The main indications for colchicine treatment until recently were gout, pericarditis, familial Mediterranean fever and some other auto-inflammatory diseases. The expansion of indications (repositioning) for the use of colchicine in the direction of prevention of cardiovascular complications should be considered as one of the major events in medicine of the XXI century. Deciphering the role of inflammation as the most important mechanism for the development of atherosclerosis has created prerequisites for the development of the concept of anti-inflammatory therapy of atherosclerosis, in which low-dose colchicine therapy can take an important place, complementing the effects of aspirin, statins and antihypertensive therapy. The analysis of materials from randomized placebo-controlled studies of colchicine indicates a decrease in the frequency of cardiovascular complications in patients with coronary heart disease (by 31%) and in patients who have recently suffered a myocardial infarction (by 23%), as well as myocardial infarction (by 33%), stroke, the need for myocardial revascularization and cardiovascular mortality. The use of colchicine in a low dose (0.5 mg/day) is approved by the U.S. Food and Drug Administration for the prevention of cardiovascular complications in patients with coronary heart disease. It can be assumed that in the future colchicine will take an important place in the prevention and treatment of cardiovascular pathology associated with atherosclerotic vascular disease.

Patients with ANCA-associated systemic vasculitis (AAV) are at risk of severe COVID-19. At the same time, in immunocompromised patients, in particular those receiving anti-B cell therapy with rituximab (RTX), the post-vaccination effect may be insufficient. Since 2022 the long-acting virus-neutralizing monoclonal antibodies (MAB) tixagevimab and cilgavimab (Evushheld, AZD7442) have been used as pre-exposure prophylaxis for COVID-19.
The aim of the study is to evaluate the effectiveness of tixagevimab and cilgavimab (TC) for pre-exposure prophylaxis of COVID-19 and its safety in RTX treated patients with AAV.
Materials and methods. The prospective study included 63 patients with AAV receiving RTX. Median age 53 (19– 79) years, M:F 1:1.1. From March 2022 to June 2023, TC was administered in a total dose of 300 mg and/or 600 mg. Observation continued until April 2024. In November 2023 and in April 2024 a telephone and/or online survey was conducted simultaneously to identify confirmed cases of COVID-19 and adverse reactions. The survey also included the Treatment Satisfaction Questionnaire version 9 (TSQM-9). Considering the duration of the TC effect (6 months), COVID-19 cases were divided into two groups depending on the interval after the last administration of the TC: up to 6 months inclusive – group 1; more than 6 months – group 2.
Results. During the two-year follow-up period, confirmed COVID-19 was detected in 31.7% patients, the median interval between the last TC administration and the development of COVID-19 was 5.5 [2–19] months. In group 1, which included 12 cases of COVID-19, 92% of patients had a mild form of the disease, only one had lung damage, and there were no fatal outcomes. In group 2, COVID-19, detected after the cessation of the TC effect in 9 patients, was accompanied by lung damage in 89% of cases, required hospitalization in 78%, and fatal in two patients. Four patients had a prolonged course of severe COVID-19 with persistence of SARS-CoV-2 (pCOVID, persistent COVID). In 4 cases, including 3 cases with pCOVID, treatment was carried out with the combined antiviral drug nirmarelvir + ritonavir (Skyvira) in combination with intravenous human immunoglobulin (IVIG) with effect. There were no statistically significant differences in the incidence of COVID-19 in patients with secondary immunodeficiency and without it (p=0.868). At the final stage of the study, the serum level of IgG antibodies to SARS-CoV-2 was examined in 34 patients, its median was 70.4 (0.33–1086.1) binding antibody units (BAU), which indicates a lack of neutralizing antibodies in most patients; there were no statistical differences in their level between patients with and without COVID-19 (p=0.685). No adverse reactions directly related to the use of TC were observed. A high level of the TSQM-9 global treatment satisfaction domain was noted with a median 71.4 (14.3–100); 72,4% of respondents answered “satisfied”– “extremely satisfied” to the first question of TSQM-9 (effectiveness domain).
Conclusions. Pre-exposure prophylaxis of COVID-19 using TC in patients with AAV receiving RTM was safe and allowed to reduce the risk of severe COVID-19 and avoid deaths during the period of TC action. After the cessation of TC, an increase in the frequency of severe COVID-19 with the need for hospitalization and deaths was observed, cases of pCOVID were noted. The use of a combination of Skyvira and IVIG for the treatment of pCOVID was effective in all cases. The use of MAB for pre-exposure prophylaxis of COVID-19 in patients with AAV and other rheumatic diseases requires further in-depth study.

