A chronic inflammatory process is one of the risk factors of secondary osteoporosis (OP) and its related fractures. Determination of the level of C-reactive protein (CRP) is used to estimate the magnitude of an inflammatory reaction. The developed highly sensitive (hs) methods make it possible to reveal the so-called subclinical level of inflammation and to assess its role in the development of various diseases. Objective: To reveal an association between the level of hs CRP and the development of OP.
Subjects and methods. The database of the study «Cardiovascular diseases and osteoporosis» performed at the Research Institute of Rheumatology, Russian Academy of Medical Sciences, was used. The study enrolled 79 women, of them 64 were postmenopausal and 15 had a preserved menstrual cycle. Their mean age was 60 and 48 years, respectively. The exclusion criteria were systemic rheumatic diseases and conditions, which are risk factors for OP, and drug therapy for OP. Bone mineral density (BMD), biochemical blood analysis, bone metabolism markers, and CPR levels were determined by the hs method.
Results. In the postmenopause group, the mean value of hs CRP was 1.16 mg/l; the values of hs-CRP were in the range of 3-10 mg/l in 17% cases, which is associated with subclinical inflammation. Those of CRP were lower than 3 mg/l in 80% of cases. In 87% of the women with a preserved cycle, the level of CRP was in the normal range and averaged 2.25 mg/l. There was a positive correlation of hs CRP only with the level of bone alkaline phosphatase (r = 0.26; p = 0.04) in the menopause group and with BMD in the femoral neck (r = 0.65; p = 0.009) in the preserved cycle group. There were no significant differences in the level of hs-CRP between the OP subjects and the normal values of BMD in the menopausal women. No analysis was made in the preserved cycle subgroup due to a small number of cases. Conclusion. There was no strong evidence that there was an association between hs CRP (the values were in the normal range and corresponded to those of subclinical inflammation) and osteoporosis.

Objective: To study the severity of rheumatoid arthritis in a Russian patient population on the basis of the data of rheumatological care. Methods. Polyclinic and hospital rheumatologists from 27 cities and towns of Russia (a total of 30 centers) participated in the cross-sectional epidemiological study.
The study included all patients with valid rheumatoid arthritis, who had consecutively turned to a polyclinic rheumatologist or who had been treated at hospital during the established 3-month period. The demographic and social characteristics of a patient, his/her occupation, comorbidity, the onset and duration of rheumatoid arthritis, clinicofunctional status at the study and antirheumatic therapy were recorded. Results. A total of 1504 patients, including 1271 women, were enrolled; their mean age at the study was 53 years; the mean duration of the disease (after the onset of its first symptoms) was 10.5 years. Most (66%) patients had a family. More than half of the examinees were professionals and specialists. More than 64% of patients were unemployed at the study. Mean disease activity scores were high: morning stiffness [Ме, range 25-75%] for mean 60.0 (30.0-180) min; number of tender (mean [SD] - 26.1±15.8), and swollen (13.4±11.4) joints; ESR, 29.45±15.5 mm/hr; pain, 58.1±22.6 mm (VAS); general health status, 57.4±20.6 mm (VAS). The mean DAS28 score (mean [SD]) was 5.44±1.18. The absolute majority (94%) of patients had erosive arthritis (Steinbrocker stages II-IV). Severe extraarticular manifestations were identified in 10%. The distribution of the patients by the ACR functional classes was as follows: Class I, 8%; Class II, 29%; Class III, 52%, and Class IV, 11%. Comorbidity was as high as 75%, there was a preponderance of cardiovascular diseases, diabetes mellitus, and chronic lung disease. The mean HAQ score in the examined patient cohort was 1.81±0.8. At the study, 89 and 43% of the patients received nonsteroidal anti-inflammatory drugs and systemic glucocorticoids, respectively. Methotrexate (62%) headed the list of basic anti-inflammatory drugs, sulfasalazine (8%), leflunomide (7%), and aminoquinolines (6%) were much less frequently used. Biologicals were given to 9% of the patients. Conclusion. The examined cohort of Russian patients with rheumatoid arthritis, which reflects experience in real clinical practice, is generally characterized by the severe course of the disease in both clinical and functional parameters.

