The possibilities for diagnosing and treating gout have expanded significantly. However, this did not lead to solving the problem of timely diagnosis of gout, nor to improving control over it, nor to reducing mortality in patients with gout. In the article possible reasons of absence of the progress in gout control connected with the lack of usage of contemporary capabilities in diagnosis and mistakes in usage of drugs therapy is discussed. These should include the lack of conversance of medical stuff about sonography high informativity for gout diagnosis, low availability of polarizing microscopy and dual energy computer tomography; causeless ignore of prescribing prophylactic symptomatic therapy, usage of inadequate doses of drugs. Another reason may be the absence of unified concept regarding specific indications of prescribing urate-lowering drugs and choice of specific medicine.

Maintaining and strengthening the health of the population is one of the primary functions of society. Inadequate understanding of the importance of contraception by the medical community and its application by society can lead to the population’s reproductive health becoming compromised. Basic knowledge of effective and safe contraceptive methods is important for every rheumatologist, as reproductive health affects both the general condition of patients and the course of the main rheumatic diseases (RH). This is particularly true for patients with antiphospholipid antibody (aPL) positivity, antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). The presence of aPL/APS, as well as the activity of SLE, are the main factors determining the choice of contraceptive method and the risk of hormonal contraception in patients with RH. Meanwhile, the use of appropriate (highly effective and safe) contraceptive therapy in this category of patients allows not only to plan the birth of a child, but also to avoid unwanted pregnancy in cases of disease activity, the use of embryotoxic and teratogenic drugs, as well as to carry out optimal treatment of concomitant pathology, which the supervising rheumatologist should be well aware of. This publication is devoted to the consideration of the main issues of contraception in the most “vulnerable” category of patients with RH – with positive aPL, APS and SLE.

The aim – to study risk factors for severe COVID-19 in patients with rheumatic diseases (RD).
Patients and methods. The study included medical histories of 464 patients with RD who were admitted at the V.A. Nasonova Research Institute of Rheumatology from September 27, 2021 to April 26, 2023
Results. Age over 60 years, hypertension, obesity, lung disease, chronic kidney disease, coronary heart disease, diabetes mellitus, acute cerebrovascular accident or a history of pulmonary tuberculosis increase the risk of hospitalization in patients with RD with COVID-19 by 3–5 times. In addition, with an increase in the number of concomitant diseases, an increase in the risk of hospitalization was noted by 2–6 times. Taking glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, leads to an increase risk of hospitalization by 1.5–4.5 times, while patients taking hydroxychloroquine or tumor necrosis factor α inhibitors was more often required outpatient treatment.
Conclusions. It has been established that older age, the presence of comorbid pathology and the use of glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, are risk factors for severe COVID-19.

The pandemic of coronavirus disease 2019 (COVID-19), etiologically related to the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus-2), has drawn attention to new clinical and fundamental problems in the immunopathology of human diseases associated with virus-induced autoimmunity and autoinflammation. The provision that “the experience gained in rheumatology in the process of studying the pathogenetic mechanisms and pharmacotherapy of immunoinflammatory rheumatic diseases as the most common and severe forms of autoimmune and autoinflammatory pathology in humans will be in demand for deciphering the nature of the pathological processes underlying COVID-19 and developing approaches to effective pharmacotherapy” was confirmed in numerous studies conducted over the next 3 years in the midst of the COVID-19 pandemic. The main focus will be on a critical analysis of data regarding the role of autoimmune inflammation, which forms the basis of the pathogenesis of immune-mediated rheumatic diseases in the context of the immunopathology of COVID-19.

Lupus nephritis (LN) is considered to be one of the most frequent severe manifestations of systemic lupus erythematosus (SLE), its various colonic manifestations occur in at least 50% of SLE patients, both at the onset and at various stages of the disease, and develop LN is considered one of the most important predictors of mortality in SLE. The structure of nephritis is dominated by diffuse proliferative LN with clinical and morphological signs of progression and the rapid development of terminal renal failure. SLE is diagnosed based on the 2019 EULAR/ACR (European Alliance of Associations for Rheumatology/American College of Rheumatology) diagnostic classification criteria. To confirm the diagnosis, evaluate the prognosis, and choose the tactics of treating the dis-ease, all patients in the absence of contraindications require a kidney biopsy. In addition to LN, the spectrum of SLE-associated renal lesions includes vascular pathology represented by thrombotic microangiopathy, lupus vasculopathy or vasculitis, tubulointerstitial injury, and lupus podocytopathy.

