Rheumatoid arthritis (RA) is a chronic autoimmune disease that manifests itself not only in progressive destruction of joints, but also in systemic damage to internal organs, which leads, despite significant success in therapy, to a decrease in the quality of life of patients, temporary or permanent loss of ability to work. Data on the prevalence of RA and its incidence in different countries are presented, the influence of various factors on these indicators is discussed.

Idiopathic inflammatory myopathies (IIM) are a group of rare autoimmune diseases characterized by muscle weakness. IIMs are characterized by heterogeneity of manifestations and include several variants, each of which has peculiarities related to pathogenesis and autoantibody profile, clinical presentation, prognosis and response to therapy. In this context, the importance of early diagnosis and correct interpretation of clinical, laboratory and instrumental data is becoming increasingly important in order to recognize the phenotype of IIM in time.

An important tool for the assessment of muscle damage is magnetic resonance imaging (MRI), which provides detailed anatomical and topographical information about muscles and adjacent soft tissues. The characteristics of the MRI of the muscles in different IIM phenotypes have not been sufficiently investigated.

Objective: to evaluate and compare magnetic resonance (MR) signs of muscle damage in patients with dermatomyositis (DM) and sporadic inclusion body myositis (SIBM).

Material and methods. The prospective study included 30 patients with IIM, including 15 with DM and 15 with SIBM. The diagnosis was based on the 2017 EULAR/ACR classification criteria. MRI of the thigh and calf muscles was performed using a Philips Multiva 1.5 TESLA (Philips, the Netherlands), and the intensity of muscle tissue edema and fatty replacement were assessed using a 4-point scale, as well as the total score and aggregated score by muscle groups according to the topographic and anatomical structure.

Results and discussion. The total edema score was statistically significantly higher in DM than in SIBM (p<0.001). In contrast, the total fatty replacement score and the aggregated score of all thigh muscle groups (anterior, p><0.001; posterior, p=0.03; medial, p=0.02) were significantly higher in SIBM than in DM. In contrast to DM, all patients with SIBM had two additional MR signs: "distal gradient" and the "undulating fascia" symptom. No statistically significant differences were found between the compared IIM variants in the assessment of the total and aggregated edema score of calf muscle. At the same time, when assessing fatty replacement, the total and aggregated score in the anterior, posterior and lateral muscle groups were significantly higher in SIBM than in DM. Thus, the leading MR sign in DM was edema mainly in the anteromedial and posterior muscle groups of the thighs (due to the semitendinosus and semimembranosus muscles) and the anteroposterior calf muscle group. In SIBM, fatty replacement predominates in the anterior muscle group of the thighs and in the anterolateral and posterior calf muscle groups. Conclusion. The MR features of two clinically distinct variants of IIM, DM and SIBM are demonstrated, which reflect the heterogeneity of this disease group. MRI may be an informative method to identify MR patterns within the IIM group. Keywords: magnetic resonance imaging; diagnostics; inflammatory myopathies> < 0.001). In contrast, the total fatty replacement score and the aggregated score of all thigh muscle groups (anterior, p < 0.001; posterior, p=0.03; medial, p=0.02) were significantly higher in SIBM than in DM. In contrast to DM, all patients with SIBM had two additional MR signs: "distal gradient" and the "undulating fascia" symptom. No statistically significant differences were found between the compared IIM variants in the assessment of the total and aggregated edema score of calf muscle. At the same time, when assessing fatty replacement, the total and aggregated score in the anterior, posterior and lateral muscle groups were significantly higher in SIBM than in DM. Thus, the leading MR sign in DM was edema mainly in the anteromedial and posterior muscle groups of the thighs (due to the semitendinosus and semimembranosus muscles) and the anteroposterior calf muscle group. In SIBM, fatty replacement predominates in the anterior muscle group of the thighs and in the anterolateral and posterior calf muscle groups.

Conclusion. The MR features of two clinically distinct variants of IIM, DM and SIBM are demonstrated, which reflect the heterogeneity of this disease group. MRI may be an informative method to identify MR patterns within the IIM group.

Genetic polymorphisms in several genes can determine the response to therapy with biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) in rheumatoid arthritis (RA).

