The problem of coronavirus disease 2019 (Coronavirus diseases, COVID-19) two years later still remains relevant both socially and medically. As one of the methods of combating the current COVID-19 pandemic, most experts rely on the widespread use of vaccination. However, the use of vaccines against SARS-CoV-2 in patients with rheumatic diseases (RD) raises a number of issues related to the effectiveness, immunogenicity, and safety of immunization, including leveling the risks of exacerbation of the underlying disease or the development of new autoimmune phenomena. For this reason it is very important to analyze data on the above-mentioned aspects in real time, especially given that patients of the rheumatology circle were excluded from the clinical development programs of vaccines against SARS-CoV-2. This review presents the results of last year’s research on the safety of vaccination against COVID-19 in patients with RS. A brief description of the main anticovedic vaccines is given. Post-vaccination adverse events were quite frequent after the first, second or both doses of vaccines in patients with RS, which is consistent with the data obtained in the general population. In general, the frequency of exacerbation of RD after vaccination against COVID-19 seems to be quite low (5–7%) and has no significant associations with a specific vaccine or anti-rheumatic therapy. At the same time, unambiguous interpretation of these data is difficult for at least three reasons: a) in many studies, only the symptoms developing after the first dose of the vaccine were taken into account; b) the time-limited post-vaccination follow-up period; c) significant discrepancies in the interpretation of exacerbations of the disease. Within the framework of the problem under consideration, there are still a lot of questions, the answers to which should be obtained in large prospective controlled studies.

The beginning of the 21st century was marked by a simultaneous changes in view on pathogenesis, diagnostics and treatment of axial spondyloarthritis (axSpA). Anti-TNFα inhibitors were the first biologics prescribed in axSpA. 20 year after the biological treatment was first prescribed we have enough data to understand their long-term efficacy.
The aim of this study is to evaluate the long-term efficacy of etanercept in patients with axial spondyloarthritis based on data published in periodicals and clinical practice.
Patients and methods. An analysis of publications from medical database and data from the St. Petersburg register of patients with rheumatic diseases (n=68) was performed to assess the effectiveness of etanercept in axSpA treatment in the long-term perspectives. Descriptive statistics methods were used.
Results. In clinical studies and in real word practice, etanercept has shown high efficiency in reducing clinical, laboratory and visual manifestations of non-radiographic and radiographic axial spondyloarthritis at early and advanced stages of their development.
Conclusions. In the long term, the use of etanercept is associated with an increasing slowdown in structural progression while maintaining a stable clinical and laboratory improvement. Discontinuation of treatment in the majority of patients leads to exacerbation of axSpA. At the same time, the low immunogenicity of etanercept allows the resumption of axSpA treatment with a high probability of re-achieving the lost effect with a low probability of secondary ineffectiveness or anaphylaxis.

