This review systematizes current data on the relationship between osteoarthritis (OA) and comorbid conditions, demonstrating their mutual negative influence. Particular attention is paid to basic drugs, in particular crystalline glucosamine sulfate, which have positive pleiotropic effects and affect not only OA, but also comorbidities. Its potential is demonstrated in improving cardiometabolic status, intestinal microbiota; reducing the risks of carbohydrate metabolism disorders, gout, dementia and mortality.

The review focuses on the latest data on the role of neutrophils in the pathogenesis of ANCA-associated systemic vasculitis (AAV). Numerous signaling pathways for the regulation of neutrophil function during AAV development are discussed, including the role of neutrophil proteases, neutrophil extracellular traps, the influence of complement components and intercellular interactions. The impact of extracorporeal treatments is discussed. The perspective goals of therapy are considered.

Oral and ocular manifestations of Sjögren’s disease (SjD) were first described over 100 years ago, but SjD was recognized as an independent nosology in 1965. However, currently the diagnosis and treatment of this disease still pose significant difficulties due to low awareness of physicians about the characteristics of the disease. The first part of the article presents the most common and significant myths in epidemiology and diagnostics of SjD.

The aim – to study the serum level of cytokines, chemokines, growth factors in patients with systemic lupus erythematosus (SLE) in comparison with healthy volunteers to identify promising indicators for assessing disease activity and the development of organ damage.

Material and methods. The analysis included 139 patients (123 (88%) women and 16 (12%) men) with a reliable diagnosis of SLE. The median duration of the disease was 3.0 [0.3; 12.0] years, SLEDAI-2K (Systemic Lupus Erythematosus Disease Activity Index 2000) – 7 [4; 11] points, SDI (SLICC (Systemic Lupus International Collaborating Clinics) Damage Index) – 0 [0; 1] points. The study of 48 cytokines in blood serum was carried out by the method of multiplex immune analysis based on suspension microarray technology xMAP (Bio-Plex® 200 Pro Human Cytokine Screening Panel, 48-Plex; Bio-Rad Laboratories, USA) according to the manufacturer’s instructions. The control group consisted of 13 healthy donors, comparable in gender and age with the examined patients.

Results. In patients with SLE, compared with healthy donors, there was a higher level of granulocyte colony-stimulating factor (G-CSF), interferon (IFN) γ, interleukin (IL) 6, IL-8, monocyte chemotactic protein (MCP) 1, IL-1 receptor antagonist (IL-1Ra), macrophage inflammatory protein (MIP) 1α, vascular endothelial growth factor (VEGF), IL-18, interferon-inducible protein 10 (IP-10), leukemia inhibitory factor (LIF), MCP-3, macrophage colony-stimulating factor (M-CSF), MIG (monokine induced by IFN-γ) (p<0.05). In the group of patients with nephritis (n=40), there was a higher concentration of IFN-γ, IL-7, VEGF, IFN-α2, M-CSF in contrast to patients without nephritis (p<0.05). Conclusion. In the sera of patients with SLE, a higher level of proinflammatory cytokines, chemokines, colony-stimulating, stromal and angiogenic factors is noted; M-CSF probably plays an important role in the development of nephritis. Further studies are required to improve our understanding of the role of cytokine profile parameters in the pathogenesis of SLE.

The aim of the study was to determine the frequency, assess survival, and characterize the clinical features of systemic lupus erythematosus (SLE) in association with pulmonary arterial hypertension (PAH).

Material and methods. According to the results of echocardiographic screening, 8 patients with PAH-SLE were identified after verification of the diagnosis on a right heart catheterization. Two cohorts of patients with SLE observed at the V.A. Nasonova Research Institute of Rheumatology were taken as a comparison group: the first is historical, with a long follow-up period (n=154), the second is modern, with a short duration of the disease (n=400). The analyzed patient groups were examined according to a single scheme, differences in signs and survival were assessed. The intrahospital frequency of PAH in SLE was estimated based on statistical data for the period from 2008 to 2017.

Results. Despite the small number of patients in the main group, signs associated with the presence of PAH were identified: predominantly chronic course of SLE, with a long period (6–11 years) the course of the disease before the first clinical signs of PAH, the presence of Raynaud’s syndrome without capillaroscopic changes, Roand Smithautoantibodies. The survival rate of patients with PAH-SLE and the long-term observed SLE cohort did not differ. The in-hospital prevalence of SLE with echocardiographic screening was 0.29%.

