Despite the great success in the diagnosis and treatment of immuno-inflammatory rheumatic diseases (IIRD), which led to a significant improvement in the prognosis in many patients, the fundamental medical problems of this pathology – the restoration of quality of life and reduction of mortality to the population level – are far from solution. This served as a powerful impetus to the study of new approaches to pharmacotherapy of IIRD, one of which is associated with the use of low-molecular synthetic drugs that inhibit intracellular "signal" molecules-Janus kinase (JAK), the socalled Jakinibs. The current achievements and trends concerning the use of JAK inhibitors in the treatment of IIRD are considered.

The aim of the investigation was to study neuropsychic manifestations (NPM) of systemic lupus erythematosus (SLE) in the Kyrgyz cohort of patients.
Material and methods. The prospective study included 460 patients with a reliable diagnosis of SLE, verified according to the diagnostic criteria ACR (1997) and SLICC (2012), observed in the clinic of the Academician M. Mirrakhimov National Center of Cardiology and Therapy from january 2012 to december 2017. Signs of nervous system damage were revealed in 103 (22.39%) of 460 patients with SLE. Classification criteria of ACR (1999) were used to assess neuropsychic manifestations of SLE, which were diagnosed by the psychiatrist according to ICD-10. Cognitive disorders were detected by a psychologist using a specific test Mini-Mental State Examination (MMSE; mini-scheme study of the mental state of the patient).

Results and discussion. Various signs of NPM SLE were revealed in 103 (22.39%) of 460 patients with SLE. Groups of patients with and without NPM SLE at the beginning of the study were comparable in age, time from the appearance of the first signs of SLE to the verification of the diagnosis and the value of the SLEDAI-2K index (p>0.05). Acute variant of SLE course was significantly associated with NPM SLE. The acute course of SLE was observed in 56 (54.38%) of the 103 patients with NPM SLE and 109 (30.53%) of the 357 patients without NPM SLE [odds ratio (OR) 2.71, 95% confidence interval (CI) of 1.73–4.24; p<0.001]. Subacute and chronic course of the disease was diagnosed in a similar number of patients with NPM SLE – 24 (23.30%) and without NSAIDS – 23 (23.33%) (OR 5.75 95% CI 3.54–9.34; p<0.001). In the majority of patients the central nervous system (CNS) lesions prevailed. It was present in 71 (68.93%) patients, peripheral nervous system (PNS) pathology was less frequent and revealed in 32 (31.07%) of 103 cases, and 4 (3.88%) patients had combined CNS and PNS lesions. One manifestation of NPM SLE was detected in 37 (52.11%) patients, two – in 15 (21.13%), three – in 14 (19.72%) and four – in 5 (7.04%) of 71 patients with CNS lesions. According to the criteria of ACR (1999) in 103 patients 155 different NPM SLE were diagnosed: CNS disorders – in 123 (79.35%) and PNS pathology – in 32 (20.65%). The frequency of focal and diffuse CNS disorders was 61.79% and 38.21%, respectively. Cerebrovascular disease (CVD) was diagnosed most frequently – in 33 (43.42%) of the 76 cases of focal neuropsychiatric CNS disorders. Clinical manifestations of CVD were mainly characterized by discirculatory encephalopathy – in 30 (90.91%), less often – by ischemic stroke in the middle cerebral artery basin on the left – in 2 (6.06%) and transient ischemic attack – in 1 (3.03%) of 33 CVD cases. One manifestation was present in 52.11% of patients with CNS pathology. In other cases, there were more symptoms of its damage. Among the 47 diffuse lesions, neuropsychic disorders of the psychosis type prevailed, the main manifestations of which were visual and auditory hallucinations – in 34 (72.34%) patients.

