Since the discovery in the early 1960s by D.J. McCarty crystals of calcium pyrophosphate in the synovial fluid of a patient with suspected gout, descriptions by D. Zitnan and S. Sitaj of radiological signs of cartilage calcification, and the subsequent appearance of the terms “pseudogout” and chondrocalcinosis, up to the present time, the issue of standardization of terms and concepts related to the disease of conditions and symptoms has not been resolved. The various alternative names of the disease and classification of phenotypes considered in the article should be the basis for creating a unified nomenclature of the disease of deposition of calcium pyrophosphate crystals, reflect the essence of the disease, and be understandable to doctors and patients.

Many rheumatic diseases are a model of human pathology disease. These are inflammatory rheumatic diseases, autoinflammatory and autoimmune diseases. Antiphospholipid syndrome (APS) is a model of antibody-induced thrombosis or acquired thrombophilia. In 2023, classification criteria were published, which were developed jointly by the American College of Rheumatology (ACR) and EULAR (European League against Rheumatism) and included a four-stage methodology. This review presents the existing APS classification criteria until 2023 and the 2023 criteria with their explanation.

Conclusion. The classification criteria of ACR/EULAR 2023 reflect the multi-organicity and multidisciplinarity of this symptom complex. At the same time, like all classification criteria, they are designed to select homogeneous groups in clinical trials.

The article discusses the modern trends in the development of digital technologies in medicine, exemplified by rheumatology, especially, the significance of radiomics, which combines radiology, mathematical modeling, and deep machine learning. Texture analysis of computed tomography images and other imaging methods provides a more deeply characterization of the pathophysiological features of tissues and can be considered as a non-invasive “virtual biopsy”.

It is shown that radiomics enhances the quality of diagnostic and predictive modeling. The potential application of radiomic models for studying and predicting chest organ lesions in various pathological conditions, including immune mediated inflammatory diseases, systemic vasculitis.

Progress in the diagnosis and treatment of rheumatic diseases may be facilitated by the integration of radiomics and other omics technologies. The digital era, which opens up vast prospects for advancements in rheumatology, will undoubtedly require complex solutions to new technical, legal, and ethical challenges.

The study of galectins is provoked by the search for new biomarkers of activity, clinical manifestations, and disease outcomes of systemic lupus erythematosus (SLE). The presented literature review summarizes the data on the most well-known galectins-1, -3, -9, as well as antibodies to galectins and galectin-3-binding protein, obtained in culture studies, in animal models of lupus and in patients with SLE.

Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are immunoinflammatory rheumatic diseases (IRDs) associated with a high risk of developing cardiovascular diseases (CVD). Despite advances in diagnostics and therapy, the risk of cardiovascular pathology is 1.8–2.8 times higher than in individuals without autoimmune diseases, is increased at an early stage of the disease, and is associated with high clinical activity, disease duration, need for hospitalization, and mortality. According to modern data, CVD in patients with SLE and RA is considered a consequence of a systemic (subclinical) inflammatory process induced by pathological activation of the main components of innate and acquired immunity, more often developing in patients with low or moderate cardiovascular risk. The main cells of the innate immune system involved in the development and maintenance of inflammation are monocytes and macrophages. There are two main phenotypes of macrophages: M1 (proinflammatory) and M2 (anti-inflammatory). M1 macrophages produce the main proinflammatory cytokines interleukin (IL) 6, IL-23, tumor necrosis factor α, which are involved in maintaining inflammation by engaging new immune cells, while M2 secrete anti-inflammatory mediators and limit inflammation. It is assumed that an imbalance between the two phenotypes may underlie SLE, RA, and the development of early manifestations of CVD.

Currently, various diagnostic non-invasive methods are used to visualize subclinical CVD, the results of which can provide additional values for risk stratification for asymptomatic patients. The importance of monitoring arterial stiffness as one of the markers characterizing vascular remodeling in the development of early signs of atherosclerosis has been confirmed. Several studies have demonstrated the effectiveness of new echocardiographic techniques (tissue Doppler), especially global longitudinal strain using speckle tracking, in assessing subclinical cardiac damage and left ventricular diastolic dysfunction. Thus, clarifying the relationship between proinflammatory monocyte activation and early cardiovascular disorders in patients with SLE and RA will contribute to understanding the common pathogenetic mechanisms in IRDs and CVD.

