Systemic lupus erythematosus (SLE) is a systemic autoimmune rheumatic disease of unknown etiology, characterized by hyperproduction of non-organ-specific autoantibodies to various components of the cell nucleus and the development of immune-inflammatory damage to internal organs. Currently, SLE is considered as a prototype of a systemic human autoimmune pathology, the central mechanism of immunopathogenesis of which is a violation of immunological tolerance to self-antigens, due to a complex interaction of genetic, epigenetic, environmental factors. The publication discusses the history of the study of SLE, the contribution of Russian scientists (V.A. Nasonova and others) to the study of th is problem, current trends in clinical and scientific research related to the improvement of diagnostic criteria and pharmacotherapy of this disease. 

Objective – to describe the course of COVID-19 and its effect on ankylosing spondylitis (AS) activity in women infected with SARS-CoV-2 during pregnancy and within one 1 year after childbirth.

Material and methods. 78 pregnant women with confirmed AS (modified New York criteria, 1984) were included for prospective observation. In the course of the COVID-19 pandemic (03.2020 – 04.2022) 26 of them were followed during pregnancy and 22 within maximum 12 months after childbirth. The average age of pregnant patients was 33.0±3.9 years, the duration of the disease was 117.0±72.0 months. The average age of patients after delivery was 31.5±4.3 years. The activity according to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in the 1st, 2nd and 3rd trimester of pregnancy was 2.0±1.4, 2.0±1.4 and 1.9±1.5. The activity according to BASDAI at 1, 6 and 12 months after delivery was 2.0±1.3, 2.2±1.3 and 2.5±2.0 respectively.

Results. 4 women were COVID-positive: 3 of them at the beginning of 3rd trimester, 1 – on the 38th week of pregnancy. In 3 cases, the activity of AS was low, in one – high due to axial manifestations and arthritis. In 3 women, the course of COVID-19 was mild, in one – moderate (febrile temperature for more than 3 days); only 1 woman had a dry cough. One pregnant woman canceled AS therapy (certolizumab pegol (CZP)), against which the back pain of the inflammatory rhythm increased. In other cases, AS therapy was not canceled, there was no effect of COVID on AS activity.

Within one year after delivery 5 women were COVID-positive. At the time of infection, AS activity in all patients was low, 3 women received CZP. In all cases, COVID proceeded with febrile fever for at least 1 day, while general symptoms disappeared within a maximum of 7 days. Only 1 woman had a dry cough. No effect of COVID on AS activity was found, including in 2 patients who canceled CZP. None of the patients were vaccinated against COVID.

Conclusion. According to preliminary data, COVID in pregnant women with AS is to be characterized by a mild to moderate course. During pregnancy, against the background of ongoing therapy, there was no increase in AS activity. During lactation, there was also no effect of COVID on the initially low AS activity. One of the main symptoms of COVID during lactation was a febrile fever, regardless of the period between the childbirth and infection.

Coronavirus disease 2019 (COVID-19) can manifest with a wide range of extrapulmonary symptoms and have longterm consequences (so-called post-covid syndrome (PCS) or “long COVID-19”). Manifestations of PCS show a wide clinical spectrum and include cardiac, pulmonary, neurological, gastrointestinal, dermatological, mental symptoms, vascular thrombosis and avascular necrosis (AVN) of the bones.

We present our own observations of the development of bone’s AVN in 3 patients who underwent COVID-19 with bilateral lung disease, in whom after 4–6 months the first signs of AVN were noted and characterized by a progressive multifocal lesion, which was accompanied by an increase of C-reactive protein concentration.

The pathogenetic mechanisms of AVN development in the framework of PCS are discussed. The importance of conservative and surgical methods in the treatment of the disease are considered. Since the development of AVN of various localizations with a long latent period is possible after COVID-19, long-term monitoring of patients is required. Further study of the problem of PCS in general and AVN in particular is required. 

One of the main tasks of modern complex therapy of rheumatoid arthritis (RA) is to improve the quality of life of patients. To do this, it is necessary not only to achieve remission or low activity, but also to successfully control the main, most painful, manifestations of the disease. Therefore, when evaluating the results of RA treatment, the dynamics of not only standard indices (DAS28 (Disease Activity Score 28), CDAI (Clinical Disease Activity Index), SDAI (Simplified Disease Activity Index)), but also the so-called “patient reported outcomes” (PRO) – a patient’s global assessment of disease activity (PGA), pain, functional disorders and fatigue.

