In rheumatology, the problem of infectious pathology is quite acute. This is primarily due to the participation of various infectious agents in the development of immuno-inflammatory rheumatic diseases (IIRD), in which microorganisms play a trigger role, triggering the immunopathological mechanisms of inflammation. Vivid examples of such diseases are acute rheumatic fever and reactive arthritis. The infectious etiology of Lyme disease has been proven. An equally difficult task is the fight against comorbid infection (CI), which often complicates the course of many IIRD due to a violation of the immune status caused by both the background disease and the use of immunosuppressive drugs. The predominance of respiratory tract lesions in the structure of CI in patients with IIRD makes it necessary to use influenza and pneumococcal vaccines in them, since the risk of deaths from these infections among these patients is quite high. During the development of the COVID-19 pandemic, which has become a challenge to all mankind, a large number of new fundamental and medical problems have been revealed concerning the relationship between viral infection and many widespread chronic non-communicable diseases, among which IIRDs occupy an important position. As one of the methods of combating the current COVID-19 pandemic, great hopes are pinned on the widespread use of vaccination. The possibility of using mo noclonal antibodies for pre-exposure prophylaxis of COVID-19, including in patients with IIRD, is discussed.

At the present stage of development of rheumatology, much attention is paid to the problem of comorbid infections, which have a significant impact on mortality and mortality, especially in immuno-inflammatory rheumatic diseases (IIRD). The active introduction into clinical practice of innovative drugs, the action of which is aimed at specific components of the pathogenesis of IIRD, has led to an increase in the risk of developing infections of various nature and localization, including chronic and opportunistic (COI). This article analyzes the recommendations for screening and prevention of COI in adult patients with acute respiratory infections, proposed in November 2022 by experts of the European Alliance of Rheumatology Associations (EULAR). It is noted that these recommendations should be considered through the prism of national guidelines that take into account regional risk factors, features of the course, diagnosis, therapy and prevention of СOI. At the same time, it seems absolutely justified to periodically review screening and preventive procedures as new scientific data accumulate. Despite the importance of a multidisciplinary approach and the need for close cooperation with doctors of other specialties, the EULAR working group emphasizes the central role of a rheumatologist in the management of patients with HOI that occur against the background of IIRD and are associated with the received anti-rheumatic therapy.

