Glucocorticoids (GC) continue to be indispensable drugs for the treatment of systemic lupus erythematosus, since there are no other alternatives that can so quickly stop the activity of the disease. However, the accumulation of irreversible damage to organs (cataracts, osteoporosis, diabetes mellitus, etc.) significantly limits their use. This article examines the current views of leading rheumatologists on the treatment with GC in patients with SLE, namely three main principles: a) the use of pulse therapy with 6-methyl prednisone to induce remission not only in severe cases of the disease; b) limiting the initial doses of prednisone to <30 mg/day, with a rapid decrease to maintenance dose <5 mg/day; c) a personalized approach to the GC withdrawal strategy. Long-term hydroxychloroquine therapy and early implementation of immunosuppressive therapy will help achieve these goals.

In immuno-mediated rheumatic diseases (IMRD), laboratory biomarkers, which include autoantibodies, proteins of the acute phase of inflammation, cytokines, markers of endothelial damage, components of the complement system, subpopulations of lymphocytes, indicators of bone metabolism, and many others, occupy a central place in the diagnosis, assessment of activity, and monitoring of the effectiveness of pharmacotherapy. In the range of biomarkers of inflammation in recent years, special attention has been drawn to calprotectin (CP), which is a heterodimeric complex of S100A8 and S100A9 calcium-dependent proteins. Currently, to characterize inflammation in IMRD, attention is drawn to determining the concentration of CP in biological fluids, the so-called circulating or serum (s) CP, an increase in the concentration of which may be more associated with local (in situ) than with systemic synthesis of protein. The narrative review summarizes the clinical significance of the sCP determination in IMRD as a new biomarker of inflammation. Preliminary recommendations regarding indications for determining the sCP in IMRD are presented.

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. The second part of the article presents the most common and significant myths in clinical and laboratory manifestations, lymphoproliferative complications, and treatment of SjD.

Background. Interleukin (IL) 6 plays an important role in the pathogenesis of comorbid rheumatoid arthritis (RA) depression. IL-6 inhibitors used to treat patients with RA may also have an antidepressant effect.
The objective of this study is to evaluate the effectiveness of 24-week interleukin 6 inhibitor therapy with olokizumab (OKZ) in combination with or without psychopharmacotherapy (PPT) in patients with moderate to high rheumatoid arthritis activity.
Material and methods. A total of 125 patients with RA were included, 102 (81.6%) of them being women. The average age of the patients was 48.5±12.6 years; the majority of the patients (86.4%) had high RA activity and had shown ineffectiveness with stable 12-week therapy using conventional synthetic disease modifying antirheumatic drugs (csDMARDs). Additionally, 34 (27.2%) patients had shown inefficiency with one or more biological DMARDs. According to the International Classification of Diseases, 10th revision (ICD-10), a psychiatrist diagnosed varying severity of depression (chronic or recurrent) in all patients during a semi-structured interview. At week 0, all patients were randomized using sequential numbers in a 2:2:1 ratio into one of three groups: in the group 1, patients received csDMARDs+OKZ 64 mg subcutaneously once every 4 weeks (q4w) (n=49); in the group 2, patients received csDMARDs+OKZ 64 mg subcutaneously q4w along with psychopharmacotherapy (PPT) (n=51); in the group 3, patients received csDMARDs+PPT (n=25). The study duration was 24 weeks. The severity of depression was assessed using the PHQ-9 (Patient Health Questionnaire 9) and MADRS (Montgomery – Åsberg Depression Rating Scale) scales; while anxiety was assessed using the HAM-A (Hamilton Anxiety Rating Scale) scale. Projective experimental psychological techniques were also used.
Results. After 12 and 24 weeks of therapy, a significant decrease in the severity of depression and anxiety was observed in all groups of patients. However the differences between the final and initial values of the scales filled in by a psychiatrist were statistically significantly greater (p<0.001) in the groups of patients receiving PPT: in the group 2 (ΔMADRS24–0=–20.2±6.57; ΔHAM-A24–0=–13.2±5.68) and group 3 (ΔMADRS24–0=–17.8±4.73; ΔHAM-A24–0=–13.4±4.41), compared with the group 1 (ΔMADRS24–0=–5.42±7.14; ΔHAM-A24–0=–4.58±6.80). There were no significant differences between the groups according to the PHQ-9 depression questionnaire (respectively, in group 1, ΔPHQ-924–0=–4.89±4.87; in group 2, ΔPHQ-924–0=–6.73±4.97; in group 3, ΔPHQ-924–0=–7.26±5.58), despite a greater decrease in the severity of depression observed in the groups with PPT. According to a semi-structured interview with a psychiatrist and in accordance with the criteria of ICD-10 the proportion of patients without depression 24 weeks after the start of therapy was significantly higher in the groups receiving PPT: 84.3% in group 2, 100% in group 3, and 16.3% in group 1.
Conclusion. In patients with moderate/high RA activity and comorbid depression, OKZ without PPT can lead to a decrease in the severity of depression or, less often, to a complete regression of depressive symptoms, mainly in patients with minor depression. OKZ therapy without PPT also reduces the severity of anxiety, but does not eliminate it completely. The combination of OKZ and PPT is optimal for achieving complete regression of depression and anxiety in this category of RA patients.