The aim – to evaluate the clinical effectiveness, safety, pharmacokinetics, pharmacodynamics, and immunogenicity of seniprutug (BCD-180) in patients with radiographic active axial spondyloarthritis (r-axSpA, or ankylosing spondylitis).
Subjects and methods. 260 patients with active r-axSpA and inadequate response to nonsteroidal anti-inflammatory drugs (NSAIDs) were randomized into three groups: seniprutug (BCD-180) at doses of 5 mg/kg or 7 mg/kg, or placebo. BCD-180 was administered on weeks 0–12–36. Patients in the placebo group were switched to BCD-180 at a dose of 5 mg/kg at week 24 and continued therapy at week 36. The primary endpoint was the proportion of patients achieving 40% improvement by Assessment in Spondyloarthritis International Society scale (ASAS40) at week 24. Secondary endpoints were proportion achieving ASAS20/40, improvement of 5 out of 6 criteria of ASAS (ASAS5/6), ASAS partial remission, clinically important improvement in ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score with C-reactive protein) (ASDAS-CII) and major improvement in ASDAS-CRP (ASDAS-MI). The dynamics of the disease activity status according to ASDAS-CRP, the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and BASFI (Bath Ankylosing Spondylitis Functional Index) indices, as well as the dynamics of laboratory markers (C-reactive protein anderythrocyte sedimentation rate (ESR)) were analyzed. Safety was assessed by the frequency and profile of adverse events (AEs) and adverse reactions (ARs).
Results. The proportion of patients achieving ASAS40 at week 24 with seniprutug (BCD-180) at the dose of 7 mg/kg and 5 mg/kg was 51.4% and 40.8%, respectively, compared with 24% in the placebo group (p=0.0012 and p=0.0417, respectively). Analysis of secondary endpoints showed that in patients with r-axSpA, BCD-180 at both study doses was significantly superior to placebo at week 24 in the following measures: decrease in the proportion of subjects with very high disease activity (ASDAS-CRP>3.5) achieving ASDAS-CII, ASAS20, ASAS5/6. A statistically significant decrease in the ASDAS-CRP, BASDAI, BASFI indices, as well as the concentration of CRP and ESR were demonstrated. Tolerability of seniprutug therapy was assessed as acceptable. Infusion reactions were the most common observed adverse events, the vast majority of which were mild to moderate in severity according to CTCAE 5.0 (Common Terminology Criteria for Adverse Events) and developed predominantly during the first administration. The proportion of patients with binding antibodies was 5.1%. However, no neutralizing antibodies were detected.
Conclusion. Seniprutug (BCD-180) demonstrated superiority over placebo in clinical efficacy with a favorable safety profile and low immunogenicity as a treatment of r-axSpA.

The effect of an inhibitor of interleukin (IL) 6 receptors on the state of the cardiovascular system in patients with rheumatoid arthritis (RA) remains poorly understood, especially with its long-term use.
The aim – to study the effect of therapy with the IL-6 receptor inhibitor tocilizumab (TCZ) on the dynamics of modifiable risk factors (RF), total cardiovascular risk (CVR), structural changes in the carotid arteries (CA) and the incidence of cardiovascular complications (CVC) in patients with rheumatoid arthritis during the 260-week follow-up period.
Material and methods. The study included 37 patients with active RA (32 women and 5 men) with ineffectiveness and/or intolerance to disease modifying anti-rheumatic drugs (DMARDs); median age was 56 [48; 68] years, disease duration was 92 [49; 158] months; DAS28 (Disease Activity Score 28) – 6.2 [5.5; 6.7] points; all patients were seropositive for rheumatoid factor (RF), 86% – for antibodies to cyclic citrullinated peptide (ACCP). Patients received TCZ therapy 8 mg/kg intravenously every 4 weeks; after 192 [176; 210] weeks, 60% of patients switched to subcutaneous administration of the drug at a dose of 162 mg once a week. In 51% of patients with RA, TCZ monotherapy was performed, in 49% – combination therapy of TCZ with DMARDs. Statins were received by 17 (46%) patients, including 7 patients before and 10 after inclusion in the study. All patients underwent an assessment of traditional risk factors, the total cardiovascular risk was calculated using the mSCORE scale, atherosclerotic vascular lesions were assessed by the detection of atherosclerotic plaques (ASP) of CA. The observation period was 260.4 [251.5; 283.4] weeks.
Results. After 260 weeks of TCZ therapy, RA remission was observed in 32 (86%) patients, low activity – in 5 (14%) patients. During the observation period, the frequency of modified RF and the total CVR did not change significantly, an increase in body mass index (BMI) by 11% was recorded, the number of patients with hypercholesterolemia and a reduced level of HDL cholesterol (C) decreased. In patients without statin therapy, there were no significant changes in the blood lipid spectrum. In the group of patients receiving statins, there was an increase in HDL-C by 43%, a decrease in cholesterol levels by 15%, atherogenic index (AI) by 56% (p<0.01 in all cases) and associations between the dynamics of ∆cholesterol and ∆CRP (r=0.35; p=0.04), ∆LDL-C and ∆CRP (r=0.41; p=0.03). Significant structural changes in CA in RA patients by the end of 260 weeks of TCZ therapy were not identified. Initially, intima-media thickness (IMT) CA positively moderately correlated with age (r=0.7; p<0.01), BMI (r=0.37; p<0.01), systolic blood pressure (SBP) (r=0.62; p<0.01) and weakly with lipid spectrum parameters – cholesterol (r=0.29; p<0.01), LDL-C (r=0.36; p<0.01). No new associations of IMT CA by the end of the observation, as well as the relationship of the IMT CA value with the indicators of RA activity and the ongoing therapy, were identified. By the end of the study, the distribution of patients by mSCORE value and CVR level did not change significantly. The incidence of CVC was 0,54 per 100 patient-years over a 260-week period of TCZ use. Conclusion. Against the background of long-term TCZ therapy in RA patients, there was no increase in CVR and significant structural changes in CA. It is necessary to dynamically monitor the blood lipid profile and CVR in RA patients receiving TCZ therapy. Statin therapy can successfully control dyslipidemia in RA patients who receive long-term TCZ.

