The problem of fibrosing interstitial lung diseases (ILDs) unites specialists from different areas: pulmonologists, radiologists, therapists, rheumatologists, occupational doctors and others. Actual achievements in studying fibrosing ILDs which are connected with development of immunology and molecular biological methods for the determination of biomarkers, new principles of image-diagnostics of lung pathology, search of new therapeutic “targets”, dictate the necessity of integration of knowledge by specialists from different areas of medicine for improvement pharmacotherapy algorithms. These algorithms directed to decrease fibrosis progression in ILDs, improve quality and increase lifespan of the patients.

Aseptic necrosis of bone is a serious disease that, if detected early and with adequate therapy, can be cured. Late diagnosis and lack of therapy leads to rapid joint destruction and patient disability. The proposed draft guidelines are a part of the National Clinical Guidelines for Aseptic Bone Necrosis (Osteonecrosis). Purpose of the study was creating an algorithm for diagnosing and treating osteonecrosis based on assessment of the level of evidence of literature data. The Guidelines reflect aspects of the clinical, instrumental and laboratory examination of patients with osteonecrosis, treatment options depending on the localization of the process and stage of the disease.

The aim of the study was to evaluate the comparative efficacy and safety of biologics registered and reimbursed in the Russian healthcare system for the treatment of adult patients with active ankylosing spondylitis.

Material and methods. We performed a systematic literature review of randomized controlled trials in PubMed, Embase, and eLIBRARY.RU databases. 17 articles reporting results from 16 trials were selected for qualitative and quantitative analysis. The main efficacy criteria were ASAS 20/40 over 12-16 weeks of therapy, additional criteria were BASDAI 50, changes from baseline in BASDAI and BASFI indexes. Safety criteria were determined based on the incidence of adverse events; we also analysed the proportion of patients suffering from at least one serious adverse event. Biologics were ranked based on the SUCRA values.

Results. Subgroup analysis showed no statistically significant differences between IL-17 and TNF-a inhibitors, but the IL-17 inhibitor class had a higher SUCRA values. For the combination of all analyzed efficacy outcomes, netakimab, infliximab, and ixekizumab hold the first three ranks. The safety profiles of biologics included in the review were comparable with each other.

Conclusion. The results of this review are intended to help healthcare professionals make decisions about optimal therapy for adult patients with active ankylosing spondylitis.

IgA anti-CD74 can be a promising marker for diagnosis, assessment of activity and prognosis for ankylosing spondylitis.

The aim of the study was to determine the level of IgA anti-CD74 in patients with ankylosing spondylitis and to evaluate its relationships with ankylosing spondylitis activity and carriership of genetic alleles.

Materials and methods. In 48 patients with a reliable diagnosis of ankylosing spondylitis, aged 18 to 69 years were measured the ASDAScrp, BASDAI, level of highly sensitive С-reactive protein, concentration of IgA anti-CD74. The polymorphisms of the genes interleukin (IL)-17A197 a/g, IL-17F7 histidine (His) / arginine (Arg), IL-17F11139 c/g, TNF-a-863, TNFα-308, TNFα-238, IL-1B-31, IL- 4-590, IL-6-174, IL-10-1082, IL-10-592, vascular endothelial growth factor (VEGF)-2578, VEGF-936, matrix metalloproteinase (MMP)2-1306, MMP3-5A6A, MMP9-1562, HLA-B27 were evaluated in their relationships with AS activity and IgA anti-CD74 levels.

Results. The mean age of patients was 45.1±14.2 years, male - 72.9%, psoriasis - 10.4%, IBD - 2.1%, BASDAI -2.99±0.28, ASDAS - 2.29±0.16, CRP - 6.5±1.65 mg/L, IgA эпй-СВ74 - 18.6±1.73 U/mL (72.9% of the patients with >12 U/mL). The relationship between an increase in concentration of IgA anti-CD74 and ASDAScrp, BASDAI activity indices, between an increase in the level of CRP and the presence of the IL-17A genotype heterozygous for the AA allele (r=0.965) was determined. CRP did not demonstrate the relationship with the BASDAI.