Interleukin 6 (IL-6) plays a key role in the immunopathogenesis of rheumatoid arthritis (RA), with the pleiotropic effect on organs and tissues. Blocking IL-6 receptors is of interest both in terms of correcting joint syndrome and alleviating systemic inflammation. Levilimab (LVL) is a monoclonal antibody drug against the interleukin 6 receptor, which has demonstrated efficacy and safety in patients with active RA when administered 162 mg subcutaneously (SC) every week. The article presents data obtained from the two-phase clinical study (CS) LUNAR (NCT05800327), in which the first stage was a CS phase I, and the second – CS phase III.
The aim is to study the tolerability, safety, immunogenicity and main pharmacokinetic and pharmacodynamic parameters of the LVL after its single SC or intravenous (IV) administration in increasing doses to healthy volunteers, as well as to confirm the efficacy and safety of new dosing regimens of LVL at a dose of 648 mg IV once every 4 weeks (Q4W) in combination with methotrexate (MT) and at a dose of 324 mg SC once every 2 weeks (Q2W) in combination with MT in patients with active RA resistant to MT monotherapy.
Materials and methods. During the first stage of clinical trial, the safety and tolerance of new regimens of LVL 648 mg Q4W IV and 324 mg Q2W SC were demonstrated in healthy volunteers and these doses have also been shown to provide the required therapeutic concentration throughout the entire interdose interval. In the phase III study, patients with active RA (according to American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) 2010 criteria) resistant to MT therapy at a stable dose of 15–25 mg/week for ≥12 weeks were included.
The study had a double-blind design until week 24, evaluation of the efficacy of LVL new dosing regimens with the standard regimen of 162 mg SC QW was conducted at week 24 based on the parameter “Proportion of patients achieving low RA activity according to DAS28-ESR (Disease Activity Score with Erythrocyte Sedimentation Rate) <3.2)”. After the week 24, all patients continued to receive LVL in an open-label manner. Due to achieving RA remission (DAS28-ESR<2.6) at week 24, patients were switched to a maintenance regimen depending on the group: 324 mg IV Q4W for patients previously receiving LVL at a dose of 648 mg IV Q4W, and 162 mg SC Q2W for patients previously receiving LVL at doses of 324 mg SC Q2W and 162 mg SC QW. Patients who did not achieve RA remission at week 24 continued to receive LVL in the initial regimen.
The efficacy analysis included the assessment of achieving remission and low RA activity according to DAS28-ESR, DAS28-CRP (DAS28 with C-reactive protein), CDAI (Clinical Disease Activity Score), and SDAI (Simplified Disease Activity Score) indices, achieving 20%/50%/70% improvement according to ACR criteria (ACR20/ACR50/ACR70), moderate and good response according to EULAR criteria, as well as the dynamics of laboratory markers (CRP and ESR). Safety was assessed by the frequency and profile of adverse events (AEs) and adverse reactions (ARs).
Results. 232 patients were randomized into one of the LVL application groups: 162 mg SC QW (n=78), 324 mg SC Q2W (n=77), and 648 mg IV Q4W (n=77). At week 24, the groups with 324 mg SC Q2W and 648 mg IV Q4W demonstrated non-inferior efficacy in terms of the “Percentage of patients achieving low activity according to DAS28- ESR”: 68.8% and 63.4%, respectively, compared to 62.6% in the 162 mg SC QW group (p=0.8277 and p=0.3954). The efficacy analysis for secondary endpoints (achievement of remission and low RA activity according to DAS28- ESR, DAS28-CRP, CDAI, SDAI, achievement of ACR20/ACR50/ACR70, dynamics of ESR and CRP) also demonstrated comparable efficacy of the new dose regimens of LVL.
At week 24, more than 39% of patients in all groups achieved RA remission according to DAS28-ESR and were switched to a maintenance regimen of the drug, while by week 52 of therapy, the vast majority of patients maintained RA remission according to DAS28-ESR, as well as the relative number of patients with RA remission according to DAS28-CRP, CDAI, and SDAI indices increased. In cases where RA remission according to DAS28-ESR was not achieved at week 24, continuation of initial LVL therapy led to achieving low activity and RA remission in a significant number of cases (up to 45.8% according to DAS28-ESR) by week 52. The most of AEs and ARs were mild and moderate according to CTCAE 5.0 (Common Terminology Criteria for Adverse Events). The use LVL new dosing regimens was accompanied by a favorable and predictable safety profile.
Conclusion. The efficacy and safety of LVL at a dose of 648 mg IV once every 4 weeks and 324 mg SC once every 2 weeks are comparable to the previously approved dosing regimen. Transitioning to maintenance therapy upon achieving RA remission is accompanied by the retention rate of clinical response.