The COVID-19 pandemic has significantly changed the understanding of the safety profile of therapies for immunoinflammatory rheumatic diseases (IRDs). This is primarily due to the negative impact of a number of basic anti-inflammatory drugs (DMARDs) and biological DMARDs on the course and outcomes of a new coronavirus infection. A number of studies have shown that anti-B-cell therapy (rituximab) gave a statistically significant increase in the risk of severe COVID-19 and an increase in mortality. At the same time, the analysis of real clinical practice data dictated the need to establish a number of restrictions on the use of certain classes of biological DMARDs and to search for alternative therapy programs to maintain control over disease activity.
Purpose of the study – to evaluate the efficacy and safety of the drug Artlegia® (olokizumab), solution for subcuta neous injection, 160 mg/ml – 0.4 ml, manufactured by R-Pharm JSC, Russia) for the treatment of patients with rheuma toid arthritis in real clinical practice after switching with rituximab during the COVID-19 pandemic.
Materials and methods. The study included 14 patients with a confirmed diagnosis of rheumatoid arthritis (RA), who were previously on rituximab therapy at a dose of 1000–500 mg twice with an interval of 2 weeks, who received at least one course of therapy with this drug. As RA worsened, patients were switched to olokizumab against the background of standard DMARDs. At 4, 8, 12 weeks after the switch, the severity of pain was assessed on the VAS scale, the number of painful and swollen joints (TJC28 and TSC28), the level of acute phase markers of inflammation, the DAS28 disease activity index calculated using ESR and CRP, and the CDAI (clinical activity index), functional state index HAQ, as well as assessment of the safety profile of therapy.
Results. Data analysis was performed using median values (Me) were used for data analysis. A significant decrease of TJC28 was after the injection of olokizumab (Artlegia®) in 8 and 12 weeks (Me baseline = 10; Me 8 weeks = 4; Me 12 weeks = 4; p<0.05) and a decrease of TSC28 in 4, 8 and 12 weeks (Me baseline = 9; Me 4 weeks = 3.5; Me 8 weeks = 2.5; Me 12 weeks = 2.0; p<0.05). Laboratory markers of inflammation showed a decrease in CRP and ESR levels after 4 weeks of treatment (CRP: Me baseline = 21, Me 4 weeks = 1 (p<0.05); ESR: Me baseline = 31, Me 4 weeks = 7 (p<0.05)). Positive dynamics persisted at 8 and 12 weeks (CRP: Me 8 weeks = 1, Me 12 weeks = 0; ESR: Me 8 weeks = 4, Me 12 weeks = 5). The level of CRP by the fourth week 4 became within the normal range, regardless of the initial values. All activity indices improved from the fourth week in each evaluation period compared to baseline: DAS28-ESR: Me baseline = 5.52, Me 4 weeks = 3.59, Me 8 weeks = 3.33, Me 12 weeks = 3.22 (p<0.05); DAS28-CRP: Me baseline = 5.39, Me 4 weeks = 3.71, Me 8 weeks = 3.35, Me 12 weeks = 3.45 (p<0.05); CDAI: Me baseline = 28.5, Me 4 weeks = 18.0, Me 8 weeks = 16.5, Me 12 weeks = 16.0 (p<0.05). All patients showed a reduction in pain (VAS scale) by week 8. The functional status of patients, according to the HAQ index, showed a significant decrease only by the 12th week of the study: Me baseline = 1.62, Me 12 weeks = 1.31 (p<0.05).
Conclusion. The study found that switching from rituximab to olokizumab was effective and safe during the COVID-19 pandemic.

The impact of the transferred coronavirus infection on the musculoskeletal system still remains an urgent problem. Аrthralgia, myalgia, arthritis, autoimmune disorders and also osteonecrosis are may be development of the postCOVID period. This article discusses the case of the debut of multifocal osteonecrosis after a coronavirus infection.

Patients with ANCA-associated vasculitis (AAV) cause extreme alertness during the coronavirus disease 2019 (COVID-19) pandemic, associated with many factors: the initial damage to the respiratory system (upper respiratory tract, lungs) and kidneys, immunosuppressive treatments, difficult prognosis of COVID-19 with the risk of AAV exacerbation. We present a clinical case of а moderate COVID-19 in a patient with granulomatosis with polyangiitis, who received anti-B cell therapy with rituximab (RTX) for a long time. Coronavirus pneumonia developed one year after RTX, while B-lymphocyte depletion persisted. In order to achieve an adequate antiviral immune response and prevent hyperinflammation, treatment was carried out with antiviral drugs, anticoagulants, convalescent plasma, human normal immunoglobulin, and interleukin-6 antagonist tocilizumab. Possible predictors of severe COVID-19 in patients with AAV are discussed.

Pericarditis, a clinical syndrome characterized by inflammation and thickening of the pericardium, is one of the most common forms of inflammatory diseases of the cardiovascular system. The most common and severe complication of acute pericarditis is idiopathic recurrent pericarditis (IRP), which has a poor prognosis associated with the risk of cardiac tamponade and constrictive pericarditis. The pathogenesis of pericarditis is associated with a complex interaction of environmental factors, genetic predisposition, and pathological activation of innate and acquired immunity. Autoinflammatory mechanisms associated with hyperproduction of interleukin (IL) 1 attract particular attention. Standard therapy for pericarditis includes non-steroidal antiinflammatory drugs, colchicine, glucocorticoids, and immunosuppressive drugs. A new direction in the pharmacotherapy of pericarditis is associated with the use of Anakinra (a recombinant non-glycosylated analog of an IL-1 receptor antagonist), which blocks the signaling of IL-1β and IL-1α. The materials of numerous studies are summarized, indicating that Anakinra is an effective drug for the treatment of patients with IRI who are resistant to standard therapy. It is assumed that the wider use of Anakinra, especially in the early stages of pericarditis, will not only improve the prognosis, but also be important for the identification of the autoinflammatory phenotype of IRI and the development of personalized therapy programs.

