Systemic sclerosis (SSc) is a severe systemic autoimmune rheumatic disease (SARD), pathogenetically associated with inflammation and pathological disorders in the microvascular bed, leading to the development of autoimmune fibrosis and vasculopathy. An important role in the pathogenesis of SSc is played by pathological activation of B-cell immunity, manifested in the disruption of B-cell signaling, B-cell homeostasis, hyperproduction of “profibrotic” cytokines and “pathogenic” autoantibodies. Despite the fact that the pathogenetic mechanisms of SSc associated with dysregulation of B cells and the synthesis of “sclerodermic” autoantibodies have not been sufficiently studied, anti-B-cell therapy is considered one of the important areas of treatment for this disease. The article examines modern concepts about the place of anti-B-cell therapy in the treatment of SSc, primarily in relation to the progression of interstitial lung diseases and skin lesions, and discusses the results of the use of new types of monoclonal antibodies to B-cells and CAR-T-cell therapy.

In January 2013, at the initiative of the world’s leading rheumatologists Ronald F. van Vollenhoven, Josef Smolen, Marta Mosca and Matthias Schneider, a project was launched to create the “Treat-to-Target” concept for systemic lupus erythematosus (SLE). In 2014, the group published recommendations “Treat-to-Target for SLE”. The article discusses the problems of implementing the strategy in real clinical practice and discusses the proposed ways of its implementation, proposed by international experts in 2025: 5 basic principles and 11 statements.

Inflammation of the sacroiliac joints (SIJ) – sacroiliitis (SI) – is an obligatory criterion of axial spondyloarthritis. The main place in the diagnosis of SI is occupied by X-rays and magnetic resonance imaging (MRI). Anatomical features of the SIJ structure can mimic the signs of radiologic and active SI according to MRI, which often leads to diagnostic errors. The article discusses the variability of anatomical changes of the SIJ and its correlation with imaging findings.

Rheumatoid arthritis (RA) most often affects women, and the onset of RA often occurs around the middle age of menopause. RA in women, compared to men, is more severe, characterized by difficulties in achieving remission and a more negative prognosis. Research results indicate a relationship between menopause, estrogen levels and RA. Early menopause is characterized by an increased risk of developing RA, as well as difficulty achieving remission and a lower quality of life. Menopausal hormone therapy (MHT) may influence both the risk of developing RA and its course. Given the relationship between menopause and other conditions such as obesity, cardiovascular disease, osteoporosis and fibromyalgia, off-label MHT may be one of the possible ways to overcome treatment resistance in RA.

Under real-world clinical practice together with indices for assessing disease activity and the effectiveness of therapy, drug retention provides critical information on efficacy, safety, compliance and convenience of use.

The aim – to obtain data on the safety of netakimab (NTK) in a population of patients with ankylosing spondylitis (AS), including various somatic diseases, as well as to assess retention on therapy during 2 years of observation in real word clinical practice.

Materials and methods. Patients were recruited for the study from August 2020 to December 2021 at 23 centers in the Russian Federation. The study included 137 patients who were prescribed netakimab therapy before enrollment. Clinical and medical history data for the first visit were entered retrospectively, and following visits at 12, 24, 52, 76, 104 weeks of therapy were collected within the study. The average age of the patients 42,3 y. O., 34.3% of them with previous biologics therapy.

Results. Median observation period was 104 weeks (range 1–137 weeks). At the end of the analyzed period (104 weeks of therapy), 85,5% [95% confidence interval (95% CI): 79.7–91.8] of patients continued treatment with Netakimab. Retention on NTK therapy was slightly better in “bio-naïve” vs patients who received biologics earlier: 88.7% (95% CI: 82.3–95.5) and 78.9% (95% CI: 67.5–92.2), respectively, without significant differences between groups (p=0.16). 21 (15.3%) patients withdrew from study before visit 6. The main end of study reasons was lost to follow-up – 7 (5.1%) patients, and treatment inefficacy – 6 (4.4%) patients. The BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score with C-reactive protein) showed statistically significant decreases from baseline: by three times during the first 3 months of therapy and two times decrease during the first year of treatment. This trend continued in the second year of treatment, although with a lower rate of reduction. By week 104 of therapy, 52.9% (95% CI: 47.3–58.4) reached low disease activity (1.3≤ASDAS<2.1), 21.3% (95% CI: 12.8–29.8) had inactive disease (ASDAS<1.3). Netakimab was well tolerated by patients: AEs, related to therapy according to the investigator’s opinion, were reported in 8 (6.0%) patients.