Almost half of the patients with axial spondyloarthritis (axSpA) in Russia have hip joint lesions (HJD), but the causes and rates of its progression have not been studied.
Aim. To assess the relationship of X-ray progression with MRI data of hip joint examination in patients with axial spondyloarthritis during a two-year follow-up.
Material and methods. We analyzed 77 patients (23 women and 54 men) with axSpA (ASAS criteria, 2009), followed for at least 2 years with clinical and/or instrumental signs of coxitis. After 2 years, the patients underwent a complete clinical, laboratory and instrumental examination (MRI and radiography of the hip joint) again. Their average age was 30.8±7.7 years, with an average disease duration of 74.0±90.3 months. 72 (94%) patients were HLA-B27 positive. In all patients, the BASRI-Hip index was assessed for each hip joint. The median values of laboratory parameters of inflammation – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level – were initially high (20.0 mm/h and 14.5 mg/l respectively), but after 2 years the indicators decreased: ESR – down to 8.0 mm/h, and CRP – down to 5.0 mg/L (p<0.05). The median values of the BASDAI also decreased over 2 years of active observation from 4.5 to 2.2 (p<0.05). The value of the ASDAS-CRP index was high and corresponded to 3.1±1.1 and after 2 years also decreased down to 1.94±1.0 (p<0.05). Pain in the hip joint was detected in 66 out of 77 patients (86%) at the time of inclusion, and 2 years later – in 48 (62%) (p<0.05). As for other clinical manifestations of the disease at the time of inclusion in the study, among 77 patients, 75% had peripheral arthritis, and after 2 years – only about 39% (p<0.05). The patient’s functional index (BASFI) was initially 3.3, and after 2 years it decreased down to 1.3 (p<0.05).
Results. At inclusion in the study, 59 patients had no radiological changes in the hip joint (BASRI-hip<2). 2 years after the start of follow-up, the number of patients with radiological changes in the hip joint was 48 (62%). Initially, according to MRI, synovitis was detected in 75 (97%), and osteitis – in 23 (30%), chronic changes were present in 2 (3%) patients. After 2 years, synovitis persisted in 46 (60%) (p<0.05), bone marrow edema – in 17 (22%) (p>0.005), and the number of chronic changes increased up to 29 (38%). In 25 (32%) MRI patients, signs of active inflammation were arrested, while only two (13.3%) of them showed the development of chronic changes. To assess the relationship between X-ray progression and MRI signs of inflammation of the disease, patients were divided into two groups according to the total stage of radiographic coxitis (ΔtsrC=0 and ΔtsrC>0). The group with ΔtsrC=0 included 33 patients (22 men and 11 women), and the group with ΔtsrC>0 included 44 patients (32 men and 12 women) (p>0.05). The groups did not differ in clinical parameters such as disease duration, patient age, BASDAI, ASDAS-CRP, BASFI, ESR and CRP (p>0.05). According to MRI, the signs of inflammation (osteitis, synovitis) of the groups also did not differ.
Conclusion. The progression of coxitis did not depend on the activity of the disease, on the gender of the patients, and on MRI signs of inflammation in the hip joint.

The question about the peculiarities of the course of rheumatoid arthritis in different age periods was raised in the literature repeatedly and the answer depended on the period of development of rheumatology and was not unambiguous. The course of age-specific features of the initial stages of disease development has also been studied (although less frequently). At the same time, the issues of age-related features of as yet untreated early rheumatoid arthritis have not been previously presented in the literature studied by the authors. This article gives a brief overview of the problem and discusses the findings.
The aim of the present study was the comparative study of the characteristics of untreated early rheumatoid arthritis with early (18–49 years) and late (50 years and older) onset.
The material was represented by 292 patients with rheumatoid arthritis with disease duration from 1 to 12 months from the disease onset, entered into the All-Russian Register of Patients with Inflammatory Arthritis “OREL” in the period from January 01, 2012 to December 31, 2018 with the results of examination at the time of the first examination. All patients were naïve to treatment with basal (synthetic, biological or other targeted) drugs and systemic glucocorticoid therapy. In 141 patients, the disease started at a younger age, group 1 (18–49 years), and in 151, at an older age (50 years or older), group 2.
Methods. Disease activity (according to DAS-28 index), radiological stage – (according to Steinbroker, modified), functional disorders – according to functional class, immunological characteristic and additional immunological characteristic (rheumatoid factor, cyclic citrullinated peptide antibodies) and other parameters were estimated in accordance to requirements of current national rheumatoid arthritis classification. 
The results of the study indicate that the disease in older age is characterized by more pronounced inflammatory, destructive changes in relation to the joint apparatus and functional disorders than the onset of rheumatoid arthritis at a young age. 