Conclusion. NPM SLE was identified in 22.39% of patients. Acute variant of SLE and very high activity was associated with NPM SLE. The risk of NPM SLE developing in very high activity of SLE was increased by 5.75 times. In the vast majority of cases in Kyrgyz patients there was CNS involvement (68.93%), twice less – PNS damage (31.07%), combined lesion of PNS and CNS was noted less frequently (3.88%). 47.89% of patients had more than one manifestation of NPM SLE. In most patients with diffuse NPM SLE, psychosis was observed in the form of visual and auditory hallucinations (72.34%), and focal ones were presented by CVD (43.42%), usually in the form of discirculatory encephalopathy (90.91%).

Investigation of the evolution of early axial spondylitis (axSP) is now of great importance especially before the appearance of reliable radiological signs of ankylosing spondylitis (AS). Of particular interest is the assessment of inflammatory and post-inflammatory changes in the sacroiliac joints (SJ) and in the spine using magnetic resonance imaging (MRI).
The aim of the study was to analyze inflammatory foci in bone according to MRI in the area of SJ and lumbar spine (LS) in patients with early axSP.
Material and methods. The study involved the patients of the Moscow cohort CORSAIR (Early Spondyloarthritis Cohort), which was formed in V.A. Nasonova Research Institute of Rheumatology. Low field MRI of SJ and LS was carried out in all patients at inclusion in the study in the T1 and STIR modes.
Results and discussion. SJ MRI most often (34.1%) revealed combined foci of inflammation (active and chronic sacroiliitis – SI), 32.9% of patients showed signs of only chronic, rarely – only active SI (19.5%). In a few cases, MRI showed inflammatory changes in LS, which were regarded as active and chronic spondylitis. In patients with a disease duration of up to 1 year, signs of active SI were more common according to MRI than in patients with a longer duration of the disease (30.0 and 14.4%, respectively; p<0.05). All active foci of inflammation (with or without signs of chronic SI) were significantly more frequently detected in patients with AS than in non-radiological axSP (NR-axSP; 61.6% and 44.2%, respectively; p<0.05). The overall incidence of chronic spondylitis (in combination with or without active spondylitis) in patients with AS was higher than in NR-axSP(13.9% and 5.8%, respectively; p<0.05).

Conclusion. Patients with AS more often have active lesions at MRI of SJ and chronic ones at MRI of LS than patients with NR-axSP

The aim of the study was to assess the relationship between the detection of hyperechogenic deposits (HD) in the hyaline cartilage of the knee joints (KJ) at ultrasonography in patients with osteoarthritis (OA), clinical manifestations and structural changes according to KJ ultrasonography and radiography.
Material and methods. A prospective analysis of clinical, radiological and ultrasonographic data of 114 patients with knee OA was conducted. The patients were divided into two groups: 32 patients with HD detected in at least one of the KJ, and 82 patients without HD; 32 patients of the 1st group and 34 patients of the 2nd group were observed for 2 years. A comparative assessment of initial clinical manifestations (WOMAC index), x-ray data and ultrasonographic parameters of the subchondral bone, hyaline cartilage and the degree of synovial inflammation in the groups of patients at the beginning of the study and after 2 years was carried out. The exclusion criteria were other joint diseases; paroxysmal course of the inflammatory process in KJ; trauma and history of operations on KJ; ESR >20 mm/h, uric acid level >360 μmol/l and C-reactive protein >5 mg/l.
Results and discussion. HD in hyaline cartilage was found in 28.1% of patients with knee OA. After 2 years HD remained in all patients having them at inclusion, and in 5.6% of the patients they were found for the first time.
In 13 patients with HD in hyaline cartilage, synovial fluid was studied and in all cases calcium pyrophosphate crystals were identified by phase-contrast microscopy. The presence of HD in the hyaline cartilage of patients with knee OA was accompanied by more pronounced ultrasonographic signs of synovitis and was associated with a higher rate of osteophytes growth in the absence of the changes of the hyaline cartilage thickness according to the ultrasonography and the width of the joint space according to x-ray.
Conclusion. The presence of HD in the hyaline cartilage of patients with knee OA according to ultrasound examination may be associated with the deposition of calcium pyrophosphate crystals and is associated with persistent synovitis and accelerated growth of osteophytes.