In recent years, there has been significant progress in the study of psoriatic arthritis (PsA). The possibilities of psoriasis (Ps) and PsA therapy have expanded. The following drugs are used for the treatment of PsA: conventional synthetic disease-modifying antirheumatic drugs (DMARDs); biological DMARDs targeting tumour necrosis factor (TNF), interleukin (IL) 12/23 or IL-23 pathway, and IL-17A and IL-17A/F pathway; and targeted synthetic DMARDs that inhibit Janus kinases or phosphodiesterase 4. There have been changes since the last EULAR (European Alliance of Associations for Rheumatology) recommendations for the treatment of PsA from 2019, so an update was required, which examines the treatment of the entire spectrum of PsA manifestations, including cutaneous Ps, extra-musculoskeletal manifestations and concomitant diseases. The updated recommendations include 7 general principles and 11 recommendations. The article presents the EULAR recommendations for the treatment of PsA, as well as research agenda indicating priorities for future research in PsA. The updated recommendations should be useful not only for clinicians, but also for patients when discussing treatment options and making decisions.

Interstitial lung disease is one of the most relevant extra-articular manifestations of rheumatic diseases resulting in a substantial increase in morbidity and mortality. Early diagnosis and close monitoring to identify patients at risk of progression are crucial to establish the need for targeted treatment with immunomodulatory and antifibrotic drugs, with potential ability to change the course of the disease. High resolution computed tomography (HRCT) is the standard radiographic technique to diagnose lung involvement in patients suffering from respiratory symptoms or presenting with a pathological pulmonary function test. HRCT is able to detect changes in the lung before they are apparent on conventional X-ray. Recently, sonography of the lung was introduced as a safe and easily available method for detecting lung fibrosis, bronchiolitis or pneumothorax Sonographic signs like tissue B-lines, irregularities of the pleura or the absence of lung sliding might be a suitable screening tool for lung involvement. In this context, lung ultrasound (LUS) is an attractive tool in a growing research and validation process.

The onset of rheumatoid arthritis (RA) in the old age differs from that at an earlier age in terms of severity of course, disease activity, response to therapy, and outcomes, which has led to the suggestion of a specific phenotype of RA with onset in old age. However, the difficulties of managing the elderly patient with RA are not only due to the specific features of the main disease, but also due to other factors: multimorbidity, polypharmacy and geriatric syndromes (sarcopenia, senile asthenia, falls, cognitive deficit, incontinence). Such a combination of clinical conditions significantly exacerbates not only the course of the main disease, but also complicates the decision-making process regarding the optimal tactics for the overall patient management. The existing difficulties of managing elderly patients with RA have not yet led to the formation of a generally accepted approach; however, to solve this problem, a comprehensive geriatric assessment (CGA) has been proposed. CGA is a diagnostic process aimed at evaluating the physical, psycho-emotional status, functional abilities and social problems of the elderly person in order to keep their independence, general functioning, as well as to optimize medical and social care.

Background. Lymphocyte subsets in autoimmune diseases, such as systemic lupus erythematosus (SLE) and primary Sjogren’s syndrome (pSS), have been intensively studied in recent years. However, their clinical and diagnostic significance has not been finally determined.

The aim of the study – to investigate features and diagnostic utility of B cell subcets in systemic lupus erythematosus and primary Sjogren’s syndrome.

Material and methods. A total of 27 SLE patients, 41 pSS patients and 49 healthy volunteers were included in the study. Phenotyping of blood B cell subpopulations was carried out by means of flow cytometry. All peripheral blood B cells were identified by using CD19 antibody, detection of subpopulations of B cells based on expression of IgD, CD38, CD27. Statistical analysis was carried out using Statistica v. 12.0 (StatSoft Inc., USA). The absolute and relative values of B lymphocyte subpopulations were evaluated using three main classifications: based on IgD and CD38 co-expression, IgD and CD27 co-expression as well as CD38 and CD27 co-expression. For comparison of quantitative traits, the Mann – Whitney U-test and Kruskal – Wallis test were used. Method of discriminant analysis was performed to evaluate diagnostic utility of B cell subsets.

