berdilar. ...Oradan 5 -6 yil o'tib, G'oyibnazar o'g'il ko'rib, ismini Xo'janazar qo'yadi. U paytda G'oyibnazar O'shda yashar edi. Keyinchalik u Farg'onaning Chimyon qishlog'iga ko'chib kelib, madrasa va xonaqoh ochib, mudarrislik bilan mashg'ul bo'lgan. Huvaydo ta'lim -tarbiyani o'z otasidan olgan. So'ng Qo'qon madrasalarida tahsil olib, o'z qishlog'iga qaytib, mudarrisldik qilgan, she'riy ijod bilan mashg'ul bo'lib, g'azallar bitgan"
Ko'rinadiki, Ostonaqulov ham Huvaydoni O'sh shahrida tavallud topgan degan qarashni ilgari suradi. Ammo biz bu kabi baxslardan eng ishonchlisi sifatida shoirning o'zi yozgan "Rohati dil" dostoniga tayanishimiz maqsadga muvofiq deb bildik. Chunki, shoirning o'zining fikri eng ishonchli manba
sifatida qaraladi. Qodirqul Ro'zmatzoda yana bir xolatga ham e'tirozli fikr bildiradi. U ham bo'lsa, olimning Qo'qon madrasalarida tahsil olganligidadir. Yuqorida keltirganimizdek Huvaydo haqidagi ma'lumotlarni uning devoniga hamda "Rohati dil" dostonidagi ma'lumotlarga tayanib mulohaza qilayotgan Beg'ali Qosimov ham Ikromiddin Ostonaqulov ham Xo'janazar Huvaydoni Qo'qon madrasalarida tahsil olganligini ta'kidlaydi. Ammo Qodirqul Ro'zmatzodaning fikricha bunday ma'lumot yo'q va olimlarning bu fikrga kelishiga sabab Huvaydo singari istedodli shoir, albatta, o'z ilmlarini biror Qo'qon madrasalarida olgan bo'lishi aniq deb tahmin qilganligidir. Qodirqul Ro'zmatzoda o'z maqolasida bu holatga shunday izoh beradi: ".. ..Huvaydoning Qo'qon madrasalaridan birida tahsil ko'rganligi yoki otasi Chimyonda qurgan madrasada mudarrislik qilganligi haqida ma'lumot uchramaydi. Afsuski, ko'p tadqiqotchilar Huvaydo singari iste'dodli shoir katta bilim va badiiy mahoratga ega bo'lish uchun Qo'qon madrasalaridan birida tahsil ko'rgan bo'lsa kerak, degan taxminlarini o'quvchiga haqiqat sifatida taqdim etadilarki, bu ilmiylik va xolislik talablariga ziddir."
Ma'lum bo'ladiki, Shoirning tavalludi xususida adabiyotshunosligimizda bir qancha bahsli xolatlar mavjud. Qishlog'ida maktab ochib, uzoq vaqt o'zi o'sha maktabda maktabdorlik bilan shug'ullangan, qolgan vaqtlarida kosiblik bilan ham mashg'ul bo'lgan Xo'janazar Huvaydo hazratlari mumtoz she'riyatimizning deyarli hamma janrlarida ijod qilgan. Uning bizgacha 351 g'azal, 28 ruboiy, 41 to'rtlik, 3 muxammas, 1 musaddas, 1 musamman, 1 mustazod, 3 masnaviy hamda axloqiy-didaktik mazmundagi «Rohati dil» manzumasi kirgan devoni yetib kelgan. Bu devon shoirning nabiralari tomonidan tuzilgan. Shoirning barcha she'rlari xalq orasida juda ham mashhur bo'lgan.
Xo'janazar Huvaydo hazratlari otasi so'fiy G'oyibnazar eshon domla xonadonida ulg'ayadi. Dastlab, padari buzrukvoridan islom dinining asoslarini, fiqh ya'ni islom xuquqshunosligi ilmini, qol ilmini hamda hol ilmini chuqur o'rgandi. Bu haqda shoirning o'zi:
Ham o'qub ilmu adab, bo'ldum "Aqoyid"xoni ishq,
Mushkilotu ilmi fiqhdin so'rsalar berdim javob —
deb yozdi. "Aqoyid" ilmi aqidaga doir ilm bo'lib, ijodkor bu yerda ilohiy ishq ilmini, ya'ni tasavvufni nazarda tutmoqda. Tasavvuf tarixidan ma'lumki, so'fiy zotlar ilohiyot nazariyasini egallash uchun madrasada tahsil olish zarurligi haqida qayg'urgan emaslar. Tariqat yo'liga kirish uchun tolibdan birinchi o'rinda fiqh ilmini juda yaxshi bilishi talab etilgan. Bu ilmni ilmi qol, ya'ni zohiriy so'z bilan anglatiladigan ilm deb bilishgan. Ilmi hol esa so'fiylik ilmi bo'lib, murid o'zining piri murshidi nazorati ostida tavhid kalomini zikr qilish bilan o'rgangan. Ho'janazar Huvaydo hazratlari ham har ikkala ilmda dastlabki saboqlarni otasidan olganini aytadi. Huvaydo ijodini o'rganish bizga haqni yanada yaqindan tanishimizga katta yordam beradi.
Foydalanilgan adabiyotlar:
1. Huvaydoning badiiy falsafiy me 'rosi. Qodirqul Ro'zmatzoda "Sharq yulduzi" jurnali, 2015 - 1
2. Avliyolar sultoni. Turonlik valiylar (To'plamni nashrga tayyorlovchi va so'z boshi muallifi Ikromiddin Ostonaqulov) - Toshkent, "Yangi asr avlodi". 2004.B.192-193
3. Huvaydo. Rohati dil. Ibrohim Adham (Tabdil qiluvchi nashrga tayyorlovchi va so'z boshi muallifi Qodirqul Ro'zmatzoda). T. "Navro'z",201L B. 35
4. Xo'janazar Huvaydo. Devon. Toshkent:. "Yangi asr avlodi", 2005-yil.