The aim of the study – to analyze the effectiveness and tolerability of subcutaneous methotrexate (sc MTX) (Metorthrit; S.C. Rompharm Company S.R.L) in patients with rheumatoid arthritis (RA) with high disease activity and rapid dose escalation, to assess their quality of life (QoL) in real clinical practice.

Material and methods. The study included 105 patients, mostly women, with a reliable diagnosis of RA with high disease activity (DAS-28 (Disease Activity Score 28) ≥5.1) aged 18 years and older and ineffectiveness of previous oral MTX therapy for at least 6 months or who had not received MTX. Sc MTX therapy was started at a dose of 15 mg/weekly. During the first month of therapy, a rapid escalation of the sc MTX dose of 2.5 mg/week was performed once a week. until the dose of 22.5 mg/week was reached, then, with insufficient response, the dose of sc MTX could be increased to 25 mg/week. The evaluation of the effectiveness of therapy, functional status, and QoL was carried out after 4–12–18–24 weeks.

Results. After a rapid escalation of the sc MTX dose during the first month of the study, at all stages of follow-up, a rapid decrease in disease activity was noted for all standard indices (DAS-28 – from 5.8±0.75 to 2.93±1.05; CDAI (Clinical Disease Activity Score) – from 30.13±8.33 to 7.08±6.07; SDAI (Simplified Disease Activity Score) – from 32.78±9.64 to 7.48±6.53) and the activity index, which was evaluated by the patients themselves (RAPID-3 (Routine Assessment of Patient Index Data 3) from 16.18±4.6 to 5.56±4.66; p≤0.05). The number of patients with high disease activity according to DAS-28 decreased by 2 times by the week 4 of therapy (to 46.2%), after 12 weeks they remained 13.3%, and by week 24 high activity remained only in 4.4% of patients. There was a marked decrease in pain from 65.6±13.07 to 20.5±17.1 mm in VAS (Visual Analogue Score) (p<0.001), which contributed to an improvement in the functional state: the HAQ (Health Assessment Questionnaire) index decreased on average from 1.47±0.65 to 0.64±052 points. Population indicators of functional status (HAQ≤0.5) by the week 24 of therapy were observed in 48.9% of patients. A decrease in the level of fatigue (from 6.25±7.04 to 1.81±1.71 cm according to VAS; p<0.001) was accompanied by a decrease in anxiety (from 7.47±4.03 to 2.36±2.72; p<0.001) and depression (from 7.77±3.84 to 2.50±2.56; p<0.001), as well as improved sleep. By the week 24 of the study, 45% of patients had population-based indicators of QoL according to the EQ-5D index. Glucocorticoids (GC) were completely eliminated in 2/3 of the patients. Patients who did not receive GC had lower disease activity by 24 weeks in all indices: DAS-28 (2.7±0.1 and 3.4±0.2, respectively), CDAI (6.0±0.3 and 10.2±0.1), SDAI (6.4±0.2 and 10.9±0.3) (p<0.05). Patients receiving and not receiving GC had the same number of adverse reactions (p>0.05), however, the number of infections in patients receiving GC was significantly higher (9.5% and 0.0%, respectively; p=0.009). The need for nonsteroidal anti-inflammatory drugs (NSAIDs) at the beginning of the study was in 93.2% of patients on average 21.1 days per month, after 24 weeks, the need for NSAIDs was in 54.4% of patients on average 3.8 days per month. In general, the safety profile of MTX was acceptable.

Conclusion. With high RA activity, the tactics of starting therapy with sc MTX at a dose of 15 mg per week and a rapid escalation of its dose of 2.5 mg weekly to 22.5–25 mg/week, allows achieving therapy goals by 3 months in 17.8% of patients, and by 6 months in 54.5%, to quickly improve the QoL, reduce the level of pain, reduce the dose of GC by 3 months of therapy or completely cancel them, reduce the need for NSAIDs by 7 times with an acceptable level of therapy safety.

