In the spectrum of comorbid pathology in rheumatic and musculoskeletal diseases (RMD), metabolic disorders attract special attention, primarily obesity, associated with an increased risk of developing autoimmune diseases, including RMD, in the population. In rheumatology, the problem of using antidiabetic drugs that reduce the risk of obesity is considered not only from the point of view of treating type 2 diabetes mellitus (T2DM), but also as a broader problem associated with the prospects of repositioning, defined as a strategy for finding new medical indications for existing, approved for use or studied drugs, which is especially important for the harmonization of therapy for complex RMD. In recent years, new classes of drugs have been developed for the treatment of T2DM and its complications: glucagon-like peptide 1 receptor agonists (GLP1-RAs), and sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors; gliflozins). Along with the classical antidiabetic effects, GLP-1RAs and SGLT-2 inhibitors have a wide range of anti-inflammatory and immunomodulatory mechanisms of action, which can potentiate the effectiveness of anti-inflammatory therapy for RMD and inhibit the development of comorbid pathology. The article discusses data regarding the mechanisms of anti-inflammatory activity of antidiabetic drugs and their effectiveness in RMD. However, in order to determine the true place of these drugs in relation to the personalization of RMD therapy, primarily in reducing the risk of various comorbid pathologies, further studies are needed aimed at directly comparing the effectiveness of drugs in various clinical scenarios.

Although the role of inflammation in the development of atherosclerotic vascular lesions, as the leading form of organ pathology in the cardiovascular diseases (CVD), has been discussed for more than 100 years, only in the last 30 years has the “inflammatory” theory of atherosclerosis begun to be considered as one of the most important areas of fundamental and clinical research in cardiology and other areas of biology and medicine. According to modern concepts, chronic low-grade inflammation, the development of which is associated with uncontrolled activation of innate and acquired immunity, plays a fundamental role at all stages of the progression of the atherosclerotic process associated with CVD. The fundamental contribution of inflammation to the development of atherosclerotic vascular lesions has drawn attention to the similarity of the mechanisms of immunopathogenesis of atherosclerosis in CVD and rheumatoid arthritis, and subsequently other systemic immune-mediated rheumatic diseases (IMRDs). In the spectrum of numerous inflammatory mediators and “immune” cells involved in the immunopathogenesis of atherosclerosis in both CVD and IMIRD, the central place is occupied by “pro-inflammatory” cytokines such as interleukin (IL) 1, IL-6, tumor necrosis factor α, as well as IL-17 and interferon type I, which closely interact within the “cytokine network”. IL-6, which occupies a central place in the development of many IMIDs, on the one hand, and CVDs associated with atherosclerotic vascular lesions, on the other hand, is attracting special attention as a promising therapeutic “target”: coronary heart disease, acute coronary syndrome, peripheral arterial disease, ischemic stroke, heart failure, and others. Of particular importance is the fact that hyperproduction of IL-6 plays a significant role in the development of a wide range of cardiometabolic diseases, including type 2 diabetes mellitus, obesity, chronic kidney disease, metabolically associated fatty liver disease, associated with the development of atherosclerotic vascular lesions. Data were obtained indicating the important clinical significance of IL-6 for predicting the risk of premature mortality and other cardiovascular complications both in the general population of conditionally “healthy” people and in patients with various manifestations and forms of CVD. Several biologics, which are monoclonal antibodies specific for both IL-6R and IL-6 itself, have been developed. Several randomized clinical trials have recently been initiated to study the efficacy and safety of new anti-IL-6 mAbs: ziltivekimab, clazakizumab, and Pacibekitug (TOUR006) in patients with coronary artery disease, heart failure, and chronic kidney disease. The article will review new data regarding the pathogenetic and clinical significance of IL-6 and the prospects for IL-6 inhibition as a component of anti-inflammatory therapy for CVD.

The article is devoted to the updated recommendations of the European Alliance of Rheumatology Associations (EULAR) in 2025 on the management of patients with Behcet’s syndrome/disease, which include 5 fundamental principles and 12 recommendations related to the treatment of various organ lesions, as well as comments to them. The methodology of creating recommendations is considered, as well as unresolved issues of managing patients with Behcet syndrome/disease, which are planned to be investigated in the future.

