Much attention has been recently paid to the study of interleukin 6 (IL-6) among the cytokines involved in the development of immune inflammatory rheumatic diseases (IIRDs). The introduction of monoclonal antibodies that inhibit the activity of IL-6 (tocilizumab, TCZ) in clinical practice in 2010 is one of the biggest advances in IIRD treatment in the early 21st century. IL-6 inhibition is now regarded as one of the most promising areas in the treatment of rheumatoid arthritis (RA), many other inflammatory diseases, and malignant neoplasms. The data obtained in international studies are confirmed by extensive Russian experience with TCZ used to treat RA in the LORNET study that has established the rapid and steady-state clinical effect of the drug, better quality of life in the patients, slower progression of joint destruction, positive changes in the ultrasound signs of articular inflammation and in the immunological biomarkers of inflammatory activity and identified the immunological and immunogenetic predictors for the efficiency of the drug. There is recent evidence that TCZ is highly effective in treating large-vessel vasculitis – giant cell arteritis concurrent with polymyalgia rheumatica and Takayasu’s arteritis. Noteworthy are the achievements by the Russian scientists (BIOCAD) who have designed BCD-089 that is a human anti-IL-6 receptor monoclonal antibody. IL-6 inhibition is one of the most rapidly developing areas of pharmacotherapy for human IIRDs. Further deciphering the mechanisms determining the physiological and pathological effects of IL-6 along with the design of novel drugs that block the effects of this cytokine is of considerable importance for the progress of rheumatology and many other branches of modern medicine.

In 2016, after 10 years since publication, the international guidelines of the European Antirheumatic League (EULAR) for the management of gout were updated for the first time. The final version of the updated guidelines includes three overarching postulates and 11 key recommendations evaluating principles of the symptomatic therapy of an acute attack of arthritis and, more importantly, strategies of urate-lowering therapy. The aim of the above-mentioned guidelines is the possibility of their practical use. However, some statements, which contain controversial judgments, require further discussion and clarification, also in the context of russian realities.

Achievement of minimal disease activity (MDA) is the main goal of the Treat-to-target (T2T) strategy in early psoriatic arthritis (ePsA). Radiographic progression in patients with ePsA treated according to the T2T strategy has been studied insufficiently. Objective: To study the frequency of achievement of MDA and X-ray progression in patients with early PsA treated according to the T2T strategy 1 year after initiation of treatment. Subjects and methods. Forty patients (22 women) with active ePsA, who met the CASPAR criteria (mean age was 38,4±11,1 years, the median duration of PsA – 7,0 [4,0; 18,0] months, the duration of psoriasis – 38,0 [9,5; 114,0] months, DAS – 3,8 [3,2; 4,7]), were included in the REMARKA study. At the start of the study all patients received subcutaneous methotrexate (MTX) in a dose of 20–25 mg/week. If high or moderate disease activity persisted after 3–6 months, patients (n=21) were transferred to combined therapy with MTX and a biological agent (BA). The remaining 19 patients continued MTX monotherapy. Initially and one year later, the MDA criteria were evaluated (tender joint count ≤1, swollen joint count ≤1, PASI ≤1 or BSA ≤3, pain on visual analog scale (VAS) ≤15 mm, patient global assessment of activity on VAS ≤20 mm, HAQ ≤0,5, tender enthesis count ≤1) and digital radiography of hands and feet was performed. Radiographic progression was assessed by an independent radiologist using the modified method of Sharp/van der Heijde: total score (TS) = erosion score (ES) + joint space narrowing score (JSNS). Results and discussion. At the time of enrollment, 23 patients (57%) with ePsA had erosions. One year later the number of patients with erosions increased to 26 (65%). The TS has significantly increased, although its median has not changed (before treatment – 91.5 [72; 108,5], after one year – 91.5 [73,5; 111,5], p<0,01). In this case, the median of the ES increased from 2 [0; 4,5] to 2,5 [0; 5], (p><0,05), and the median of the JSNS – from 85 [69; 105] to 87 [71,5; 107], (p><0,01). After one year, there was no significant difference between patients receiving MTX monotherapy and MTX + BA, according to TS (p>0,05). In 29 out of 40 patients (72,5%), no radiographic progression was detected neither in the ES nor in the JSN; 13 out of 29 (45%) received MTX and 16 (55%) – MTX + BA. In 11 out of 40 (27,5%) patients, negative radiographic changes according to ES (n=10) and JSNS (n=4) were detected, with three patients having progression in both scores. In this group, 6 patients (54,5%) received MTX monotherapy and 5 (45,5%) – MTX + BA. After 1 year, 25 (62,5%) patients achieved MDA. Among patients who did not achieve MDA (n=15) after 1 year, the ES was significantly higher at the beginning of the study compared to those who achieved MDA: median 3 [2; 9] and 0 [0; 3], respectively (p<0,05). In the group of patients who did not achieve MDA in a year, radiographic progression was more significant. Conclusion. In russian cohort more than half of patients with ePsA had erosions. After one year of follow up 72,5% of patients with ePsA treated according to the T2T strategy showed no radiographic progression, and a quarter of patients (27,5%) had negative radiographic changes, regardless of the type of the therapy. Patients with ePsA, who achieved MDA, had less prominent radiographic progression in a year. Keywords: early psoriatic arthritis; treat to target strategy; radiographic progression; minimal disease activity>< 0,05). In the group of patients who did not achieve MDA in a year, radiographic progression was more significant. Conclusion. In russian cohort more than half of patients with ePsA had erosions. After one year of follow up 72,5% of patients with ePsA treated according to the T2T strategy showed no radiographic progression, and a quarter of patients (27,5%) had negative radiographic changes, regardless of the type of the therapy. Patients with ePsA, who achieved MDA, had less prominent radiographic progression in a year.