Depending on the epitope specificity of antineutrophil cytoplasmic antibodies (ANCA) and the presence or absence of a granulomatous inflammation. Patients with ANCA-associated vasculitis (AAV) show variability in clinical manifestations and prognosis depending on the epitope specificity of ANCA and the presence or absence of granulomatous inflammation. In this regard, it is important to identify the clinical and immunological phenotypes of AAV and a personalized approach to treatment. Microscopic polyangiitis (MPA) with antibodies to myeloperoxidase (aMPO) has a relatively high incidence of lung involvement and pulmonary fibrosis. We present our own clinical case of pulmonary fibrosis in MPA with aMPO and rheumatoid factor. Literature data are discussed. In cases of early arthritis and interstitial pneumonia, the possibility of AAV should be considered, a detailed examination is necessary to identify pathognomonic signs of AAV, including asymptomatic ones. Before prescribing immunosuppressants, the epitope specificity of ANCA should be determined. Treatment with rituximab, mycophenolate mofetil and nintedanib is discussed.

The emergence of modern methods of treatment of systemic lupus erythematosus (SLE) has led to an increase in the duration and quality of life of patients with this disease. However, the majority of patients with SLE are women, and it is well known that the female sex hormone estrogen can influence the activity of systemic autoimmune diseases, including SLE. An increase in life expectancy means an increase in the length of a postmenopausal woman’s stay, with the possibility of the appearance of classic menopausal disorders, and the development or aggravation of comorbid pathologies, primarily osteoporosis and cardiovascular diseases, as well as the need to improve the quality of life for women with these diseases. This review collects and analyzes data on the risks and benefits of using menopausal hormone therapy for SLE.

Modern tactics for the treatment of rheumatoid arthritis is aimed at achieving remission or low activity of the disease, the maximum elimination of the manifestations of the disease and the restoration of physical and social activity of patients. At the same time, despite the wide range of the most modern pathogenetic agents, a good therapeutic response can’t be obtained in all cases. A difficult problem is the so-called rheumatoid arthritis RA (difficult to treat), in which two or more sequentially prescribed genetically engineered biological drugs or JAK inhibitors are ineffective. One of the important factors negatively affecting the outcome of RA treatment are functional disorders of the nociceptive system, such as peripheral and central sensitization. These phenomena, associated with persistent activation of nociceptive neurons and the development of nociplastic changes, are caused by systemic autoimmune inflammation and the influence of various cytokines and chemokines on the neuronal membrane. This review considers the molecular biological aspects of the formation of peripheral and central sensitization in RA, with a separate analysis of the pathogenetic role of individual interleukins.