Results. The most significant discriminant model was obtained using the relative values of all subpopulations.

In this model the top significance was documented while assessing the percentage of «unswitched» memory В-cells (IgD^dimCD27^dim), «naive» (IgD^dimCD38^low) and activated «naive» B cells (IgD^dimCD38^dim), germinal center progenitor B cells (IgD^hiCD38^hi), germinal center B cells (IgD^dimCD38^hi) and «transient» B cells (CD27^lowCD38^hi), model percent correct was 75.2% (p<0.05). During ROC analysis, performed for the differential diagnosis of healthy and sick patients, this discriminant model had a sensitivity of 70.6% and a specificity of 85.7%, the area under the curve (AUC) – 0.91 (p<0.001). Among the group of ill patients, distinguishing between SLE and pSS showed a sensitivity of 81.5% and а specificity of 80.5%, AUC=0.84 (p<0.001).

Conclusion. B cell subsets might provide an additional diagnostic tool to differentiate between SLE and pSS.

Aim – to assess baseline rates and five-years outcomes of mild cognitive impairments (MCI) in patients with rheumatoid arthritis (RA) and comorbid anxiety and depressive disorders (ADD) receiving conventional synthetic diseasemodifying antirheumatic drugs (csDMARDs) alone or in combination with biologic DMARDs (bDMARDs) and/or adequate psychopharmacotherapy (PPT). To assess factors associated with MCI after five years.
Materials and methods. 128 RA patients were enrolled, ADD were diagnosed in 123 (96.1%) by a licensed psychiatrist. Severity of depression and anxiety was evaluated with Montgomery – Asberg and Hamilton Anxiety scales. CI were diagnosed during clinical and psychological examination using the battery of pathopsychological and projective techniques. CI outcomes were considered favourable in cases with no CI diagnosed throughout the study and in cases of CI reversal. PPT was offered, 52 (42.3%) agreed. Patients were divided into the following treatment groups: сsDMARDs (n=39), сsDMARDs + PPT (n=43), сsDMARDs + bDMARDs (n=32), сsDMARDs + bDMARDs + PPT (n=9). Multivariable logistic regression was performed to determine factors associated with CI after five years.
Results. MCI were diagnosed in a majority of RA patients (73.2%) including logical thinking impairments (51.2%) and memory deficit (67.5%). At 5-years endpoint 74 patients were included. Total CI rates in no-PPT groups increased from 69 to 85.7% (p=0.037) and were higher compared to PPT groups (85.7% vs 62.5%; р=0.021; RR=1.37). Patients with favourable CI outcomes had lower major depression prevalence and baseline Montgomery – Asberg scores, major improvement in depression symptoms and higher rates of ADD remission after five years. Baseline DAS28 (OR=1.29; р<0.001) was positively associated and remission of ADD negatively associated with MCI after five years (OR=0.25; р=0.03), R2=0.48; p<0.001.
Conclusion. ADD and MCI are highly prevalent in RA patients. While CI tend to persist and worsen over time, PPT is associated with reduced risk of CI in long-term perspective. Personalized PPT with antidepressants and neuroleptics may show potential to lessen the rates of MCI in RA patients with ADD.

Aim – to evaluate the parameters of body composition in patients with early rheumatoid arthritis on the background of anti-inflammatory therapy after 24 weeks of follow-up.
Material and methods. The study included 37 patients (31 women and 6 men) with early RA (ACR/EULAR (American College of Rheumatology/European Alliance of Associations for Rheumatology) criteria 2010), who had their waist circumference (WC), height and weight measured, body mass index (BMI) calculated, body composition determined using dual-energy X-ray absorptiometry using the “Whole Body” program on the HOLOGIC device (USA) before prescribing and 6 months after antirheumatic therapy (methotrexate (MT) monotherapy, combination therapy: MT and a biologic agents).
Results. Initially, patients with early RA who later required the appointment of combination therapy had higher values of anthropometric (weight, BMI, WC) and acute phase parameters (erythrocyte sedimentation rate, C-reactive protein). On the contrary, patients on MT monotherapy initially had a lower body weight, “skinny” and fat mass than patients receiving combination therapy. After 24 weeks of MT monotherapy, RA patients showed an increase in “lean” mass in the absence of changes in total fat mass; against the background of combination therapy, an increase in fat and total mass in the absence of changes in the mass of “skinny” tissue. In patients who achieved remission/low RA activity after 24 weeks of therapy, the initial BMI, adipose tissue mass and total body weight were lower than in patients with moderate/high disease activity persisting despite treatment.
Conclusion. In patients with early RA, after 6 months of combination therapy (methotrexate and biological drugs), an increase in fat and total mass was observed in the absence of changes in the mass of lean tissue. On the contrary, in RA patients, against the background of MT monotherapy, an increase in lean mass was observed in the absence of changes in total fat mass. Insufficient effectiveness of anti-inflammatory therapy by the 3rd month of follow-up was associated with high baseline BMI, lean and fat mass, by the 6th month – with high BMI and fat mass.