Musculoskeletal diseases (MSDs) are a topical medical, social, and economic problem. According to the 2015 data, MSDs in the structure of primary morbidity were 3.9% and those in the structure of mortality were 0.2% in the Russian Federation. Official mortality statistics is formed only by one (underlying) cause of death. The study of multiple causes of death will enable the understanding of its mechanisms, the necessity of making changes in the management tactics for patients and in the standards of medical care, as well as the possibility of correcting the mortality reduction plans. Objective: to investigate the reliability of statistics on MSD mortality and the ways of its reduction, by analyzing the underlying and multiple causes of death. Materials and methods. This investigation used a database on medical death certificates of the residents of the Tula Region in 2015. Mortality rates were calculated by conventional statistical methods. Death rates for the Russian Federation and the Tula Region were taken from the book «Medico-demographic indicators of the Russian Federation in 2015» by the Ministry of Health of Russia and C52 tables by the Federal State Statistics Service. The 2012–2014 European mortality databases were used for international comparisons. Results and discussion. The mortality rates were analyzed using the underlying and multiple causes of death. Expert evaluation showed that the 2015 mortality rates from MSDs were underestimated by approximately 11%. The MSD mortality rates in the Tula Region were 2.4 and 2.7 times higher than those in the entire Russian Federation and in Europe, respectively. Defects were found in drawing up medical death certificates. The reliability of mortality statistics was shown to be related to monitoring, physician training, and introduction of an automated system. Emphasis is laid on the correction of treatment tactics for patients with MSD.

Telemedicine, including mobile applications for patients, is progressing rapidly now. However, patients with axial spondyloarthritis (axSpA) still have no applications that can be used to monitor their health status independently and to contact their physician remotely. Objective: to develop and test an «ASpine» mobile application for smartphones in real clinical practice. Material and methods. The draft «ASpine» mobile application has two parts: a mobile application for patient and a personal computer program used by a rheumatologist to monitor disease activity in patients. The patient part of «ASpine» consists in filling out the BASDAI and BASFI questionnaires and monitoring how recommendations for daily exercise therapy and medications are fulfilled. There is also an opportunity for constant contact with the physician through the mobile application. The patients from the Moscow cohort CoESAr (Cohort of Early SpondyloArthritis) which was made up at the V.A. Nasonova Research Institute of Rheumatology in 2013 and is being formed to the present time took part in mobile application testing. Results and discussion. The mean scores of BASDAI at inclusion and after 12-month follow-up were 3.3±1.7 and 2.1±1.7 (p > 0.5) and those of BASFI were 1.6±1.3 and 1.3±1.2, respectively (p > 0.5). To analyze the health status of 35 patients, one doctor requires 1 min daily if there are no reports of their worse health. It takes an average of 5–8 min to make a decision if the patient reports the occurrence of any symptom or an adverse reaction. The findings can lead to the conclusion that the «ASpine» mobile application allows patients to independently monitor disease activity, to store medical records, and to contact their physician remotely. Continuous monitoring of the patient's condition makes it possible to maintain low disease activity or remission for a long time.