The aim of the study – to evaluate the safety and influence of tenoxicam (Texared®) on the duration and severity of morning stiffness, spinal pain at night, activity and function in patients with ankylosing spondylitis (AS)
Materials and methods. The study included 30 patients (aged 18 to 60) with AS who sequentially sought medical care at the V.A. Nasonova Research Institute of Rheumatology and voluntarily signed an informed consent form to participate in the study. Most patients (66.7%) were male. The average age of patients was 37.6±9.5 years, and the average duration of the disease was 134.5±92.3 months. HLA-B27 antigen positivity was detected in 76.7% of cases. All patients who voluntarily agreed to participate in the study and signed an informed consent form at the initial visit were prescribed tenoxicam (Texared®) at a daily dose of mg. At week 0, 14 days and 90 days (3 months) after the start of therapy, standard clinical and laboratory examinations were performed.
Results and discussion. On the background of regular tenoxicam administration, most patients with AS achieved a reduction in clinical parameters of disease activity compared to baseline and its dynamics after 90 days: a decrease in BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) indices to 3.8 (p<0.016) and ASDAS (Ankylosing Spondylitis Disease Activity Score) to 2.8±1.3 (p<0.011) was noted; the severity and duration of morning stiffness to 3.9±2.5 and 3.0±2.7 (p<0.01 in both cases), respectively; patient assessment of disease activity to 4.1±2.2 (p<0.00); night-time back pain – to 3.0±2.6 (p<0.00). After 14 days of treatment, one third of patients achieved a 20% improvement according to ASAS (Assessment of SpondyloArthritis International Society) criteria. After 90 days, the number of responders was 70.3%. Tolerability of therapy was good in 44.4% of cases. No serious adverse events were recorded during the study.
Conclusion. In patients with high and very high AS activity, tenoxicam (Texared®) therapy has been shown to have a positive effect on disease activity, including the severity of night-time back pain and the severity and duration of morning stiffness. The drug is well tolerated and has a favourable safety profile.

Objective – to study the incidence of hypogonadism in men with ankylosing spondylitis (AS) and evaluate its impact on AS and comorbidities.
Materials and methods. The one-time continuous study included 124 men with AS who were undergoing inpatient treatment at the V.A. Nasonova Research Institute of Rheumatology. Patients were assessed for total testosterone levels and subsequently divided into subgroups with normal (≥12.0 nmol/l) and reduced levels. An intergroup comparison was carried out on the main indicators used in clinical rheumatological practice to assess the stage, activity and other medical and demographic characteristics of AS, as well as on concomitant diseases. A correlation analysis was performed between the level of total testosterone and some clinical and laboratory parameters.
Results. The frequency of detected testosterone deficiency in the study group was 25.0%. With testosterone deficiency, a more frequent incidence of uveitis (45.2% vs 23.6%; p=0.022), as well as arterial hypertension (51.6% vs 30.1%; p=0.030) and type 2 diabetes mellitus (16.1% vs 4.3%; p=0.028). Testosterone deficiency was accompanied by higher levels of C-reactive protein (16.7 [3.2; 43.4] vs 5.0 [1.3; 17.4] mg/l; p=0.020), as well as higher frequency of increased ESR (45.2% vs 25.8%; p=0.043). There was a higher glucose level (5.75±1.19 vs 5.36±0.71 mmol/l; p=0.027) and more frequent impaired fasting glucose (25.8% vs 4.3%; p<0.001). A more frequent occurrence of hypercholesterolemia was revealed (43.3% vs 16.3%; p=0.010). Testosterone deficiency was accompanied by higher levels of uric acid (377.0±105.3 vs 324.0±67.7 µmol/l; p=0.002) and the incidence of hyperuricemia (67.9% vs 41.2%; p=0.014).
Conclusion. A high incidence of hypogonadism in patients with AS has been revealed. Testosterone levels and the presence of hypogonadism were not associated with the stage and activity of AS, but testosterone deficiency was accompanied by a higher incidence of uveitis, higher laboratory indicators of AS activity, and the incidence of concomitant metabolic disorders.

