In the spectrum of rheumatic diseases, systemic autoimmune rheumatic diseases (SARDs) are of particular interest. Despite the dramatic improvement in the prognosis for SARD, associated with the improvement of the treatment strategy (treat-to-target) and the introduction of new effective anti-inflammatory drugs, more than 10% of patients with SARD develop severe organ pathology, potentially requiring treatment in intensive care units (ICUs). This article presents an analysis of the clinical and pathological manifestations that define the “severe” course of SARS. The prospects for pharmacotherapy for patients with SARS in the ICU setting are also discussed. The article opens a series of planned publications in the journal concerning the diagnosis and treatment of severe complications of SARDs.

The review is devoted to the analytical analysis of the recommendations of the American College of Rheumatology and the American Association of Hip and Knee Surgeons on the optimal time for elective total arthroplasty of the knee or hip joints in patients with moderate to severe osteoarthritis (OA), moderate to severe pain and loss of function, Kellgren – Lawrence radiological stages III–IV, who have received ≥1 course of appropriate conservative therapy that has been ineffective. The discussion focuses on whether to delay surgical treatment or continue with physiotherapy, intra-articular glucocorticoid injections, or viscoelastic synovial fluid implants, whether to wait for improvement with the use of mobility aids or orthoses, and whether to postpone surgery until significant weight loss or glucose control is achieved in severe OA patients with concomitant diabetes mellitus who require knee or hip arthroplasty.

Retroperitoneal fibrosis, also known as Ormond’s disease, is a rare chronic disorder of unknown etiology characterized by progressive proliferation of non-neoplastic fibro-inflammatory tissue in the retroperitoneal space. The fibrotic mass typically localizes around the infrarenal segment of the aorta, extending to the iliac vessels and involving the ureters and other retroperitoneal organs. The disease often presents with acute urinary obstruction, which is frequently associated with delayed diagnosis due to low awareness among clinicians. This review focuses on describing the clinical features, epidemiology, and pathogenesis of the disease. Current approaches to diagnosis and treatment are discussed, along with a summary of literature. The article is descriptive in nature and aims to provide a comprehensive overview of existing knowledge in this field.

Systemic lupus erythematosus is a systemic autoimmune disease characterized by a wide spectrum of clinical manifestations. Cardiovascular disease is a common complication of systemic lupus erythematosus. Acute cerebral circulatory disorders in patients with systemic lupus erythematosus may present as ischemic or hemorrhagic stroke, or as cerebral venous thrombosis. The pathophysiologic mechanisms depending on the type of acute cerebral circulation disorder are different and have their own peculiarities. In systemic lupus erythematosus, ischemic stroke occurs by several different mechanisms, including cardioembolism, stenosis of large arteries of nonatherosclerotic or atherosclerotic etiology, arterial dissection, hypercoagulable states, and others. Along with major population-wide risk factors for stroke, kidney damage in systemic lupus erythematosus may increase the risk of stroke. Stroke is one of the causes of death among patients with systemic lupus erythematosus.

Olokizumab (OKZ) is a monoclonal antibody that binds interleukin 6 in the blood plasma, thereby exerting a pronounced anti-inflammatory effect in rheumatoid arthritis (RA). In addition to its effect on RA disease activity, OKZ significantly reduces the severity of key RA symptoms, which are referred to as patient-reported outcomes (PROs).

The aim – to evaluate the effect of olokizumab on patient-reported outcomes using data from a meta-analysis of randomized controlled trials (RCTs) and observational studies.

Materials and methods: We searched PubMed, Web of Science, Scopus, Cochrane, and eLibrary for publications from January 2014 to June 2025 using the keywords “olokizumab”, “rheumatoid arthritis”, and “patient-reported outcomes”: pain, PtGA, HAQ-DI, and FACIT-F. A meta-analysis was then conducted of a series of studies that met the selection criteria. In addition to the effect of OKZ on RA disease activity, it also examined its effect on PROs: pain (visual analog scale, 0–100 numeric rating scale), patient global assessment (PtGA), functional impairment (HAQ-DI (Health Assessment Questionnaire – Disability Index)), and fatigue (FACIT-F (Functional Assessment of Chronic Illness Therapy – Fatigue)). The efficacy of OKZ in the most commonly used regimen – subcutaneous injections of 64 mg every 4 weeks – was assessed.