Background. Previously, 24-week results of phase III double-blind, placebo-controlled randomized clinical study (SOLAR) of levilimab in subjects with active rheumatoid arthritis (RA) proved a superiority of levilimab over placebo. Here we present 1-year efficacy and safety data of the SOLAR study.
Objective – to evaluate the efficacy and safety of levilimab in combination with methotrexate (MTX) in subjects with MTX resistant active RA.
Methods. The study was conducted at 21 clinical sites in Russia and Belarus. All randomized subjects have completed the study between November 2019 and October 2021.
154 adults, aged ≥18 years with confirmed diagnosis of RA were randomly assigned (2:1) to receive either levilimab (162 mg, SC, QW) + MTX (n=102) or placebo + MTX (n=52).
After W24 of the study all subjects continued to receive open label levilimab. Subjects who have achieved DAS28-CRP≤2.6 at W24 were switched to maintenance (Q2W) regimen of levilimab at W28 (LVL QW/Q2W and PBO/LVL Q2W arms). Those with DAS28-CRP>2.6 at W28 continued with QW regimen (LVL QW and PBO/LVL QW arm). The PBO/LVL Q2W arm contained only one subject, thus not included in the analysis.
The efficacy analysis was done in a population of all randomized subjects. Those with missing data due to study discontinuation or rescue therapy prescription were considered non-responders. Otherwise, the analysis was performed on complete cases.
Safety was assessed through monitoring of adverse events (AEs) in a population of those, who received at least on dose of LVL (n=152).
Results. Better response to treatment was observed in LVL QW/Q2W as it composed of those who reach DAS28-CRP≤2.6 at W24. At this time point 15/27 (55.6%) of them achieved ACR70; 23/27 (85.2%) achieved DAS28-CRP remission (<2.6) and 7/27 (25.9%) achieved ACR/EULAR 2011 remission of RA. After switching to LVL Q2W, rates of ACR70 and DAS28-CRP<2.6 did not significantly changed until W52: 17/27 (63.0%) and 21/27 (77.8%), respectively, yet the proportion of subject with ACR/EULAR 2011 remission further increased and reached 12/27 (44.4%).
LVL QW arm was diminished by subjects who achieved high response to treatment at W24 and composed LVL QW/Q2W arm. Thus, ACR70, and remissions rate in this arm was close to zero at W24. However, continuation of LVL QW in those who not achieved DAS28-CRP≤2.6 at W24 induced ACR70 response in 37/75 (36.0%), DAS28-CRP remission in 35/75 (46.7%) and ACR/EULAR 2011 remission in 8/75 (10.7%) at W52.
The most common adverse events (reported in ≥5% of subjects) were blood cholesterol increase (30.3%), ALT increase (23.0%), lymphocyte count decrease (17.1%), ANC decrease (16.4%). blood triglycerides increase (13.8%), bilirubin increase (11.2%), AST increase (9.9%), WBC decrease (9.9%), IGRA with Mycobacterium tuberculosis antigen positive (7.2%) and injection site reactions (5.9%). No deaths were occurred.
Conclusions. Open label period confirmed the lasting efficacy and safety of levilimab in combination with MTX in subjects with MTX resistant active RA and suggested the possibility of switching to maintenance (Q2W) regimen in those who achieved remission of RA at week 24.

The relevance of the problem of immunoinflammatory rheumatic diseases (IIRD) for modern medicine is determined by their high prevalence in the population, the difficulty of early diagnosis, the rapid development of disability and poor life prognosis. Recent data on the significance of anti-DFS70 have opened up new possibilities for optimizing the step-by-step diagnosis of IIRD. The detection of these antibodies can help in the interpretation of a positive result for antinuclear antibodies (ANA) by indirect immunofluorescence assay on HEp-2 cells (IIFA-HEp-2) in the absence of autoantibodies specific for IIRD. Detection of anti-DFS70 in antinuclear factor (ANF) seropositive patients without clinical and/or serological markers characteristic of a certain disease from the IIRD group can be considered as a potential marker that excludes this group of diseases.

The aim of the study was to assess the incidence of arterial lesions of various localizations in patients with giant cell arteritis (GCA) according to positron emission and computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG).
Methods. Patients over 50 years of age diagnosed with GCA (with or without polymyalgia rheumatica) were included in a retrospective study. Damage to extracranial arteries was assessed based on the accumulation of 18F-FDG in the walls of large vessels according to PET/CT data.
Results. The study included 47 patients, 14 (30%) men and 33 (70%) women, with a median age of 65 [57; 68] years. In 32 (68%) patients, 18F-FDG-PET/CT was performed before the start of therapy with glucocorticosteroids (GCS), in 15 (32%) after the start of treatment. In 40 (91%) patients, signs of damage to extracranial vessels of various localization were revealed, most often in the thoracic and abdominal aorta (72% and 64%, respectively).
Conclusions. According to 18F-FDG-PET/CT data, in most patients with GCA, not only the arteries of the head and neck, but also vessels of other localization are involved in the pathological process.