The aim – evaluation of the efficacy and safety of anifrolumab (AFM) therapy in patients with severe and moderate systemic lupus erythematosus (SLE) in real clinical practice.

Material and methods. A prospective observational study (6 months) involving 14 patients with SLE (13 women and 1 man; mean age 37.5±14 years) treated in the rheumatology department of the Research Institute – Krasnodar Regional Clinical Hospital named after Professor S.V. Ochapovsky. All patients included in the study were prescribed anifrolumab (Safnelo) 300 mg parenterally once every 4 weeks.

Results. Already after 3 months, regression of skin rashes was noted in all patients according to the CLASI (Cutaneous Lupus Erythematosus Disease Area and Severity Index) 10.0 [4.0; 11.0] vs 2.0 [2.0; 4.0] (p=0.013). Against the background of AFM therapy, relief of articular syndrome was noted in 90% of patients in the form of a decrease in the number of painful joints 1.5 (0.0; 10.0) vs 0.5 (0.0; 4.0) (p=0.041). Three months after the start of AFM therapy, a decrease in the SLEDAI-2K (Systemic Lupus Erythematosus Disease Activity Index 2000) activity index was registered in all patients. Its median decreased from 8.0 [6.0; 8.0] to 5.0 [4.0; 7.0] (p=0.007), and after 6 months – to 2.0 [0.0; 6.0] (p=0.005). Six months after the initiation of AFM therapy, 2 (16%) patients managed to achieve a decrease in SLEDAI-2K to 0, which corresponds to the indicators of clinical and laboratory remission of SLE. The criteria for low LLDAS (Lupus Low Disease Activity State) activity after 6 months of therapy were met by 8 (66%) out of 12 patients. Against the background of AFM therapy, positive dynamics of immunological activity was noted after 3 months – a decrease in the level of anti-dsDNA by 37%, the titer of ANF by 33%. Positive dynamics of hematological syndrome was observed against the background of AFM therapy. By the 3rd month of therapy, the proportion of patients with leukopenia less than 4×10⁹/l decreased from 21% to 0%, with lymphopenia less than 1×10⁹/l from 21% to 16%, with thrombocytopenia less than 100×10⁹/l from 8% to 0%, with hemolytic anemia from 8% to 0%. According to the LupusQol questionnaire, which assesses the quality of life associated with the disease, positive dynamics were recorded on all scales 6 months after the start of AFM treatment. Addition of AFM to standard therapy allowed to reduce the dose of glucocorticosteroids by 33% after 3 months from initiation and by 50% after 6 months.

Conclusions. Anifrolumab is a highly effective drug for the treatment of patients with severe and moderate systemic lupus erythematosus, has a favorable tolerability and safety profile.

Previously published results of a retrospective analysis showed that switching to levilimab from other interleukin 6 receptor inhibitor (iIL6R) allows maintaining the achieved effect, and in some cases, increasing the effectiveness of treatment. This article presents the results of an extended observation period.

The aim – to evaluate the efficacy, safety and retention rate of levilimab in patients with rheumatoid arthritis (RA) during one year of observation.

Materials and methods. A retrospective analysis of data from the Moscow register of RA patients. The analyzed sample included RA patients who received levilimab 162 mg weekly after switching from other iIL6R (tocilizumab and sarilumab). Patient retention rate on levilimab therapy was assessed during 52 weeks of observation. The efficacy was evaluated at months 3, 6, 9 and 12 of levilimab therapy by the following parameters: laboratory markers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate), assessment of the number of swollen (SJC) and painful (PJC) joints, assessment of the patient’s global assessment (PGA) by visual analogue scale (VAS), and DAS28-CRP (Disease Activity Score 28 with CPR).

Results. 141 patients were included in analysis, the majority of patients were female (89%), the mean age was 57.8 years. The mean duration of levilimab therapy was 12.2±4.4 months. After 12 months of treatment, 87.5% [95% confidence interval: 82.1; 93.2] of patients continued levilimab therapy. Retention rate of levilimab therapy remained high in the levilimab monotherapy and combination therapy subgroups, and when prescribed as second or following biologic disease-modifying antirheumatic drugs (DMARDs). The mean DAS28-CRP, CRP level, TJC, SJC, and PGA by VAS were low at the time of initiation of levilimab therapy and remained stable during the year of therapy.