Results. Five phase II–III RCTs and four observational studies in real-world clinical practice (n=3013) were selected for the meta-analysis. According to the data obtained, significant positive dynamics in PROs were observed after 12 and 24 weeks from the start of therapy with OKZ treatment. Thus, pain dynamics by 24 weeks (mean difference) was –33.29 (95% confidential interval (95% CI): –39.53; –27.07), PtGA dynamics at 24 weeks was –28.62 (95% CI: –33.87; –23.37), HAQ-DI dynamics at 12 weeks was –0.24 (95% CI: –0.35; –0.13), and FACIT-F at 24 weeks was 8.80 (95% CI: 5.81; 11.79). The data obtained had moderate to high heterogeneity (I2 index >25%). The dynamics of PROs in RCTs and observational studies were unidirectional and similar.

Conclusion. OKZ has a significant positive effect on PROs in RA. OKZ can be considered as an effective treatment for patients with RA, chronic pain, and fatigue.

The aim – to evaluate the effect of olokizumab (OKZ) on acute-phase reactants, interleukin (IL) 6, and its soluble receptor (sIL-6R) levels in patients with rheumatoid arthritis (RA) and comorbid depression.

Material and methods. A total of 125 patients with RA and comorbid depression were included, including 102 (81.6%) women, with a mean age of 48.5±12.6 years. The majority (86.4%) had high RA activity and had failed stable 12-week therapy with synthetic disease-modifying antirheumatic drugs (DMARDs). Thirty-four (27.2%) patients had failed one or more biological agents. At week 0, all patients were randomized using the sequential numbers method in a 2:2:1 ratio to one of three groups: Group 1 received treatment with sDMARDs + OKZ 64 mg subcutaneously once every 4 weeks (n=49); group 2 – sDMARDs + OKZ 64 mg subcutaneously + psychopharmacotherapy (PPT) (n=51); group 3 – sDMARDs + PFT (n=25). The study duration was 24 weeks. Serum IL-6 concentrations were determined using xMAP multiplex technology on a Bio-Plex Array System analyzer (Bio-Rad, USA) and immunochemiluminescence assay (ICL) on a Cobas e411 analyzer (Roche, Switzerland).

Results. The use of OKZ was accompanied by a significant decrease in the level of C-reactive protein (CRP) and calprotectin (CP) in the group as a whole; normalization of the CRP level was noted 4 weeks after the start of therapy (p<0.05). When comparing the groups of patients who achieved (n=50) and did not achieve remission (n=50) according to the EULAR (European Alliance of Associations for Rheumatology) criteria (according to DAS28-CRP (Disease Activity Score 28 with CRP determination)) by 24 weeks of OKZ therapy, significant differences were noted in the concentration of CP (respectively, 1.54 [1.2; 2.56] versus 2.42 [1.5; 4.54] μg/ml; p=0.022) in contrast to CRP (0.45 [0.2; 0.7] versus 0.6 [0.2; 0.9] mg/ml). There was a significant decrease in the concentration of IL-6 in the group as a whole by 5.5 times after 12 weeks and by 3.5 times after 24 weeks of therapy. The level of sIL-6R decreased in the group as a whole and among patients with a good response to therapy (p<0.05).

Conclusion. Thus, the use of OKZ is accompanied by a decrease in the levels of acute-phase reactants, CP, IL-6, and sIL-6R. CP can be considered a more sensitive marker for assessing inflammation during OKZ therapy compared to CRP.

In rheumatoid arthritis (RA) mortality is higher than in the general population and is due to cardiovascular diseases (CVD) associated with traditional risk factors (TRFs) and autoimmune inflammation. An early predictor of CVD is arterial stiffness (AS), determined by pulse wave velocity (PWV) and the augmentation index (AIx). AS assessment can be used for cardiovascular risk stratification, complementing PWV and improving the accuracy of predicting cardiovascular events.

