The development of lymphoid tumors in patients with rheumatic diseases can significantly worsen the quality of life and negatively affect the prognosis. The article presents modern data on the relationship between lymphoid tumors and rheumatic diseases. Practical differential diagnosis guidelines of T cell large granular lymphocytic leukemia in patients with rheumatoid arthritis and Felty’s syndrome are given. The results of the study of pathogenesis and biological predictors of diffuse large B cell lymphoma in patients with rheumatic diseases are presented. This study of the lymphoproliferative tumor pathogenesis in patients with rheumatic diseases sheds light on the mechanisms underlying the development of sporadic lymphoproliferative tumors and autoimmune diseases, as well as on the progress in the treatment of these diseases.

Giant cell arteritis (GCA) characterized by the paradoxical discrepancy between the high effectiveness of glucocorticoid (GCs) in the short term and the increase in signs associated with the persistence of inflammatory activity and the accumulation of organ damage induced by GCs in the long term, which indicates the need for the use of therapy, primarily in the direction of optimizing the use of GCs. New opportunities for pharmacotherapy of GCA are associated with the use of monoclonal antibodies (mAbs) that block the activity of cytokines involved in the immunopathogenesis of IMIRDs. Among pharmacological “targets”, interleukin (IL) 6, as well as IL-17, attracts special attention. Currently, several mAbs specific for IL-17 have been developed. The article summarizes data regarding the pathogenetic significance of IL-17 in GCA and the prospects for pharmacotherapy of GCA using mAbs to IL-17.

Psoriatic arthritis (PsA) is characterized by a combination of musculoskeletal and extra-articular manifestations, such as peripheral arthritis, axial disease, dactylitis, enthesitis, uveitis, inflammatory bowel disease, psoriasis (Ps). Currently, great progress has been made in the study of the pathogenesis of PsA and pharmacotherapy of this disease. The article presents data on the efficacy and safety of the IL-17 inhibitor ixekizumab (IXE). IXE demonstrates high therapeutic efficacy against all clinical manifestations of PsA in most patients, regardless of concomitant methotrexate intake and previous intake of biological disease-modifying antirheumatic drugs, the presence of cardiometabolic comorbidity. This drug delays the progression of destructive processes in the joints. IXE is indicated for patients with Ps of problematic localization: palmar-plantar, anogenital, scalp and nails.

Literature review presents the data of recent scientific studies aimed to analyze the impact of cigarette smoking on the risk of rheumatoid arthritis (RA). It is shown the main mechanisms of interaction between genetic constitution, synthesis of RA-specific antibodies, and other immune trait under the influence of cigarette smoke in patients with RA. We presented summarized data indicating the positive effect of smoking cessation in RA patients.

Standard therapy for Takayasu arteritis (TA) usually comprises glucocorticoids in combination with cytotoxic agents. However, despite ongoing therapy disease activity remains high in some patients. In these cases, biological therapy is prescribed.

The aim – to evaluate the efficacy and safety of tumor necrosis factor α inhibitors (TNFi) and interleukin 6 (IL-6) pathway antagonists (anti-IL-6) therapy in TA patients refractory to conventional therapy.

Subjects and methods. In this single center retrospective cohort study, we included 36 female adult patients aged from 20 to 57 years (54 courses of biological therapy) with TA, diagnosed in accordance with the ACR classification criteria (1990 and/or 2022) and/or Chapel Hill Consensus Conference (2012) definition. All patients were on biologics due to resistance to corticosteroids and cytotoxic agents.

Results. A total of 54 courses of TNFi (n=29) and anti-IL-6 (n=25) inhibitors were analyzed. The median duration of biological therapy was 14 (9; 32) months, with a median duration of 14 (8; 32) months for TNFi and 13 (7; 32) months for anti-IL-6. The remission rate showed no significant difference between TNFi (79%) and anti-IL-6 (84%; p=0.736) treatment groups. The incidence of relapses was higher with TNFi, although the difference between groups did not reach statistical significance (36% and 14%, respectively; p=0.291). Relapse was established after 15 (10; 22) weeks for TNFi and after 22 (13; 31) weeks for anti-IL-6 (p=0.919). TNFi and anti-IL-6 had a comparable steroid-sparing effect: the median dose of GC in terms of prednisolone decreased from 13 to 8 mg (p=0.009), and from 15 to 8 mg (p=0.026), respectively. Factors associated with achieving TA remission were assessed using a logistic regression model. None of the parameters (age at the start of biological therapy, duration of disease before the start of biological therapy, class of biological therapy) were associated with achieving remission of TA. Adverse events (AEs) occurred in 22% of cases resulting in therapy discontinuation in 13% of patients.