The aim is to carry out language adaptation and validation on the Russian sample of a special SarQoL questionnaire, designed to assess the quality of life of elderly people with sarcopenia.
Material and methods. 100 patients over 65 years, mean age 74.0±6.5 years, observed on an outpatient basis were included. 50 from them had sarcopenia and 50 participants were without it. The diagnosis of sarcopenia was based on criteria developed by the European working group on sarcopenia (EWGSOP, 2010). The validation procedure was carried out in accordance with the Protocol.
Results and discussion. There was a significant decrease in the overall quality of life according to SarQoL questionnaire in patients with sarcopenia compared with the control group without sarcopenia (50.65±14.23 and 75.10±14.46, respectively; p<0.001). High internal consistency of the SarQoL (Cronbach's á coefficient 0.924) was revealed. A significant positive correlation of domains with the overall SarQoL index in the range from r=0.37, p=0.0083 to r=0.92, p<0.001 was established. Moderate correlations of SarQoL with some domains SF-36 and the EQ-5D questionnaires were revealed. High internal consistency (ICC) of 0.935 (95% CI 0.91-0.96) was found.
Conclusion. The Russian version of the SarQoL questionnaire is valid, consistent and reliable and can be used to assess the quality of life in older patients with sarcopenia.

The aim of the investigation was to study the changes of cytokine profile parameters in patients with rheumatoid arthritis (RA) 12 and 24 weeks after initiation of therapy with rituximab (RTM) biosimilar at a total dose of 1200 mg, in comparison with the original drug
Material and methods. The study included 54 patients with a reliable diagnosis of RA. Depending on the therapy, all patients were divided into two groups: 34 patients received the original RTM (group 1) and 20 patients – biosimilar (group 2) in a total dose of 1200 mg according to the standard scheme. The concentration of 27 cytokines in blood serum was determined by multiplex xMAP technology on the analyzer Bio-Plex Array System (BIO-RAD, USA).
Results and discussion. The use of the original drug has been accompanied by reliable and significant reduction (over 30%) by 24 weeks of treatment levels of proinflammatory [interleukin (IL) 1â, IL2, IL6, IL12, IL15, interferon ã (IFN-ã), tumor necrosis factor á (TNF-á)], IL1 receptor antagonist (IL1ra), IL5, IL9, IL10, IL13 cytokines, growth factors (IL7, granulocyte-macrophage colony stimulating factor, fibroblast growth factor) and chemokines (monocyte chemoattractant protein 1 – MCP1). During the treatment with Acellbia a rapid and marked reduction in the concentration of practically the whole range of investigated parameters already 12–24 weeks after the first infusion was achieved. After 24 weeks a decrease in the concentration IL1â, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, eotaxin, granulocyte colony-stimulating factor, IFN-ã, IFN-ã-induced protein 10, MCP1, macrophage inflammation protein 1â, TNF-á, vascular endothelial growth factor was recorded (p<0.05).
Conclusion. Analysis of the effectiveness of two infusions of RTM biosimilar Acellbia («BIOCAD», Russia) 24 weeks after the start of therapy shows its ability to cause a decrease of levels of proinflammatory cytokines, chemokines and growth factors in the blood serum. Changes of the cytokine profile during the therapy with Acellbia are not significantly different from that during the treatment with the original drug.