Conclusions. In real-world clinical practice, 85.5% of patients continued treatment with Netakimab at the end of 104 weeks. By 104 weeks 74% patients had low disease activity or inactive disease. Netakimab was well tolerated by most of patients.

The aim of this study was to investigate the survival and the impact of various factors on it in patients with pulmonary arterial hypertension (PAH) associated with systemic sclerosis (PAH-SSc).

Methods. We analyzed the data of 76 patients diagnosed with PAH-SSc who received PAH-specific therapy and were followed-up for at least 5 years. A group of “historical control” consisted of 20 patients who did not receive PAH-specific treatment. The primary endpoint of the study was death from any cases.

Results. The use of PAH-specific therapy significantly reduces the 5-year risk of death in patients with PAH-SSc by 67%, compared to the “historical control” group. At the present time, 1-, 2-, 3-, and 5-year survival rates for patients with PAH-SSc are 88%, 76%, 68%, and 51%, respectively. Factors associated with mortality include age, functional class, 6-minute walking distance, right atrial pressure, cardiac output, pulmonary vascular resistance, and elevated biomarkers. The use of macitentan and/or riociguat as monotherapy or in combination with other PAH-specific medications significantly reduced the risk of death after 5 years (hazard ratio – 0.44 [0.19; 1.07]; p=0.07).

However, immunosuppressive therapy did not improve survival.

Conclusion. The survival rate for patients with PAH-SSc remains low. Further research is needed to identify new treatments targets. The use of modern PAH-specific drugs, such as macitentan and riociguat, can modify the course of disease and improve survival.

The aim – to develop a method for predicting the effectiveness of psoriatic arthritis (PsA) therapy.

Methods. 377 PsA patients (pts) were examined: (М/F 185/192). Pts’ age 47.6±12.4 years, psoriasis (PsO) duration 206.8±156.3 months, PsA duration – 84.8±84.6 months. Pts underwent standard clinical examination, the analysis included detection of comorbidities according to ICD-10. Pts were evaluated for achieving minimal disease activity (MDA). Data of visit 2 (6 months of treatment) were analysed.

Results. At 6 months of treatment tender joint count was 3,0 [0.0; 8.0], swollen joint count – 1,0 [0.0; 5.0], C-reactive protein (CRP) – 4,3 (0.0–90.6) mg/l, LEI (Leeds Enthesitis Index) – 0,0 (0.0–6.0), body mass index (BMI) – 27.6±5.2 kg/m². 273 (72%) pts had BMI<30 kg/m², 75 (19.9%) pts – 30≤ BMI<35 kg/m², 29 (7.7%) pts – BMI≥35 kg/m². Mild PsO (BSA≤3%) was found in 264 (70.0%) of 377 pts, moderate (3%<BSA≤10%) – in 96 (25,5%) pts, severe PsO (BSA>10%) – in 17 (4.5%) pts. 82 (21.8%) pts met the MDA criteria. Comorbid diseases were found in 152 (40%) pts.

Multivariate analysis was performed and the following parameters were revealed that negatively correlate with MDA achievement – CRP (p=0.0001), LEI (p=0.001), arterial hypertension (AH) (p=0.08), BSA (p=0.063), BMI (p=0.289). A discriminant rule was obtained that makes it possible to predict the possibility of MDA achievement: 0.046×(CRP, mg/l) + 0.470×LEI + 0.527×(AH) + 0.451×(BSA) + 0.237×(BMI) ≤1.184.

This formula includes the values of CRP, LEI, AH (no AH – 0 points, with AH – 1 point), BSA (BSA≤3% – 1 point, 3%<BSA≤10% – 2 points, BSA>10% – 3 points), BMI (BMI<30 kg/m² – 0, 30≤BMI<35 kg/m² – 1 point, BMI≥35 kg/m² – 2 points). When the expression value is ≤1.184, the achievement of MDA in PsA pts is predicted.

The area under the ROC curve is 0.76, which makes it possible to estimate the predictive accuracy of the model as high (95% CI: 0.71–0.81; p=0.26. For the selected total value of the discriminant function 1.184, sensitivity is 85.4%, specificity – 59.3%.

Conclusion. The developed method for predicting the MDA achievement in PsA pts including the following indicators: CRP, LEI, the presence of hypertension and obesity, severity of PsO – makes it possible to predict the treatment outcome in PsA pts and stimulates both the physician and the patient to modify the factors included in this formula.