Conclusion. Our study demonstrated the high effectiveness of TNFi and anti-IL-6 in patients with refractory to conventional immunosuppressive therapy TA: remission was achieved in 80% of cases, allowing for a reduction in glucocorticoid dosage. The safety profile of TNFi and antiIL-6 was acceptable. However, AEs occurred slightly more frequently in the TNFi group.

The aim – to determine the frequency and characteristics of anxiety-depressive spectrum disorders (ADSD) in patients with obstetric antiphospholipid syndrome (APS).

Material and methods. The study is prospective-retrospective. Data on obstetric pathology was obtained from medical documents and from conversation with a patient. Stress factors were assessed upon inclusion in the study. Diagnosis of ADSD was carried out by a psychiatrist, according to ICD-10. The study included 61 women with APS, established according to the international criteria of 2006, who had a history of pregnancy. 30 (49.2%) of 61 patients had pregnancy loss (PL). Systemic lupus erythematosus (SLE) was diagnosed in 29 (47.5%) women. The average age of patients at the time of inclusion in the study was 40.9±11.0 years: 41.2±7.77 years in patients with PL and 40.7±12.8 years in patients without PL.

Results. ADSD were identified in the majority of women with APS – 53 (86.9%) out of 61. These mental disorders developed in the majority of patients before the onset of APS (37 (69.8%) out of 53). Moderate and severe depression in patients with PL was more related to stressful events not associated with APS (mainly with childhood and adolescent psychological trauma), and was also more often detected in the presence of PL after the week 10 of gestation and more than two PL. Childlessness as a stress factor at the time of the study was significant for 7 (38,9%) out of 18 patients with PL who did not have children. Almost half (14 (46.7%) out of 30) of patients with PL had more than two interrupted pregnancies (multiple PL). In the group of patients with multiple PLs, significantly more often than in patients with one or two PLs, a pronounced distortion of logical thinking was detected, while the frequency of organic-type thinking disorders associated with ischemic damage to the central nervous system within the framework of APS did not differ in patients in the compared groups.

Conclusion. The incidence of depression in women with APS did not depend on a history of PL. Multiple PLs predisposed to more severe types of depression. The psychopathological features of ADSD in patients with multiple PLs were determined – more frequent pronounced distortions of logical thinking. It has been established that childlessness is not a significant stress factor for all patients.

The aim – to study the association between serum uric acid (SUA) level, bone mineral density (BMD) and osteoporosis (OP) in postmenopausal women.

Materials and methods. 394 postmenopausal women were examined (median age – 62 [56; 68] years). Examination and anthropometric measurements, a biochemical blood test, including level of SUA, dual-energy X-ray absorptiometry of the lumbar spine (L1–L4), femoral neck (FN) and total hip (TH) were carried out.

Results. In women with OP, the level of SUA and the frequency of hyperuricemia were lower than in those without OP (p=0.005 and p=0.019, respectively). SUA was weakly positively correlated with BMD in L1–L4 (r=0.20; p<0.001), FN (r=0.12; p=0.021) and TH (r=0.17; p=0.001). A weak negative correlation was found between the level of SUA and the presence of OP (r=–0.13; p=0.008). Multiple logistic regression analysis showed that the independent factors associated with OP in postmenopausal women were age (odds ratio (OR) – 1.06 (95% confidence interval (95% CI): 1.02–1.10); p=0.003) and body mass index (OR=0.83 (95% CI: 0.77–0.89); p<0.001). There was no significant relationship between the level of SUA and OP.

Conclusion. Thus, in postmenopausal women, the effect of SUA on the risk of OP was not revealed.

The aim – to study the incidence of hypogonadism in men with psoriatic arthritis (PsA) and to assess its impact on PsA and comorbidities.

Materials and methods. A cross-sectional continuous study included 128 men with PsA who were hospitalized at the V.A. Nasonova Research Institute of Rheumatology. The patients underwent determination of their total testosterone levels and subsequent division into subgroups with normal (≥12.0 nmol/l) and reduced levels. An intergroup comparison was conducted for the main indicators used in clinical rheumatology practice to assess the stage, activity, and other medical and demographic characteristics of PsA, as well as for comorbidities. A correlation analysis was performed between the level of total testosterone and some clinical and laboratory parameters.