ASAS health index (ASAS HI) is a comprehensive tool developed on the basis of the international system of ICF (the International Classification of Functioning, Disability and Health) to quantify the health of patients with spondyloarthritis (SPA), including ankylosing spondylitis (AS). ASAS HI is a questionnaire containing 17 questions, each related to a specific ICF pool (pain, emotions, sleep, sexual function, mobility, self-care and communication). ASAS HI additionally includes 9 questions (ASAS EF Item Set) to assess the impact of environmental factors on the health of the patient with SPA.
The aim is a Russian translation and adaptation of the ASAS HI (including ASAS EF Item Set).
Material and methods. Translation of ASAS HI and ASAS EF Item Set from English into Russian and its adaptation were carried out in five stages: the stage of direct translation; the stage of synthesis of translations and formation of the Russian version; the stage of reverse translation from Russian into English; the stage of comparison of the original English-language questionnaire with the result of reverse translation and the formation of the final Russian-language version; field test.
Results and discussion. Three researchers performed an independent translation of ASAS HI (including ASAS EF Item Set), after which the fourth researcher created and agreed on a single Russian version of the questionnaire. Then two volunteers, for whom English is the main language, performed a reverse translation of ASAS HI from Russian into English (reverse translation). An independent researcher has compared the original and the resulting reverse translated English version of the ASAS HI, and then the three translators performed the joint correction of the text of the three questions, differing in English-language versions. The obtained second Russian-language version of ASAS HI (including ASAS EF Item Set) was tested by 10 patients with SPA: AS – 60%; non-radiological axial spondylitis (NR axSPA) – 40%, men – 60%; mean age – 32±12 years; duration of symptoms – 7.5±2.2 years; BASDAI index – 3.39±3.04; ASAS HI – 6,96±3,35.The average time to fill the questionnaire – 2,2±1,18 min. Patients rated the Russian version of the questionnaire as clear, easy to fill in and comprehensively characterizing health problems related to SPA. The results of testing Russian-speaking patients are comparable with the results obtained in testing 206 patients with SPA from 19 non-English-speaking and 4 English-speaking countries (AS – 65%; men – 59.7%; mean age – 42.4±13.9 years; duration of symptoms – 11.2±11.0 years; BASDAI – 3.8±2.3; ASAS HI – 7.1±4.4; filling time – 2.6±1.6 min).
Conclusion. During the study translation and adaptation of the Russian version of ASAS HI, which is a tool for comprehensive assessment of health and function of patients with SPA, including AS were performed.

The aim of the study was investigation of association of the rs7574865 polymorphism of STAT4 gene (Signal Transducer and Activator of Transcription 4, a family of signal transduction and transcription activation molecules 4) with very early rheumatoid arthritis (RA) in Russian patients, and the study of the relationship of "phenotype – genotype", particularly of positivity for antibodies to cyclic citrullinated peptides (ACCP), their concentration, the presence of erosive joint damage at inclusion in patients the study with the STAT4 gene polymorphism.
Material and methods. The study was conducted in the framework of the program REMARKA (Russian study of Methotrexate and biological drugs in Early active Arthritis). 85 patients with very early RA with a duration of symptoms no more than 6 months, not receiving disease modifying anti-rheumatic drugs (DMARD) and biologicals were included.
Results and discussion. The analysis of the distribution of genotypes and alleles of STAT4 rs7574865 polymorphism showed that the frequencies of g/G, G/T and T/T genotypes differ at the level of the prominent tendency to statistical significance between patients with RA and the control group (p=0.05). The frequency of minor allele T in RA is significantly higher than that in the control group, and this allele is associated with a predisposition to RA [odds ratio (OR) 1.7; 95% confidence interval (CI) 1.1–2.8; p=0.03]. In the study of the "genotype – phenotype" relationship, STAT4 gene polymorphism correlated with erosive joint damage (r2=0.289; p=0.008). In carriers of the homozygous genotype TT, the number of erosions at inclusion in the study was significantly higher compared with carriers of genotypes GG/GT (median 5.50 [0.754; 7.5] and 0.00 [0.00; 2.00], respectively; p=0.003). The risk of erosion is also associated with the polymorphism of the STAT4 gene (OR 8.6; 95% CI 1.0–204.9; p=0.03). A difference of the ACCP level depending on STAT4 gene polymorphism was revealed: carriers of at least one minor allele T (G/T+T/T) had significantly higher concentration of ACCP than that in carriers of homozygous GG genotype: 248.97±151.00 and 179.51±147.01 U/ml, respectively; p=0.048).