Objective: to determine the association between polymorphisms of genes of IL-6 (rs1800795), IL-6R (rs2228145), TNFAIP3 (rs10499194, rs6920220), TNFα (rs1800629), CTLA-4 (rs231775), TNFSF13B (BAFF) (rs9514828), KCNS1 (rs734784), COMT (rs4633), IL-10 (rs1800872) and STAT4 (rs7574865) and inadequate response when switching RA patients from an ineffective bDMARD and/or JAKi to another bDMARD or JAKi.

Material and methods. The study group consisted of 94 patients with RA (85.1% women, mean age 47.2±13.8 years) with moderate or high disease activity that persisted despite therapy with a bDMARD/JAKi. All patients were switched to another bDMARD or JAKi, including 12 (12.8%) to a tumor necrosis factor-α inhibitor, 27 (28.7%) to an interleukin-6 inhibitor, 46 (48.9%) to rituximab and 9 (9.6%) to a JAKi. After six months, RA activity was assessed using the DAS28-CRP, SDAI and CDAI indices. Two groups of patients were identified: those who responded to treatment (n=47), achieved remission or low activity (DAS28-CRP ≤3.2, SDAI ≤11, CDAI < 10), and those who did not respond to treatment (n=47) and had moderate/high activity according to the aforementioned indices. All patients underwent genotyping of the polymorphisms of the indicated genes using the polymerase chain reaction method.

Results and discussion. Carrying the mutant T allele (TT + CT) of the TNFAIP3 polymorphism (rs10499194) and the T allele (GT + TT) of STAT4 (rs7574865) independently increased the risk of bDMARD/JAKi inefficiency (TT + CT vs. CC: odds ratio, OR 2.84; 95% confidence interval, CI 1.23–6.56; p=0.013; GT + TT vs. GG: OR 3.18; 95% CI 1.36–7.46; p=0.007). The presence of T minor alleles of TNFSF13B (BAFF) (rs9514828) and G (AG + GG) KCNS1 (rs734784) gene polymorphisms was independently associated with a lower risk of treatment failure (CC vs. CT + TT: OR 0.25; 95% CI 0.10–0.66; p=0.004; AA vs. AG + GG: OR 0.29; 95% CI 0.12–0.74; p=0.008, respectively). For the TNFA gene polymorphism (rs1800629), the multiplicative model was statistically significant (G vs. A: OR 3.12; 95% CI 1.1–9.03; p=0.037), and for the CTLA-4 gene (rs231775), the super-dominant model was statistically significant (AA + GG vs. AG: OR 2.6; 95% CI 1.14–6.25; p=0.022).

Conclusion. Six genetic predictors of treatment failure in bDMARDs/JAKi switching were identified: TNFAIP3 (rs10499194), STAT4 (rs7574865), TNFA (rs1800629), TNFSF13B (BAFF) (rs9514828), KCNS1 (rs734784) and CTLA-4 (rs231775).

Objective: to evaluate body composition and functional status of muscle tissue in women with rheumatoid arthritis (RA) in relation to background therapy.

Material and methods. The study included 138 patients (mean age 60.8±8.6 years) with confirmed RA. Of these, 18 received tumor necrosis factor-α inhibitors, 30 rituximab, 19 abatacept and 71 methotrexate (MTX) monotherapy. A clinical and laboratory examination, evaluation of body composition using dual-energy X-ray densitometry and tests to assess muscle strength and physical performance were performed.

Results and discussion. Muscle and fat mass, bone mineral density and muscle strength did not differ depending on the background therapy. At the same time, gait speed ≤0.8 m/s was less frequent in women receiving biologic disease-modifying antirheumatic drugs (bDMARDs) compared to MT monotherapy (p<0.001). Significant correlations were found between bDMARD therapy and physical performance as assessed by the results of a short physical performance battery (p=0.035) and gait speed (p=0.003). Logistic regression analysis confirmed the association between bDMARD therapy and muscle functional state. Conclusion. No differences in body composition were found depending on the type of background therapy. bDMARD therapy was associated with better skeletal muscle functional state as assessed by gait speed and a short physical performance battery compared to MT monotherapy. Keywords: rheumatoid arthritis; body composition; biologic disease-modifying antirheumatic drugs; physical performance> < 0.001). Significant correlations were found between bDMARD therapy and physical performance as assessed by the results of a short physical performance battery (p=0.035) and gait speed (p=0.003). Logistic regression analysis confirmed the association between bDMARD therapy and muscle functional state.