Results. The incidence of reduced total testosterone levels was 36.7%. Patients with testosterone deficiency were older (47.9±10.3 vs 40.1±12.1 years; p<0.001), had a higher body mass index (31.2±5.2 vs 27.2±6.1 kg/m2; p<0.001) and were more often obese (48.9% vs 23.4%; p=0.001). They had higher mean glucose levels (5.9±1.39 vs 5.34±0.57 mmol/l; p=0.001) and frequency of impaired fasting glycemia with similar frequency of type 2 diabetes mellitus. Patients with hypogonadism were characterized by higher uric acid levels (402.9±99.3 vs 354.0±81.5 μmol/L; p=0.003) and the frequency of hyperuricemia. A lower proportion of HLA-B27 positive patients was noted in the hypogonadism group, as well as a more frequent occurrence of stage III sacroiliitis (p=0.004) and a smaller amplitude of lateral flexion in the spine (10.3±3.3 vs 12.4±4.3 cm; p=0.014). Significant negative relationships were found between total testosterone levels and age, body mass index, glucose and uric acid levels, as well as a positive relationship with the amplitude of lateral flexion and chest excursion.

Conclusion. Hypogonadism was detected in one third of patients with PsA. Decreased testosterone levels were observed in older individuals and were associated with metabolic disorders, as well as with decreased spinal mobility and the presence of stage III of sacroiliitis.

The aim of the study was to reveal the relationship between the activity of inflammation, the infectious component, platelet function and dyslipidemia, in the development of subclinical atherosclerosis in patients with systemic lupus erythematosus (SLE).

Material and methods. Fifty women with SLE at the age of 52.0 [48.0–58.0] years and disease duration – 11.5 [6.0– 22.0] years were examined. The control group consisted of 21 healthy women. The concentration of high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), IgG antibodies to Chlamydia pneumonia (at IgG CP), the level of Toll-like receptor (TLR2), platelet factor 4 (PF4) and antibodies to oxidized high-density lipoproteins (at oxLDL) were determined by enzyme immunoassay. Platelet aggregation indices, lipid spectrum, intima-media thickness (IMT) of common carotid arteries were investigated.

Results. A significant increase in IMT of the common carotid artery (1.00 [0.80–1.10] and 0.80 [0.70–0.90] mm, respectively; p<0.01) and TKIM of the carotid bifurcation (1.10 [1.00–1.20] and 0.80 [0.70–1.10] mm, respectively; p<0.01), increased hsCRP concentration (3.67 [2.17–5.92] and 0.74 [0.30–1.26] mg/L, respectively; p<0.01), IL-6 (1.72 [1.39–2.68] and 0.60 [0.22–0.75] pg/mL, respectively; p<0.01). Significant platelet activation was noted in SLE: significant increase in TF4 concentration (21.5 [19.80–23.28] and 18.30 [13.88–20.46] ng/mL, respectively; p<0.01), marked dyslipidemia, increased concentration of oxLDL (3.16 [1.45–4.60] and 1.39 [1.26–2.04] kp, respectively; p<0.01). At IgG CP concentration and TLR2 values in patients with SLE did not differ from controls.

Conclusion. In addition to traditional risk factors for the development of cardiovascular disease, the association between SLE and subclinical atherosclerotic lesions of the vascular wall can be explained by additional risk factors – inflammation and autoimmune processes. The role of the infectious component is for further study.

Coxitis is one of the most common extra-axial manifestations of axial spondyloarthritis in Russia. According to studies conducted in the Russian Federation, the main factors leading to disability of patients with axial spondylitis (acSpA) is coxitis.

The aim of our study was to evaluate the factors of radiographic progression of coxitis in patients with axial spondylitis.

Material and methods. A prospective cohort study was conducted of 77 patients (23 women, 54 men) with axSpA (ASAS (Assessment of SpondyloArthritis International Society) criteria, 2009), observed for at least 2 years, with clinical and/or instrumental signs of coxitis. After 2 years, the patients again underwent a complete clinical, laboratory and instrumental examination (magnetic resonance imaging and pelvic survey). In all patients, the BASRI (Bath Ankylosing Spondylitis Radiology) Hip Index was determined for each hip joint (HJ). To assess the damage to the hip joint, the total stage of radiographic coxitis was used, to assess the rate of radiographic coxitis progression – a previously developed formula. To describe the data and their variability with a normal distribution of the feature, the arithmetic mean and standard deviation were used, and with an abnormal distribution of the feature or a small sample – the median, minimum and maximum values, interquartile range (Me [25th; 75th percentiles]). To assess the significance of differences between the analyzed groups, the Mann – Whitney U-test was used. To detect interrelated parameters, the Euclidean distance was determined using cluster analysis using the single linkage method. To detect the relationship between the clinical manifestations of axSpA and the radiographic progression of coxitis, a cluster analysis of the main parameters was performed.