Currently, it is considered generally accepted to assess the activity of inflammation in rheumatoid arthritis (RA) according to the disease activity index (DAS28), which requires computer technology. However, there have been reports that inflammatory activity in autoimmune diseases can be diagnosed with peripheral blood counts.
Aim. To clarify the possibility of using peripheral blood parameters for the diagnosis of inflammatory activity in rheumatoid arthritis.
Material and methods. The study included 100 patients with RA who were consecutively hospitalized in the first quarter of 2021 due to an exacerbation. The control group consisted of 59 healthy donors. When patients were admitted to the clinic, along with standard clinical, laboratory and radiological parameters, the neutrophil-tolymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios were determined.
Results. Correlation analysis of the studied clinical and laboratory parameters of the inflammatory activity of RA patients using the Pearson method showed that the NLR indicator, in contrast to the PLR, was statistically significant (p<0.05) correlated with the swollen joint count (r=0.236), the values of C-reactive protein (CRP) (r=0.448), erythrocyte sedimentation rate (ESR) (r=0.274) and DAS28-ESR (r=0.274). ROC-analysis of the sensitivity and specificity of the NLR value in relation to the CRP and ESR indicators confirmed an acceptable level of sensitivity and specificity in assessing the inflammatory activity of RA.
Conclusions. The NLR index, calculated from the data of the analysis of peripheral blood, can be used in clinical practice as an objective and accessible marker of the inflammatory activity of RA.

The aim of our study was to assess the relationship between the changes of antinuclear autoantibodies (ANA) and autoantibodies to topoisomerase 1 (anti-Topo 1) in systemic sclerosis (SSc) patients on rituximab (RTX) therapy.
Materials and methods. The prospective study included 88 patients (73 women) with a mean age of 47 (17– 71) years. The mean disease duration was 5.9±4.8 years. The mean follow-up period was more than 2 years (27 (12–42) months).
Results. We documented a statistically significant change in skin score, the disease activity index, improvement of pulmonary function and reduction of mean dose of prednisolone after RTX treatment. There was a significant decrease in the number of patients with high levels of ANA and overall decrease of the ANA and anti-Topo 1 levels. A moderate positive statistically significant correlation was found between ANA and anti-Topo 1 (r=0.403). In the group of patients positive for anti-Topo 1 there were a more pronounced depletion of B lymphocytes, significantly higher increase in forced vital capacity and diffusion capacity, decrease in the disease activity index, compared with a patients negative for anti-Topo 1.
Conclusions. We observed the decline in the level of ANA and anti-Topo 1 in SSc patients after RTX therapy and it was correlated by an improvement of the main outcome parameters of the disease. Therefore, anti-Topo 1 positivity could be considered as a predictor of a better response to RTX treatment, especially in SSc patients with hyperproduction of anti-Topo 1.

Objective. To study the involvement of the rs1800629 G/A polymorphisms of the TNF-α gene, rs1205C/T of the CRP gene, and rs12218T/C of the SAA1 gene in the predisposition to ankylosing spondylitis (AS) and their role in the formation of clinical phenotypes of AS.
Materials and methods. 122 patients with AS were included in the study. All patients had a diagnosis of AS based on the modified New York criteria. The presence of the HLA-B27 antigen was detected in 109 (89.3%) patients, the presence of peripheral arthritis – in 71 (58.2%), enthesitis – in 92 (75.4%), coxitis – in 82 (67.2%) patients. All patients had a high degree of activity with an average BASDAI index of 5.6±1.2. The control group consisted of 142 healthy blood donors. Polymorphisms were studied using allele-specific real-time polymerase chain reaction (RT-PCR).
Results. Significant differences were found in the frequencies of genotypes and alleles of the -308G/A polymorphism of the TNF gene and the frequencies of alleles of the rs12218 T/C polymorphism of the SAA1 gene between patients and the control group (p=0.01, p=0.01 and p=0.03 respectively). Logistic regression analysis showed that the presence of at least one -308A allele in the patient’s genotype reduced the risk of developing AS by 4.4 times compared with the GG genotype (p=0.006). In carriers of the GA genotype, the probability of a predisposition to the development of enthesitis was 2.2 times lower than in carriers of the GG genotype (p=0.01). The relationship between the rs1205 polymorphism of the CRP gene and the predisposition to peripheral arthritis has been established. Carriage of the rs1205T allele doubled the susceptibility to arthritis compared with the rs1205C allele (p=0.013). Carriage of at least one rs12218C allele of the SAA1 gene doubled the susceptibility to AS (p=0.018).
Conclusion. The data obtained confirm the involvement of polymorphisms rs1800629 of the TNF gene, rs1205 of the CRP gene, and rs12218 of the SAA1 gene in the predisposition to AS. TNF gene polymorphism is associated with the formation of the clinical phenotype of enthesitis, and CRP gene polymorphism is associated with a predisposition to peripheral arthritis.