The work of recent decades has changed the idea that axial spondylitis (axSpA) is an exclusively “male” disease. However, at present, when deciding on further treatment tactics, gender differences in the course of the disease and response to treatment are not taken into account.
The aim – to study gender differences in disease activity indices in patients with axial spondylitis.
Material and methods. The study included 108 patients who met the 2009 ASAS (Assessment of SpondyloArthritis International Society) criteria for axSpA or the modified New York criteria for ankylosing spondylitis (AS) of 1984. The mean age of patients at inclusion in the study was 35.4±10.8 years, most of them were men – 62 (57.4%). The AS criteria were met by 67.2% of women and 88.5% of men. The remaining patients were diagnosed with non-radiographic axSpA.
Results and discussion. The duration of the disease did not differ between patients of different sexes (p=0.3): 60.0 [24.0; 96.0] months in men and 42.0 [21.8; 84.0] months in women. HLA-B27 antigen positivity was detected in 36 (78.3%) women and 55 (88.7%) men. Women were more often (p=0.048) diagnosed with arthritis than men: 37 (80.4%) and 39 (62.9%), as well as dactylitis (p=0.01): 15 (32.6%) and 8 (12.9%), respectively. No differences were found between men and women in the frequency of other extraskeletal and extraaxial manifestations of axSpA. Also, no differences were found in the BASFI (Bath Ankylosing Spondylitis Functional Index), MASES (Maastrich Ankylosing Spondylitis Enthesitis Score) indices and in all domains of the BASMI (Bath Ankylosing Spondylitis Metrology Index) index. In men, the C-reactive protein level was significantly higher than in women (p=0.03). At the same time, the disease activity according to the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) index, as well as the patient’s pain assessment indicators, global assessment of general well-being according to the numeric rating scale in women of the study group were higher than in men. The average anxiety value according to the HADS (Hospital Anxiety and Depression Scale) scale was higher in women (p=0.01) than in men – 9.0 [6.0; 10.0] and 5.0 [2.0; 8.0], respectively. The average depression value according to the HADS scale did not differ between the groups (p=0.3): 5.5 [3.0; 6.0] and 3 [1.0; 5.6], respectively.
Conclusions. The revealed clinical heterogeneity of axSpA manifestations in men and women, the peculiarities in pain assessment by patients of different genders, allow us to state that gender influences the interpretation of disease activity. Further studies are needed to study gender differences in patients with axSpA to optimize treatment approaches and assess its effectiveness.

Introduction. Chronic inflammation in rheumatoid arthritis (RA) is one of the causes of activation of bone resorption, occurrence of erosive changes, disruption of microarchitecture, bone mineral density (BMD) decrease and increased risk of vertebral and peripheral bone fractures.
The aim – to study the dynamics of bone mineral density, vertebral deformations and degenerative changes in the lumbar spine in patients with rheumatoid arthritis during long-term prospective observation. 
Materials and methods. A prospective multi-year cohort study, the duration of which was 9.7±1.7 years, included 151 women with RA aged 53.9±9.2 years with a reliable diagnosis established at the age of 41.9±12.5 years. All patients underwent clinical, laboratory and radiological examination (X-ray densitometry of the lumbar spine (L1–L4), femoral neck (FN) and total hip (TH), X-ray morphometry of the spine using the Genant method, assessment of degenerative changes in the lumbar spine) in dynamics.
Results. A BMD decrease in FN and TH and stabilization in L1–L4 were established; in patients over 55 years of age it was an increase in BMD in L1–L4 and a decrease in FN and TH; a decrease in BMD in all studied skeletal regions in patients under 55 years of age. The appearance or increase in deformations (fractures) of the vertebrae in the thoracic spine was observed in 50 (33%) patients, in the lumbar spine – in 4 (2.6%) patients; a relationship between deformations (fractures) of the vertebrae and an increase in BMD was not established. An increase in degenerative changes in all segments of the lumbar spine was established in patients with pain and a significant increase in L1–L4 BMD. Long-term monotherapy with DMARDs, as well as with biologics, did not have a positive effect on the BMD.
Conclusions. A long-term prospective cohort study revealed stabilization of the BMD in L1–L4; its increase in the group of patients with RA over 55 years of age against the background of the appearance or intensification of the initial deformation (fractures) of the vertebrae; and an increase in degenerative changes in all segments of the lumbar spine.