Asymptomatic hyperuricemia (AH) and gout are characterized by the presence of elevated uric acid (UA) levels. It is not known whether there are differences between these conditions, beyond the acute attacks of arthritis unique to gout.

The aim – to identify differences in the frequency of concomitant diseases, metabolic disorders and dietary habits in patients with gout and asymptomatic hyperuricemia.

Material and methods. A single-stage observational case-control study included 202 people: 101 patients each with AH and gout, matched by age and gender. The examination included collection of anamnesis and medical documentation data on the presence of cardiovascular diseases, type 2 diabetes mellitus (T2DM), nephrolithiasis; inspection and measurement of anthropometric data. The intake of medications was recorded. A survey was conducted regarding the frequency of consumption of meat, seafood and alcohol. Blood levels of glucose, sUA, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), creatinine, cholesterol, C-reactive protein (CRP), and ESR according to Westergren were determined. GFR was calculated using the CKD-EPI formula. All patients underwent ultrasound examination of the knee joints to determine signs of synovitis and deposition of monosodium urate (MSU) crystals.

Result. In patients with gout, arterial hypertension (86 (85.1%) vs 53 (52.4%) patients, respectively; p<0.05), T2DM (12 (11.9%) vs 4 (4.0%) patients, respectively; p<0.05) were detected more often than in patients with AH. In the gout group, there were more patients consuming alcohol ≥1 time per week (p=0.02), while there were no differences in the frequency of consumption of meat and seafood. Among patients with gout, there were more participants with GFR<60 ml/min/1.73 m². In patients with gout, there was a significant direct correlation between the levels of UA and ALT, creatinine, CRP, and an inverse correlation between serum UA and GFR. Ultrasound of the knee joints showed a significantly more frequent deposition of MSU crystals (46 (45.5%) vs 17 (16.8%) patients, respectively; p<0.05) and the presence of synovitis (37 (36.6%) vs 14 (13.8%) patients, respectively; p<0.05) in the gout group.

Conclusions. Despite the apparent commonality of gout and AH, they have a number of differences. In gout, arterial hypertension and T2DM are more often detected. Also, in patients with gout, there is a significant direct correlation between the levels of sUA and ALT, creatinine, CRP, while GFR is inversely correlated with the level of serum sUA. Among patients with AH, such correlations were not found. Gout also predicts a statistically more frequent detection of MSU crystal deposits (45.5% vs 31.1% of patients). The intake of meat and fish products did not differ in both groups.

The aim – to evaluate the effectiveness of long-term therapy with Russian rituximab (RTX) biosimilar in Sjögren’s disease (SjD) in real-life clinical practice.

Materials and methods. The retrospective study included 53 patients with SjD (Russian 2001 criteria and ACR/ EULAR (American College of Rheumatology/European Alliance of Associations for Rheumatology) 2016 criteria), observed at the V.A. Nasonova Research Institute of Rheumatology from 2017 to 2024 and receiving long-term RTX therapy (Russian biosimilar Acellbia®, BIOCAD). The signs of clinical and laboratory activity of the disease, stomatological and ophthalmological tests, as well as the incidence of new systemic manifestations and lymphomas were assessed dynamically.

Results. The median duration of RTX therapy was 27 [19; 55] months, and the median total dose was 4 [3.5; 5.5] g. Before the therapy, 13 (25%) patients had recurrent parotitis, which was relieved in all patients during the therapy. Persistent enlargement of the salivary glands was observed in 10 (20.4%) patients, in 9 of them it was relieved. A significant increase in stimulated saliva flow was found (from 1.5 [0.5; 3] to 2.4 [1.4; 3.5] ml; p=0.002), an increase in salivation was found in 51% of patients, stabilization in 28.6%, and deterioration in 20.4%. When assessing the ultrasound dynamics of the salivary glands, the size of hypoechoic avascular lesions significantly decreased (from 1.8 [1.3; 2.3] to 1.3 [1.1; 1.5] mm; p<0.001), and according to the ultrasound activity index, stabilization was noted in 67.4% of patients, improvement in 27.9%, and deterioration in 4.7% of patients. When assessing the dynamics of sialography, the size of cavities significantly decreased (from 1.5 [1.5; 2.5] to 1.0 [0; 1.5] mm; p<0.001), and according to the assessment of sialographic stages, stabilization was noted in 67.5% of patients, improvement in 32.5% of patients, and deterioration was not noted in any patient. When assessing the lacrimal glands function, a significant increase in lacrimation was found according to the stimulated Schirmer’s test (from 6 [3.75; 12] to 8 [5; 15] mm; p=0.005); an increase in lacrimation was noted in 38% of patients, stabilization in 40.6%, and a decrease in 21.4%. When assessing the tear break-up time, a tendency towards its increase was noted, but statistically insignificant (from 5 [3.75; 9.25] to 5.5 [4; 9] sec; p=0.35). Corneal epitheliopathy during the therapy was relieved in 44% and persisted in 56% of patients; worsening of corneal epitheliopathy during the treatment was observed in a few patients, while no cases of ulcer formation or perforation of the cornea were recorded. During the therapy, a significant decrease in the levels of erythrocyte sedimentation rate, gamma globulins, IgG, IgA, IgM, rheumatoid factor, an increase in the C3 complement level, and the elimination of monoclonal gammopathy were observed, while the dynamics of the C4 complement level and cryoglobulinemia were multidirectional. The median duration of B lymphocyte depletion was 5 [4; 6] months, constant depletion could be maintained only in 59.6% of patients. During the therapy, the SjD systemic activity index (ESSDAI, EULAR Sjögren’s Syndrome Disease Activity Index) significantly decreased (from 5 [2; 8] to 1 [0; 3] points; p<0.001), and minimal clinically important improvement of this index was achieved in 66.6% of patients. During the observation, one patient developed a new skin lesion (lupus chilblain); no other new systemic manifestations or lymphomas were registered.