Objective: to determine frequency and grade of the coronary artery (CA) damage using coronary angiography data in patients with rheumatoid arthritis (RA) and suspected coronary artery disease (CAD); to evaluate the association of its progress with traditional risk factors (TRF), inflammatory markers and antirheumatic therapy. Subjects and methods. 25 male and 38 female RA patients with suspected or verified CAD, (median age was 58 [52; 63] years, RA duration – 10,5 [7; 23] years), were included in the study. 85% of patients were seropositive for IgM rheumatoid factor, 69% – for cyclic citrullinated peptide (CCP) antibodies. DAS28 median was 4,7 [3,3; 5,8]. CA stenosis was diagnosed if hemodynamically significant narrowing of the artery lumen (≥50%) was present. Results and discussion. CA stenosis was diagnosed in 22 (35%) patients (group I), 15 (68%) of them had single vessel damage, 7 (32%) – three-vessel involvement; the damage of two vessels was not diagnosed in any RA case. 41 (65%) patients had no lesions in CA (group II). The frequency of CA stenosis was higher in male patients (15 out of 25; 60%) than in female (7 out of 38; 18%; p<0,05). CAD incidence in group I was higher than in group II: myocardial infarction (MI) history was documented in 32% and 2%, stable angina pectoris in 77% and 32% of cases respectively, p><0,05. TRF incidence was similar in both groups. Concentration of serum high density lipoprotein cholesterol (HDLC) in group I was lower than in group II (median 1,2 [1,0; 1,5] vs 1,3 [1,2;1,8] mmol/L respectively, p=0,025). Carotid artery atherosclerotic plaques were detected in 19% and 16%, carotid artery intimamedia thickening – in 53% and 57% of patients respectively (p>0,05). The multiple regression analysis did not revealed any direct relationship of CA stenosis development with age, gender, DAS28, erythrocyte sedimentation rate, C-reactive protein level, concentration of cholesterol, low density lipoprotein cholesterol, HDLC, and consumption of anti-rheumatic drugs. The prediction of CA stenosis development was not possible with parameters used in this study. However, differences in age were the closest to statistical significance (OR=0,85; 95% CI [0,72–1,0], p=0,05). Other parameters, including HDLC level< 1,2 mmol/L for women and< 1,0 for men (OR 0,82; 95% CI [0,64–0,90], p=0,09) had less predictive power. Conclusion: CA stenosis was diagnosed in every third patient with RA and suspected CAD or verified CAD. Male gender and low level of HDLC may increase the risk of CA stenosis.

The article presents the results of an investigation conducted to study the prevalence of Helicobacter pylori (H. pylori) infection in patients with rheumatoid arthritis (RA) in relation to the clinical and immunological features of the disease. Objective: to investigate an association between the gastric mucosal (GM) colonization with H. pylori and the clinical and immunological features of RA. Material and methods. The investigation enrolled 75 patients (8 men and 67 women) aged 20 to 75 years (mean age, 45.5±10.1 years) who were diagnosed with RA. The disease duration was 6 months to 30 years (mean 8.3±6.9 years). H. pylori were detected by a histological method. For this purpose, all the patients underwent esophagogastroduodenoscopy using a PENTAXEKP 1000 endoscope (Japan). During endoscopic examination, targeted biopsy was performed, by taking multiple GM biopsy specimens. The degree of H. pylori contamination was compared in patients with seropositive and seronegative RA, as well as depending on the presence or absence of anti-cyclic citrullinated peptide (anti-CCP) antibodies. Results and discussion. The results of the investigation may lead to the conclusion that there is a relationship between the contamination with H. pylori and the immunological manifestations of RA. A direct correlation was found between the prevalence of H. pylori infection and the presence of anti-CCP antibodies. There was also a trend toward the increased spread of H. pylori in patients with seropositive RA as compared to those with seronegative RA.