Aim – to evaluate the association among appendicular lean mass and immunological markers of blood serum in women with rheumatoid arthritis (RA).
Material and methods. 200 women with RA (median age – 60.0 [52.5; 65.5] years) were enrolled in the study. Using dual-energy X-ray absorptiometry appendicular lean mass (ALM) was measured to determine the sarcopenic phenotype of body composition. The assessment of C-reactive protein (CRP), rheumatoid factor, and antibodies to cyclic citrullinated peptide was also performed. The levels of serum myostatin, follistatin, interleukin 6 (IL-6), IL-6 receptors, insulin-like growth factor 1 (IGF-1), adiponectin, leptin, fibroblast growth factor 23 (FGF23), tumor necrosis factor SF12 (superfamily member 12) were studied in 87 patients.
Results. According to the presence of the sarcopenic phenotype the patients differed in the levels of CRP (8.6 [1.3; 22.2] and 5.6 [1.2; 17.4] mg/l, respectively; p=0.041) and leptin (3.8 [2.4; 5.7] and 5.4 [3.8; 6.9] ng/ml, respectively; p=0.030). ALM correlated with the levels of CRP, follistatin and leptin. Linear multivariate regression analysis revealed the association between ALM index and follistatin (β=–0.35; p=0.007), IGF1 (β=–0.38; p=0.002), leptin (β=0.36; p=0.004) and FGF23 (β=0.33; p=0.008).
Conclusion. The study showed that there is an association between the lean mass and the level of follistatin, IGF-1, leptin and FGF23 in patients with RA.

Central sensitization (CS) is a pathophysiological phenomenon that plays a fundamental role in the development of chronic pain and fibromyalgia. The presence of CS can significantly worsen the condition of patients with rheumatoid arthritis (RA) and reduce the response to antirheumatic therapy.
The aim of the study – to evaluate the effect of central sensitization on satisfaction in patients with rheumatoid arthritis.
Material and methods. The study group consisted of 521 patients with a reliable diagnosis of RA (ACR/EULAR (American College of Rheumatology / European Alliance of Associations for Rheumatology) 2010 criteria), 82.3% of women, 52.0±14.3 years old, with moderate and high disease activity (DAS28-CRP (Disease Activity Score with C-reactive protein) – 4.7±1.0), observed at the clinic of the V.A. Nasonova Research Institute of Rheumatology in 2021– 2022. During hospitalization, all patients underwent correction of the individual therapeutic regimen. At the time of discharge, therapy with genetically engineered biologic DMARDs or Janus kinase inhibitors (JAKi) was continued, induced or modified in 364 patients (69.8%). The presence of a CS was determined by the CSI (Central Sensitisation Inventory) and painDETECT questionnaires. Satisfaction with their condition was assessed during a telephone survey using the PASS index (patient acceptable symptom state) 6 months after discharge from the hospital.
Results. Signs of CS according to the CSI questionnaire (≥40 points) were noted in 56.0%, according to the pain- DETECT questionnaire (>18 points) – in 22.5% of patients. A telephone survey was conducted after 6 months in 473 patients (90.8%). 52.0% of respondents considered their condition acceptable (PASS “+”). PASS “+” was significantly more common in patients receiving biologic DMARDs or JAKi, compared with those receiving only synthetic (s) DMARDs: 65.0% and 33.6% (p<0.001). In patients with signs of CS according to CSI, the PASS index “+” was noted in 41.7%, without signs of CS in 65.0% (p<0.001), with signs of CS according to painDETECT, the PASS index “+” was noted in 40.6%, without signs of CS in 55.6% (p<0.001). A significantly lower frequency of PASS “+” was observed in patients with CS both on the background of taking biologic DMARDs or JAKi, and on the background of taking only sDMARDs.