Relevance. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by loss of immune tolerance and sustained production of autoantibodies.
The aim of the study – to compare composition of peripheral blood cytotoxic CD8⁺ T lymphocytes (Tc) subsets and assess the clinical significance of them in systemic lupus erythematosus. Materials and methods. A total of 35 SLE patients and 49 healthy volunteers were included in the study. Phenotyping of peripheral blood T cell subpopulations was carried out by means of flow cytometry. T lymphocytes were determined using CD3⁺, CD4⁺, CD8⁺ antibodies. Tc were identified by using CD45RA and CD62L antibodies. Also the expression of chemokine receptors (CCR4, CCR6, CXCR3 and CXCR5) on Tc cells was assessed and the main Tc subpopulations were determined: Type 1 (Tc1), type 2 (Tc2), type 17 (Tc17), type 17/1 (Tc17.1), type 17/22 (Tc17.22) cytotoxic cells and T follicular cytotoxic cells (Tfc).
Results. The absolute and relative number of Tc was significantly higher in the group of patients with SLE compared with the control group. Additionally, there was a significant decrease in the relative number of Tc1, Tc 17.1 and Tfc1 and a significant increase in the relative number of Tc2, Tfc 17 and Tfc17.1 within the SLE group when compared to the control group. There were significant positive correlationfor Tc1 and levels of C3 and C4 complement components (r=0.404, p<0.05).
Conclusions. The absolute and relative number of peripheral blood Tc subsets is altered in SLE patients compared with the control group. It was found that patients with SLE contained increased number of Tc2 cells, which seems to be associated with markers of disease activity. These results demonstrate a prominent pathological role of Tc2 in SLE. While Tc1, Tc17, Tc17.1, Tfc subsets probably have regulatory functions

Objective – to assess the dynamics of the sacroiliac joint radiographic progression (X-SIJ) in early psoriatic arthritis (ePsA).
Methods. 32 patients (pts) (19 men and 13 women) with PsA were examined at baseline (BL) and after 7 years. Mean age – 43.9±12 years, Me PsA duration – 7.5 [6; 8.25] years, follow-up – 7 [5.75; 7.83] years. All patients received standard treatment using biologic therapy in 59.4% of cases, mainly with tumor necrosis factor α (TNF-α) inhibitors (43.7%). Radiographs of sacroiliac joint (SIJ) at BL and after 7 years were evaluated by an independent reader by Kellgren. Sacroiliitis (SI) on radiografhy (rSI) was recorded if there were changes in at least one SIJ grade II or higher. SI was considered radiologically significant (r-sSI) when it was bilateral grade II or higher, or unilateral grade III or IV. Progression was defined as the sift by ≥1 grade on any side.
Results. At BL SI was not observed in 11 (34.3%) pts, SI grade I was present in 7 (21.9%) pts, grade II – in 10 (31.3%), grade III – in 4 (12.5%). After 7 years SI was not observed in 6 (18.75%) pts, SI grade I was present in 6 (18.75%) pts, grade II – in 8 (25%), grade III – in 8 (25%), grade IV – in 4 (12.5%). At BL rSI was registered in 14 (43.75%) patients, after 7 years the number of patients with rSI increased to 20 (62.5%). At BL and 7 years follow-up r-sSI was detected in 10 (31.3%) and 16 (50%) pts (p=0.128). On each side X-SIJ progression was detected in 15 (46.9%) pts (at 1 grade – in 10, 2 grades – in 1, 3 grades – in 4), 1 patient showed a decrease at 1 grade (from III to II).
Conclusion. In ePsA radiographic progression of SI is slow. Dactylitis, high CRP, and lack of iTNF-α therapy are associated with radiographic progression.