Objective: To study the detection rate of arterial hypertension in patients with gout by 24-hour blood pressure monitoring (BPM). Results. The study included 93 gouty patients who were arbitrarily divided into 2 groups: 1) 22 (24%) subjects with normal pressure, as measured by the Korotkov method; 2) 71 (76%) patients with elevated blood pressure (BP). All the patients underwent 24-hour BPM. Various 24-hour BPM abnormalities (increases in average daily BP, pulse pressure, load-induced pressure indices, impaired daily BP profile) were found in 100% of the patients in both groups), which is indicative of the presence of latent arterial hypertension in Group 1 patients with gout.
Conclusion. The found 24-hour BPM abnormalities in gouty patients with normal BP, as measured by the Korotkov method, indicate that these patients have latent AH.

Objective: To gain experience with adalimumab therapy in patients with ankylosing spondylitis (AS) and to clarify the effect of the drug on MRI-detectable inflammatory changes (IC) in the vertebral column and heel enthesis with the short-term use of this gene engineering biological.
Subjects and methods. This open-label observation included 14 patients diagnosed as having AS in accordance with the modified New York criteria [4] and 3 patients with early undifferentiated spondyloarthritis (uSA). The ESSG criteria were used for the diagnosis of uSA. In addition to the BASDAI index, the new international index for disease activity in AS (ASDAS) proposed by the ASAS group in 2009 was first employed to assess the activity of AS. MRI-detectable IC in the thoracic spine, sacroiliac articulation, AND heel bones (in patients with heel enthesitis) was an additional criterion for AS activity. The results of adalimumab use were assessed at weeks 4 and 14 of the study. The efficiency of therapy was evaluated by the ASAS criteria, 40% improvement was taken into account, 50% improvement and partial remission were separately assessed; 50% improvement was assessed by the BASDAI index. The number of patients who had achieved partial remission after 6 adalimumab injections is the major efficiency criterion.
Results. The median (Ме) age of all the patients was 31.6 years [range 22-56]; the Ме disease duration was 72 months [range 11-264]. HLA-B27 was detected in 83% of the patients. Peripheral arthritis and enthesitis were present in 12 and 9 patients, respectively. Partial remission was recorded in 17.8 and 41% of patients after 2- and 12-week adalimumab therapy, respectively; 40% ASAS improvement was observed in 58.8 and 76.6% of patients after 2- or more and 6-week therapy, respectively. The BASDAI activity index was decreased by 50% or more in 47 and 86.6% of the patients with the baseline high index after 2 and 6 injections, respectively. The ASDAS activity corresponded to low activity in 67 and 75% of the patients having the baseline high activity in this index (>3.0) after 2- and 12-week therapy, respectively. In 3 patients, 100% clinical improvement in heel enthuses was achieved, as confirmed by MRI data. Although the Ме IC in the thoracic spine substantially diminished from 8 (9) to 0 (1) following 12-week therapy, the differences were insignificant (p=0.07). After 12-week therapy, thoracic IC completely disappeared in one patient. Conclusion. Adalimumab therapy-induced improvement was frequently seen after just the first two injections of adalimumab and preserved
after 12-week therapy. Adalimumab rapidly and considerably reduces the magnitude of inflammation in the spinal structures and entheses, as evidenced by МЫ data.

The paper describes two patients (a 50-year woman and a 72-year man) in whom the clinical manifestations of ulceronecrotic vasculitis had long preceded before the diagnosis of multiple myeloma was made. In the former, monoclonal cryoglobulinemia type I induced ulcerative lesions with the development of dry toe gangrene and paraproteinemic renal lesion. In the latter, ulceronecrotic vasculitis with the development of dry toe gangrene was a manifestation of monoclonal paraproteinemia without signs of cryoglobulinemia. Both patients were found to have monoclonal blood secretion (РIgGλ и РIgGκ) and urine Bence Jones protein (BJλ+BJκ, BJκ) in the absence of immunological markers of vasculitis developing in patients with rheumatic diseases. Immunochemical study of serum/urine and, when monoclonal secretion of PIg+BJ is detected, further examination for plasma cell dyscrasia should be performed in all cases of vascular disorders (cold allergy, Raynaud's syndrome, purpura, ulcers of cruses, and gangrene of distal phalanxes of the hands/feet) in patients with atypical vasculitis. The timely immunochemical study of blood and urine will make it possible to diagnose plasma cell dyscrasia (different types of myelomic disease, Waldenstrцm macroglobulinemia, primary amyloidosis) at the early stage of the disease and to rule out unjustifiably diagnosed vasculitis in patients with atypical vascular lesions.