The aim of the work – to research the relationship between the dynamics of cytokine levels in the early period (the first 12 and 24 weeks) of pharmacotherapy for rheumatoid arthritis (RA) and long-term outcomes in patients with the disease.
Material and methods. The analysis included 93 patients with early RA. The majority of patients were women (n=77), middle-aged (58 [49; 66] years), with an early stage of the disease (the duration of the disease is 7 [4–11.5] months), seropositive according to IgM rheumatoid factor and cyclic citrullinated peptide antibodies, who had high (59.7%) or moderate (38.8%) disease activity.
The concentration of 27 cytokines in the blood serum was determined with the help of multiplex xMAP technology on the Bio-Plex array system analyzer (BIORAD, USA). Repeated clinical examination of patients was carried out after 6 years.
Results. Patients who achieved remission/low disease activity SDAI after 6 years had a lower level of IL-6 (7.7 [7.4; 23.3]), IL-9 (13.5 [9.1; 18.9]) 12 weeks after the start of therapy; lower IL-9 level (12.6 [6.8; 16.2]) 24 weeks after the start of the treatment, compared with the group of patients with moderate and high inflammatory activity (23.5 [12.4; 69.5], 17.8 [15; 29] and 18.5 [14.2; 22.8] respectively).
Findings. The assessment of the level of proinflammatory cytokines (IL-6, IL-17), immunoregulatory cytokine IL-9 allows to evaluate the activity of the disease more fully and identify a group of patients, who needs the therapy intensification.

Among the pathophysiological mechanisms of immune-mediated inflammatory diseases (IMIDs), specific attention has been paid to the abnormal activation of Th17 type immune response related to the dysregulated synthesis of cytokines forming the interleukin (IL)-23 and IL-17 axis. IL-23 blockade is an innovative approach to the treatment of psoriasis and psoriatic arthritis (PsA). Much of the interest has focused on guselkumab (GUS) (TREMFYA, Janssen, Johnson & Johnson, USA), a fully human IgG λ monoclonal antibody (mAb) targeting the p19 IL-23 subunit and the first-in-class treatment approved for patients with psoriasis and PsA. In patients with psoriasis, GUS is at least as effective as other biologic therapies for PsA and is superior to ustekinumab, an anti-IL-12/IL-23 mAb, and secukinumab, an anti-IL-17 mAb. Compared with TNF-α inhibitors, GUS therapy is less likely to cause infections and does not increase the risk of the reactivation of latent TB infection. The new GRAPPA guidelines (2021) recommend GUS (and other IL-23 inhibitors) for patients with PsA resistant to conventional disease-modifying antirheumatic drugs (DMARDs), who have peripheral arthritis, enthesitis, dactylitis, psoriatic skin and nail lesions. The paper discusses new data on the efficacy of GUS in patients resistant to TNF-α inhibitors, its benefits in patients with axial PsA, and safety during the COVID-19 pandemic.

Instrumental imaging modalities play an important role in the diagnosis, evaluation of treatment efficacy and early detection of recurrences in patients with large vessel systemic vasculitis (SV). There’s no currently available universal imaging modality yielding comprehensive information about large vessels regardless all spectacular progress in rheumatology with associated significant insights into SV pathogenesis, innovative therapeutic strategies and broadened diagnostic approaches. Therefore, standardization of instrumental methods in order to accurately assess the disease activity and recognize timely its’ relapse remains a pending issue in management of patients with large vessel SV.
Published in 2018 the EULAR (European League Against Rheumatism) guidelines highlighted a wide range of problems concerning visualization of large vessel lesions in SV, resultant from a systematic analysis of up-to-date scientific achievements and clinical experience. The intent of this publication is to summarize the potential of available imaging modalities for patients with large vessel SV in the context of main provisions in the EULAR guidelines and discuss some controversial issues