Conclusion. According to our retrospective study conducted in real-life clinical practice, long-term therapy with Russian RTX biosimilar in most cases (60–80%) led to stabilization or improvement of SjD manifestations. RTX can be used to treat not only systemic but also glandular manifestations of the disease. Given the lack of an optimal response to RTX therapy in a number of SjD patients, it is necessary to study the effectiveness of drugs that lead to a deeper depletion of B lymphocytes.

The aim – to study the effect of interleukin (IL) 6 blockers on body composition, as well as leptin, adiponectin, and insulin-like growth factor (IGF) 1 levels in patients with rheumatoid arthritis (RA) during a prospective follow-up of 6 months.

Material and methods. The study included 29 patients with RA with moderate to high disease activity who were first initiated on therapy with tocilizumab 8 mg/kg/infusion intravenously (n=13) or olokizumab 64 mg subcutaneously (n=16) every 4 weeks. At two points, at baseline (T0) and at the end of observation (T1), body composition (fat mass and lean mass) was assessed using dual-energy X-ray, and leptin, adiponectin, and IGF-1 levels were determined using an enzyme immunoassay.

Results. After 6 months of therapy, remission and low disease activity were achieved in 11 (84.6%) patients in the tocilizumab group and 14 (87.5%) in the olokizumab group (p=0.75). Repeated DXA was performed after 5.5 [5.5; 8.0] months; overall, BMI, fat and lean mass, leptin, adiponectin and IGF-1 concentrations increased in RA patients (p<0.05). Correlations were found between ∆ fat mass and ∆ CRP (r=–0.6; p=0.0005), ∆ leptin and ∆ fat mass (r=0.69; p=0.000048), ∆IGF-1 and ∆ lean mass (r=0.39; p=0.042). When using tocilizumab, ∆ fat mass was –0.04 [–1.1; 0.4] kg, when using olokizumab – +3.9 [2.1; 5.0] kg (p=0.00008), ∆ leptin – 0.16 [–3.84; 3.12] and 6.26 [1.94; 20.7] ng/ml, respectively (p=0.037), ∆ lean mass, ∆ adiponectin and ∆IGF-1 were comparable in the two groups (p>0.05).

Conclusions. The use of both IL-6 blockers resulted in a significant decrease in disease activity after 6 months of therapy in most patients with RA, which was accompanied by an increase in BMI, fat and lean mass, as well as serum leptin, adiponectin and IGF-1 levels. The accumulation of fat mass was directly related to a decrease in the severity of inflammation, and an increase in the concentration of leptin and IGF-1 – with body composition changes. Tocilizumab, unlike olokizumab, did not significantly affect fat mass accumulation and leptin levels elevation.

Osteoarthritis (OA) is the most common joint disease, the first line of treatment for which are non-steroidal anti-inflammatory drugs. In terms of sufficient duration for pain relief and minimization of the risk of adverse events (AE), it seems relevant to evaluate the efficacy and safety of a short course of OA therapy with the drug etoricoxib (Dolocox®).

The aim of the study was to evaluate the clinical efficacy (effect on the activity of the inflammatory process, intensity of pain) and safety of etoricoxib (Dolocox®) in a short course of therapy (at least 10 days) in the treatment of osteoarthritis.