Conclusion. PAH is a rare manifestation of SLE associated with the features of the course and clinical picture, which does not significantly affect survival when using PAH-specific therapy.

The aim – to evaluate the relationship between bone mineral density (BMD) and muscle mass with uric acid (UA) level in women with rheumatoid arthritis (RA).

Materials and methods. A total of 182 women with confirmed RA (median age 61 [53; 66] years) were examined. Clinical and laboratory examination was performed, including blood serum UA testing, dual-energy X-ray absorptiometry in standard measurement areas and the whole body.

Results. The UA level in the examined group was 258.5 [198.0; 309.5] μmol/l. A comparative analysis depending on the UA level quartile revealed significant differences between the groups in age, body mass index, appendicular muscle index (AMI), total muscle mass (TMM), and total muscle index (TMI). The direct stepwise regression method showed that the UA level in women with RA was not associated with the BMD value in all measurement areas (p>0.05), but was associated with all quantitative indices of muscle mass (with AMI – β=0.29; with TMM – β=0.37; with TMI – β=0.35; p<0.001).

Conclusion. In women with RA, no independent association was found between UA level and BMD in standard measurement areas. A significant positive association between UA and appendicular and total muscle mass was revealed.

Background. Infections of the lower respiratory tract (LRT) and ENT organs in patients with rheumatic diseases (RD) are an urgent problem of rheumatology, the real solution of which can be vaccination. However, there is still insufficient data on the clinical efficacy, immunogenicity, and safety of pneumococcal vaccines in rheumatological patients.

The aim – to evaluate the clinical efficacy, immunogenicity, and safety of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with RD who were observed at the V.A. Nasonova Research Institute of Rheumatology.

Materials and methods. An open prospective study included 254 patients with RD, including 97 with rheumatoid arthritis (RA), 52 with ankylosing spondylitis (AS), 27 with psoriatic arthritis (PsA), 78 with systemic lupus erythematosus (SLE), including 18 with secondary antiphospholipid syndrome. PPV-23 was administered in a single dose (0.5 ml) intramuscularly. The clinical efficacy of vaccination during the 12-month follow-up period was assessed by the frequency of reported infections of LRT and ENT organs. The level of post-vaccination antibodies (AT) was determined by enzyme immunoassay (ELISA) using a commercial EIA PCP IgG kit (Test Line Clinical Diagnostics, Czech Republic) initially, 1–3 and 12 months after vaccination. The safety of vaccination was determined by the frequency and severity of post-vaccination reactions and the effect on activity and course of RD.

Results. The clinical efficacy of PPV-23 during a 12-month follow-up was confirmed in 92.1% of patients with RD. A statistically significant increase in AT levels was detected 1–3 and 12 months after vaccination. 87.5% of patients with RA, 61.5% with AS, 72.7% with PsA, and 56.0% with SLE were “responders” to PPV-23. Post-vaccination local reactions in the vast majority of cases (94.1%) were mild or moderate and stopped on their own. Systemic reactions were rare, mild, and short-term. There was no negative effect of vaccination on the activity of RD, as well as the occurrence of new autoimmune phenomena.

Conclusion. The data obtained indicate sufficient clinical efficacy, immunogenicity, and safety of PPV-23 in patients with RD.

The aim of the study – to analyze the relationship between iron metabolism disorders and the assessment of the main patient-reported outcomes (PROs) – fatigue, pain, functional limitations and quality of life, as well as the influence of anemia genesis on the effectiveness of therapy in patients with active rheumatoid arthritis (RA).

Materials and methods. The study included 108 patients with RA (DAS28 (Disease Activity Score 28) – 5.0±1.2) who were sequentially admitted for inpatient treatment at the V.A. Nasonova Research Institute of Rheumatology. The diagnosis of anemia was made according to World Health Organization criteria. The nature of iron metabolism disorders was verified by the level of serum hepcidin. Anemia of chronic inflammation (AI) was classified with an increase in hepcidin levels above reference values (>120 pg/ml), iron deficiency anemia (IDA) was diagnosed in patients with hepcidin levels below 40 pg/ml. All patients underwent PROs assessment using FACIT-F (Functional Assessment of Chronic Illness Therapy – Fatigue) – fatigue level, HAQ (Health Assessment Questionnaire) – functional impairment level, EQ-5D (EuroQol-5 Dimensions – patient’s quality of life.