Conclusion. The study showed that in Russian patients with very early RA, the STAT4 gene rs7574865 polymorphism is associated with both predisposition to the disease and prognostically unfavorable manifestations (phenotypes) of the disease, namely, with the development of erosion in the early stages of the disease and an increase of the ACCP level.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of rheumatic diseases (RD). In some cases, their long-term use is advisable: NSAIDs slow the progression of spondylarthritis, are an important element in the control of chronic pain in osteoarthritis (OA) and rheumatoid arthritis (RA). However, the risk of serious adverse events (AE) should be considered. A good choice for long-term therapy may be amtolmetin guacil (AMG), which rarely induce gastrointestinal AE.
The aim of the study was to assess the effect and safety of long-term use of AMG in RD.
Material and methods. An open observational study was conducted in which AMG (Nayzilat) was assigned to 442 patients with OA (mean age 60.6±10.2 years, women 88.7%), 126 patients with RA (55.0±14.0 years, women 84.2%) and 73 with ankylosing spondylitis (AS, 47.0±12.0 years, women 30.0%). The dose of AMG depended on the clinical situation and was determined by the attending physician: from 1800 to 600 mg/day. The main criterion of the effect was the changes of pain by numeric rating scale (NRS), additional measures of efficacy were pain on the WOMAC and HAQ for OA, DAS28 for RA, BASDAI, BASFI and ASDAS-CRP for AS. The result of treatment was evaluated during three consecutive visits every 3 months (9 months of follow-up).
Results and discussion. At the end of follow-up 65.2% of patients with OA, 75.3% of patients with RA and 82.2% of patients with AS continued treatment with AMG. The reasons for discontinuation of treatment were significant reduction or absence of pain (70.3%), the patient's decision (26.6%) or AE (3.1%). At the end of follow-up, there was a significant decrease in pain intensity compared to the baseline: in OA, the median pain decreased from 5.6 [4.1; 6.9] to 3.4 [1.7; 5.1], in RA from 5.8 [4.0; 7.5] to 3.4 [2.0; 4.8], in AS from 5.8 [4.2; 7.5] to 3.1 [1.5; 5.0] according to NRS, the difference was significant in all groups (p<0.001). In OA, the median WOMAC pain decreased from 127 [24; 159] to 13.7 [14; 40] (p<0.001), the average HAQ value – from 0.54±0.44 to 0.34±0.26 (p<0.001). In RA, the average value of DAS28 decreased from 4.81±1.18 to 4.30±1.24 (p<0.05). The number of painful and swollen joints, ESR and C-reactive protein also significantly decreased. In AS, the median BASDAI index decreased from 4.5 [1.0; 8.0] to 3.0 [0; 8.0] (p<0.001). The number of patients with high activity according to ASDAS-CRP (>3.5) decreased from 76.9 to 25.8% (p<0.001). The BASFI index did not changed. 77.9% of patients with OA, 77.0% with RA and 74.5% with AS were satisfied with the results of AMG treatment. AMG tolerance was good. Mild dyspepsia was observed in 15–25% of patients. AE, which caused the discontinuation of therapy, were observed only in 6 (0.93%) patients. There was no development or deterioration of hypertension, as well as other cardiovascular complications.
Conclusion. AMG is an effective NSAID with good tolerability, which is advisable to use for long-term treatment of RD. Limitations are the open nature of the study and the absence of a control group.

Molecular mechanisms of development of normal and pathological neuroendocrine and immune adaptive response to psychological (mental) stress are analyzed considering its possible provoking role in the development of rheumatoid arthritis (RA). A detailed analysis reveals the synergism of mechanisms that provoke the development of pathological anti-stress adaptive response and RA. It is possible that in persons at risk of developing RA minimal and unobtrusive for the individual stressful situations, periodically provoking prolonged production of pro-inflammatory cytokines, can, finally, lead to the development of rheumatic disease.