An association of IL-17F-11139 СС and the presence of psoriasis (r=0.870) was established. 93.8% of patients with ankylosing spondylitis were carriers of the homozygous histidine allele IL-17F7 (his/his) and the TNF238 allele (GG).

Conclusions. The increase in anti-CD74 IgA level was found in 72.9% of patients with ankylosing spondylitis receiving inhibitors of TNF-a and NSAIDs and associated with clinical and laboratory indicators of ankylosing spondylitis activity and with carriage of the homozygous histidine allele IL-17F7 (his/his) detected in 93.8% of patients. Carriage of TNF-238 GG; TNF-863 CC; HLA-B27; TNF-308 GG; IL-4-590 CC; IL-6-174 CG;

MMP9-1562 CC; MMP9-1562 CC; VEGF- 936 CC alleles was not associated with an increase in concentration of IgA anti-CD74. CRP demonstrated an association with IL-17A-197 AA (r=0.965) detected in 29.2% of patients with no correlation with the clinical ankylosing spondylitis activity in patients receiving treatment with iTNF-α and NSAIDs.

Wide usage of biologic disease-modifying anti-rheumatic drugs (DMARDs) biosimilars in clinical practice has greatly increased the availability of biologic therapy for rheumatic patients. Nevertheless, not only economic expediency but efficacy and safety are the key principals of any treatment including biologic DMARDs.

Objective. To investigate the efficacy and safety of switching from the original rituximab (MabThera®, “F. Hoffmann-La Roche Ltd.”, Switzerland) to its biosimilar (Acellbia®, “BIOCAD”, Russia) by non-medical reasons in rheumatoid arthritis patients.

Subjects and methods. 40 rheumatoid arthritis patients on basic therapy who had taken at least one course of original rituximab (MabThera®) 1000 mg twice in 2 weeks more than 6 months ago were included. They were switched to equal-dose biosimilar (Acellbia®) by non-medical reasons and were observed throughout the year. At 12, 24 weeks and one year after switching dynamics of the next parameters were evaluated: pain level according to visual analogue scale (VAS), tender joint count (TJC), swollen joint count (SJC), acute inflammatory and immunological markers, disease activity score (DAS28) calculated using erythrocyte sedimentation rate (DAS28-ESR) or C-reactive protein (DAS28-CRP), health assessment questionnaire (HAQ) index and safety profile.

Results. All the data are presented as median of indicator in the moment of measurement after switching therapy (Meperiod). In 12-week period TJC [(Me]_0=9.50, Me_12=6.0, p< 0.01) and SJC (Me_0=2,0, Me_12=1,0, p<0.01) were decreased with positive dynamics on the 24 and 48 weeks. Also, similar results were observed in the VAS pain level. DAS28 showed significant decreasing during observation: Me0=4.38, Me24=3.55, Meyear=3.49, p<0.01 for DAS28-ESR; and Me0=3.91, Me24=3.15, Meyear=3.03, p<0.01 for DAS28-CRP. Immunological markers were increased or stable during the first months after switching, but then they were significantly decreased: Me0=45.0 U/ml, Meyear=23.0 U/ml, p<0.01 for rheumatoid factor; and Me0=88.0 U/ml, Meyear=50.5 U/ml, p<0.01 for anti-cyclic citrullinated peptide. HAQ index was stabilized during 1 year: Me0=1.00, Meyear=0.75, p<0.01. Severe infusion reactions on Acellbia® were not observed, safety profile was similar to MabThera®.

Conclusion. Our investigation revealed that non-medical switching from original rituximab (MabThera®, “F. Hoffmann-La Roche Ltd.”, Switzerland) to its biosimilar (Acellbia®, “BIOCAD”, Russia) has no significant influence on the therapy efficacy and safety.

Objective. To assess the expression of interferon-stimulated genes in patients with rheumatoid arthritis (RA).

Material and methods. Twenty patients with RA were examined. All patients received methotrexate therapy at a stable dose (Me 15 [10-17.5] mg) for at least 4 weeks. To assess the Type I IFN gene signature (IFNGS) we selected five genes (IFI44L, MX1, IFIT1, RSAD2, EPSTI1). The expression of IFI44L and IFIT1 could not be determined, and further analysis took into account three genes - MX1, EPSTI1, RSAD2.