Smoking is one of the main proven environmental factors that worsen the course and effectiveness of rheumatoid arthritis (RA) treatment.
The aim – to evaluate the effect of smoking cessation on rheumatoid arthritis activity, pain, and quality of life in patients during a one-year prospective follow-up.
Material and methods. 194 patients included in the prospective intervention cohort (individual preventive counseling, “Smoking Cessation School”). The follow-up period was 12 months. Demographic and medical history data, information about comorbidity, and smoking status were analyzed. The activity of RA (Disease Activity Score 28 (DAS28) with erythrocyte sedimentation rate) and the intensity of pain (using visual analogue scale (VAS)) were evaluated at baseline and after 3, 6, and 12 months. The quality of life was assessed at the 6th and 12th months of follow-up using the SF-36 (Short Form 36) questionnaire and the HAQ (Health Assessment Questionnaire).
Results. At the time of baseline, there were no differences in the groups of those who continue to smoke and those who quit in the future in terms of activity RA, HAQ and VAS (all p>0.05). In patients in the smoking cessation group, disease activity was significantly lower by 6 months (p=0.000002), as were the HAQ and VAS values after 6 and 12 months (all p<0.05). By the end of the follow-up year, remission and low RA activity were recorded in 9 (40.9%) of those who quit smoking and 20 (13.8%) who continued (p=0.002). In patients who had given up smoking, physical functioning, role-playing physical functioning, and general health were significantly better (p=0.015, p=0.013, and p=0.026, respectively) at the time of a baseline. In all domains of the SF-36 questionnaire, at 6 and 12 months of follow-up were statistically significantly better for those who stopped smoking (all p>0.05).
Conclusion. The study shows the need to develop and implement educational programs on smoking cessation in RA in clinical practice.

The high comorbidity of eating disorders, especially anorexia nervosa, and various autoimmune diseases is well known but only a few foreign publications address the prevalence and course of eating disorders in children with immuneinflammatory rheumatic diseases, while in the domestic scientific press the problem of comorbidity of eating disorders and rheumatic diseases isn’t still discussed, neither in children nor in adult patients
The aim of this review is to try to fill this gap in the Russian-language scientific literature by summarizing the data available in foreign publications on eating disorders in patients suffering from juvenile-onset systemic lupus erythematosus, juvenile idiopathic arthritis, juvenile fibromyalgia and other syndromes of chronic musculoskeletal pain, as well as hyperuricemia.

“Rice bodies” symptom are a secondary clinical manifestation of a number of pathologies involving the synovial tissue. The conditions associated with this phenomenon include rheumatoid arthritis, tuberculosis, juvenile idiopathic arthritis, infectious arthritis, systemic lupus erythematosus, sarcoidosis, and reactions to orthopedic implants. It is possible that other nosological entities may be involved, although no data is currently available. “Rice bodies” present as multiple round-shaped bodies located both intra-articularly and periarticularly in synovial bursae and tendon sheaths. The etiology of this condition remains unknown, reliable statistics on its prevalence are not found in the literature, and its pathogenesis remains controversial. Clinically, the condition may be associated with pain and/or functional limitations, but it can also be asymptomatic and discovered incidentally. The optimal method for diagnosis is magnetic resonance imaging, while the preferred treatment is surgical extraction of the structures along with the adjacent components of hypertrophied synovium, followed by mandatory histopathological examination and conducting differential diagnostics with synovial chondromatosis and villonodular synovitis. These patients require a team-based multidisciplinary approach led by a specialist responsible for treating the underlying disease.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that affects many organs and is characterized by a complex interaction of immune cells, factors and pathways leading to various clinical manifestations. During the disease duration, skin involvement occurs in about 75–80% (up to 20–25% in the debut) of patients with SLE. This article describes two clinical cases with rare chronic skin involvement in patients with SLE.

The LUPUS 2025 Congress showcased cutting-edge data on systemic lupus erythematosus (SLE). Highlights included an updated step-wise treatment algorithm for cutaneous lupus, the proposal of an early triple-therapy regimen for lupus nephritis with standardized histologic response criteria, and the identification of novel biomarkers that enhance patient stratification. In addition, an expert consensus provided therapeutic guidance for 24 rare SLE manifestations.