Results. The incidence of anemia in patients with active RA was 46%. Among patients with anemia (n=47), isolated AI was diagnosed in 54% of cases (n=27). IDA was detected in 19 (37%) patients. In both types of iron metabolism disorders, the patients were comparable in age, duration of the disease, swollen joint count (SJC), patient’s pain level, HAQ and FACIT-F. Significant differences were obtained in terms of tender joint count (TJC; 6.0 [4.0; 9.0] and 9.0 [6.0; 14.0], DAS28 index (5.1±1.0 and 5.9±1.1), respectively. Fatigue correlated with HAQ (r=–0.49; p=0.04) and hemoglobin levels (r=0.49) in IDA (p=0,04). In AI, the fatigue level correlated with EQ-5D (r=–0.61; p=0.02) and with HAQ (r=0.71; p=0.00). Only in AI did fatigue correlate with IL-6 (gil-6=0.6; r=0.6; p=0.01). In patients with active RA and IDA, severe fatigue was almost twice as common as in AI (33% and 18%, respectively). There was no fatigue with AI in 37%, with IDA – in 28% of cases. Among patients with anemia who had a change of two classes of biological disease-modifying antirheumatic drugs(bDMARDs)/targeted synthetic DMARDs (tsDMARDs), the incidence of IDA was 75%.

Conclusions. Concomitant IDA makes a significant contribution to severe fatigue in active RA, which is poorly diagnosed by doctors due to the similarity of clinical manifestations with AI. It is patients with IDA who are three times more likely to have the change of two classes of bDMARDs/tsDMARDs compared with AI.

The aim of the research – to identify predictors of «difficult-to-treat» (DtT) rheumatoid arthritis (RA) and investigate its association with prior drug therapy.

Materials and methods. A cohort study based on a retrospective analysis of medical documentation data from 8985 hospitalizations at the round-the-clock inpatient facility (from 04.2018 to 03.2024) and 25071 hospitalizations at the day hospital (from 01.2014 to 03.2024) was conducted. The study included 1090 patients with a confirmed diagnosis of RA. The final study included 564 patients. Patients were divided into 2 subgroups: DtT RA (n=133 (12.2%)) – with the ineffectiveness/intolerance of at least 2 different disease-modifying antirheumatic drugs (DMARDs)/biologic DMARDS (bDMARDs) (according to the European Alliance of Associations for Rheumatology criteria, 2021); non-refractory RA (non-DtT; n=431 (39.5%)) – treated with ≥1 DMARD/bDMARD and achieving low disease activity (LDA) in RA (DAS28-CRP/ESR (Disease Activity Score 28 with detection of C-reactive protein/erythrocyte sedimentation rate) >2.6–3.2). An assessment and comparative analysis of clinical-laboratory and instrumental data in the RF (rheumatoid factor) and non-RF groups were conducted. Differences were considered statistically significant at p<0.05.

Results and discussion. DtT compared to non-DtT were significantly younger (median (Mе) age – 54 and 58 years, respectively), had a longer disease duration (Mе – 186 and 116 months, respectively), shorter lifespan (Me – 662 and 823 months, respectively), more often seropositive for DtT (82.0% and 74.5%, respectively) and anti-citrullinated protein antibodies (82.3% and 69.8%, respectively). The onset of RA in DtT compared to non-DtT also occurred at a younger age (37 and 46 years, respectively). DtT patients compared to non-DtT statistically significantly more frequently developed erosive RA form (88.0% and 70.7%, respectively), reached the fourth radiographic (erosive) stage (38.3% and 20.9%, respectively), had rheumatoid nodules (27.1% and 14.4%, respectively), a history of the withdrawal of medications due to adverse events (49.2% and 35.9%, respectively), less frequently achieved remission (Rem) and LDA in RA (Rem: 19.6% and 60.3%, respectively; LDA: 36.5% and 95.8%, respectively). Additionally, in the DtT group compared to the non-DtT group, a significantly later initiation of methotrexate (MT) after diagnosis (104 and 65 months, respectively), biologic therapy (80.0 and 38.0 months, respectively) was noted. Etanercept (17.4% and 8.3%, respectively), infliximab (17.4% and 1.9%, respectively), and abatacept (16.7% and 7.0%, respectively) were more frequently used as first-line treatments in the DtT group. Tumor necrosis factor α inhibitors predominated on the first two lines (52.8% versus 24.4%, respectively), baricitinib was never used, and IL-6 inhibitors were significantly less frequently used (19.6% versus 40.6% in the non-DtT group), rituximab (6.8% versus 19.6%), with more frequent switches to another drug class (72.4% and 58.6%).