The frequency and risk factors for the development of diastolic function in patients with calcium pyrophosphate crystal deposition disease (CPPD) and osteoarthritis (OA) have not been studied.
The aim – to determine the frequency and to identify risk factors (RF) for the development of diastolic dysfunction (DD) of the left (LV) and right (RV) ventricles in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis.
Material and methods. 26 patients (18–65 years) each were included with CPРD and with knee OA, matched in age and gender, without cardiovascular disease (CVD), type 2 diabetes mellitus, rheumatic diseases. Traditional risk factors of CVD were assessed, echocardiography was performed.
Results. The frequency of DD in patients with CPРD and OA was quite high and almost did not differ in both groups: it was detected in 19 patients, of which 11 (42%) with CPРD and 8 (31%) with OA (p=0.39). Type 1 LV DD was detected in 10 (39%) patients with CPРD and in 8 (31%) with OA (p=0.11); type 1 RV DD – in 8 (31%) patients with CPРD and in 7 (27%) patients with OA (p=0.17); type 1 LV DD and RV DD – in 7 (27%) patients with both CPРD and with OA. DD types 2 and 3 were not detected in both groups. There were no differences in both groups in CV risk factors, except for the level of C-reactive protein (CRP) – it was higher in CPРD (p=0.03). In the CPРD group, mean values of LV E/E′ (p=0.02), LV DT (p=0.03), LV MI (p=0.04) were significantly higher than in patients with OA. On the contrary, in patients with OA, the following indicators: EDV (p=0.004), TVC (p=0.02) were higher.
There were direct correlations between diastolic function indices and the following factors in CPРD: LVL, PWLV and PTH level (r=0.7; p<0.005), LV E′ and PTH level (r=0.7; p<0.005); inverse correlations – the level of PTH and IS (r=–0.5; p<0.005), LV MI (r=–0.5; p<0.005), the level of vitamin D and VD DT (r=–0.6; p<0.005). Direct correlations in OA: the level of CRP and PVAdiast (r=0.6; p<0.005), and the level of sUA (r=0.7; p<0.005), the level of vitamin D and E/E′ LV (r=0.6; p<0.005).
Conclusion. A high prevalence of LV and RV DD was found in patients with CPРD and OA. The presence of DD in CPРD was associated with lower vitamin D levels, and in OA with a higher level of sUA and a lower level of PTH.

Pain in the shoulder joint is one of the most common reasons for seeking medical help associated with the pathology of the musculoskeletal system. The most common disease in this area that causes chronic pain is impeachment syndrome (IS) of the rotator muscles of the shoulder. The domestic literature describes in sufficient detail surgical and conservative approaches for lesions of the shoulder joint, but there are only a few publications on the types of IS. This review is devoted to the description of all occurring types of compression of the tendons of the muscles of the rotator cuff of the shoulder joint within the framework of IS.

Interstitial lung disease associated with rheumatoid arthritis (RA-ILD) is one of the systemic manifestations of rheumatoid arthritis (RA) associated with high mortality. According to the latest data, the prevalence of RA-ILD is 3–4%. 26% of patients with RA-ILD develop a progressive interstitial lung disease (ILD) phenotype. To date, for the diagnosis of ILD, including in RA, the ultrasound method of research is being intensively introduced. Ultrasonography of the lungs is a useful adjunct to high-resolution computed tomography (HRCT) and an affordable aid for frequent use. The advantages of lung ultrasound are high information content, reproducibility, ease of use, speed of execution, prognostic value, absence of ionizing radiation. Identification of B-lines in various variants, an uneven, thickened, discontinuous pleural line, and/or delimited cortical consolidations in the form of hypoechoic small areas during ultrasound of the lungs in RA patients can help to promptly suspect ILD and send them to HRCT. The simple and uncomplicated research technology makes it attractive for monitoring the progression of pulmonary fibrosis. The use of ultrasound is necessary, in particular, in the presence of a progressive ILD phenotype, confirmed by HRCT, for conducting serial studies in order to monitor the progression of the disease.