Despite the progress of molecular genetic testing, the diagnostic issues of monogenic autoinflammatory diseases (AIDs) remain largely unresolved. It’s associated with a heterogeneous clinical picture and problems in interpreting the results of molecular genetic testing. A significant group of patients are classified as recently identified undifferentiated AIDs, which characterized by the presence of clinical signs of monogenic AIDs and negative or inconclusive result of molecular genetic testing. In recent years, the problem of undifferentiated AIDs or SURF (syndrome of undefined recurrent fevers) has been considered within the framework of the concept of genetically transitional disease. It was discussed that undifferentiated AIDs with genetic variants of uncertain significance should be distinguished into a special subtype. Further study of such cohorts is needed to identify significant biomarkers and find therapeutic targets.

The article discusses the role of macrophage polarization in the processes of inflammation and fibrosis. Targeting the polarization of alternatively activated M2 macrophages could be a promising strategy to prevent fibrosis progression. The prospects for the treatment of immune-inflammatory diseases with lung damage, aimed at macrophage functions, are considered, including the possibilities of using the selective neuropilin 2 modulator efzophytimod in systemic sclerosis and sarcoidosis, as well as other diseases.

Existing guidelines for the treatment of systemic lupus erythematosus (SLE) mainly include issues related to common clinical manifestations. This review presents some rare manifestations of SLE caused by damage to the nervous system, gastrointestinal tract, lungs, heart, skin, some types of vasculitis, hematological disorders, and clinical guidelines for the treatment of 24 rare manifestations developed by an international group of experts. The international group included 119 specialists from three SLE expert groups: the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET), the Systemic Lupus Erythematosus International Collaborating Clinics group (SLICC), and the European Lupus Society (SLEuro). These consensus expert recommendations can serve as a basis for choosing a therapy in cases where current recommendations are insufficient or inapplicable.

Polymyalgia rheumatica (PMR) is a prevalent immune-mediated inflammatory rheumatic disease that typically affects individuals over the age of 50. Despite significant advances in the diagnosis and treatment of PMR, challenges remain in the objective assessment of disease activity, which hinders the development and implementation of the treat-to-target (T2T) strategy. Diagnosis is primarily based on clinical symptoms and laboratory markers of inflammation—most notably, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). However, the diagnostic value of these markers is reduced in patients receiving interleukin-6 inhibitors, emphasizing the need for alternative biomarkers. The Polymyalgia Rheumatica Activity Score (PMR-AS) and its modifications (CRP-PMR-AS, ESR-PMR-AS, and clin-PMR-AS) are among the most thoroughly studied tools for the quantitative assessment of disease activity. The potential of imaging modalities such as ultrasound and magnetic resonance imaging (MRI) is also being actively explored for visualizing structural changes and assessing inflammatory activity in PMR. These techniques have demonstrated high sensitivity and specificity but require further standardization and validation of their clinical relevance. The development of a comprehensive monitoring strategy based on validated indices and objective biomarkers may serve as a foundation for the creation of national clinical guidelines and facilitate the successful implementation of the T2T approach in routine rheumatologic practice.

Psoriatic arthritis is a chronic, progressive, heterogeneous disease that includes peripheral arthritis and spondyloarthritis, associated with cutaneous psoriasis and affecting various body systems. In addition to its impact on physical health, psoriatic arthritis is interconnected with mental disorders. Inflammatory processes, chronic pain, and other comorbid somatic conditions significantly contribute to the development of mental disorders, primarily depressive and anxiety disorders. Mental disorders often precede and accompany psoriatic arthritis, negatively influencing the severity, disease progression, and treatment efficacy, promoting the development of therapeutic resistance.

Osteoarthritis (OA) is one of the leading causes of chronic pain and disability worldwide, with its prevalence steadily increasing, particularly among older adults and patients with obesity. Nutraceuticals are considered an adjunctive component of symptomatic OA therapy aimed at reducing pain intensity and the need for nonsteroidal anti-inflammatory drugs (NSAIDs), while maintaining a relatively favorable safety profile. Experimental and clinical data indicate that selected nutraceutical components (zinc, Boswellia serrata, avocado/soybean unsaponifiables, rosehip, resveratrol, etc.) exert anti-inflammatory and chondroprotective effects through modulation of pro-inflammatory cytokines. However, the available evidence is limited in both number and duration of studies, underscoring the need for further independent randomized trials and providing the rationale for the present open prospective comparative study of Revokka in patients with hand OA.

The aim – to evaluate the efficacy of adding Revokka to analgesic therapy in patients with hand osteoarthritis, compared with analgesic monotherapy, with regard to pain and function (AUSCAN questionnaire), treatment satisfaction (physician and patient), adherence, and changes in analgesic dosing.