Results. Baseline level of MX1 expression - 11.48 [5.45-19.38], EPSTI1 - 12.83 [5.62-19.64], RSAD2 - 5.16 [2.7310.4] and IFN score - 10.3 [5.18-17.12] in patients with rheumatoid arthritis was significantly higher compared with healthy donors - 1.26 [0.73-1.6], 1.06 [0.81-1.48], 0.93 [0.72-1.19], and 1.09 [0.92-1.42] respectively, p<0.05. IFN signature was found in 15 (75%) patients, was absent - in 5 (15%) patients. A positive correlation was found between the IFNGS and the level of EPSTI1 expression with the duration of methotrexate therapy (r=0.46, p=0.03). Among patients who received methotrexate therapy for more than one year, there was a tendency to a higher level of EPSTI1 expression (10.74 [12.6-32.8]) and IFNGS (16.2 [8.9-38.3]) compared with patients taking methotrexate for less than a year (9.67 [5.4-14.2] and 7.9 [4.5-13.4]), (p=0.06).

Conclusion. Preliminary results on the assessment of IFNGS indicate an increased expression of IFN-stimulated genes in patients with RA, which may be important for predicting the course of the disease and personalizing therapy.

The aim of the study was to determine the diagnostic significance of the SARC-F (A Simple Questionnaire to Rapidly Diagnose Sarcopenia) questionnaire for sarcopenia screening and tests for assessing muscle strength in patients with rheumatoid arthritis.

Material and methods. The study included 87 women aged 40-75 years who completed the SARC-F screening questionnaire. All patients underwent muscle strength assessment tests - wrist dynamometry and “Rising from a chair”, as well as dual X-ray absorptiometry (DXA) to quantify muscle mass. Sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value were determined for the SARC-F questionnaire and muscle strength tests.

Results. Significant sarcopenia was diagnosed in 20 (23%) women. The sensitivity, specificity and diagnostic accuracy of the SARC-F questionnaire was 30, 42 and 39%, respectively, of the wrist dynamometry - 95, 34 and 48%, of the “Rising from a chair” test - 50, 21 and 28%, respectively. Paired use of different combinations of tests did not lead to an improvement in diagnostic value. With all three tests, the sensitivity, specificity and diagnostic accuracy were 71, 20, and 33%, respectively.

Conclusion. The SARC-F questionnaire used to screen for sarcopenia has a rather low diagnostic value for identifying patients with rheumatoid arthritis in need of further evaluation. Among muscle strength tests, hand dynamometry was found to be a highly sensitive, but insufficiently specific method, which can lead to overdiagnosis of probable sarcopenia. All this indicates the need to develop a screening method specific for rheumatoid arthritis and to improve the methods of stage I of sarcopenia diagnosis.

During the pandemic of the new coronavirus infection COVID-19, the need for remote communication between doctors and patients has increased around the world.

Objective: remote interaction between rheumatologist and patients using “ASpine” technology in the context of the COVID-19 pandemic.

Subjects and methods. Within the framework of the scientific project, the information technology “ASpine” was used, which consists of two parts. The first is directly a mobile application for patients with a diagnosis of axial spondyloarthritis and the second is a program for a personal computer that is used by a rheumatologist.

In the “ASpine” application, patients fill out BASDAI, ASDAS-CRP, BASFI questionnaires, enter data from various studies, and control the performance of daily exercise therapy. Also, the program has the ability to contact the attending physician via text messages.

The paper presents the experience of one rheumatologist with the information technology “ASpine” during the COVID-19 pandemic from April to June 2020.

Results. From January 1 to June 6, 2020, the total number of downloads of “ASpine” applications from the AppStore and GooglePlay was 1778, most of all during the COVID-19 pandemic. During this period, a rheumatologist using “ASpine” remotely observed 71 patients with axial spondyloarthritis. 47 (66.1%) of them were attached from April to June 2020. As of June 1, 2020, the average BASDAI in the observed values of patients was 4.7±2.3, BASFI -3.5±2.7, ASDAS-CRP - 3.1±1.1. During a pandemic, messages from patients came in daily from 1 to 16.