Conclusions. Levilimab had high patient retention in therapy when used both as monotherapy and in combination with conventional synthetic DMARDs, as well as when prescribed in second and following lines of biologic DMARDs.

The aim – to develop a unified diagnostic algorithm for axial psoriatic arthritis (axPsA).

Subjects and methods. 122 patients with psoriatic arthritis (PsA), duration less than 10 years, were included in the study according to CASPAR (The ClASsification for Psoriatic ARthritis) criteria, provided they also had axial involvement. Axial involvement was detected in case of radiographic sacroiliitis ((rSI); bilateral grade ≥2 or unilateral grade ≥3) or SI active according to magnetic resonance imaging (MRI) (MRI-SI), or ≥1 syndesmophyte(s) of the cervical and/or lumbar spine (CS/LS), or facet joints ankyloses of the CS. Patients were evaluated for the presence of inflammatory back pain (IBP) by ASAS (The Assessment of SpondyloArthritis international Society) criteria. Back pain lasting over three months, that did not meet ASAS criteria was considered chronic back pain (chrBP). HLA-B27 antigen status was observed.

Results and discussion. IBP was identified in 87 (71.3%), chrBP – in 35 (28.7%) patients, 49 (40.2%) patients had older age (>40 years) at back pain onset. 120 (98.4%) patients had peripheral arthritis, 75 (61.5%) – dactylitis, 69 (56.6%) – enthesitis, 122 (100%) – psoriasis, 90 (73.8%) – nail psoriasis. Isolated axial disease without peripheral arthritis was found in 2 (1.6%) patients. RSI was detected in 85 (69.7%) patients, in 28 of 85 (32.9%) patients rSI developed without IBP. Spinal lesions of the LS and CS were found in 100 (82.0%) patients, chunky “non-marginal” syndesmophytes – in 60 (49.2%), asymmetrical syndesmophytes of the LS – in 22 of 72 (30.6%), paravertebral ossification – in 5 (4.1%) patients. Isolated spinal lesions without rSI were found in 37 (30.3%), isolated spinal lesions without rSI or MRI-SI – in 21 (17.2%) patients. HLA-B27 was observed in 27 of 86 (31.4%) examined patients. Diagnostic algorithm for axPsA was developed. All PsA patients, regardless whether they experienced IBP/chrBP or not, must undergo diagnostic imaging: pelvis, LS and CS X-ray. In patients without rSI, MRI of the sacroiliac joints should be performed. AxPsA diagnosis must be confirmed by imaging. Axial involvement is detected in case of rSI or MRI-SI, or ≥1 syndesmophyte(s) of the CS/LS, or facet joints ankyloses of the CS.

Background. The assessment of organ damage in patients with systemic sclerosis (SSc) is challenging. The Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI) proposed in 2019 has not been sufficiently studied and requires testing for wider use.

The aim of the study was to examine the progression of organ damage in patients with systemic sclerosis assessed by SCTC-DI during a one-year prospective follow-up.

Materials and methods. A prospective observational study was performed, within the framework of which the SCTC-DI was assessed twice with an interval of 12 [10; 14] months in 74 adult patients (62 (84%) women) with SSc with an average age of 48±13 years. SSc was classified according to the criteria of progressive systemic sclerosis and in 43 (58%) cases was represented by a limited form. The duration of the disease was 92 [47; 164] months. The inclusion criterion was SCTC-DI≥1 point for at least one of 23 indicators at one of the assessment points. Statistical data processing was performed using parametric and nonparametric analysis methods.

Results of the study. At inclusion in the study, the median (Me) of the SCTC-DI was 7.5 [4; 12] points (min–max: 0–23). 27 (36%) patients initially had a low degree of damage (SCTC-DI≤5), the rest had moderate or severe damage. Upon repeated assessment, the Me of SCTC-DI decreased to 7 [4; 10] points (min–max: 0–17; p=0.023). After one year, there was a significant decrease in the incidence of digital ulcers, clinical signs of esophageal hypotension and symptoms of gastroesophageal reflux disease (GERD). At the same time, the incidence of myocardial disease associated with SSc increased (p<0.001). There was also a decrease in the median vascular and gastrointestinal tract damage scores (p<0.001), and an increase in the median cardiovascular score (p=0.027). The decrease in the total SCTC-DI score was statistically associated with the use of oral glucocorticoid therapy during the study period (p=0.011), as well as cyclophosphamide anamnesis (p=0.015).