This review examines the effect of one of the main classes of anti–rheumatic drugs - biological disease-modifying antirheumatic drugs (bDMARDs) on the PROs. The results of a series of randomized controlled trials are presented, in which changes in PROs were studied using various tumor necrosis factor α (TNF-α) inhibitors, abatacept T-lymphocyte co-stimulation inhibitor, rituximab CD20 inhibitor and interleukin (IL) 6 inhibitors.

The use of bDMARDs in combination with methotrexate (MTX) provides a reduction in PGA and pain by 50-60%, functional disorders according to HAQ (Health Assessment Questionnaire) and fatigue according to FACIT-F (Functional Assessment of Chronic Illness Therapy – Fatigue) – by 15-30%. B DMARDs monotherapy (with the exception of the effect of tocilizumab on HAQ) does not exceed MTX monotherapy in its effect on PROs. Monotherapy with tocilizumab provides more favorable dynamics of PGA and pain than monotherapy with TNF-α inhibitors. An important advantage of IL-6 inhibitors is the rapid achievement of a clinical effect, which is noted already in the first 2 weeks after the first administration of the drug. 

Psychic trauma received in childhood is a common phenomenon that causes damage to the child’s body that hasn’t been fully formed. Severe traumatic events in childhood disrupt the development of regulatory systems, which can lead to the occurrence of many diseases and disorders: increased risk of developing mental disorders, rheumatic, cardiovascular and oncological diseases, and reduced life expectancy. This article discusses the pathogenetic aspects of the influence of psychotraumas experienced in childhood on the occurrence of systemic inflammation and, as a result, the development of mental disorders and rheumatic diseases in adults. 

Сlinical, immunological and genetic differences between patients with early and late onset psoriasis are reported. Comparative studies of clinical characteristics of psoriatic arthritis according to age of psoriasis onset (skin manifestation) are lacking.

Aim – to compare the prevalence and clinical characteristics of psoriatic arthritis depending on age of psoriasis onset (skin manifestation) in patients included to the psoriasis patient registry of Russian Society of Dermatovenereologists and Cosmetologists.

Materials and methods. Prevalence of psoriatic arthritis in 3,227 patients with psoriasis aged 18 years and older was calculated. Comparison of the clinical characteristics of psoriatic arthritis according to the age of onset of psoriasis was performed on 916 patients with psoriasis and psoriatic arthritis.

The U-test was used to compare quantitative variables. To identify the association between qualitative variables, the χ2 test was used; odds ratio and 95% confidence interval were calculated, unadjusted and adjusted for other independent variables.

Results. In the majority of patients (73%), psoriasis manifested before the age of 40. Psoriatic arthritis at the time of inclusion to the registry was diagnosed in 31.7% of patients with early onset psoriasis and in 19.5% of patients with late onset psoriasis (p=0.0005).

The odds of having psoriatic arthritis were almost two times lower in patients with late onset psoriasis (p=0.0005). When adjusted for sex and age, the odds of having psoriatic arthritis among patients with late onset psoriasis became 4 times lower than in patients with early onset psoriasis (p=0.0005). However, when adjusted for sex and duration of psoriasis, the odds ratio lost its statistical significance.

The axial involvement (32.1% vs 20.5%; p=0.003) and the involvement of foot joints (59.7% vs 51.5%; p=0.048) was more likely in patients with early onset psoriasis. The odds ratio for axial involvement was still statistically significant when adjusted for other independent variables.

Conclusions. Age of onset of psoriasis before 40 years of age is associated with more frequent axial involvement in psoriatic arthritis.

Background. Systemic sclerosis-related interstitial lung disease (SSc-ILD) is the leading cause of death in SSc. Predictors of the outcomes of ILD in SSc are under investigation.

Objective – to assess association of the digital ulcers with dynamics of forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLco) in patients with SSc-ILD.