Conclusion. No differences in body composition were found depending on the type of background therapy. bDMARD therapy was associated with better skeletal muscle functional state as assessed by gait speed and a short physical performance battery compared to MT monotherapy.

Our previous study has shown that the new biologic disease-modifying antirheumatic drug (bDMARD) anifrolumab (AFM) can be considered as a cost-effective alternative to belimumab (BLM) in the treatment of systemic lupus erythematosus (SLE). Following a review by the Commission of the Ministry of Health of Russia, AFM was recommended for inclusion in the List of vital and Essential Drugs (VED).

Objective: to conduct a clinical and economic analysis (CEA) of the use of bDMARD for the treatment of adult patients with moderate to severe SLE, to update the previously conducted CEA considering changing circumstances, including populational changes, price characteristics and law in the context of the Russian healthcare system, and to assess the impact of changes.

Material and methods. The CEA was conducted from a healthcare system perspective and was based on the results of an indirect comparison of the efficacy of AFM and BLM drugs using a cost-effectiveness analysis. The costs of drug therapy with the compared bDMARDs for one year, the cost-effectiveness ratio and the incremental indicator of cost-effectiveness growth were calculated. Drug prices were calculated based on the register of maximum retail prices for drugs from the VED. A comparison of the main results of the analysis is presented.

Results and discussion. The results of the indirect comparison of efficacy showed statistically significant advantages of AFM over BLM according to the SRI-4 criterion: odds ratio – 2.61 (95% confidence interval 1.22–5.58). The cost of therapy for one patient for 52 weeks, recalculated considering the changed indicators, for AFM in combination with standard therapy was 655.5 thousand rubles, for BLM – 622 thousand rubles, the difference in cost was 5.1%. When prescribing AFM, the cost of the effect (achieving a response to therapy according to the SRI-4 criterion) in one patient was 1181 thousand rubles, which is 38.6% lower than when using BLM (1924 thousand rubles). The additional cost of achieving a response according to SRI-4 in one additional patient for AFM compared to BLM amounted to 144 thousand rubles, which is significantly less than the previously calculated similar indicator – 3.4 million rubles.

Conclusion. The CEA, considering the current data allows us to conclude that the use of AFM in patients with moderate to severe SLE is economically feasible within the framework of the Russian healthcare system. The expansion of the VED list by including new, more effective and economically justifiable options, and registration of maximum retail prices will increase the availability of SLE therapy, reduce the financial burden on the budgets of regions of the Russian Federation and enable more patients to receive the necessary treatment.

The search for new therapeutic options for the treatment of systemic sclerosis (SSc) is an urgent issue in rheumatology. The article presents the results of the double-blind, randomized, placebo-controlled phase III clinical trial BCD-132-5/LIBERIUS on the efficacy and safety of divozilimab (BCD-132) in the treatment of SSc.

Objective: to investigate the efficacy and safety of divozilimab in patients with SSc compared to placebo.

Material and methods. After enrolment in the study, patients received divozilimab or placebo for 48 weeks, after which they were switched to an open-label divozilimab therapy until week 96.

Results and discussion. Divozilimab was superior to placebo regarding the primary endpoint change in mRSS at week 48 compared to baseline, and the therapy had a positive effect on respiratory function parameters. Divozilimab treatment was well tolerated.

Conclusion. Thus, divosilimab may represent a new therapeutic option for patients with SSc.

Fibromyalgia (FM) affects 2 to 4 % of the population. In rheumatic diseases (RD), the frequency of FM is higher than in the general population, but the question remains whether it is a secondary disease, a complication of RD or an independent comorbid disorder.

Objective: to determine whether FM in patients with rheumatoid arthritis (RA) is a secondary or an independent comorbid disorder.