Positron emission tomography with computed tomography with fluorodeoxyglucose F 18 is an accurate non-invasive hybrid imaging modality that has high sensitivity in diagnosing the most common causes of fever of unknown origin – infectious, inflammatory and neoplastic processes. The aim of this article is to provide a brief overview of the role of positron emission tomography with computed tomography in the evaluation of patients with fever of unknown origin, as well as present specific clinical cases demonstrating the detection of the most common causes of fever of unknown origin using this technique.

The aim – to compare the long-term efficacy of netakimab with other registered drugs in the Russian Federation to treat radiographic axial spondyloarthritis over a period of up to 3 years.

Materials and methods. A systematic literature search was conducted in PubMed and Embase databases. 19 publications evaluating the results of 11 clinical trials were selected. The simulated treatment comparison method according to NICE DSU TSD 18 (National Institute for Health and Care Excellence Decision Support Unit Technical Support Document 18) recommendations was used for comparison. Age, sex, BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), ASDAS (Ankylosing Spondylitis Disease Activity Score), C-reactive protein, disease duration since axial spondyloarthritis diagnosis, and HLA-B27 status were selected as confounding variables for adjustment.

Results. Netakimab demonstrated superiority over all interleukin 17 and tumor necrosis factor α (TNF-α) inhibitors, as well as tofacitinib, on the main efficacy endpoints ASAS20 and ASAS40 (20% and 40% improvement according to the Assessment of SpondyloArthritis international Society criteria) over a period of up to 3 years. No superiority was detected compared to upadacitinib.

Conclusion. Netakimab is one of the most superior therapeutic option among available biologics for long-term treatment of active axial spondyloarthritis. Using netakimab as the first-line or second-line therapy allows achieving treatment goals with the highest probability. The results are useful for evidence-based clinical decision-making when choosing biological therapy considering patient profile and can be used for planning treatment strategy after TNF-α inhibitor failure.

The aim – to study the features of geriatric status in patients with rheumatoid arthritis (RA) aged ≥65 years.

Materials and methods. The EUCALYPT study enrolled 4308 people (30% men) aged 65 to 107 years (median 78 years) residing in 11 regions of the Russian Federation. A comprehensive geriatric assessment, consisting of a survey using a specially developed questionnaire and an objective examination, was performed for all participants. The presence of RA in the subjects was determined based on records in their medical charts. Information on the presence or absence of RA was available for 4295 (99.7%) patients.

Results. The prevalence of RA among all patients was 6.9%, including 7.6% among individuals aged 65–74 years, 7.5% among those aged 75–84 years, and 5.2% among those aged ≥85 years (p=0.026). The prevalence of RA in women was 1.4 times higher than in men (7.6% vs. 5.3%; p=0.005). Univariate regression analysis showed that with each additional year of age the odds of having RA decreased by 2% (odds ratio ( R) – 0.98; 95% confidence interval (95% CI): 0.97–0.997; p=0.019), whereas women had 49% higher odds of having RA (OR=1.49; 95% CI: 1.12–1.97; p=0.005). Compared with patients without RA, the geriatric status of patients with RA was somewhat worse, as they had a higher prevalence of a number of geriatric syndromes (GS): chronic pain (97.6% vs. 86.4%; p<0.001), frailty (70% vs. 62.2%; p=0.007), depression (56.8% vs. 47.5%; p=0.002), falls during the preceding year (46.5% vs. 29.1%; p<0.001), malnutrition (11.1% vs. 5.5%; p<0.001), and pressure ulcers (4% vs. 2.1%; p=0.032), but a lower prevalence of cognitive impairment (52.1% vs. 61.5%; p=0.004). Multivariate regression analysis adjusted for age and sex demonstrated that age (OR=0.98 per each year; 95% CI: 0.96–0.99; p=0.007) and 5 geriatric syndromes were independently associated with the presence of RA: frailty (OR=1.47; 95% CI: 1.09–1.99; p=0.013), malnutrition (OR=1.90; 95% CI: 1.18–3.07; p=0.008), cognitive impairment (OR=0.62; 95% CI: 0.46–0.83; p=0.001), chronic pain (OR=5.56; 95% CI: 2.27–13.62; p<0.001), and falls during the preceding year (OR=2.03; 95% CI: 1.55–2.67; p<0.001).