Methods. It was a longitudinal study involving 77 pts with SSc-ILD (mean age was 46±13.2; 69% have limited subset of the disease; 93% were female). The mean duration of follow up was 58.9±11.3 months. At the end of the study a number of pts with digital ulcers (DUs) was 27 (35%). Additionally 77 pts with SSc-ILD were investigated with HRCT and were divided into 3 groups; The group 1 (16 pts) with improvement; group 2 (39 pts) without any changes and group 3 (22 pts) with worsening of fibrosis. PFT (measurement of forced vital capacity (FVC) and diffusion lung capacity (DLco)) were made.

Results. 27 (35%) pts with SSc-ILD had DUs at the end of the study. The most pts with DUs was in groups 2 and 3 (14 and 9) accordingly at the end of the study. After 5 years of follow up FVC increased significantly in all pts without DUs (n=54) from 88.5±19 to 96±23% (p<0.05); in group 1 – from 92±20.5 to 106±19% (p><0.05); in group 2 – from 87±18 to 94±23.5% (p><0.05) and only in group 3 FVC was stable (88±22 and 87±24.5%) (p>0.05). The mean value of FVC in all pts with DUs didn’t change (88±14 and 86±16%; p>0.05) with tendency to decreasing in group 3 (from 83±12.5 to 74±13%; p>0.05). After 5 years of follow up DLco declined significantly in all pts with or without DUs, however in the 1st group decline of DLco wasn’t significant. The decreasing of DLCO was more prominent in group 3 than in group 2. Therefore, in group 2 in patient without DU (n=24) – from 65±16 to 60±11% (p<0.05) and in patients with DU (n=14) DLCO changed from 61±15 to 57±14% (p><0.05). In group 3 in patients without DU (n=13) DLCO decreased from 55±15 to 48±15% (p><0.05) and in patients with DU (n=9) – from 50±20 to 44.5±15% (p><0.05). Conclusions. In patients without DUs significant increasing of FVC during 5 years long follow up was observed. The worsening of fibrosis on HRCT in pts with DUs was associated with the lowest value of FVC and DLco at the entry and at the end of the study. Key words: systemic sclerosis, interstitial lung disease, digital ulcers>˂ 0.05) and in patients with DU (n=14) DLCO changed from 61±15 to 57±14% (p 0.05). In group 3 in patients without DU (n=13) DLCO decreased from 55±15 to 48±15% (p˂ 0.05) and in patients with DU (n=9) – from 50±20 to 44.5±15% (p˂ 0.05).

Conclusions. In patients without DUs significant increasing of FVC during 5 years long follow up was observed. The worsening of fibrosis on HRCT in pts with DUs was associated with the lowest value of FVC and DLco at the entry and at the end of the study. 

Actuality. Data on the prevalence of comorbid infections (CI) in patients with spondyloarthritis (SpA) are few. Risk factors for CI has not been sufficiently studied.

Objective. To evaluate the frequency of comorbid infections in patients with spondyloarthritis treated with biological drugs in the form of monotherapy or in combination with DMARD and/or GC.

Subjects and methods. The study included 93 patients (55 men, 38 women; average age – 37.0±11.5 years). In 59 patients, AS was diagnosed, in 32 – PsA, in 2 – undifferentiated SpA and SpA associated with nonspecific ulcerative colitis. All patients received biological drugs in combination with DMARD and/or GC or without them. The patients were interviewed by a research doctor with fi lling out a unified questionnaire. Additional information was obtained from medical records.

Results. The leading place in the structure of CI was occupied by respiratory tract infections and ENT organs, the 2nd place belonged to herpes viral infections, the 3rd to mycotic infection. Serious CI (SCI) were also represented mainly by injections of respiratory tract infections and ENT organs. A tendency to an increase in the frequency of pneumonia, tuberculosis, acute bronchitis, skin infections, genital organs and mycoses against the background of SpA compared to the period preceding the development of the disease (no significant differences were found) was revealed. 69% of patients noted a more severe course of previously observed CI. 47 patients reported the temporary cancellation of therapy due to the development of CI. 49% of patients have documented exacerbation of SpA. The number of cases of SCI against the background of SpA doubled (p=0.03). There was a positive correlation between the intake of GC and the development of mycoses (r=0.216; p=0.04); between the duration of taking GC and the development of eye infections (r=0.385; p=0.01); between the duration of taking methotrexate and the development of tonsillitis (r=0.25; p=0.03); between taking interleukin 12/23 inhibitors and the development of tonsillitis (r=0.261; p=0.01); between the duration of taking tumor necrosis factor α inhibitors (iTNF-α) and the development of otitis (r=0.287; p=0.01); between the number of consistently used iTNF-α and the development of otitis (r=0.273; p=0.02).