Material and methods. The study involved 127 patients who were divided into three groups. Group 1 comprised patients with RA without FM (n=47), group 2 comprised patients with RA + FM (n=55), and group 3 comprised patients with FM without RD (n=25). FM was diagnosed based on the 2016 ACR diagnostic criteria. Pain intensity was assessed using a visual analogue scale (VAS, 10 cm) at rest. We also assessed the frequency of the neuropathic pain using the Pain DETECT and DN4 questionnaires for neuropathic pain, the presence and severity of central sensitization symptoms using CSI, fatigue using FSS, anxiety and depression using HADS, sleep disturbances using the PSQI and cognitive impairment using the DSST. Quality of life (QOL) was assessed using the EQ-5D and the revised FM impact questionnaire – FIQR, in the group of patients without FM, its modified version – SIQR – was used.

Results and discussion. Signs of FM preceded the inflammatory changes in the joints and complicated the diagnosis of RA, which was reflected in an increase in the time until RA diagnosis in the RA + FM group to an average of 20 months compared to 10 months in the RA without FM group. No relationship was found between the presence of FM and the degree of RA activity according to DAS28. No specific clinical picture of FM was found in the RA + FM group compared to the FM group without RD.

Conclusion. The results obtained suggest that FM in patients with RA is an independent comorbid condition and the cause of various comorbid disorders, which contributes to an even greater impairment of QOL. The diagnosis of FM in patients with RD will optimize treatment: patients suffering from RD and FM require complex therapy.

The Tyumen Regional Rheumatology Center has gained experience in the use of the interleukin-6 inhibitor olokizumab (OKZ) in the treatment of patients with rheumatoid arthritis (RA).

Objective: to evaluate the efficacy and safety of OKZ therapy in patients with RA in real-life clinical practice.

Material and methods. The analysis included 75 patients with a confirmed diagnosis of RA who were prescribed OKZ at a dose of 64 mg every 4 weeks. All patients underwent a standard clinical and laboratory examination and concomitant diseases were recorded. The results were evaluated after 1, 6 and 12 months of therapy. A retrospective evaluation of radiological outcomes was performed in 20 patients who had received OKZ for at least 1 year.

Results and discussion. After only one month of OKZ treatment, the proportion of patients with high RA activity according to DAS28-CRP decreased statistically significantly from 81% to 53.3%. After 6 months, 55 (73.33%) of 75 patients continued OKZ therapy, and most of them (74.55%) achieved the stage of drug remission, while high RA activity was not detected. After 12 months, 43 (57.33%) of the 75 patients continued OKZ therapy, with low activity and remission observed in 16.2 and 69.8% of them, respectively. During these periods, there was no radiological progression of RA against the background of OKZ therapy. Ten patients (13.33%) discontinued OKZ therapy due to insufficient efficacy, 2 (2.67%) due to pregnancy, 14 (18.67%) due to adverse events and 6 (8%) for other reasons.

Conclusion. In real-world clinical practice, OKZ showed significant therapeutic potential and a favorable safety profile in patients with RA.

The negative impact of chronic disease on the psychological well-being and adaptation of patients with rheumatoid arthritis (RA) remains a common problem despite advances in its comprehensive treatment and rehabilitation. In this context, it is important to investigate the psychological factors that determine the extent of anxiety and depression in patients with RA.

Objective: to analyze the perception of the disease, mindfulness and self-compassion as psychological characteristics of patients with RA and marked anxiety-depressive manifestations.

Material and methods. A total of 180 patients (149 women and 31 men) with a confirmed diagnosis of RA were examined. Their mean age was 43.41±11.18 years, and the mean duration of the disease was 10.03±8.98 years. A package of psychodiagnostic methods was used to assess the level of anxiety and depression, characteristics of the disease perception, development of mindfulness skills, and components of self-compassion.

Results and discussion. Based on the study data, two patient groups were identified: patients with clinically significant anxiety and depressive manifestations and patients without them. The perception of the disease in patients with marked anxiety-depressive manifestations was characterized by the expectation of a threat from the disease, emotional apprehension and a decrease in the sense of personal control over the disease. In addition, in this group general and structural indicators of awareness and self-compassion were reduced.

Conclusion. The specificity of disease perception, diminished awareness and capacity for self-compassion can be considered as psychological characteristics of patients with RA who have marked anxiety and depressive manifestations. The study allowed us to gain new, more differentiated ideas about the goals of psychodiagnostics and psychological correction in RA.