Materials and methods. This open cohort comparative study included 60 female patients with hand OA of Kellgren – Lawrence stages I–III fulfilling ACR (American College of Rheumatology) criteria; median age was 63.0 [59.0; 65.0] years. Patients were randomized into two groups: meloxicam monotherapy (7.5–15 mg/day) or combined therapy with meloxicam plus Revokka (2 capsules/day) for 90 days with three study visits. Efficacy and safety were assessed using the AUSCAN questionnaire, visual analogue scale (VAS; patient/physician), and NSAID use.

Results. The groups were comparable in age (63.0 [59.0; 65.0] years), body mass index, comorbidity profile, OA duration, and radiographic stage distribution (predominantly stages II–III, with no cases of stage IV in Kellgren – Lawrence). By visit 3, VAS pain in hand joints decreased from 74.2 [58.6; 86.3] to 21.2 [15.4; 27.2] mm in group 1 and from 67.1 [62.4; 74.2] to 10.5 [8.7; 14.0] mm in group 2 (total reduction – 71.4% and 84.4%, respectively; between-group p<0.001). Pain reduction was accompanied by an increase in treatment satisfaction on the patient VAS to 71.0 [66.0; 81.0] and 92.5 [89.0; 98.0] mm and on the physician VAS to 76.0 [73.0; 84.0] and 80.0 [75.0; 84.0] mm in groups 1 and 2, respectively. In addition, the median duration of NSAID use from day 30 to day 90 decreased from 56 days in group 1 to 35 days in group 2, with high adherence (90.1% and 97.4%, respectively), indicating additional benefits of including Revokka in the treatment regimen.

Conclusion. In female patients with hand osteoarthritis, combination therapy including the nutraceutical complex Revokka provides a greater reduction in pain intensity, higher treatment satisfaction, and a reduction in NSAID use compared with meloxicam monotherapy.

According to an epidemiological study, hip joint involvement was detected in 12–56% of patients with axial spondyloarthritis (axSpA) in Russia. Data on the incidence of coxitis in patients with axial psoriatic arthritis (axPsA) are lacking.

The aim of the study was to compare radiographic changes in the hip joints in patients with axial spondyloarthritis and axial psoriatic arthritis and to evaluate the relationship between coxitis and disease activity.

Material and methods. The study included 222 patients with a mean age of 35.7±12.7 years. The first group included 108 patients who met the 2009 ASAS (Assessment of SpondyloArthritis International Society) criteria for axSpA or the 1984 criteria for ankylosing spondylitis (AS); The second group included 114 patients with axPsA who met the CASPAR (ClASsification for Psoriatic ARthritis) criteria. Signs of axial involvement in psoriatic arthritis (PsA) were determined using instrumental imaging methods. Diagnosis required the presence of radiologically reliable sacroiliitis (SI), i.e., bilateral stage ≥II or unilateral stage ≥III according to Kellgren, or active sacroiliitis according to magnetic resonance imaging. The presence of at least one syndesmophyte (paraspinal ossificate) in the cervical (CS) or lumbar (LS) spine, as well as ankylosis of the facet joints of the CS, were also taken into account. The mean age of disease onset was 26.3±20.3 years; HLA-B27 was detected in 54% of patients. The diagnosis of coxitis was established based on a pelvic X-ray and calculation of the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI hip) for each joint.

Results. Radiographic evidence of coxitis was detected in 52 of the 222 patients included in the study, including 22 patients with AS and 30 patients with axPsA. Patients with axPsA were older than those with axSpA (median age 32 years and 45 years, respectively; p<0.05). Radiographic coxitis was more common among men with axSpA and equally common among men and women with axPsA. The ASDAS (Axial Spondyloarthritis Disease Activity Score) index value was high in both groups; however, it was statistically significantly higher in patients with axPsA than in patients with axSpA (on average, 2.1 and 3.2, respectively; p<0.05). Acute phase indices (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)) were slightly higher in axSpA than in axPsA (CRP – 5.8 and 4.2 mg/L; ESR – 20 and 17 mm/h, respectively), but these differences were not statistically significant (p>0.05). Functional impairment according to BASFI (Bath Ankylosing Spondylitis Functional Index) was more pronounced in axPsA than in patients with axSpA (p<0.05). Peripheral arthritis was also more common in patients with axPsA (96.6% and 59.0%, respectively; p<0.05).

Conclusion. Radiographic coxitis was detected in 20% of patients with axSpA and 26% with axPsA. In previous studies, the incidence of radiographic coxitis in patients with psoriatic arthritis did not exceed 10%. According to our study, patients with axPsA had high clinical and laboratory indicators of disease activity, as well as significant functional impairment.

Background. Syndesmophitis is a pathognomonic sign of damage to the axial skeleton in ankylosing spondylitis (AS), however, the characteristics of its formation and growth are poorly understood.

The aim – to evaluate the dynamics of changes of syndesmophyte growth according to multispiral computed tomography (MSCT) data in patients with ankylosing spondylitis.