Material and methods. 60 patients were included, of which 55% (33) had comorbidities. Pain was assessed using the visual analogue scale (VAS), symptoms of knee OA – using the WOMAC (Western Ontario and McMaster University) scale, and patient satisfaction with their condition – using the PASS (Patient Acceptable Symptom State) index. The dynamics of symptoms, adverse events, and tolerability were recorded daily. Etoricoxib (Dolocox®) was prescribed to patients by the physician at a dose of 60 mg once daily in the morning for 10 days. Differences were statistically significant at p<0.05.

Results. With etoricoxib (Dolocox®) on day 10 pain decreased at movement from 55,3 to 19,4 (p<0.05), at rest – from 50,3 to 18,5 (p<0.05), at night – from 46,6 to 17,6 (p<0.05). Reduce of pain of 40% and more was observed during movement in 92%, at rest – in 87%, at night – in 90% of patients on day 10. According to the WOMAC, on day 10, a decrease of more than 40% of all subscales was noted (“Pain” – 45%, “Stiffness” – 53%, “Function” – 45% of patients); positive PASS was recorded in 97% of patients. 75% of participants rated tolerability as excellent, 23% – as good. Physicians noted excellent tolerability in 70% (42) cases, good – in 28% (17). AEs were reported in 7% of patients, all of them are mild.

Conclusions. Etoricoxib (Dolocox®) is highly effective in the treatment of knee and hip OA in a short course of therapy, which allows its use in real clinical practice.

Approximately 2.7% of all total joint arthroplasties are performed on patients with inflammatory arthritis. Severe structural and functional changes of the hip joints (HJ) increase the risks of intra- and postoperative complications.

The aim of the study – to carry out a comparative analysis of the functional state of the hip joints before total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA) and osteoarthritis (OA).

Materials and methods. A retrospective study included 170 patients diagnosed with AS who met the modified 1984 New York criteria. For comparative analysis, age-matched individuals with AS were selected from the cohort of RA (n=1604) and OA (n=1458) patients. The preliminary analysis included data on 68 patients with RA and 52 with secondary coxarthrosis (posttraumatic and due to HJ dysplasia). All patients underwent elective THA between 1998 and 2020. Among AS patients, men (80.6%) predominated. The mean age was 38.1±11.3 years, duration of disease from the onset of the first symptoms was 17.0±8.5 years, duration of HJ pain before THA was 7.4±4.8 years. The majority of patients with RA were women (83.8%). The mean age of the patients was 42.8±9.9 years. The mean duration of RA from disease onset to THA HJ was 15.9±8.6 years. The duration of HJ pain before surgical treatment was significantly (p<0.05) less than in AS – 5.7±2.3 years. Women (57.7%) were also predominant among patients with OA. Patients with OA at the time of THA HJ were significantly older than AS patients, their mean age was 45.3±8.4 years. The duration of pain in HJ was 6.8±5.3 years. Preoperative functional state of HJ was determined using the modified Harris scale.

Results and discussion. The mean total Harris scale score before surgical treatment in AS was significantly higher than in RA and lower than in OA: 38.0±15.4, 33.9±12.7, and 44.9±12.2, respectively. In most parameters of the Harris scale, patients with AS had similar indicators with RA patients. The following parameters of the Harris scale were significantly more frequently used in RA and were worse in comparison with AS: fixed adduction, fixed inward rotation, fixed flexion contracture, HJ flexion. Patients with AS were significantly more likely than those with OA to have more severe claudication, problems with distance walking, more frequent use of additional support, and more severe anatomical deformities on the Harris scale.

Conclusion. Assessment of function according to the Harris scale revealed a high degree of functional impairment of the HJ before THA in all the studied diseases. The average total score on the Harris scale before surgical treatment in AS was significantly higher than in RA and lower than in OA. According to the majority of parameters characterizing functional limitations in the HJ, AS patients had similar indices with RA patients.

A high degree of structural and functional changes in the HJ before surgical treatment may potentially increase the risks of postoperative complications, whereas better results can be expected with initially higher functional capabilities.

Acquired hemophilia is a rare disease that develops because of the synthesis of antibodies to endogenous VIII blood clotting factor. The most common symptom of acquired hemophilia is spontaneous bleeding. Acquired hemophilia is observed more frequently in older population and in 50% is secondary to malignant tumors and autoimmune rheumatic diseases. In this article, we present a clinical case of autoimmune hemophilia that developed shortly before the onset of systemic lupus erythematosus.