The aim – to study the parameters of arterial stiffness in patients with rheumatoid arthritis, their relationship with clinical and immunological parameters and cardiovascular diseases traditional risk factors.

Materials and methods. The study included 100 female patients with RA (90% of whom were seropositive for rheumatoid factor (RF)) with a median age of 43 [34; 51] years, disease duration of 5.3 [3.0; 12.0] years. High activity according to the DAS28 (Disease Activity Score 28) was predominantly present in 61% of RA patients. Extra-articular manifestations were detected in 37%, and complications – in 22%. The control group included 30 healthy women matched for age. All subjects underwent determination of TRFs and AS parameters – PWV and AIx.

Results. RA patients, compared with controls, had higher PWV values: 7.1 [6.1; 8.0] m/s versus 6.2 [6.0; 7.0] m/s, respectively (p=0.004). No difference in AIx was observed. PWV and AIx correlated with age (r=0.655 and r=0.351), QRISK-3 (r=0.627 and r=0.504), intima-media thickness (r=0.463 and r=0.37), the presence of atherosclerosis (r=0.439 and r=0.295), and RA duration (r=0.271 and r=0.335) (p<0.05). AIx was associated with anti-cyclic citrullinated peptide (anti-CCP; r=0.204; p=0.04).

Elevated AS values were more common in patients with arterial hypertension, menopause, overweight, RF+/antiCCP+ patients, and with the development of complications (p<0.05). Smoking and a history of cardiovascular disease did not significantly affect AR. We registered higher absolute values of PWV and AIx in hypertension (7.7 [7.0; 9.2] versus 6.8 [5.8; 7.8] m/s, 3.4 [0.9; 8.4] versus 0.4 [–0.7; 4.2]%, respectively) and in menopause (7.9 [7.1; 8.8] versus 6.6 [5.7; 7.7] m/s, 4.4 [1.2; 11.2] versus 0.3 [–0.8; 3.7]%, respectively; p<0.05). In seropositive RA, AIx was higher compared to seronegative: 1.5 [–0.2; 5.0] versus –1.0 [–2.4; 3.6]% (p=0.002). Patients who developed RA complications had higher PWV and AIx values: 7.4 [6.8; 8.8] versus 7.0 [6.0; 7.9] m/s and 4.0 [1.2; 7.9] versus 0.7 [–0.5; 4.3]%, respectively (p<0.05). In patients receiving glucocorticoids and disease-modifying antirheumatic drugs, PWV and AIx values were higher than in patients without therapy.

Conclusion. The obtained results highlight the multifactorial mechanism of AS in RA. These data can serve as the basis for more accurate risk stratification and personalized therapy in patients with RA.

Systemic lupus erythematosus (SLE) predominantly affects women, with peculiar clinical, laboratory and gender manifestations. The most severe phenotype of the disease is observed in men due to the high frequency of kidney involvement, cardiovascular complications (CVC) and early damage to vital organs.

The aim of the study was to investigate gender differences in clinical and laboratory manifestations, irreversible organ damage, and prognostic factors for severe systemic lupus erythematosus in a cohort of Kyrgyz patients.

Materials and methods. The study included 800 patients with a confirmed diagnosis of SLE according to the 2012 SLICC (Systemic Lupus International Collaborating Clinics) classification criteria. All patients underwent standard clinical, laboratory and instrumental examinations. To analyze gender differences, patients were divided into two groups: group 1 consisted of 65 (8.1%) men (mean age 33.5±10.5 years), group 2 – 735 (91.9%) women (mean age 35.5±12.3 years). All patients underwent standard clinical, laboratory and instrumental examination.