Materials and methods. The data of MSCT of the thoracic or lumbar spine were analyzed in 10 patients with AS (8 men). Changes in the dynamics of the length of syndesmophytes and the width at their base were studied. Only patients who had previously been diagnosed with at least 1 syndesmophyte in the thoracic or lumbar spine were included in the study. The average age of patients included in the analysis was 43.5±8.4 years, with an average disease duration of 16.4±7 years. All patients underwent repeated MSCT. The average follow-up period was 16 months (from 9 to 26 months). 9 patients were positive by HLA-B27. The median age of disease onset was 31 [22; 49] years. All patients had high activity initially.

Results. On 226 endplates of thoracic (216 in 9 patients) and lumbar (10 in 1 patient) vertebrae in 10 patients with AS, a total of 90 syndesmophytes (from 1 to 9 syndesmophytes in 1 patient) were detected on MSCT during 2 observation periods, of which 44 (48.9%) were present initially and 46 (51.1%) – during the repeat examination. Accordingly, 2 (4.5%) new syndesmophytes appeared during the observation period. The minimum length of syndesmophytes was 2.4 mm, and the maximum was 14.3 mm, while the width ranged from 4.9 to 23.0 mm. A significant (>10%) increase in the length of syndesmophytes was observed in 27 (61.4%) cases, and in 2 (4.5%) of them the increase was more than half of the initial one. The width of syndesmophytes and their changes also varied widely. In 2 patients it decreased by more than 10%, and in 18 (40.9%) it increased significantly during the observation period. In 15 (34.1%) syndesmophytes the length, and in 24 (54.5%) the width during the analyzed period remained virtually unchanged or was within ±10% of the initial size. The growth rate and sizes of different syndesmophytes, even in the same patient, often varied greatly.

Conclusions. In this study, an attempt was made to evaluate the dynamics of changes of linear sizes of syndesmophytes in patients with AS according to CT scans of the thoracic or lumbar spine. Preliminary data show that practically every syndesmophyte tends to grow, and the growth rate of different syndesmophytes, even in the same patient, can vary greatly. It is noteworthy that some syndesmophytes decreased in dynamics, possibly due to drug therapy, although possible errors in the analysis of parameters cannot be excluded. The data obtained by us and data from other authors suggest that AS may regress in some patients.

The aim – to investigate the relationship between cytokines (interleukin (IL) 6, tumor necrosis factor (TNF) α and IL-1 receptor antagonist (RA)) and multifocal atherosclerosis (MFA) in patients with rheumatoid arthritis (RA).

Materials and methods. The study included 71 patients with a confirmed diagnosis of RA, corresponding to the 2010 ACR/EULAR (American College of Rheumatology/European Alliance of Associations for Rheumatology) classification criteria. Most of them (81.4%) were women, the average age was 47.0±10.9 years, the median duration of the disease was 120 [60.0; 204.0] months, 54 (76.1%) patients had advanced disease, and moderate to high disease activity according to the DAS28 (Disease Activity Score 28), SDAI (Simplified Disease Activity Index) and CDAI (Clinical Disease Activity Index) indices prior to the administration of genetically engineered biological drugs. All patients had their serum IL-6, TNF-α, and IL-1 RA levels determined by enzyme-linked immunosorbent assay (ELISA), and underwent ultrasound Doppler imaging (UDI) of the carotid (CA) and femoral (FA) arteries with assessment of intima-media thickness (IMT) and the presence of atherosclerotic plaque. The control group consisted of 30 healthy individuals matched for age and gender.

Results. Among the RA patients examined, atherosclerotic lesions of the CA were found in 22 (31%), FA in 20 (28.2%), including combined lesions of the CA and FA in 13 (18.3%) patients. In RA patients, CA and FA atherosclerosis was significantly more common than in the control group (p<0.05). In the group of RA patients, the levels of IL-6 and TNF-α cytokines were significantly higher than in the control group. The level of IL-1 RA did not differ significantly. The thickness of the CA IMT was higher with elevated TNF-α (0.65 vs. 0.56 mm; p<0.05), and the CA IMT was higher with elevated IL-1 RA (0.60 vs. 0.56 mm, p<0.05). No differences were found for IL-6. Cytokine levels (IL-6, TNF-α, IL-1 RA) did not differ between RA patients with MFA and those without (p>0.05). RA patients were analysed according to the combination of elevated cytokine levels. Three groups were identified: group 1 – with elevated levels of all three cytokines (CT) (n=14); group 2 – with elevated levels of 2 cytokines (n=36); group 3 – with elevated levels of 1 cytokine (n=19). It was found that the thickness of the FA IMT with an increase in 3 CT was 0.77 [0.62; 0.86] mm, with an increase in 2 CT it was 0.62 [0.49; 0.77] mm, and with an increase in 1 CT it was 0.62 [0.43; 0.63] mm (p<0.05). A statistically significant positive correlation was found between FA IMT and TNF-α concentration (r=0.4; p=0.003), CA IMT and IL-6 (r=0.2; p=0.05) and IL-1 RA (r=0.2; p=0.05).