Conclusion. The data obtained indicate the relevance of the problem of CI in SpA. Further studies are needed on a larger cohort of patients with an assessment of the effect of therapy on the incidence of CI and the search for risk factors for CI. 

Aim – to investigate relationship of trabecular bone score (TBS) with activity and structural progression of ankylosing spondylitis (AS) in males younger than 50 years old without osteoporosis.

Materials and methods. 26 male AS patients took part in the investigation. AS activity was evaluated by BASDAI and ASDAS-CRP indices, and highly sensitive C-reactive protein level. Structural AS progression was evaluated by sacroiliitis (SI). TBS was evaluated using the double-energy X-ray absoptiometry. Correlation between clinical measures and TBS was obtained using the Spearman r-criterion for quantitative variables and Kendall’s τ coefficientfor qualitative variables.

Results. There was obtained no correlation between AS activity and TBS. Among clinical characteristics, SI stage was negatively correlated with TBS (τ=–0.313; p<0.05). Conclusion. TBS is associated with the severity of sacroiliitis in young AS male patients. Key words: ankylosing spondylitis, trabecular bone score, structural progression>˂ 0.05).

Conclusion. TBS is associated with the severity of sacroiliitis in young AS male patients. 

Objective: to evaluate clinical and instrumental characteristics of axial lesion in psoriatic arthritis (PsA) in real-life clinical practice.

Subjects and methods. Examination were made in 52 patients (32 men and 20 women) with back pain recorded either at the time of their admission or in their medical histories. The inflammatory back pain (IBP) was diagnosed according to the Assessment of SpondyloArthritis international Society (ASAS) criteria. Back pain lasting over three months without meeting the ASAS criteria was taken to be chronic back (chrBP). Hands, feet, pelvis, cervical spine (CSP) and lumbar spine (LSP) were X-rayed. Erosions, osteolysis, and periarticular osteo-proliferative lesions were evaluated applying PsA-modified Sharp/van der Heijde score (SHS). Sacroiliitis (SI) was considered radiologically significant (r-sSI) when it was bilateral grade II or higher, or unilateral grade III or higher by Kellgren. 15 patients without r-sSI had their sacroiliac joints (SIJs) scanned using magnetic resonance imaging (MRI). Syndesmophytes, paravertebral ossifications, constriction and ankylosis of the CSP zygapophysial joints were considered to be radiological signs of psoriatic spondylitis. HLA-B27 typing was performed in 45 patients.

Results and discussion. IBP was identified in 34 (66.7%), chrBP in 17 (33.3%) patients; 15 patients (28.8%) were of advanced age (over 40) at the onset of IBP/chrBP; 30 cases (57.7%) had r-sSI; in 18 cases SI was not detected. 13 out of 30 r-sSI patients (43.3%) didn’t suffer IBP. Erosions were detected in 38 (76%) patients, osteolysis in 13 (26%) and osteo-proliferative lesions in 18 (36%) patients. Average SHS was 82.79±64.77 correlating with the presence of r-sSI (r=0,46; p<0,05). Correlation of r=0.35 was found between r-sSI and the spine limited mobility according to Bath Ankylosing Spondylitis Metrology Index (BASMI); r-sSI was detected with much higher statistical significance in the presence of periarticular osteo-proliferative lesions than in the absence of such (р=0.02). In PsA patients having periarticular osteolysis, axial lesion in the form of asymmetric syndesmophytes was detected ten times more frequently than in those not having it (OR=10; 95% CI: 1.63–61.327). In CSP, syndesmophytes developed two times more frequently than in LSP (p=0.01). Discrete CSP lesions in the absence of any LSP changes was observed in 30% of cases. SI was MRI detected in 2 (13.3%) patients. In 9 (18.0%) patients axial lesions were observed without SI. 15 patients (33.3%) were HLA-B27 positive. A set of specific PsA axial skeletal involvement features were revealed: possibility of oligosymptomatic clinical presentation; patient’s advanced age at the back pain onset; association with severe destructive peripheral arthritis; and more pronounced CSP lesions as compared to LSP. An alternative phenotype patient group (18%) without X-ray or MRI SI but with spine involvement was identified. Key words: psoriatic arthritis; axial lesion>˂ 0,05). Correlation of r=0.35 was found between r-sSI and the spine limited mobility according to Bath Ankylosing Spondylitis Metrology Index (BASMI); r-sSI was detected with much higher statistical significance in the presence of periarticular osteo-proliferative lesions than in the absence of such (р=0.02). In PsA patients having periarticular osteolysis, axial lesion in the form of asymmetric syndesmophytes was detected ten times more frequently than in those not having it (OR=10; 95% CI: 1.63–61.327). In CSP, syndesmophytes developed two times more frequently than in LSP (p=0.01). Discrete CSP lesions in the absence of any LSP changes was observed in 30% of cases. SI was MRI detected in 2 (13.3%) patients. In 9 (18.0%) patients axial lesions were observed without SI. 15 patients (33.3%) were HLA-B27 positive. A set of specific PsA axial skeletal involvement features were revealed: possibility of oligosymptomatic clinical presentation; patient’s advanced age at the back pain onset; association with severe destructive peripheral arthritis; and more pronounced CSP lesions as compared to LSP. An alternative phenotype patient group (18%) without X-ray or MRI SI but with spine involvement was identified. 