Arterial stiffness is an independent predictor of cardiovascular diseases. A possible link between the development of osteoporosis (OP) and cardiovascular diseases is presently being considered. Cytokines that can affect the skeletal and cardiovascular systems act as pathogenetic factors of this interaction. Objective: to identify a relationship between the measures of arterial stiffness, the serum level of cytokines and the state of bone mineral density (BMD) in women with OP; to establish the role of elevated cytokine concentrations in lowering BMD and raising pulse wave velocity (PWV) in this category of patients. Subjects and methods. A total of 115 postmenopausal women were examined. X-ray densitometry was used to investigate BMD in two areas: the lumbar vertebrae and the proximal femur. Carotid-femoral PWV was measured by applanation tonometry. The serum level of cytokines was investigated by enzyme immunoassay. Results and discussion. Women with osteoporosis were found to have a higher PWV and elevated concentrations of interleukin (IL) 6, IL-8, tumor necrosis factor-α, IL-4, and IL-10. The higher level of IL-6 is an independent factor in decreasing proximal femur bone BMD and in increasing PWV.

The frequency of anxiety-depressive spectrum disorders (ADSDs) in patients with rheumatic diseases (RDs) is much higher than that in the general population. ADSDs are known to be associated with pain intensity, disease activity, and functional limitations. However, the majority of available papers are limited by the framework of a certain disease. Objective: to investigate the association of ADSDs with the characteristics of joint damage beyond the nosological approach. Subjects and methods. The investigation enrolled 38 women aged 18 years and older who had different RDs and preserved reproductive function, were treated at round-the-clock hospitals, and had no clinically significant comorbid diseases. All the patients were divided into two subgroups: 1) those with predominant hand joint injury and 2) those with joint involvement at other sites. All the patients were evaluated for disease activity (DAS-28-ESR, ASDAS-ESR), pain (visual analogue scale), and functional status (HAQ). The Hospital Anxiety and Depression Scale (HADS) was used to detect ADSDs and the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale were employed to rate the severity of anxiety and depression, respectively. Results and discussion. The frequency of anxiety disorders evaluated through the HADS and the HAM-A was 44.7 and 34.2%, that of depressions was 34.2 and 60.5% respectively. The clinically evident level of HADS anxiety (11+) in Subgroup 1 was detected 5 times more frequently (30.0%) than in Subgroup 2 (5.5%); and that of HAM-A anxiety (18+) was twice as often: 45.0 and 22.2%, respectively. The frequency of clinically significant depression according to HADS (11+) and HAM-D (14+) in Subgroup 1 was 30.0 and 40.0%, and that in Group 2 was 11.1 and 16.7% respectively. The probability of severe depressions (HAM-D 19+) in hand joint injury was twice higher (odds ratio, 2.2; 95% confidence interval, 1.51–3.19) than in arthritis at various sites. Thus, this investigation provides evidence for the high frequency of ADSDS in patients with RDs. Reproductive-aged women with hand joint injury are one of the most vulnerable groups.

Juvenile arthritis is the most common group of childhood rheumatic diseases, the dominant manifestation of which is chronic progressive joint inflammation showing the considerable variability of clinical presentations and the possibility of different nosological outcomes. Diagnosis and monitoring of disease activity in juvenile arthritis, unlike inflammatory joint diseases in adults, are attended with great difficulties in the interpretation of clinical symptoms and radiological findings. One of the most popular current technologies of musculoskeletal visualization is ultrasonography that has become an integral part of a pediatric rheumatology practice. Based on the data available in the literature and their own experience of long-term daily use of ultrasound diagnosis, the authors present current approaches to using the ultrasound diagnostic technique in patients with juvenile arthritis, by taking into account the features of child development.

Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease characterized by chronic inflammation of joint synovial membrane and progressive destruction of bone and cartilage. Massive synovial infiltration with immune and inflammatory cells, such as macrophages, monocytes, granulocytes, plasma cells and dendritic cells, B lymphocytes, CD4+ and CD8+ T lymphocytes, presented mainly by effector T cells (T_eff), underlies chronic inflammation and joint destruction in RA. C-X-C-chemokine 10 (CXCL10) was originally identified as a chemokine secreted by several types of cells: macrophages, endothelial cells, and fibroblasts in response to the production of interferon-γ (IFN-γ). It is also known as IFN-γ- induced protein 10 (IP-10). It has been recently discovered that the level of CXCL10 is elevated in the serum and joint tissues of laboratory animals with collagen-induced arthritis. Patients with RA demonstrated higher serum, synovial fluid, and synovial tissue levels of IP-10 than those with osteoarthritis or healthy donors at both early and late stages of the disease. Peripheral blood IP-10, unlike acute-phase measures or indices of activity, may more accurately reflect remission status, which should be kept in mind while deciding for therapy optimization. IP-10 may be a marker for more severe disease and can be used to assess the risk of psoriatic arthritis in patients with psoriasis; its prognostic value in patients with probable RA requires further clarification. Elevated IP-10 levels may be associated with the development of interstitial lung disease in patients with RA and identified in asymptomatic early-stage patients. Thus, IP-10 may be a useful and promising prognostic marker in RA, the significance of which requires further investigation.