Results and discussion. The median values of laboratory inflammation parameters – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) – were high at baseline (20.0 mm/h and 14.5 mg/l, respectively). As for other clinical manifestations of the disease, 75% of 77 patients had peripheral arthritis at the time of inclusion in the study. The functional index of patients (BASFI, Bath Ankylosing Spondylitis Functional Index) was 3.3 at baseline. The average age of patients was 30.8±7.7 years with an average disease duration of 74.0±90.3 months. 72 (94%) patients were positive for HLA-B27. The BASRI Hip Index was assessed for each hip joint in all patients. The analysis showed that the most closely interrelated groups of clinical parameters are high clinical activity of the disease, the rate of radiographic progression of coxitis and the total stage of radiographic coxitis (Euclidean distance 100). It is also worth noting that the relationship between laboratory parameters of inflammation and disease activity indices is relatively weak, as well as with structural damage in axSpA.

Conclusion. Factors influencing the development and progression of coxitis in axSpA are a combination of such signs as high clinical activity of the disease, the presence of peripheral arthritis and male gender.

The aim – to study the frequency of left ventricular (LV) myocardial dysfunction and its relationship with disease activity in patients with systemic lupus erythematosus (SLE).

Materials and methods. The study included 100 patients with SLE who met the criteria of SLICC/ACR 2012, 87% were women, the average age was 33 [25; 40] years, the average duration of the disease was 1 [1; 9] year, patients with varying degrees of activity according to SLEDAI-2K (low/moderate/high) – 30/45/25 (30%/45%/25%). All the subjects had not previously received biological therapy and had no previously diagnosed cardiovascular diseases and other rheumatic diseases. All patients received glucocorticoids (GCs) and hydroxychloroquine therapy in different dosages depending on the severity of the disease, according to the standards recommended by the Association of Rheumatologists of Russia from 2021. Methotrexate was received by 6% of patients, azathioprine – 14%, cyclophosphamide – 3%, nonsteroidal anti-inflammatory drugs – 81.2%. The control group consisted of 20 healthy individuals, having no signs of rheumatic diseases and CVD comparable in age and gender. All the subjects underwent echocardiography (ECHO) with tissue dopplerography and left ventricle global longitudinal strain (LV GLS) assessment by speckle tracking.

Results. Violation of LV GLS was observed in 65 (65%) patients with SLE. In the SLE group, compared with the control group, a significantly more damaged LV GLS was revealed. In all patients with impaired diastolic function of the left ventricular myocardium, deterioration of LV GLS parameters is observed. Impairment of LV GLS correlated with clinical and immunological parameters in patients with SLE: the degree of SLE activity according to SLEDAI-2K (r=0.219), the level of antibodies to double-stranded DNA (a/b to ds-DNA) (r=0.316), the C3 level of the complement component (r=–0.389), the C4 level of the complement component (r=–0.238), the hemoglobin level (r=–0.255), the number of red blood cells (r=–0.286), the level of C-reactive protein (r=–0.284) and CRP (r=–0.927). Also, patients with SLE with diagnosed nephritis (n=26) had a significant violation of LV GLS parameters.

Conclusions. In patients with SLE, according to ECHO using the Speckle tracking technique, violation of LV GLS occurs with a high frequency (65%). Violation of LV GLS parameters is associated with SLE activity, immunological and hematological disorders. In all patients with impaired diastolic function of the left ventricular myocardium, LV GLS was obviously decreased. The presence of lupus nephritis is associated with a significant violation of the GLS parameters.

Ollier’s disease (enchondromatosis, dyschondroplasia) is a violation of the growth and development of bone structure, manifested by the formation of foci of cartilage tissue in one or more bones of the skeleton. It is accompanied by deformation, shortening and dysfunction of the segments of the bone apparatus involved in the pathological process. Enchondromatosis is a rare disease. At the end of the 20th century, 30 cases of the disease were mentioned in the specialized literature. Taking into account the insufficient familiarity of doctors with this pathology, which causes difficulties in diagnosis, a review of the literature and a description of the clinical case are presented.