Objective: to evaluate the role of monitoring the level of matrix metalloproteinase 3 (MMP-3) in patients with rheumatoid arthritis (RA) during anti-B-cell therapy.

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 MMP-3 in serum was measured by enzyme immunoassay using a kit of reagents from Invitrogen (USA).

Results. The level of MMP-3 in patients with RA was significantly higher than in healthy donors, its median was 42.9 [10.0; 110.7] and 7.8 [5.5; 11.8] ng/ml, respectively (p<0.05). 12 and 24 weeks after the first infusion of the original RTM, there was a statistically significant decrease in the concentration of MMP-3, amounting to 80% of the initial level. Against the background of the use of the RTM biosimilar, after 12 and 24 weeks, a statistically significant decrease in the concentration of MMP-3 was observed, which was 46.8 and 59% of the basal level, respectively. According to the ROC analysis, it was found that the basal level of IL-6 more than 100.0 pg/ ml and the level of MMP-3 more than 78.6 ng/ml were associated with the preservation of inflammatory activity by the 24th week of therapy with the RTM biosimilar with a sensitivity of 85% and 57% and a specificity of 62% and 61.5%, respectively. Conclusion. Determining the level of MMP-3 in patients receiving anti-B-cell therapy is important for a more objective assessment of disease activity and predicting the effectiveness of treatment. Key words: rheumatoid arthritis, matrix metalloproteinase 3, anti-B-cell therapy, rituximab biosimilar>˂ 0.05). 12 and 24 weeks after the first infusion of the original RTM, there was a statistically significant decrease in the concentration of MMP-3, amounting to 80% of the initial level. Against the background of the use of the RTM biosimilar, after 12 and 24 weeks, a statistically significant decrease in the concentration of MMP-3 was observed, which was 46.8 and 59% of the basal level, respectively. According to the ROC analysis, it was found that the basal level of IL-6 more than 100.0 pg/ ml and the level of MMP-3 more than 78.6 ng/ml were associated with the preservation of inflammatory activity by the 24th week of therapy with the RTM biosimilar with a sensitivity of 85% and 57% and a specificity of 62% and 61.5%, respectively.

Conclusion. Determining the level of MMP-3 in patients receiving anti-B-cell therapy is important for a more objective assessment of disease activity and predicting the effectiveness of treatment. 

Currently, the list of microorganisms that have a possible connection with the development of rheumatoid arthritis continues to be updated. The role of not only traditional pathogens, but also representatives of conditionally pathogenic microflora is being actively studied. A number of domestic and foreign works demonstrate a high degree of Helicobacter pylori infection in patients with rheumatic diseases, including rheumatoid arthritis.

The aim of the present study is to identify the frequency of detection of Helicobacter pylori infection in patients with rheumatoid arthritis and in adult residents of the city of Tula.

Material and methods. The study included 3288 residents of Tula who do not have rheumatic diseases, and 119 patients with rheumatoid arthritis. To detect the infection, FEGDS was performed according to the generally accepted method with the taking of biopsies of the mucous membrane of the antrum and the stomach body, followed by verification of Helicobacter pylori using the Helpil-test test system.