Conclusion. The conducted analysis identified several significant predictors of treatment resistance in RA: young age at disease onset, positivity for ACPA, erosive nature of arthritis, presence of rheumatoid nodules, and history of the withdrawal of medications due to adverse events. These factors can be utilized for the establishment of risk groups. The prognostic model developed based on the identified predictors may be useful for determining a risk group for treatment resistance. Additionally, several factors related to therapeutic strategies may influence the development of treatment resistance in RA: delayed initiation of DMARD therapy, late commencement of biological therapy, and insufficient use of rituximab, abatacept, interleukin 6 inhibitors, and Janus kinase (JAK) inhibitors in the early lines of therapy for bDMARD /JAK inhibitors.

The aim of the study – to compare the mid-term results of joint-preserving surgery on the forefoot and arthrodesis of the 1st metatarsophalangeal joint in combination with resection of the heads of the small metatarsals in patients with rheumatoid arthritis (RA) and osteoarthritis (OA).

Materials and methods. The patients were divided into 2 groups depending on the diagnosis. The main group included 143 patients with rheumatoid arthritis, and the control group included 57 patients with osteoarthritis. Arthrodesis of the 1st metatarsophalangeal joint with resection of the small ray heads and joint-preserving surgery were performed in both groups. To evaluate the results, changes in pain intensity on a visual analog scale, the functional status of the foot on the AOFAS (American Orthopaedic Foot and Ankle Society) scale (for 1st and 2–5th toes) before surgery, 3 months, 1 year, and 3 years after surgery, as well as disease activity (in the case of patients with rheumatoid arthritis) were studied.

Results. In group 1 (RA), 3 years after surgery, there was a decrease in pain intensity according to VAS in 134 (93.71%) patients <40 mm, in 6 (4.2%) – from 41 to 70 mm, and in 3 (2.1%) ≥71 mm; on the AOFAS scale (for 1st and 2–5th toes), the results were as follows: excellent – 33 (23.08%) and 40 (27.97%) , good – 88 (61.54%) and 84 (58.74%), satisfactory – 20 (13.99%) and 16 (11.19%), unsatisfactory – 2 (1.4%) and 2 (1.4%), respectively. In group 2 (OA), 3 years after surgery, VAS pain intensity decreased in 56 (98.25%) patients <40 mm and in 1 (1.75%) – from 41 to 70 mm; on the AOFAS scale (for 1st and 2–5th toes): excellent – 19 (33.33%) and 21 (36.84%), good – 37 (64.91%) and 34 (59.65%), satisfactory – 1 (1.75%) and 1 (1.75%), unsatisfactory – 2 (1.4%) and 1 (1.75%), respectively. At the same time, the average value of DAS28 (Disease Activity Score 28) disease activity in patients with unsatisfactory results was 3.98±0.6 points.

Conclusions. Joint-preserving surgery in the group of patients with rheumatoid arthritis and osteoarthritis improve the functional status of the foot and reduce the intensity of pain in the medium-term postoperative period. Given the absence of statistically significant differences with the results after arthrodesis of the 1st metatarsophalangeal joint and resection of the small ray heads, these surgical techniques are recommended for patients with rheumatoid arthritis with an inflammatory activity level of the disease <3.98 according to DAS28.

Calcium pyrophosphate deposition disease (CPPD) is a disease that occurs under the guise of various diseases and is characterized by a variety of clinical forms. One of the most rare and diagnostically difficult variants is chronic arthritis with the formation of periarticular deposits of calcium pyrophosphate crystals, imitating gouty tophi. The article presents a clinical case and analysis of the differential diagnosis of a patient with a pseudo-tophaceous form of CPPD.