Axial spondyloarthritis (axSpA) is actively treated with biologic disease-modifying antirheumatic drugs, but their efficacy decreases over time, leading to the development of exacerbation, the onset of severe and chronic pain, progression of structural changes and deterioration of quality of life, as well as significant economic losses. The international community is increasingly concerned about the problem of identifying difficultto-treat (D2T) patients. In this context, it is necessary to develop strategies and markers for their identification and effective treatment. The authors propose a regimen of follow-up that represents an innovative approach to monitoring patients with D2T axSpA.

Systemic lupus erythematosus (SLE) is characterized by an unpredictable and unfavorable course. The ethnicity of the patient has a significant impact on the course and outcome of the disease. SLE is more severe in African Americans and Asians than in white Europeans. This review examines epidemiological data, characteristics of the course and clinical manifestations of SLE in Asians.

Avascular osteonecrosis (AON) is a common condition that most often affects people of working age (20–60 years). The disease leads to rapid destruction and collapse of the subchondral bone with subsequent development of secondary osteoarthritis of the affected joint. The current data on laboratory abnormalities in AON are presented. Biomarkers directly related to the development and progression of AON are described in detail. Ideas for future research are formulated to improve the detection and treatment of the disease.

Chronic pain (CP) impairs quality of life and increases the risk of non-communicable diseases and mortality. Pain is variable, and different mechanisms of its development determine the tactics of patient treatment. Researching pathogenesis of different types of pain can serve as a prerequisite for the development of more effective treatment approaches. The introduction of drug combinations into clinical practice enables a better response to treatment with lower doses, thereby reducing drug burden and potential toxicity.

The review presents studies that address the question of how the efficacy of chronic pain therapy can be increased by including adjuvants in the treatment regimen, particularly a vitamin B complex.

Osteoarthritis (OA) is a chronic progressive joint disease that ranks first in the frequency of all musculoskeletal diseases. OA is a serious general medical and social problem associated with a steady increase in prevalence. Reducing the pain in OA, maintaining active daily activity and preserving social functioning are the main goals of treatment for almost all patients suffering from this disease. In addition to the well-known traditional methods of treatment of OA, there are adjuvant therapies. Complex bioregulatory drugs are drugs whose composition is put together empirically and which contain only ingredients of natural origin. Drugs of this group have anti-inflammatory, immunomodulatory and antimicrobial effects, and their efficacy and safety have been proven in large-scale clinical trials.

Gout is the most common inflammatory joint disease, related to microcrystalline arthritis. With improper or inadequate treatment, gout can lead to disability.

A patient with a misdiagnosis of tophaceous gout is described in whom a differential diagnosis with a neoplasm was performed. As a result of the additional examination, a giant cell tenosynovial tumor of the second finger of the right hand was discovered.

Hemarthrosis (HA) of the knee of non-traumatic origin is rarely encountered in the practice of a traumatologist-orthopedic surgeon. The differential diagnosis of this pathology requires a thorough medical history tacking and clinical examination of the patient, and a knee joint aspiration can only confirm the presence of blood in the joint. A diagnostic arthroscopy with a synovial biopsy helps to clarify the diagnosis. The most common causes of non-traumatic HA are tumors of vascular or synovial origin, tumor metastases and the use of high-dose anticoagulants in combination with a vascular malformation.

A clinical observation of the development of symptoms of non-traumatic HA on the background of anticoagulant use is presented, where the task of the orthopedic surgeon was to identify the true cause of the disease.

On December 18, 2024, a meeting of the Expert Council was held to discuss approaches to the treatment of non-specific back pain and pain in rheumatic musculoskeletal disorders. It was noted that non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of therapy for inflammation-related pain and that optimal therapy should provide a balance between high efficacy and good tolerability in each patient. A new NSAID, pelubiprofen (Pelubio®), has been registered in the Russian Federation. According to research data, its efficacy is comparable to that of non-selective and selective NSAIDs and at the same time the drug has a high safety profile. The resolution of the Expert Council states that this medicine can be prescribed within the framework of Russian clinical practice, considering the registered indications for pelubiprofen and the clinical guidelines adopted in Russia for the treatment of acute and chronic non-specific back pain, radiculopathy, osteoarthritis (including gonarthrosis and coxarthrosis) and rheumatoid arthritis.