Results and discussion. At the time of inclusion in the study, male and female patients did not differ in age, ethnicity, education, comorbidities, course, or activity of SLE (p>0.05), except for disease duration, which was significantly shorter in men than in women (p<0.05). Among the clinical manifestations of SLE, men were significantly more likely than women to have severe forms of lupus nephritis with a predominance of nephrotic syndrome and acute kidney injury, combined involvement of the central (CNS) and peripheral nervous systems (PNS), a high frequency of arthritis, mesenteritis and exudative pleuritis (p<0.05). In women, with a high prevalence of mucocutaneous manifestations (93.6%) and alopecia (71.6%), renal and nervous system (NS) involvement was observed in approximately 40% of cases (35.9% and 40.1%, respectively). The irreversible organ damage (IOD) was detected in 163 patients, including 22 (13.5%) men and 141 (86.5%) women. A significant proportion of patients with IOD had NS involvement – 50 (6.3%), including 7.7% of men and 6.1% of women. The next most common type of injury was kidney involvement, which was observed in 40 (5%) patients, significantly more often in men than in women (7 (10.8%) vs. 33 (4.5%); p=0.04). In addition, men were statistically significantly more likely to have peripheral vascular damage and skin changes (1 (1.5%) vs. 1 (0.1%), respectively; p=0.03) and (2 (3.1%) vs. 3 (0.4%), respectively; p=0.01). Adverse prognostic factors for severe SLE in male patients were C4 hypocomplementemia (p=0.012), previous accumulation of IOD (p=0.006), arthritis (p=0.009), active LN with high serum creatinine (SC) values (p=0.02), and protein loss of more than 500 mg/day (p=0.001). At the same time, independent predictors of severe SLE in women included acute disease course (p=0.024), C3 hypocomplementemia (p=0.031), positive anti-Smith antibodies (p=0.043), PNS involvement (p=0.024), and active SLE with proteinuria more than 500 mg/day (p=0.015).

Conclusions. Patients in the Kyrgyz cohort show a similar gender pattern in the clinical course, activity, laboratory, and immunological manifestations of SLE. However, compared to women, men have a higher incidence of mesenteritis, exudative pleuritis, oligoarticular arthritis, severe forms of vasculitis, combined CNS and PNS involvement, as well as early accumulation of damage mainly to the kidneys, skin PNS. At the same time, women more frequently present with mucocutaneous manifestations, alopecia and fever, while renal and NS involvement occurs in approximately 40% of cases. Independent predictors of the risk of severe SLE in men are C4 hypocomplementemia, earlier accumulation of IOD, joint involvement, active LN with high SC values and protein loss of more than 500 mg/day. In women, predictors include acute disease onset, C3 hypocomplementemia, positive anti-Smith antibodies, PNS involvement and proteinuria >500 mg/day.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the primary tool for pain control in rheumatic diseases. However, their use significantly limits the risk of developing class-specific complications affecting the gastrointestinal tract, cardiovascular system, and kidneys.

Dexibuprofen (dIBF) is a modified form of one of the most popular NSAIDs, ibuprofen. Its biologically active dextrorotatory stereoisomer ((S)-(+)), with therapeutic doses half that of the racemate, offers good therapeutic potential and is better tolerated than “regular” ibuprofen.

The aim of this study was to review clinical trials of dexibuprofen in rheumatic diseases.

Materials and methods. A search of publications in PubMed, Web of Science, Scopus, and Cochrane electronic libraries was conducted using the keywords “dexibuprofen”, “S(+)-ibuprofen”, “rheumatic disease”, “treatment”, “efficacy”, and “safety”. The review included original publications representing randomized controlled trials, open-label studies, or observational studies that examined the efficacy and safety of dexibuprofen in the treatment of rheumatic diseases.

Results. Seven publications were identified, including four double-blind, randomized controlled trials (a total of 925 patients), one open-label, controlled safety study with endoscopic monitoring, and two observational studies aimed at assessing the safety of dexibuprofen in real-world clinical practice. An analysis of these studies showed that dexibuprofen is as effective as “regular” ibuprofen (although the latter’s dose is twice as high) and diclofenac at a dose of 150 mg/day, while the incidence of gastrointestinal complications with dexibuprofen is statistically significantly lower. Observational studies of dexibuprofen in real-world practice also demonstrate good therapeutic efficacy and a favorable safety profile for this drug.

Conclusion. Dexibuprofen is an effective, well-tolerated analgesic that can be successfully used in the combination treatment of rheumatic diseases.