Their review and preparation of a response by a doctor per call took an average of 5 minutes; usually it took no more than 30 minutes to answer each day.

Conclusion. The “ASpine” program for patients with axial spondyloarthritis during a difficult situation in the country caused by restrictive means of preventing COVID-19 provided real help as an alternative method of communication with the attending physician. In turn, the technology allows a rheumatologist to remotely monitor the health status of a large number of time expenditures (no more than 30 minutes per day for 71 patients).

Objective. To assess the duration of remission or inactive disease status in patients with achieved partial remission due to treatment with adalimumab (ADA) after it discontinuation.

Materials and methods. A dynamic observation was conducted of 26 patients with ankylosing spondylitis with partial remission achieved due to prolonged use (for 24 months or more) of subcutaneous injections of 40 mg ADA once every two weeks. The discontinuation of ADA was carried out after a 3-4 month period of its use in de-escalation mode in the form of 1 injection (40 mg) once every 4 weeks. After discontinuation of ADA, patients continued to take non-steroidal anti-inflammatory drugs, sulfasalazine at a dose of 1.5-2 g per day (11 patients) and methotrexate 10 mg per week (3 patients). Assessment of the clinical, laboratory and ultrasonographic parameters of ankylosing spondylitis was carried out in 3, 6 and 12 months after the abolition of the ADA.

Results and discussion. Among the observed patients, partial clinical remission of ankylosing spondylitis maintained after 6 months in 12 (46.2%) patients, and after 12 months - in 10 (38.5%). A low degree of ankylosing spondylitis activity (BASDAI <4) was maintained for 6 months after the abolition of ADA in 14 (53.8%) patients, and after 12 months - in 12 (46.2%).

Conclusion. Within 12 months after cancellation of ADA, ankylosing spondylitis exacerbation was observed in 53.8% of patients with initially achieved partial clinical remission.

Aim. To study the frequency and timing of the onset of remission and minimal disease activity after the administration of genetically engineered biologic drugs (GEBD) in patients with early and long-term psoriatic arthritis observed within the framework of the All-Russian register of patients with psoriatic arthritis.

Material and methods. The study included 140 patients with psoriatic arthritis (77 men, 63 women) who met the CASPAR criteria, who took part in the All-Russian register and were followed up every 6 months. Previously, patients did not receive GEBD. The median age of the patients was 42 [19-73] years. All patients were divided into two groups depending on the duration of psoriatic arthritis before the appointment of GEBD: early psoriatic arthritis - ≤2 years (67 patients) and long-standing psoriatic arthritis - more than 2 years (73 patients). All patients were prescribed GEBD (37 - adalimumab, 26 - infliximab, 20 - etanercept, 19 - golimumab, 1 - certolizumab pegol, 33 - ustekinumab, 4 - secukinumab) in combination with or without methotrexate. All patients were assessed for the activity and efficacy of psoriatic arthritis therapy according to DAPSA and the criteria for minimal disease activity (number of painful joints - ≤1, number of swollen joints - ≤1, PASI - ≤1 or BSA - ≤3, pain score - ≤15, overall assessment of activity disease by the patient - ≤20 mm on a visual analogue scale, HAQ - ≤0.5, enthesitis -≤1) at the beginning of the study and every 6 months. The number of patients who achieved remission (DAPSA ≤4) or minimal disease activity (5 criteria out of 7) at least 1 time during therapy with GEBD was determined. The cumulative frequency and timing of achieving remission after the appointment of GEBD were calculated.

Results. After the initiation of treatment with GEBD, DAPSA remission was achieved at least once in 24 out of 67 (36%) patients with early psoriatic arthritis and in 19 out of 73 (26%) patients with long-standing psoriatic arthritis. The minimum disease activity was achieved, respectively, in 33 of 67 (49%) and 23 of 73 (32%) patients. The time interval to achieve remission in early psoriatic arthritis was significantly less than in long-standing one. Its median was 48 months (95% CI: 11.75-84.25) and 139 months (95% CI not determined) (p<0.05), respectively. The time until the minimum activity of the disease was reached in patients with early psoriatic arthritis was significantly less than in patients with long-standing psoriatic arthritis. Its median was 21 months (95% CI: 13.1-28.9) and 58 months (95% CI: 0-118.1), respectively (p<0.05).