Conclusion. The EUCALYPT study provided, for the first time, domestic (Russian) data on the prevalence of RA in individuals aged ≥65 years and examined the associations between RA and GS.

Men with spondyloarthritis (SpA) are characterized by a high incidence of hypogonadism (low testosterone levels). Hypogonadism is associated with higher indicators of systemic inflammation and metabolic disorders.

The aim – to compare the dynamics of spondyloarthritis activity with changes in total testosterone (TT) levels in men with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).

Materials and methods. Thirty-six men with AS and 47 men with PsA were included. All patients had their TT levels measured at baseline and during follow-up (on average, after 14.5 [12.8; 17.3] months for AS and 14.0 [9.5; 19.0] months for PsA). Subgroups were identified based on the presence/absence of decreased BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and DAPSA (Disease Activity in Psoriatic Arthritis) indices, as well as C-reactive protein (CRP) levels. A comparative assessment of quantitative and qualitative indicators reflecting the clinical features of AS and PsA was conducted at baseline and over time, as well as a correlation analysis between the studied quantitative indicators over time.

Results. An inverse correlation was found between changes in testosterone levels and CRP (ρ=–0.4; p=0.015) in patients with AS. In PsA, no significant correlations were found between changes in TT levels and changes in indicators reflecting activity. In patients with AS, with decreased BASDAI activity, no significant changes in TT levels were observed. At the same time, a decrease in CRP from 9.6 [2.7; 33.9] to 1.9 [0.65; 8.5] mg/L (p<0.001) was accompanied by an increase in TT levels (from 17.9 [12.2; 21.1] to 19.2 [14.2; 23.7] nmol/L; p=0.03), while no such dynamics were observed in the absence of a decrease in CRP. Among patients with PsA, neither a decrease in DAPSA activity nor a decrease in CRP were accompanied by significant dynamics in testosterone levels. In both AS and PsA, the proportion of patients with hypogonadism (TT level ≤12.0 nmol/L) at baseline and over time remained comparable across all comparisons.

Conclusion. In patients with AS, a decrease in CRP during treatment is accompanied by an increase in TT levels.

Background. Systemic lupus erythematosus (SLE) is associated with a high risk of early cardiovascular disease, which is driven by chronic systemic inflammation associated with proinflammatory cytokines and autoantibodies. Heart failure is 2–4 times more common in patients with SLE than in the general population, and mortality is twice as high. The aim of the study – to assess the incidence of asymptomatic myocardial dysfunction (AMD) in patients with systemic lupus erythematosus before the administration of genetic engineering therapy and to analyze its association with clinical and immunological characteristics and cytokine levels.

Materials and methods. We included 100 patients with SLE according to the 2012 SLICC (Systemic Lupus International Collaborating Clinics) criteria (age 36±11 years) and 38 healthy controls, matched for gender and age. SLEDAI-2K (Systemic Lupus Erythematosus Disease Activity Index 2000) activity was 8 [6; 13] points. Ninetyfive percent received glucocorticoids, and 84% received hydroxychloroquine. Thirty-nine patients were diagnosed with hypertension, coronary heart disease (CHD) in 1, and stroke in 1. Echocardiography was performed to assess global longitudinal myocardial strain (GLS) of the left (LV) and right ventricles (RV). Levels of interleukin (IL) 6, IL-1 receptor antagonist (IL-1RA), IL-18, and tumor necrosis factor α (TNF-α) were determined in the blood serum.

Results. SLE patients had lower LV GLS and RV GLS values than in the control group (–18.6 [–19.8; –16.5]% vs –20.3 [–21.5; –19.6]%; –19.2 [–22.8; –16.1]% vs –21.9 [–23.5; –21.2]%, respectively; p<0.05). LV GLS impairment was more often diagnosed in SLE patients (58%) than in the control group (13%); GLS of the pancreas in 42% versus 10% (p<0.05).