Tocilizumab (TCZ) is one of the biological agents that are most commonly used in the treatment of juvenile idiopathic arthritis (JIA), especially its systemic variant. The development of neutropenia, which is associated with the use of TCZ and its mechanism of action, requires a detailed study. Based on the analysis of their own results and comparison of the latter with the data available in the literature, the authors analyze the aspects of development of neutropenia during TCZ therapy. Objective: to analyze all cases of neutropenia with the use of TCZ in polyarticular (pJIA) and systemic (sJIA) variants of the disease. Subjects and methods. The open-label prospective study enrolled 27 patients with pJIA and 83 patients with sJIA, who were resistant to prior standard therapy. The treatment duration was 4 to 84 months (median, 22 months for pJIA; 34 months for sJIA). The frequency and timing of neutropenia and the relationship to infection and concomitant/previous therapy were examined. Results and discussion. 22 and 62 patients with pJIA and sJIA, respectively, continued treatment; its median duration was 27.4 [9; 72] months. 7 patients with pJIA and 21 with sJIA, discontinued TCZ due to severe adverse events (n=2 and n=11, respectively) and organizational reasons (n=5 and n=7); in sJIA, therapy was discontinued for sustained remission in two patients and for secondary inefficiency in one patient. At least one episode of neutropenia was observed in 63% of patients with pJIA and in 48.2% of those with sJIA; among them, there was grade 1 neutropenia in 5 and 15 patients, respectively; grade 2 in 6 and 15, grade 3 in 4 and 10, and grade 4 in two patients with pJIA. Neutropenia was more frequently observed in the first months of therapy for pJIA; that was seen in patients with sJIA when the latter reached its inactive status. In 5 patients with sJIA, neutropenia was recorded as a manifestation of macrophage activation syndrome (MAS); no correlation with TCZ infusions was found. Neutropenia was not associated with an increased rate of infections. The use of methotrexate was not significantly related to the low level of neutrophils, whereas the earlier age was associated with the degree and frequency of neutropenia. All cases of neutropenia were recorded in patients with a therapeutic response rate of >50% according to the American College of Rheumatology Pediatric (ACR Pedi) criteria. The findings suggest that there are different mechanisms and periods of neutropenia during TCZ therapy for JIA: 1) benign, transient neutropenia, a predictor of the high efficiency of therapy, develops primarily in the first few days after infusion; 2) neutropenia as a phenomenon of «redundancy» of therapy (more resistant) develops more often in the inactive phase of the disease; 3) neutropenia as a component of MAS, which is associated with its other markers. No relationship was found between neutropenia and an increased risk of infections. TCZ-treated patients need careful clinical and laboratory monitoring, including consideration of a risk for neutropenia and subsequent individual treatment when this condition is identified.

Knee osteoarthritis (OA) is the most common form of OA. Medical treatment for OA does not provide the desired effect in a significant proportion of patients. With greater rates of knee OA and its rejuvenation, high tibial osteotomy (HTO) that can prolong the period of the patient’s own knee joint (KJ) function and postpone or completely avoid total knee arthroplasty is becoming increasingly relevant. Objective: to investigate the efficiency of HTO for stage II–III knee OA and the impact of age, body mass index (BMI), and correction angle on the immediate result of surgery. Subjects and methods. Thirty-five HTOs were carried out in 32 patients in 2003 to 2016. The male and female ratio was approximately 2:1. The patients’ mean age was 59.0±13.1 years; BMI, 29.04±3.57 kg/m2 , correction angle, 12.5±2.78°. A visual analog scale (VAS) was used to assess pain; and the Knee Society Score (KSS) was employed to rate the functional and objective status of the KJ. The degenerative process was graded using the Kellgren–Lawrence radiographic classification. Results and discussion. HTO proved to be effective in patients with both Stage II and III knee OA. A year after surgery, there was a substantial reduction in VAS pain (from 72.27±11.79 to 7.72±6.62 mm) and an improvement in functional and objective KSS scores (from 43.66±11.5 and 54.39±11.77 to 86.51±10.86 and 81.93±6.65 mm, respectively). The results were excellent (36.4%), good (57.6%), and satisfactory (6%). No X-ray signs of progressive OA were revealed one year after surgery. BMI affected immediate results (Spearman correlation coefficient = -0.34; p < 0.05). Thus, HTO has been established to be more effective in Stage II knee OA than in its Stage III. Age and correction angle do not affect immediate results while higher BMI is associated with worse outcomes and complications.