Conclusion. MFA is frequently detected in patients with RA. Elevated levels of IL-1RA and IL-6 are more common in RA patients with MFA. The greatest thickness of the FA IMT was found with a simultaneous increase in IL-6, IL-1RA, and TNF-α levels. Patients with RA require UDI of the CA and FA to detect MFA and stratify the risk of cardiovascular events.

Introduction. Early diagnosis of spondyloarthritis (SpA) remains a serious problem in regions where brucellosis is endemic, as musculoskeletal (MSK) involvement in chronic brucellosis (ChB) is similar and can mimic SpA.

The aim is to identify signs and symptoms important for the differential diagnosis of spondyloarthritis and chronic brucellosis by comparing a wide range of clinical manifestations of these diseases.

Materials and methods. In a retrospective-prospective study conducted in a brucellosis-endemic region, the epidemiological characteristics and clinical features of two groups of patients meeting the ASAS (Assessment of Spondyloarthritis International Society) criteria were compared: those with SpA and those with ChB. Patients with a probable combination of these two diseases were excluded from the study.

Results. The comparative analysis included 40 people with HBP who met the ASAS criteria and 139 people with SpA. ASAS criteria for peripheral SpA were identified in 85% of patients with HBP and in 30% of patients with SpA. HLA-B27 was present in 25% of patients with IBD and 71% with SpA. A positive epidemiological history was frequently recorded not only in ChB (100%) but also in SpA (38%) (p<0.001). Important distinguishing features of ChB were unilateral sacroiliitis (65% vs. 13.7% in SpA; p<0.001), predominantly mechanical back pain (47.5% vs. 5.8%, p<0.001), and polyarthritis of small joints (30% vs. 14.4%; p<0.001), with frequent involvement of upper limb joints. ChB was particularly characterized by signs of infection (95% vs. 24.4%), damage to the autonomic (75% vs. 29.5%) and peripheral (47% vs. 15.8%) nervous systems, affective disorders (47.5% vs. 6.4%) (all p<0.001), and reproductive system pathology, including obstetric pathology. Unlike SpA, MSK involvement and other manifestations of ChB did not respond adequately to NSAIDs and disappeared after antibiotic therapy.

Conclusion. The study identified distinctive clinical features that may help distinguish SpA from ChB.

The joints of the hand are most frequently involved in pathological process in rheumatoid arthritis (RA). This is the cause of future functional impairment, inability to perform professional activities, significant difficulties in activities of daily living, and worsening of life quality. The goal of surgical treatment of hand involvement is to achieve a balance between minimal pain and maximal preservation of function. Joint-preserving surgical techniques are applied; however, in cases of severe wrist joint destruction, total wrist fusion (arthrodesis) (TWF) or total wrist arthroplasty (TWA) remain the treatment options of choice.
TWF is a reliable, safe, cost-effective, and technically availability procedure with predictable long-term outcomes; however, it causes complete loss of ROM (range of motion) in wrist joint, which represents a major drawback and following search for alternative surgical options. In the early 2000s, fourth-generation TWA implants were introduced, that characterized by improved anatomical design, greater preservation of bone stock during implantation, higher survivorship rates, the usage of specialized coatings to enhance osseointegration, biomechanical stability, and applicability for revision when required.
The main advantages of TWA over TWF include preservation of wrist motion and, in some cases, an increase in ROM, which are vitally important for patients’ daily and professional activities. Accordingly, to published reports with 10–15 years of follow-up, survivorship rates have increased and the incidence of complications and revisions following TWA has decreased; nevertheless, TWA procedure is currently considered less reliable than TWF. To achieve long-term outcomes of TWA in patients with RA comparable to those of total knee and hip arthroplasty – appropriate patient selection, consideration of disease-specific characteristics, and continuous improvement of preoperative planning and surgical technique based on annually published reports and registry data are required.

The present article describes a rare clinical case of eosinophilic granulomatosis with polyangiitis in a 63-year-old patient presenting with polyneuropathy, marked weight loss, and vasculitis rash on the lower extremities. In addition to the primary disease, the patient had a history of active chronic hepatitis B virus infection, drawing attention to a possible association between viral infection and the development of vasculitis. The pathophysiological mechanisms underlying the development of polyneuropathy in this patient are discussed, along with the therapeutic approach involving glucocorticoids and azathioprine, which led to clinical stabilization. The article emphasizes the importance of comprehensive diagnostic evaluation and a differential therapeutic strategy, particularly in the context of coexisting viral hepatitis and autoimmune disease.