The article discusses the possibilities and search for the optimal concept of diagnosis of hand osteoarthritis (OA). The data of numerous studies with focus on the comparison of sensitivity and specificity of the main techniques in this type of pathology – standard radiography and magnetic resonance imaging (MRI) are presented. Determination of the earliest symptoms of OA allows to predict the development of the disease and begin its therapy. The joint space narrowing due to the loss of articular cartilage is the earliest radiological symptom of OA, which is observed in the advanced stage of the disease. MRI, unlike radiography, makes it possible to visualize the articular cartilage, fluid in the joint cavity, bone marrow edema and soft tissues, but it is more expensive and time-consuming method. At present the main difficulty lies in the absence of a standardized system for assessing the MRI hand OA manifestations, as well as insufficient number of investigations in this area.

Juvenile arthritis (JA) is a disease of unknown etiology that begins before the age of 16 years and lasts for at least 6 weeks. The main objective of most existing international registers of children with JA is assessment various aspects of the efficacy and safety of biologics in comparison with methotrexate. The results of the analysis of the effectiveness of registers as a tool for long-term monitoring of the disease and medical care for children with JA are not presented in the available literature.
The aim of the study is to develop methodological approaches to maintaining the Register of children with JA and algorithms of actions of medical personnel on the basis of the experience of the Republican Children's Clinical Hospital (Ufa).
This work is a retro- and prospective observational study. The Register included children under the age of 18 years with an established diagnosis of JA, who were admitted to the cardio-rheumatologic department of Republican Children's Clinical Hospital (Ufa). In this paper, we used the All-Russian register of children with JA, developed by «Aston Consulting» and «Norbit» (official partner of Microsoft) on the basis of the technological platform Microsoft Dynamics CRM 5.0.
In total, the Register included information about 426 children with JA. The average age of children during the analysis of the register data was 10.9±4.3 years, and in the onset of the disease – 4.7±3.7 years. According to the results of the analysis, the tasks, areas of responsibility and scope of action for each subject of medical care (rheumatologist of rheumatology hospital and office, head of department, chief freelance specialist of the Ministry of Health) and the corresponding tools of the Register were determined.
A clear algorithm of actions of specialists depending on the task will optimize the work with the register of patients, reduce the time required to enter and receive information and, at the same time, provide the possibility of the most complete and effective use of the Register in optimizing medical care for children with JA.

A significant part of the knee joint (KJ) damages comprise the lesions of its menisci. Both traumatic and degenerative menisci damages are frequent indications for surgical treatment. In the available literature there are a few articles devoted to the study of the KJ function when walking before and after meniscus resection. We have studied the biomechanical changes characteristic of KJ meniscus damage, before and after surgical treatment.
The study included 24 patients who were operated on for meniscus rupture of both traumatic and degenerative nature.
During the arthroscopic intervention, we performed a meniscus resection within the damaged unstable tissues. In the postoperative period all patients received rehabilitation treatment. The control group included 20 healthy adults (14 males and 6 females). The median age was 29.7 years. The biomechanics of gait was studied: the time of the step cycle, movements in the hip joints (HJ) and KJ in three mutually perpendicular planes and shock loads during walking.
The time characteristics of the step cycle remain normal both before and after surgery. The load on the affected limb increases in the postoperative period. The amplitude of movements in HJ and KJ is reduced before treatment and restored after it.
KJ meniscus damage does not lead to a significant change in the biomechanics of walking. The recorded parameters of the step cycle do not change, i.e. the existing changes do not affect the time structure; 3 months after surgical treatment on the side of the lesion, shock loads increase to normal values, the amplitude of HJ extension, KJ flexion and rotational movements in it increases. The function of operated KJ was normalized in conditions of walking on a flat surface.

The article presents a clinical observation of a patient with severe psoriasis and psoriatic arthritis. Due to insufficient efficacy of systemic therapy of psoriasis biologic disease-modifying therapy was started, but it was associated with difficulties. Development of erythrodermic form of psoriasis was observed during treatment with infliximab and abatacept was successfully used though it is not registered inRussiafor the treatment of psoriasis.