Novel oral anticoagulants (NOACs), such as the direct thrombin inhibitor dabigatran and the selective factor Xa inhibitors rivaroxaban and apixaban, are increasingly used as an effective antithrombotic drug in real clinical practice. Unfortunately, these medications can cause severe adverse events, including gastrointestinal bleeding, one of the most common events. This complication annually develops in 2–3% of patients taking NOACs. The sources of bleeding can be in both the upper or lower gastrointestinal tract (GIT). The common cause of bleeding is undiagnosed GIT neoplasms, often colorectal cancer. Clinical and cohort studies show that the greatest risk of bleeding is observed with the use of rivaroxaban. The risk factors are advanced age, concurrent administration of nonsteroidal anti-inflammatory drugs, aspirin, and other anticoagulants, gastrointestinal diseases, H. pylori infection, impaired renal and hepatic functions, and alcohol intake. Gastrointestinal bleeding is treated on general principles, by applying endoscopic and surgical techniques. Particular importance is attached to the blockade of the anticoagulant effects of NOACs. For this, the entire range of antidotes, such as idarucizumab (it has been already applied in several countries of the world), andexanet, and ciraparantag, has been recently designed and is undergoing clinical trials. Bleeding prevention involves control of risk factors, rational use of NOACs, prophylactic administration of proton pump inhibitors, timely discontinuation of anticoagulation prior to traumatic medical procedures on the gastrointestinal organs (before certain endoscopic procedures in particular).

The review deals with investigations aimed to examine the relationship between periodontal diseases (PDs) and a chronic autoimmune inflammatory response, the most striking models of which include systemic vasculitis (SV). PDs are associated with systemic inflammation and vascular pathology, which is characterized by endothelial dysfunction and a considerable risk for cardiovascular and cerebrovascular diseases, diabetes mellitus, and autoimmune diseases. The paper also discusses the prospect of interdisciplinary studies focused on the examination of the biological effects of PDs in SV and other rheumatic diseases.

Paget’s disease of bone (PDB) is a chronic localized skeletal disease that belongs to a group of metabolic osteopathies and is characterized by impaired bone remodeling to form foci of increased bone resorption followed by replacement with an excessive amount of defective, less durable bone that is prone to deformities and pathologic fractures. The course of PDB shows three stages: rarefaction, compaction, and coarse-trabecular remodeling – each of which is characterized by certain clinical, biochemical, and radiological manifestations. The majority of the clinical manifestations of the disease are associated with skeletal injury. The disease is characterized by the appearance of bone and joint pain in case of secondary osteoarthritis, bone deformities, pathological fractures, hearing loss due to damage to the skull bones, etc. In many patients, the disease is asymptomatic and detected incidentally after finding a high serum alkaline phosphatase activity or during bone X-ray for any pathological processes, but it can be diagnosed fairly late in the development of complications, as shown in the clinical examples. A combination of clinical, biochemical, morphological data and radiological findings allows for a diagnosis. The use of bisphosphonates is the method of choice for the treatment of PDB.

The paper briefly discusses the history of spondyloarthritis (SpA) from the article published by J. Moll et al. in 1974 to the present day. The discussion of the recent SpA concept proposed by the Assessment of SpondyloArthritis International Society (ASAS), which divides this group of diseases into axial and peripheral types, by elaborating the appropriate criteria, holds a special position. This division could rapidly introduce the principles of early diagnosis of axial SpA on the one hand; however, it hinders their investigation as a genetically and clinically associated spectrum of diseases on the other hand.