Cytokine levels were higher in SLE patients than in the CG: IL-1RA – 0.005 [0.001; 101.2] vs 0.001 [0.001; 0.2] pg/ml; IL-6 – 0.1 [0.003; 5.7] vs 0.001 [0.001; 0.001] pg/ml; IL-18 – 305.6 [226.0; 486.0] vs 155.5 [138.3; 175.0] pg/ml; TNF-α – 0.005 [0.001; 0.8] vs 0.002 [0.001; 0.006] pg/ml (p<0.05). IL-6 and IL-18 levels were higher in patients with high disease activity than in those with low disease activity (1.8 [0.006; 11.4] vs 0.003 [0.001; 0.5] pg/ml, and 468.8 [237.3; 650.1] vs 255.9 [217.4; 334.1] pg/ml, respectively; p<0.05).

IL-1RA levels were significantly higher in patients with ADM (2.5 [0.001; 134.7] pg/ml) than in patients without ADM (0.001 [0.001; 0.013] pg/ml; p=0.02).

Correlations were found between LV GPD and IL-1RA (r=–0.234), RV GPD and IL-1RA (r=–0.248; p<0.05), IL-18 and LV E` (r=–0.22), LV E/A (r=–0.218), LV ejection fraction (r=–0.249; p<0.05).

Conclusion. SLE patients are highly likely to have impaired LV and RV GPD, as well as elevated levels of IL-1RA, IL-6, IL-18, and TNF-α. ADM is associated with SLE activity, clinical manifestations, and elevated cytokine levels (IL-18, IL-1RA), confirming the role of chronic inflammation in the development of SDM.

Effective management of systemic lupus erythematosus (SLE) requires close collaboration between physicians and patients, including an adequate level of disease-related knowledge.

The aim of this study – to present the results of SLAKE (Systemic Lupus Erythematosus Essential Knowledge Assessment Score) implementation in patients with systemic lupus erythematosus in the Russian Federation and to compare them with an international cohort.

Methods. In the first stage, using a crowdsourcing approach, rheumatology experts from the European Reference Network for Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET), together with patients, identified the key knowledge domains related to SLE. Based on these domains, a digital platform was developed to assess patient knowledge. Participants completed a questionnaire consisting of 44 items selected from the SLAKE question bank, covering 11 knowledge domains. The study was conducted online, and demographic as well as clinical characteristics of the participants were collected. Upon completion of the assessment, a total SLAKE score (maximum 44 points) and domain-specific scores for each of the 11 domains (range 0–4 points) were calculated. Participants also received personalized feedback and were asked to evaluate the usability of the platform. Overall, 1,839 patients with SLE were included in the SLAKE analysis and subsequently divided into two groups: Group 1 comprised patients from the Russian Federation (n=214), while Group 2 consisted of patients from other countries (international cohort; n=1,625).

Results. The overall SLAKE score did not differ between patients from the Russian Federation and those from other countries. However, significant differences were observed in specific knowledge domains. Patients from the Russian Federation achieved higher scores in the “Disease monitoring” domain, whereas lower scores were recorded in the “Symptoms recognition” and “Non-pharmacological management” domains. Despite a shorter disease duration and lower participation in educational programs, the overall level of disease-related knowledge among Russian patients was comparable to that observed in the international cohort.

Conclusions. SLAKE demonstrated high acceptability among patients and may serve as a useful tool for identifying knowledge gaps and tailoring patient education programs to individual needs.

Behçet‘s disease (BD) is a rare systemic vasculitis with multiorgan manifestations and an unclear etiology. The difficulty in early diagnosis due to clinical polymorphism and the absence of pathognomonic markers leads to delayed treatment, disability, and a worse prognosis. This article demonstrates the diagnostic and therapeutic challenges of BD using the clinical case of patient M., 41 years old, as an example. The importance of an interdisciplinary approach and early initiation of immunosuppressive therapy is emphasized.