Systemic corticosteroids are continued to be administered in juvenile idiopathic arthritis (JIA) patients, especially in systemic JIA (sJIA), despite the ability of biologic therapy. One of the complications of long-term CS treatment is delayed hip arthritis development with risk of secondary hip osteoarthritis formation and total hip arthroplasty (THA).
We compared different types of hip joint lesions in JIA, especially, secondary hip osteoarthritis development and THA rates in systemic and non-systemic JIA, and evaluate systemic corticosteroids contribution to those complications.
The study included 753 JIA patients. They were divided into 2 groups: patients with sJIA and non-systemic JIA (nsJIA). Clinical and demographic characteristics, CS treatment regimens were compared.
Results. Hip arthritis was found equally often in both groups, but both secondary hip osteoarthritis (19% vs 5,3%) and THA (8.6% vs 1.6%) prevailed in the sJIA. Patients with sJIA had delayed hip involvement (57.9% vs 30.6%; p=0.019), earlier secondary hip osteoarthritis development (4.5 vs 5.1 years after the JIA onset) with younger age of secondary hip osteoarthritis achievement (13.7 vs 15.2 years; р=0.045), they also had higher inflammatory activity, greater systemic corticosteroids administration (94.8% vs 56.1%; р=0.0000001) and higher cumulative systemic corticosteroids dose (3085 mg vs 2000 mg; p=0,005). More than half patients (56.1%) with nsJIA had systemic corticosteroids treatment and impaired calcium-phosphorus metabolism.
Conclusion. Systemic corticosteroid treatment and delayed hip involvement are independent predictors of secondary hip osteoarthritis in all JIA categories. Calcium and phosphate metabolism disturbances are additional predictor for secondary hip osteoarthritis in non-systemic JIA categories

Intra-articular injections of glucocorticoids are widely used in the complex therapy of rheumatic diseases (RD). However, there is insufficient data on their effectiveness and safety in real clinical practice.
The aim of the study – to evaluate the effectiveness of intra-articular injections of glucocorticoids in rheumatic diseases in real clinical practice.
Material and methods. The study group consisted of 290 patients with RD, mainly osteoarthritis (OA) and rheumatoid arthritis (RA) (69.0% – women; age – 55.6±12.6 years), who underwent intra-articular injections of glucocorticoids in the knee joint. Indications for intra-articular injections of glucocorticoids were determined by the attending physicians. The control group consisted of 112 patients with OA (71.4% – women; age 59.3±14.6 years) who underwent a course of intra-articular injections of hyaluronic acid. The result of treatment was evaluated in 2 weeks, 1 and 3 months according to a telephone survey.
Result. After 2 weeks, 1 month and 3 months after the intra-articular injections of glucocorticoids, the severity of pain during movement decreased (numerical rating scale (NRS) 0–10; Me [25%; 75%]) from 6.0 [4.0; 8.0] to 1,0 [0; 2,0], 2,0 [1,0; 4,0] and 2.5 [1.0; 4.0] respectively (p<0.001). After 3 months, the number of patients with no pain or mild pain (<4 NRS) was 63.8%, with complete/almost complete absence of pain (≤1 NRS) – 30.3%. The effect of intraarticular injections of glucocorticoids was higher in RA than in OA: pain dynamics after 3 months –4.0 [–2.0; –6.0] and –2.0 [–1.0; –5.0] respectively (p=0.003). In OA, the effect of intra-articular injections of glucocorticoids and of hyaluronic acid did not differ: the dynamics of pain after 3 months was –2.0 [–1.0; –5.0] and –3.0 [–1.0; –5.0] respectively (p=0.869). No serious adverse reactions were noted at intra-articular injections of glucocorticoids.
Conclusions. Intra-articular injections of glucocorticoids are an effective and fairly safe method of short-term treatment of synovitis in rheumatic diseases.

Hematidrosis is a rare disease. Isolated cases are described in the literature, which makes it impossible to study the etiology and pathogenesis of the disease. The most convincing are the assumptions about the role of emotional stress in the clinical manifestations of the disease. The author presents his own 2-year observation of a girl who periodically had bleeding from the nose and ear canal.