The aim of the study – to evaluate the effectiveness of the drug Alflutop (bioactive concentrate of small marine fish), as well as its effect on microcirculation parameters in patients with osteoarthritis (OA) of small joints of the hands.
Patients and methods. The study included 80 patients aged 35 to 65 years with OA of small joints of the hands, stage I– II according to Kellgren – Lawrence, with pain ≥40 mm and ≤90 mm on a visual analogue scale (VAS). Subjects were distributed in 1:1 ratio. In the study group (combined therapy) patients received Alflutop according to the standard scheme: 2 ml intramuscularly every other day N 10 and meloxicam 7.5–15 mg per day in the “on demand” mode. The second group (monotherapy) received meloxicam 7.5–15 mg per day N 20. During the observation, the dynamics of joint pain on the VAS scale, the dynamics of the disease on the VAS scale by the patient and the doctor, the functional Dreiser index and AUSCAN (Australian/Canadian Osteoarthritis Hand Index), nailfold capillaroscopy (NFC) with an assessment of the number of capillaries and the number of alterations per 1 mm of the distal row of capillaries were evaluated. The duration of the study was 6 weeks.
Results and discussion. By the 35^th day of treatment with Alflutop in combination with meloxicam, a statistically significant decrease in pain and functional activity of the disease was found according to the VAS indices, the AUSCAN index (p<0.05) compared with the meloxicam monotherapy group. Microcirculation parameters according to NFC data in the Alflutop and meloxicam group remained stable by the end of the study (p>0.05). In meloxicam monotherapy group, by the 35^th day of follow-up, there was a significant increase in the number of altered capillaries by 1 mm of the distal row of the nail (p<0.001).
Thus, Alflutop demonstrates clinical efficacy in OA of the joints of the hands (reduces pain, stiffness, improves joint function). In addition, the effect of Alflutop with respect to slowing down microcirculatory disorders is not excluded.

The prevalence of concomitant mental disorders in children with rheumatic diseases is notably higher than in the overall population. However, psychiatric comorbidity in pediatric rheumatology remains poorly understood, whereas approaches to mental disorders therapy in children with rheumatic diseases are not clearly defined. The review article considers currently available data on the mental disorders prevaling in patients with juvenile idiopathic arthritis, juvenile-onset systemic lupus erythematosus and juvenile primary fibromyalgia. The article provides data on the efficacy and safety studies of psychotherapy and psychopharmacotherapy. It also discusses application prospects of biological disease-modifying antirheumatic drugs for treatment of comorbid depression in children with rheumatic diseases.

The problem of osteoarthritis (OA), the most common chronic rheumatic disease, is usually considered in relation to three groups of joints – knee, hip and hands. However, OA can affect any joints of the human body, causing pathological changes characteristic of this nosological form: destruction of joint tissue associated with mechanical stress, chronic inflammation and degenerative processes (neoangiogenesis, fibrosis, heterotopic ossification). This review examines 5 “atypical” OA localizations – shoulder, acromioclavicular, elbow, ankle and foot. The defeat of these joints is observed quite often: shoulder – about 15%, ankle – 3–5%, foot joints – 17% of the inhabitants of the modern population. The main risk factors for this disease are injuries, repeated significant stress, instability and deformities of the joints. The clinic is typical for OA and is manifested by “mechanical” and “starting” pains, stiffness, increasing dysfunction, crunching and deformation. In some cases, persistent synovitis is noted, accompanied by pain at rest and at night. Generally recognized criteria for OA of “atypical” localization have not yet been developed, therefore, its diagnosis is based on the presence of characteristic complaints, typical radiological changes (narrowing of the articular gap, subchondral sclerosis, osteophytes) and the exclusion of other pathology that can cause joint damage. Treatment of this pathology should be complex and include the combined use of non-drug methods (orthosis, physical therapy, physiotherapy) and pharmacological agents, such as nonsteroidal anti-inflammatory drugs, slow-acting symptomatic agents and local injection therapy (intra-articular administration of glucocorticoids, hyaluronic acid, platelet-enriched plasma). When conservative therapy is ineffective, a wide range of surgical interventions is used, from arthroscopic chondroplasty to total endoprosthetics.