Background. Uveitis is a heterogeneous group of inflammatory eye diseases, some of which may be associated with spondyloarthritis (SpA). The probability of SpA depends on the clinical features of uveitis.
The aim – to develop a prognostic formula for determining the probability of spondyloarthritis in patients with uveitis
Methods. 208 patients (pts) (79 men and 129 women) with different forms of uveitis, referred by ophthalmologists to the V.A. Nasonova Research Institute of Rheumatology, were assessed. The onset of uveitis at the age ≤30 years took place in 107/208 pts (51.44%), over 30 years – in 101 (48.56%). 139/208 pts had acute recurrent uveitis, 69 – chronic; 149 had isolated anterior uveitis (АU), 59 – posterior eye involvement, 160 had unilateral uveitis, 48 – bilateral; HLA-B27 was detected in 159 pts. Various SpA were identified in 60 cases and not confirmed in 148 pts. Groups of pts with and without SpA were compared by gender, age of uveitis onset, presence of HLA-B27, and clinical features of uveitis.
Result. SpA was diagnosed in 45/139 pts with acute recurrent uveitis , and was not confirmed in 94/139 (odds ratio (OR) – 1.723; 95% confidence interval (95% CI): 0.879–3.379; p=0.113); SpA was confirmed in 15/69 pts with chronic uveitis, in 54/69 – with other forms of uveitis (OR=0.597; 95% CI: 0.304–1.172; p=0.134). SpA was diagnosed in 51/160 pts with unilateral uveitis and was not diagnosed in 109/160 (OR=2.028; 95% CI: 0.913–4.501; p=0.082); out of 48 pts with bilateral uveitis was 9 with SpA and 39 without SpA (OR=0.493; 95% CI: 0.222–1.095; p=0.082); among 149 pts with isolated AU – 55 with SpA and 94 without SpA (OR=6.319; 95% CI: 2.384–16.749; p=0.001); of 59 pts with panuveitis – 5 with SpA and 54 without SpA (OR=0.158; 95% CI: 0.060–0.419; p=0.001); among 159 HLA-B27-positive – 56 with SpA and 103 without SpA (OR=6.117; 95% CI: 2.091–17.888; p=0.001); the onset of uveitis at the age of ≤30 years was in 44/107 pts with SpA and in 63/107 – without SpA (OR=3.710; 95% CI: 1.921–7.168; p=0.001); SpA was confirmed in 39/79 male pts and was not confirmed in 40 (OR=5.014; 95% CI: 2.637–9.535; p=0.001).
A formula to determine the probability of SpA in pts with uveitis was obtained by the method of multifactorial discriminant analysis: 1.972 × Х1 + 1.476 × Х2 + 1.418 × Х3 + 1.270 × Х4 + 0.668 × Х5 + 0.162 × Х6, where X1 – male; X2 – the onset of uveitis at the age of ≤30 years; X3 – HLA-B27; X4 – isolated anterior uveitis; X5 – unilateral uveitis; X6 – acute recurrent uveitis.
If the amount is greater than 4.552, the probability of SpA is estimated as high, if the amount is less than or equal to 4.552, it is low.
Conclusion. A combination of significant clinical parameters of uveitis (male, onset of uveitis at the age ≤30 years, HLA-B27, isolated anterior uveitis, unilateral lesion, acute recurrent course) allows to quantify the risk of SpA, that contributes to the timely diagnosis.