Conclusion. In real clinical practice, after prescribing GEBD, patients with an early stage of psoriatic arthritis (no more than 2 years of illness) achieve remission and minimal disease activity significantly more often and faster than patients with long-term illness.

Background. Cardiovascular diseases (CVD) is the leading cause of death for gout. Arterial hypertension is a proven CVD risk factor (CVD-RF).

Objective. To assess the factors influencing on development of an arterial hypertension in patients with a gout. Subjects and methods. 286 male patients fulfilling Wallace proposed criteria for gout were included in the study: age 51.2 [42.8; 59.4] years, disease duration - 6.2 [3.8; 12.1] years, number of joints involved during disease course - 7 [4; 12], subcutaneous tophi - in 35% of patients, intraosseous tophi - in 44%, nephrolithiasis - in 69%, abdominal obesity - in 71%. All patients underwent standard clinical examination, C-reactive protein (CRP), total cholesterol, triglycerides, low and high density lipoproteins, serum uric acid, serum creatinine, smoking, family history of arterial hypertension, body mass index (BMI), diabetes mellitus was performed by standard procedure. We estimated the adjusted odds ratio (OR) and 95% confidence interval (95% CI).

Results. There were two groups of patients with arterial hypertension diagnosed on clinical data: group 1 (with arterial hypertension) - 244 (85%) patients, group 2 (without arterial hypertension) - 42 (15%) patients. The group 1 patients were older (52.3 [44.5; 61.1] vs 41.9 [38.3; 50.1] years old), had longer duration of gout (6.7 [3.9; 13.7] vs 4.5 [3; 7.9]), a higher number of joints involved during disease course (8 [4; 12] vs 5 [3; 9]). The frequency of family history of arterial hypertension (68.3 vs 48.8%), abdominal obesity (55.3 vs 33.3%), nephrolithiasis (71 vs 54.7%), intraosseous tophi (48 vs 21%) was higher in group 1 as compared with group 2, р<0,05. BMI and CRP level was higher in group 1 compared with group 2: 30.2 [27.4; 33.1] vs 27.9 [26.3; 30.5] kg/m², and 12.7 [5.84; 19.2] vs 7.8 [3.7; 16.4] mg/l, respectively, p<0.05. We did not find differences of lipid profile, serum uric acid, and serum creatinine level in groups 1 and 2. We also did not find differences the frequency of smoking, diabetes mellitus, subcutaneous tophi in both groups.

Abdominal obesity (OR - 1.247; 95% CI: 1.063-1.462), family history of arterial hypertension (OR - 2.8; 95% CI: 1.5-5.4), disease duration more than 10 years (OR - 4.5; 95% CI: 1.1-19.4), intraosseous tophi (OR - 3.0; 95% CI: 1.4-6.4), increased the risk for arterial hypertension in patients with a gout.

Conclusion. The majority (85%) of patients with gout had arterial hypertension. Abdominal obesity, family history of arterial hypertension, disease duration more than 10 years, intraosseous tophi were associated with an increased risk of arterial hypertension in patients with a gout.

Antiphospholipid syndrome is an acquired autoimmune thrombophilia characterized by the development of recurrent vascular thrombosis of any caliber and type or obstetric pathology and the mandatory identification of persistently positive antiphospholipid antibodies. The main drug in the treatment of patients with antiphospholipid syndrome is warfarin. The role of direct-acting oral anticoagulants in the treatment of antiphospholipid syndrome remains controversial. The article discusses modern data on the place of direct-acting oral anticoagulants in the treatment of antiphospholipid syndrome.