Introduction. Radiographic progression (RP) of rheumatoid arthritis (RA) is one of the main signs of the disease and a key factor in assessing the effectiveness of therapy. RP is accompanied by an increase in the number of erosions, narrowed joint spaces, and radiographic stage (Rg stage).

The aim – to compare the characteristics of patients with rheumatoid arthritis with rapid and slow rates of radiographic progression during long-term follow-up.

Materials and methods. A prospective cohort study lasting 9.7±1.7 years included 151 women with RA aged 53.9±9.2 years. All patients underwent clinical, laboratory, and radiographic examinations. RP was analyzed taking into account changes in the Steinbrocker RA stage, the number of erosions, and the degree of joint space narrowing using the Sharp/van der Heijde (SVH) method.

Results. An increase in the erosion count according to SVH was detected in 66 (53%) patients, and narrowed clefts – in 81 (65%) patients. The number of patients with Rg1, Rg2, and Rg3 decreased; those with Rg4 increased from 29 (19%) to 54 (36%) people (p<0.05). Slow RP (Rg1–Rg2 in dynamics) was observed in 63 (42%) patients, and rapid RP (increase in Rg stage) – in 32 (21%) patients. In 56 (37%) patients, the Rg stage did not change.

Rapid RP is associated with a younger age at RA onset and inclusion in the study, with a longer duration of RA, with a higher matrix metallopeptidase 3 index and interleukin 6 level above normal in dynamics, with a lower dose of methotrexate both in monotherapy and in combination with other agents; with a higher average daily and cumulative dose of glucocorticoids.

Conclusions. A long-term prospective study demonstrated RP despite achieving remission and decreasing activity in the majority of RA patients. The rate of RP depends on many factors, both RA-related and non-RA-related. Distinguishing phenotypes of RA patients with rapid and slow RP will enable a personalized approach to patient management.

Relapsing polychondritis (RP) is a systemic autoimmune disease characterized by inflammation and destruction of cartilage in various organs. Aortic involvement in RP is relatively rare, occurring in 6.7–9.7% of cases, and is associated with a high risk of mortality (27.3–41.3%) and surgical interventions (65%). Typically, cardiac and aortic involvement in patients with RP is identified approximately five years after the onset of the first symptoms, with 19% of cases being asymptomatic. There are currently no universally accepted standards for screening, diagnosis, and treatment of aortic involvement in RP.

We present a clinical case of a patient with RP, aortic involvement, and the development of an aneurysm, who underwent sequential therapy with cyclophosphamide and rituximab. This treatment approach allowed for the control of disease activity and a reduction in glucocorticoid dosage.

Methotrexate (МТX) is one of the most widely used medication as a basic anti-inflammatory therapy in the treatment of rheumatic diseases (RD). It is prescribed to rheumatological patients in doses not exceeding 25 mg per week. As it was used in clinical practice, data appeared on a possible side effect on bone tissue – osteopathy associated with its long-term use, which is rare in patients with RD. Methotrexate osteopathy is characterized by the presence of three signs: bone pain in weight-bearing limbs; atraumatic fractures localized in various bones of the lower extremities; the presence of osteoporosis on the X-ray image.

The article describes a case of osteopathy after long-term treatment with МТX in a postmenopausal patient with RA and osteoporosis who had multiple atraumatic stress fractures of both distal femurs, proximal and distal part of both tibias, as well as the talus of the left foot.

Despite the frequent mention of the famous Mexican artist Frida Kahlo in Russian scientific publications, only a few Russian-language articles relate to her medical history, and only those aspects that indicate a high probability of Frida Kahlo having fibromyalgia, which developed after receiving multiple traumatic injuries in a serious accident. At the same time, Frida Kahlo’s medical history goes far beyond post-traumatic fibromyalgia, and is of particular interest, given that almost all of its aspects are reflected in the numerous self-portraits of the great artist. The article presents the view of a rheumatologist on facts and hypotheses known from the life and work of Frida Kahlo, indicating a high probability of having not only fibromyalgia, but also antiphospholipid syndrome in her anamnesis.