Long-term therapy with non-steroidal anti-inflammatory drugs (NSAIDs) may be appropriate in patients with osteoarthritis (OA) who have chronic pain.
The aim – to evaluate the efficacy and safety of nimesulide in the 3-month treatment of osteoarthritis.
Material and methods. The study group consisted of 282 patients, 79.4% women (age 54.5±8.9 years), with knee OA (50.0%), hip OA (12.4%) and multi-joint OA (37.6%). All patients had comorbidity, including 94.3% arterial hypertension (AH) and 22.7% type 2 diabetes mellitus. All patients had moderate to severe pain (≥4 on a numerical rating scale (NRS 0–10)) for at least 3 months. All patients were prescribed nimesulide 100 mg twice daily. If pain decreased, a reduction in the dose of nimesulide to 100 mg daily or a switch to an on-demand regimen was suggested.
Results. After 1 and 3 months of therapy, 82.3% and 49.3% of patients continued to take nimesulide regularly, and 17.4% and 39.7% continued to take it ‘on demand’. 11,0% of patients stopped taking the drug by 3 months, mainly because of pain control or significant pain reduction. In 1 and 3 months all patients showed significant improvement in the severity of the main symptoms of OA. Thus, pain on movement (NRS) decreased from 6.7 to 4.3 and 2.0; WOMAC pain from 11.3 to 7.3 and 3.9; impaired function (NRS) from 5.4 to 3.4 and 1.6; WOMAC function from 38.9 to 25.4 and 14.7 (for all parameters p<0.001). For all parameters, more than 75% of patients showed improvement ≥50% from baseline. 83% of patients reported an acceptable symptom state (PASS). After 3 months, no serious adverse events (AEs) were noted. Dyspepsia was noted in 3.9%, stool disturbance and gastroesophageal reflux disease in 3.2% each, AH in 4.6%, and hyperglycaemia in 1.1%. No withdrawal of nimesulide due to HP was noted.
Conclusion. Nimesulide is effective and relatively safe in the long-term treatment of patients with OA and chronic pain.

Background. The prevalence of rheumatoid arthritis (RA) and associated disability as a result of a joint damage is a pressing issue in both rheumatology and rheumoorthoedics. The most common surgical techniques for correcting wrist deformities are traumatic and do not allow fully restoring the life quality of patients. In recent years, new joint-saving techniques have been actively developed to preserve hand function and prevent the development of severe deformities.
The aim of the study – to compare the results of soft tissue stabilizing operations and arthrodesis of the wrist joint in patients with rheumatoid arthritis.
Materials and methods. The study included 69 patients operated on at the V.A. Nasonova Research Institute of Rheumatology in the period from 2018 to 2023. 24 patients underwent transposition of the long radial wrist extensor and ulnar wrist extensor (ECU+ECRL, extensor carpi ulnaris + extensor carpi radialis longus) with subsequent tenodesis. The control group consisted of 45 patients who underwent arthrodesis of the wrist joint. The DASH (The Disabilities of the Arm, Shoulder and Hand) questionnaire was used to assess functional status before and after surgery. To assess quality of life we used EQ-5D (EuroQol 5 Dimensions) index, pain – visual analogue scale (VAS), disease activity was assessed using the DAS28 (Disease Activity Score 28) index. The average follow-up period for patients after surgery was 6 months.
Results. The functional status of patients after surgery, assessed by the DASH scale, was significantly better in the group of patients who underwent transposition of the tendons of the long radial wrist extensor and ulnar wrist extensor (39.41±10.17 compared to the control group of wrist arthrodesis – 46.4±15.8; p<0.05). In both groups, there was a positive dynamics of pain according to VAS, as well as an improvement in the quality of life. In the group of patients with transposition of ECU+ECRL, performed at early Rg. stages (Larsen II, III) the functional status of the hand according to DASH after surgery was significantly better compared to patients who underwent tendon transposition at stages IV–V.
Conclusions: ECU+ECRL tendon transpositions are an efficient method for stabilizing the wrist joints and correcting hand deformities, but they have a number of limitations, the most important of which is the degree of damage to the wrist joints and the severity of the deformities. The effectiveness of soft tissue techniques is significantly reduced when performing surgical interventions on stages IV and V according to Larsen.

Patients with systemic lupus erythematosus (SLE) have an increased risk of developing herpes zoster (HZ). Vaccination difficulties arise in these patients due to possible interactions with the therapy used with glucocorticoids, disease-modifying antirheumatic drugs and biologic disease-modifying anti-rheumatic drugs. The description of two clinical observations of patients with SLE, who developed severe HZ against the background of active SLE and therapy with immunosuppressive drugs, is given. The issue of the need for vaccination in Russia against varicella zoster virus of patients on immunosuppressive therapy is discussed.