Spondyloarthritis refers to immune-mediated inflammatory rheumatic diseases characterized by the most pronounced pain, inflammatory activity and disability of patients of working age. One of the most frequent comorbid to spondy-loarthritis diseases that weigh down the course and outcomes are anxiety-depressive spectrum disorders. Chronic inflammation with hyperproduction of cytokines of the interleukin-23/interleukin-17 axis and violation of intracellular signaling of these cytokines, developing against the background of a violation of the stress and immune response, is a key pathogenetic mechanism that combines spondyloarthritis and anxiety-depressive spectrum disorders, and dictates approaches to their therapy. The article discusses the current understanding of the prevalence of mental disorders among patients with spondyloarthritis and their negative impact on the course and outcomes of the rheumatic disease, the common pathogenesis and provoking factors, the influence of antidepressants on spondyloarthritis outcomes and anti-inflammatory drugs, primarily interleukin-17 inhibitors and tumor necrosis factor alpha inhibitors on the symptoms of anxiety-depressive spectrum disorders.

Hyperuricemia is a widespread problem worldwide, the incidence of which is 16-17%. However, the significance of asymptomatic hyperuricemia - hyperuricemia without gout - continues to be discussed. Asymptomatic hyperuricemia leads to the deposition of monosodium urate crystal in the tissues, contributing to chronic inflammation. Intracellular urates inhibit the protein kinase associated with the main regulator of adenosine monophosphate, causing immune responses through long-term epigenetic modifications. And if intracellular urates have a prooxidant effect, soluble extracellular urates are biologically active and exliibilL' antioxidant properties with potentially anti-inflammatory effects. Based on population studies, asymptomatic hyperuricemia is associated with many comorbidities, including arterial hypertension, chronic kidney disease, coronary heart disease, and diabetes mellitus. However, these studies have a wide range of limitations, namely that most of them are retrospective, and some do not distinguish between patients with asymptomatic hyperuricemia and gout. Studies of therapeutic strategies show that lowering the urate level can reduce the risk of some of these comorbidities occurring or progressing. Thus, the accumulated data suggest that asymptomatic hyperuricemia contributes to the onset and progression of associated comorbidity, and that treatment of asymptomatic hyperuricemia can reduce risks. However, additional prospective studies are needed to accurately establish cause and effect relationships and support the decision about whether and in which patients with asymptomatic hyperuricemia it is worth initiating treatment that reduces urate levels. In addition, the available data confirm the neuroprotective effect of uric acid on cognitive function in patients with Alzheimer’s disease, Parkinson’s disease and vascular dementia, and hypouricemia is a risk factor for the more rapid progression of neurodegenerative diseases. This literature review will discuss some associations and potential mechanistic relationships between asymptomatic hyperuricemia and comorbid conditions.

The modern concept for the treatment of osteoarthritis is based on the complex use of drugs, non-drug methods, medical and social rehabilitation. At the same time, non-pharmacological methods play an important role, given the natural combination of osteoarthritis and serious comorbid diseases, which significantly increase the risk of developing dangerous drug complications. One of the most common non-drug methods that is widely used in inpatient and outpatient treatment of osteoarthritis is magnetic therapy. During the Council of Experts, with the participation of therapists, rheumatologists, rehabilitologists and physiotherapists, the issues of the scientific substantiation of the use of magnetic therapy in clinical practice, the methodology of this method of treatment, the existence of an evidence base for its effectiveness and safety, as well as the advisability of including magnetic therapy in the national recommendations for the treatment of osteoarthritis were discussed.

Thanks to progress in understanding of Takayasu’s arteritis pathogenesis, the role of biological therapies is expanding, especially in refractory diseases. Robust data are still lacking to draw conclusions concerning the use of interleukin (IL)-6 inhibitors in Takayasu’s arteritis. The article presents own experience of the use of tocilizumab (TCZ) for Takayasu’s arteritis after insufficient response to previous treatment with glucocorticoids, methotrexate, cyclophosphamide, fludarabine and intolerance of cyclophosphamide, glucocorticoids. As result of TCZ treatment (600 mg IV every 4 weeks for 24 months), a stable Takayasu’s arteritis remission was achieved and confirmed by fluorodeoxyglucose-positron emission tomography.

The inhibition of IL-6 can be considered as a promising innovative strategy for the treatment of Takayasu’s arteritis, primarily with insufficient response, intolerance or contraindications to standard therapy.