Results. According to the results of the data on the infection rate of residents of Tula without rheumatic diseases (n=3288), the largest percentage of infected (78.8%) was detected by an invasive method – express diagnosis of urease activity of the biopsy. The detection rate using a respiratory ammonia test and serological method was lower and amounted to 51.1 and 49.3%, respectively. In total, H. pylori was detected in 1692 people, which was 51.46%. Among patients with rheumatoid arthritis, Helicobacter pylori infection was 81.5%. Signs of damage to the mucous membrane of the upper gastrointestinal tract were often detected: superficial and subatrophic gastritis, single erosions.

Conclusions. 1. Based on the study, it was found that the infection rate of Helicobacter pylori in patients with rheumatoid arthritis is at a fairly high level, not significantly different from that in residents without rheumatic diseases, when examined by an invasive method – express diagnosis of urease activity of the biopsy (81.5% and 78.8%, respectively). 2. Among patients with rheumatoid arthritis, there was a tendency to increase the frequency of infection with age and peak values in older age groups (r=0.37; p<0.05). 3. The frequency of detection of erosive and ulcerative lesions of the gastrointestinal tract in infected and uninfected Helicobacter pylori patients with rheumatoid arthritis significantly differed (42.2 and 13.6%) (p=0.03). Key words: Tula population, rheumatoid arthritis, Helicobacter pylori infection>˂ 0.05). 3. The frequency of detection of erosive and ulcerative lesions of the gastrointestinal tract in infected and uninfected Helicobacter pylori patients with rheumatoid arthritis significantly differed (42.2 and 13.6%) (p=0.03). 

Aim – to identify the frequency of isolated and combined pathological phenotypes of body composition in women with rheumatic diseases and to determine the factors associated with the sarcopenic phenotype.

Materials and methods. 255 women (median age 60 [54; 64] years) were included in the study: 114 patients with rheumatoid arthritis (RA), 46 – with systemic sclerosis (SSc), 56 – with osteoarthritis (OA), and 39 persons without rheumatic diseases (control). Questionnaires, anthropometric measurements, double-energy X-ray absorptiometry of the whole body, lumbar spine and proximal femur were performed. The assessment of the factors associated with the sarcopenic phenotype was carried out using a univariate regression analysis.

Results. The frequency of isolated and combined pathological phenotypes in women with SSc was 34.8% and 52.2%, with RA – 51.8% and 38.6%, with OA – 71.4% and 10.7%, respectively. The sarcopenic phenotype was more often determined in patients with SSc (43.5%) and RA (29.8%) compared with women with OA (1.8%) (p<0.001). The factors associated with the sarcopenic phenotype were BMI><25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96]; p><0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001). The factors associated with the sarcopenic phenotype were BMI<25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96];>˂ 25 kg/m² (OR=7.89 [95% CI: 3.90–15.96]; p<0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p<0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).>˂ 0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).

Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI<25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 25 kg/m², GC using, the presence of OP and insufficiency of calcium intake. 

According to modern concepts, myocarditis is an inflammatory disease of the myocardium, diagnosed on the basis of generally accepted histological, immunological, immunohistochemical criteria. Previously, most researchers believed that the most common cardiac extra-articular manifestation of rheumatoid arthritis (RA) is pericarditis. In the last decade, using magnetic resonance imaging (MRI) of the heart, it turned out that myocarditis in patients with rheumatoid arthritis is not a rare manifestation of the disease. Recently, there is increasing evidence that inflammatory cytokines in RA can also directly cause chronic myocardial damage, further contributing to the development of chronic heart failure (CHF). In our clinical case, myocarditis developed in a patient with active refractory rheumatoid arthritis. The myocardial lesion in the patient was characterized by pronounced echocardiographic signs of restrictive cardiomyopathy, a significant decrease in the ejection fraction with the development of heart failure, various rhythm disturbances in combination with acute renal dysfunction, which led to the formation of cardiorenal syndrome (CRS). Complete regression of myocarditis and cattle occurred precisely against the background of effective treatment of refractory rheumatoid arthritis (RA) with basic antirheumatic drugs and the successful use of biological therapy.