Conclusion. The SCTC-DI was proposed for an objective assessment of changes in the condition of patients with SSc and takes into account irreversible changes in the main manifestations of the disease, which is reflected in an increase in the index value over time. In this study, the total SCTC-DI slightly but reliably increased with a multidirectional change in the values of individual index components. The use of the DI revealed certain of its shortcomings, which impose significant restrictions on its use in practice and mean the need for further work on validating the DI and more precise definitions of the main indicators of irreversible damage.

Background. Studies of systemic lupus erythematosus (SLE) pathogenesis have identified two major families of mediators: type I interferon (IFN-I) and autoantibodies to nucleic acids and their proteins, as the main factors contributing to the development of the disease. Against a background of genetic predisposition, a trigger stimulus, possibly microbial, induces the production of IFN-I, autoantibodies or, more likely, both, leading to inflammation. The interaction of cells of the innate and adaptive immune system are involved in the autoimmune response with the development of a variety of clinical manifestations of SLE.

The aim of our study was to describe clinical and immunological characteristics of systemic lupus erythematosus depending on interferon gene signature (IFNGS).

Material and methods This observational retrospective-prospective study included 76 patients (86% women, median aged 33 [25; 43] years (median [interquartile range 25%; 75%]), with a definite diagnosis of SLE (SLICC (Systemic Lupus International Collaborating Clinics), 2012) attending a routine visit at our Clinic between February 2021 and June 2024. Baseline demographics, disease characteristic, organ system involvement/damage were analysed descriptively according to SLE Disease Activity Index 2000 (SLEDAI-2K), SLICC Damage Index (SDI) and IFNGS status (high/low). IFN status was assessed by the expression of IFN-inducible genes (MX1, RSAD2, EPSTI1) using real-time polymerase chain reaction. IFNGS was calculated as the average expression value of three selected genes. In patients, IFNGS was considered high when the average value of gene expression exceeded the average value of gene expression in donors. The control group consisted of 20 healthy donors comparable in sex and age with the SLE patients.

Results. The median disease duration was 2.3 [0.2; 11.0] years, SLEDAI-2K – 7 [4; 11], SDI – 0 [0; 2]. IFNGS-high was detected in 72% of SLE patients. IFNGS-high patients were younger at the time of inclusion (31 [25; 41] and 40 [32; 49] years, respectively), had less frequent remission of SLE (SLEDAI-2K=0) (2% and 19%, respectively), and higher concentrations of anti-dsDNA (219.8 [120.3; 729.3] and 131.0 [46.6; 265.9] IU/ml, respectively; normal <100 IU/ml), ANF titer ≥1/1280 (84% and 52%, respectively), lower absolute count of blood leukocytes (4.2 [3.2; 5.6] and 6.6 [4.2; 8.8]×10⁹/L, respectively) and lymphocytes (1.3 [0.8; 1.8] and 2.0 [1.2; 3.2]×10⁹/L, respectively; p<0,05 in all cases). Of the criterion and non-criteria manifestations of SLE the greater proportions of IFNGS-high versus IFNGS-low patients had haematological (56% and 29%, respectively), primarily leukopenia (53% and 24%, respectively) and dermal (31% and 19, respectively %) involvement (p<0,05 in all cases).

Conclusions. Elevated type I IFN signalling is a marker of a certain type of SLE patients – young age with predominant skin, haematological and immunological disorders. No association with standard therapy and the expression level of certain IFNGS was found.

The article presents a description of a 73-year-old patient with rheumatoid arthritis, complicated by the development of a neurological deficit in the form of tetraparesis. Magnetic resonance imaging of the cervical spine revealed destruction of the C2 odontoid process with its replacement by a pannus, atlantoaxial subluxation, compression of the proximal segments of the spinal cord, and a compression fracture of C5.